Keeping the Weight Off

Using evidence-based language to understand weight loss and obesity

Doesn’t it seem easier to put weight back on than it is to lose the weight in the first place?

Scientific evidence shows that hunger hormones and metabolism rate do not reset after losing weight. The body works against weight loss, instead trying to gain the weight back, because it’s used to having a bigger caloric intake.

More than one-third of United States residents have been diagnosed with obesity, and when it comes to losing weight, people with obesity should view their journey as if they are combatting a chronic disease.

“All of us have been in this cycle of we-lose-weight, we-gain-weight,” said Angela Golden, DNP, FNP-C, FAANP, owner of NP From Home, LLC, in Munds Park, Ariz., and a past president of the American Association of Nurse Practitioners. Golden said the first step in effective weight loss for anyone, including nurses, is recognizing that obesity is a chronic disease. “When we start to talk about it like it’s a disease, it makes the outlook on the weight loss journey switch,” she said.

Studying Patient Weight Loss

Golden was recently involved with the Weight Loss Cycle ethnographic study, which followed patient perspectives during their weight loss journey. Through an extensive interview process, 27 people between the ages of 40 and 62 were monitored while trying to lose weight. The participants kept video and diary entries. The overarching finding of the study, according to Golden, was the conclusion that people should “put words to the weight loss cycle.”

Six Phases of the Weight Loss Cycle

The study found that all participants consistently experienced six phases in their weight loss journey:

Defining Moment. The person recognizes that outside factors have influenced their decision to lose weight. “It’s more than a number on the scale,” explained Golden. A medical need may have developed, pushing the person to begin losing weight.

Consideration. The person feels hopeful and determined, and assesses what is the best method to lose weight.

Momentum. “They’re seeing benefits” in this phase, Golden explained. People in the momentum phase start to see results, are feeling better and are motivated by their progress.

Plateau. Frustration starts to build as the person continues to follow a weight loss regimen but isn’t losing additional weight.

Collapse. The person feels tired and unable to continue the journey. The person is almost relieved to find the pressure to lose weight has been lifted.

Fatigue. Exhaustion and unwillingness set in, causing the person to lose focus on losing weight and eventually gain back the weight lost.

Bypassing Collapse and Fatigue

Knowing that both collapse and fatigue exist and are inevitable in the weight loss process is essential. Anyone trying to lose weight has the tools-the words-to understand what they are going through. “We know this is coming. We can start to talk about it early so we don’t end up in collapse and fatigue,” Golden said.

“These last two steps have helped my patients the most,” added Golden, saying that she believes it will help nurses too. She said having the words to describe the weight loss journey gives her patients a better understanding of their own weight loss process. By viewing obesity as a chronic disease, people are able to redefine how they approach each phase. Instead of feeling defeat, the person can start to work toward their end goals.

By being able to pinpoint when they are entering the next phase, people losing weight are able to see why they are feeling a certain way about their journey.

Tips to Understanding Weight Loss

The weight loss cycle enables a person to watch for signs indicating a detour in the journey. Knowing that collapse and fatigue are on their way can help nurses avoid “falling off” the proverbial weight loss wagon, instead bypassing these two steps and starting back on track with momentum.

“We now know there is physiology that encourages our bodies to put weight back on,” said Golden. “During plateau, our bodies work against us.”

That is why, Golden said, it is important to have a partner in the healthcare profession during a weight loss journey.

Nurses who want to lose weight should follow a healthy eating plan, adhere to an exercise schedule and set realistic goals, which, Golden said, are not always what people think they are.

“Realistic goals doesn’t mean becoming the weight you were sometime in the past or becoming what we see on the front of magazines,” said Golden. “I ask my patients to look at what their obesity is preventing them from doing, and then we set goals that will remove the barriers. I encourage short-term goals as well as long-term goals.”

She said long-term goals can be difficult to reach, particularly when in plateau. “If nurses are only trying to reach long-term goals, it is more likely to move to collapse versus returning to momentum in the cycle,” Golden said. “I would love to have nurses be able to take away the understanding of obesity as a disease for their patients but also for themselves, and as such they should treat it like they would any other chronic disease and seek treatment.” Treatment, she said, includes lifestyle changes and medical interventions. “Understanding the cycle of treating this disease can create a therapeutic relationship for their patients as well,” Golden added.

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