Maintaining Weight Loss: The Facts
Losing weight is often easier than maintaining weight loss. This is due to the complex relationship between hunger, leptin, ghrelin, and the way your body signals that it needs calories.
There are real scientific reasons why weight maintenance is more difficult than weight loss. It has very little to do with willpower or exercise, and much more to do with your body’s hormonal signals.
Unfortunately — or fortunately — surgical intervention is currently one of the only consistent ways to change your hormonal profile long term.
Why maintaining weight loss is so difficult
Living with obesity can create a series of hormonal changes that last beyond both the weight gain and weight loss phases.
The more you understand what those changes are, the better equipped you are to make informed decisions about maintaining weight loss.
Sadly, approximately 1% of people with a body mass index over 30 maintain weight loss long term.
Consider your current stage and make an honest assessment. If weight gain continues, several factors may make long-term change more difficult.
- Leptin resistance may increase, causing a long-term inability to feel full.
- Common cofactors such as knee, hip, or back pain can become more prevalent, making activity and lifestyle change more difficult.
- Comorbidities such as diabetes and high blood pressure can become more likely, creating further health challenges.
- Time and resources are often limited, which makes weight gain in modern society completely understandable.
If you are already living with obesity and are worried about your next steps, it may be time to understand the options available to you.
Long-term studies give even lower odds
“During a maximum of 9 years’ follow-up, 1283 men and 2245 women attained normal body weight. In simple obesity, with a body mass index of 30.0–34.9 kg/m², the annual probability of attaining normal weight was 1 in 210 for men and 1 in 124 for women.
The annual probability decreases to 1 in 1290 for men and 1 in 677 for women with morbid obesity, with a body mass index of 40.0–44.9 kg/m².”
American Journal of Public Health, September 2015 — Probability of an Obese Person Attaining Normal Body Weight: Cohort Study Using Electronic Health Records
Ozempic: why doesn’t it work for everyone?
If GLP-1 receptor agonists — such as semaglutide, Ozempic, Wegovy, dulaglutide, or Trulicity — were successful for you during use, but the weight was gained back afterwards, this is very normal.
GLP-1 receptor agonists can affect appetite, slow stomach emptying, and influence hormones that regulate hunger and satiety. When you stop taking them, these effects diminish.
The largest long-term study to date showed that one year after the withdrawal of once-weekly subcutaneous semaglutide 2.4 mg and lifestyle intervention, participants regained two-thirds of their prior weight loss.
This level of weight gain often continues until the person returns to, or exceeds, their original weight.
The facts about your long-term choices
There are several approaches to weight loss and weight maintenance. Each has different benefits, limitations, risks, and expected outcomes.
Gastric bypass
Gastric bypass reduces stomach size and alters digestion. It may lead to 35–50% total body weight loss, with long-term maintenance possible.
It can lead to significant health improvements, but includes surgical risks. These risks have become much smaller with advances in recent years. Gastric bypass usually involves a longer hospital stay and is often considered for people who need more dramatic change.
Gastric sleeve
Gastric sleeve surgery reduces stomach size and alters hormones. It may lead to 25–35% total body weight loss, with long-term maintenance possible.
It can provide significant health improvements, with low surgical risks and minimal hospital time.
GLP-1 receptor agonists plus surgical intervention
Combining GLP-1 receptor agonists with surgical intervention may reduce surgical risks and support improved results. This approach is often suggested in modern practices.
It may lead to surgical weight loss plus an additional 10–15% weight loss, with long-term maintenance possible, significant health improvements, and reduced surgical risk.
GLP-1 receptor agonists
GLP-1 receptor agonists mimic a natural hormone, helping reduce appetite and improve blood sugar.
They may result in 10–15% weight loss, but generally require ongoing medication for maintenance. They are less invasive than surgery and can improve health, but may have side effects.
Lifestyle changes: diet and exercise
Healthy eating and increased activity may lead to 5–10% initial weight loss. By 24 months, this may reduce to 3–6% total body weight.
Lifestyle changes can create health-related improvements and are the least invasive approach, but long-term maintenance can be challenging.
There is no shame in needing surgery
Take the opportunity to understand why weight often comes back. In many circumstances, surgery may be the safest measure to protect your long-term health.
You cannot penalise a future version of yourself for understandable mistakes in calorie balancing. Weight gain is complex, and long-term weight maintenance can be extremely difficult without medical support.
Of all interventions, surgery has shown some of the strongest long-term results.