Why it is so hard to lose weight? An exploration of patients' and dietitians' perspectives by means of thematic analysis

What could be the reasons for not losing weight even after following a weight loss program?

INTRODUCTION

Approximately four million people worldwide die annually because of obesity. Weight loss is commonly recommended as a first-line therapy in overweight and obese patients. Although many individuals attempt to lose weight, not everyone achieves optimal success. Few studies point out that weight loss eventually slows down, stagnates or reverses in 85% of the cases.

RESEARCH QUESTION

What could be the reasons for not losing weight even after following a weight loss program?

METHODS

A scoping review of the literature was performed using weight loss-related search terms such as 'Obesity,' 'Overweight,' 'Lifestyle,' 'weight loss,' 'Basal Metabolism,' 'physical activity,' 'adherence,' 'energy balance,' 'Sleep' and 'adaptations. The search involved reference tracking and database and web searches (PUBMED, Science Direct, Elsevier, Web of Science and Google Scholar). Original articles and review papers on weight loss involving human participants and adults aged > 18 years were selected. Approximately 231 articles were reviewed, and 185 were included based on the inclusion criteria.

DESIGN

Scoping review.

RESULTS

In this review, the factors associated with not losing weight have broadly been divided into five categories. Studies highlighting each subfactor were critically reviewed and discussed. A wide degree of interindividual variability in weight loss is common in studies even after controlling for variables such as adherence, sex, physical activity and baseline weight. In addition to these variables, variations in factors such as previous weight loss attempts, sleep habits, meal timings and medications can play a crucial role in upregulating or downregulating the association between energy deficit and weight loss results.

CONCLUSION

This review identifies and clarifies the role of several factors that may hinder weight loss after the exploration of existing evidence. Judging the effectiveness of respective lifestyle interventions by simply observing the 'general behavior of the groups' is not always applicable in clinical practice. Each individual must be monitored and advised as per their requirements and challenges.

Validation of the Dutch Eating Behavior Questionnaire in a Romanian Adult Population

(1) Background: Obesity, part of the triple global burden of disease, is increasingly attracting research on its preventive and curative management. Knowledge of eating behavior can be useful both at the individual level (to individualize treatment for obesity) and the population level (to implement more suitable food policies). The Dutch Eating Behavior Questionnaire (DEBQ) is a widely used international tool to assess eating behavior, i.e., emotional, external and restricted eating styles. The aim of this study was to validate the Romanian version of DEBQ, as obesity is a major concern in Romania. (2) Methods: Our study tested the psychometric properties of the Romanian version of DEBQ on an adult population and explored the associations of eating behavior with weight status (3) Results: The study showed a factor load similar to the original version of the questionnaire and a very good internal validity (Cronbach’s alpha fidelity coefficient greater than 0.8 for all scales of the questionnaire) for the Romanian version of DEBQ and showed that all of the scales positively correlated with body mass index in both men and women. (4) Conclusions: This study will enable the use of the DEBQ Romanian version on the adult population of Romania where the findings could be incorporated into developing better strategies to reduce the burden of nutrition-related diseases.

Dreaming of effective diet change? Motivation, emotions, and dietician presence can all matter

The objective of this study is to verify the relevance of motivational and emotional factors, as well as dietician presence in relation to the optimization of the dietary pattern-change process. This study was carried out with an on-line survey, including 341 respondents, almost half of whom were consulted by a dietician. Two measures were applied to evaluate the effectiveness of the dietary pattern-change among participants. The first of these measures refers to subjective evaluations of diet improvement, while the second refers to weight loss. The results show that autonomous motivation and dietician presence are associated with positive anticipatory emotions, and diet improvements. Extrinsic regulation, dietician presence, and lack of negative emotional experiences are related to greater weight loss.

The Development and Validation of the Health Behavior Motivation Scale

The article presents the construction and validation process of the Health Behavior Motivation Scale (HBMS), which measures the motivation toward pro-health behaviors in population of healthy adults. The tool is conceptually based on Self-Determination Theory (SDT) and more precisely on one of its subtheories-Organismic Integration Theory (OIT). In the first stage of the construction, the linguistic validation with competent judges procedure allowed to eliminate the items which were not correctly formulated. Next, the psychometric properties of the HBMS were assessed in three studies. In Study 1 (N = 323, M age = 31), the factorial structure of the HBMS was assessed with CFA. Since the preliminary structure was rejected, in order to identify the dimensionality of the items, EFA and Horn's Parallel Analysis were performed. The results showed that the HBMS scale has 5-dimensional structure (intrinsic regulation, integrated and identified regulation, introjected regulation, external regulation and amotivation). In Study 2 (N = 342, M age = 33), the structure of the HBMS has been confirmed by conducting CFA analysis. Analyses preformed in this study provided good evidence for convergent and discriminant validity as well as the internal reliability of the HBMS subscales. Finally, in the LPA analysis two classes with distinct regulatory profiles have been extracted, which showed differences in the extend of health-related behaviors. In Study 3 (N = 60, M age = 30) the test-retest reliability of the HBMS was confirmed. The scale can be therefore successfully used in future basic and applied studies as it possesses robust psychometric properties.