Abstract
Background: Obesity is of major national and global concern, costing the New Zealand government hundreds of millions every year. While weight loss has been extensively studied, and many different approaches have been shown effective in achieving weight loss, maintaining weight loss over a sustained period of time has its difficulties. There is currently a lack of evidence regarding effective strategies to support individuals to maintain weight loss, and avoid weight regain.
Objective: The primary aim of this study was to investigate the facilitators and barriers that aid with weight maintenance following a very low calorie diet (VLCD) in New Zealand. The secondary aim was to develop and evaluate a resource to aid in weight maintenance.
Design: Participants who had completed a 12 week VLCD run by the Southern District Health Board in Dunedin weight management clinic were recruited for this study. The facilitators and barriers individuals faced in weight maintenance following weight loss were explored through 10 semi structured qualitative interviews using a phenomenological approach. Interviews were analysed using thematic analysis with an inductive approach to identify major themes, sub themes and categories. The framework analysis method was used to summarise the research outputs between and across participants in order to identify ways in which weight loss maintenance following a VLCD programme can be enhanced.
Results: This research found that the facilitators and barriers following weight loss through a VLCD could be organised into six major themes. Theme one outlines an obesity trap. This theme describes participants’ past struggles with obesity and the way in which past and present influences, such as their lived environment and emotional wellbeing, influence their weight. Theme two looks at the Optifast programme participants followed and how this affected weight loss and encourages future weightloss and weight maintenance. Theme three describes participants ‘new normal’ and the lifestyle and behavioral changes they have made that facilitate weight maintenance, as well as the barriers that made achieving behavioral change difficult. The motivation cycle as described by theme four shows a linear change in motivations for achieving weight loss and weight maintenance depending on a participant’s current weight loss and how far through the programme they are. Theme five discusses the concept that many participants thought of food as an addiction. The final theme revolves around how extensive support was required for weight loss and weight maintenance and this was facilitated if support was offered from a range of sources such as from health professionals, friends and family, as well as the wider community.
Conclusion: Weight maintenance initiatives should be designed to align with patient motivations. Providing extensive clinician support can aid with encouraging patients to find new motivations, cope with the addictive nature of food and improve accountability. Following weight loss via a VLCD participants commonly carried on with Optifast products. The efficacy of using these long term needs to be further investigated. The key facilitator for participants was having a wide support network, so designing weight loss initiatives based on this may aid with better long term results