Dr George Thom presented physiological and behavioural factors in weight loss maintenance at TDMR Europe’s webinar

Posted On: 11th May 2021

Dr George Thom, a Registered Dietitian who works as a Research Associate within the Human Nutrition team at the University of Glasgow presented some of the key physiological and behavioural factors involved in weight loss maintenance during a recent TDMR Europe webinar.

Dr Thom emphasised in his presentation that several recent large-scale trials have demonstrated the effectiveness of TDR-led interventions in inducing initial average weight losses of 10-15% body weight, but the main challenge is preventing longer-term weight regain. Among factors that may undermine behaviour change maintenance, Dr Thom specifically highlighted the seemingly unfavourable increases in appetite that accompany significant weight loss, as well as adaptive reductions in energy expenditure.

Physiological and behavioural factors involved in weight loss maintenance

George Thom, University of Glasgow


Despite widespread recognition that changes in the global food system are the driving force behind the obesity epidemic, individually focussed interventions remain the cornerstone of obesity management strategies. Several recent large-scale trials have demonstrated that a Total Diet Replacement led approach can reliably induce weight losses of 10-15% body weight. These findings are important given that remission of co-morbidities such as type 2 diabetes, sleep apnoea and osteo-arthritis, and the increasing numbers of people with a BMI >40, require weight losses of this magnitude.

However, maintaining weight losses and health benefits over the long-term continues to be the main challenge for the field. The problem of weight regain is often considered from distinct perspectives, predominantly split into fields of nutrition therapy, integrative physiology and behavioural psychology. This talk addressed why it is often difficult for people to maintain weight losses, and a range of influences, including changes in appetite and food reward, adaptive reductions in energy expenditure, and psychological influences on behavioural maintenance will be highlighted. Consideration was also given to how practitioners may support individuals living with obesity to optimise weight loss maintenance outcomes through effective behavioural approaches.

References with web-links to original papers

Anderson, J. W., Konz, E. C., Frederich, R. C. & Wood, C. L. 2001. Long-term weight-loss maintenance: a meta-analysis of US studies. American Journal of Clinical Nutrition, 74, 579-584.

Fothergill, E., Guo, J. E., Howard, L., et al. (2016). Persistent Metabolic Adaptation 6 Years After “The Biggest Loser” Competition. Obesity, 24, 1612-1619.

Greaves, C., Poltawski, L., Garside, R. et al. (2017). Understanding the challenge of  weight loss maintenance: a systematic review and synthesis of qualitative research on weight loss maintenance. Health Psychology Review, 11, 145-163.

Kwasnicka, D., Dombrowski, S. U., White, M. et al. (2016). Theoretical explanations for maintenance of behaviour change: a systematic review of behaviour theories. Health Psychology Review, 10, 277-296.

Lean, M. E. J., Leslie, W. S., Barnes, A. C. et al. (2018). Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet, 391, 541-551.

Leibel, R. L., Rosenbaum, M. & Hirsch, J. 1995. Changes in energy-expenditure resulting from altered body-weight. New England Journal of Medicine, 332, 621-628.

Sumithran, P., Prendergast, L. A., Delbridge, E., et al. (2011). Long-Term Persistence of Hormonal Adaptations to Weight Loss. New England Journal of Medicine, 365, 1597-1604.

Taheri, S., Zaghloul, H., Chagoury, O., et al. (2020). Effect of intensive lifestyle intervention on bodyweight and glycaemia in early type 2 diabetes (DIADEM-I): an open-label, parallel-group, randomised controlled trial. Lancet Diabetes & Endocrinology, 8, 477-489.

Thom, G., Lean, M. E. J., Brosnahan, et al. (2020). ‘I have been all in, I have been all out and I have been everything in-between’: A 2-year longitudinal qualitative study of weight loss maintenance. Journal of Human Nutrition and Dietetics, 34(1):199-214. doi:10.1111/jhn.12826

Thom, G., Messow, CM., Leslie, WS., et al. Predictors of type 2 diabetes remission in the Diabetes Remission Clinical Trial (DiRECT). Diabetic Medicine (published online, September 1st 2020).