THE USE OF STRUCTURED MAINTENANCE PROGRAMS
When to Use a Maintenance Program
The long-term success of weight management appears to depend on the individual participating in a specific and deliberate follow-up program. Programs to aid personnel in weight maintenance or prevention of weight gain are appropriate when:
An individual has successfully achieved his or her weight-loss goal and now seeks to maintain the new weight,
An individual who is gaining weight has taken a weight-loss readiness assessment and has determined that he or she is not ready for weight loss at this time, or
An overweight individual is temporarily excluded from a weight-reduction program until a medical, physical, or psychological problem stabilizes.
Components of a Maintenance Program
A comprehensive weight-maintenance strategy has five fundamental components:
1.
It helps the patient select a weight range within which he or she can realistically stay and, if possible, minimize health risks.
2.
It provides an opportunity for continued monitoring of weight, food intake, and physical activity.
3.
It helps the patient understand and implement the principle of balancing the energy consumed from food with routine physical activity.
4.
It helps the patient establish and maintain lifestyle change strategies for a sufficiently long period of time to make the new behaviors into permanent habits (a minimum of 6 months has been suggested [Wing, 1998]).
5.
It considers the long-term use of drugs.
Helping Patients Learn How to Balance Energy
Individuals who have achieved a weight-loss goal generally fall into one of two groups: those who see no point in participating in a maintenance program since they believe they know how to keep the weight off and those who remain open to change and improving their skills in weight management.
The critical role of the health care provider is to motivate the former group to learn the skills necessary for weight management. The skills necessary to:
Maintain regular exercise for at least 60 min/day or an expenditure of 2,000 to 3,000 kcal/wk (8,368 kJ) (Klem et al., 1997; Schoeller et al., 1997).
Decrease the amount of energy-dense foods eaten (especially those that are low in nutrients).
Practice healthy eating by including fruits, vegetables, and whole grains in the diet.
Understand portion control.
Access the services of nutrition counselors or other forms of guidance.
Helping Patients Establish Permanent Lifestyle Change Strategies
As mentioned above, individuals who have lost weight need to make permanent lifestyle changes in order to maintain their loss. To assist patients in making these changes, successful maintenance programs will include education on and assistance with the following factors (Foreyt and Goodrick, 1993, 1994; Kayman et al., 1990):
Self-monitoring. Regular weighing and recording of daily food intake and physical activity for the first month or two of the maintenance period and during periods of increased exposure to food (e.g., during the holidays). If weight gain occurs, reinstitution of this practice may help bring weight back into control. Frequent follow-up contact with counselors is also crucial (Perri et al., 1993). Effective follow-up consists of a schedule of regular weekly to monthly contacts by mail, phone, or in person. Support groups may substitute for some of this follow-up with a health care provider, but should not replace it.
Physical activity. Daily physical activity is key to successful weight maintenance; it is the factor cited as the most important in maintaining weight loss by the majority of individuals in the National Weight Loss Registry (Klem et al., 1997). An average of 80 min/day of moderate activity or 35 min/day of vigorous activity is needed to maintain weight (Schoeller et al., 1997).
Problem solving. Learning to identify and anticipate problems that threaten to undermine success is necessary. Problem solving skills allow the individual to craft strategies that will resolve problems as they emerge.
Stress management. Exercise, relaxation, and social support can help reduce stress. Techniques to reduce stress can be critical for some individuals who overeat in response to stress.
Relapse prevention. Relapse, temporary loss of control, and return to old behaviors is common. The key to relapse prevention is learning to anticipate high-risk situations and to devise plans to reduce the damages. Patients need to learn to forgive themselves for a lapse and view it as a “learning experience.” Reestablishing control is crucial.
Social influence/support. Sabotage by family or friends is seen often and may be stressful for the individual who is trying to maintain weight. The skills to recognize intentional or unintentional sabotage may be learned. In extreme cases, a choice may need to be made between the weight-maintenance program or the relationship. Identifying a fresh circle of supporters or starting a support group may be useful.
You must be logged in to post a comment.