Abstract
Obesity is a major global health problem and predisposes individuals to several comorbidities that can affect life expectancy. Interventions based on lifestyle modification (for example, improved diet and exercise) are integral components in the management of obesity. However, although weight loss can be achieved through dietary restriction and/or increased physical activity, over the long term many individuals regain weight. The aim of this article is to review the research into the processes and mechanisms that underpin weight regain after weight loss and comment on future strategies to address them. Maintenance of body weight is regulated by the interaction of a number of processes, encompassing homoeostatic, environmental and behavioural factors. In homoeostatic regulation, the hypothalamus has a central role in integrating signals regarding food intake, energy balance and body weight, while an ‘obesogenic' environment and behavioural patterns exert effects on the amount and type of food intake and physical activity. The roles of other environmental factors are also now being considered, including sleep debt and iatrogenic effects of medications, many of which warrant further investigation. Unfortunately, physiological adaptations to weight loss favour weight regain. These changes include perturbations in the levels of circulating appetite-related hormones and energy homoeostasis, in addition to alterations in nutrient metabolism and subjective appetite. To maintain weight loss, individuals must adhere to behaviours that counteract physiological adaptations and other factors favouring weight regain. It is difficult to overcome physiology with behaviour. Weight loss medications and surgery change the physiology of body weight regulation and are the best chance for long-term success. An increased understanding of the physiology of weight loss and regain will underpin the development of future strategies to support overweight and obese individuals in their efforts to achieve and maintain weight loss.
Highlights
Obesity is a major global health problem, with 500 million obese individuals worldwide.[1]
Restricting food intake through dieting generally leads to successful short-term weight loss, but, over the long term, many individuals regain the lost weight
Individuals who live in an ‘obesogenic’ environment encounter opportunities to overeat on a regular basis
Summary
Obesity is a major global health problem, with 500 million obese individuals worldwide.[1] In the United States (US) alone it was reported that 35.7% of the adult population (78 million) and 16.9%. Weight gain is the result of an imbalance between total energy intake and total energy expenditure (TEE),[5,9] and it is thought that substantial and sustained increases in total energy intake in the past three decades have led to the increase in body weight across the global population.[9] it appears that obesity is the result of flawed food intake behaviour combined with an imbalance in energy uptake and expenditure that can be rectified by caloric restriction and increased physical activity.[10] interventions based on lifestyle modification (for example, improved diet and exercise) are integral components in the management of obesity.[5] weight loss can be achieved through dietary restriction and/or increased physical activity, over the long term, many individuals regain the weight they have lost.[11] The proportion of individuals who successfully maintain weight loss varies according to how ‘successful maintenance of weight loss’ is defined. Wing and Hill[12] proposed the following definition: ‘intentionally losing ⩾ 10% of initial weight and keeping it off for ⩾ 1 year’; based on this definition, approximately a quarter of overweight individuals report successfully maintaining weight loss
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