Annals of Medicine

ISSN: 0785-3890 (Print) 1365-2060 (Online) Journal homepage: http://www.tandfonline.com/loi/iann20

Weight loss methods and changes in eating habits among successful weight losers Sirpa Soini, Pertti Mustajoki & Johan G Eriksson To cite this article: Sirpa Soini, Pertti Mustajoki & Johan G Eriksson (2016): Weight loss methods and changes in eating habits among successful weight losers, Annals of Medicine To link to this article: http://dx.doi.org/10.3109/07853890.2015.1136428

Published online: 28 Jan 2016.

Submit your article to this journal

View related articles

View Crossmark data

Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=iann20 Download by: [University of California, San Diego]

Date: 31 January 2016, At: 02:41

ANNALS OF MEDICINE, 2016 http://dx.doi.org/10.3109/07853890.2015.1136428

ORIGINAL ARTICLE

Weight loss methods and changes in eating habits among successful weight losers Sirpa Soinia, Pertti Mustajokib and Johan G Erikssona,c,d,e

Downloaded by [University of California, San Diego] at 02:42 31 January 2016

a Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland; bEndocrine Department, Helsinki University Hospital, Helsinki, Finland; cDepartment of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland; dFolkha¨lsan Research Centre, Helsinki, Helsingfors Universitet, Helsinki, Finland; eUnit of General Practice, Helsinki University Hospital, Helsinki, Finland

ABSTRACT

ARTICLE HISTORY

Background Changes in several lifestyle related factors are required for successful long-term weight loss. Identification of these factors is of major importance from a public health point of view. Methods/subjects This study was based upon findings from the Finnish Weight Control Registry (FWCR), a web-based registry. In total, 316 people were recruited and 184 met the study inclusion criteria. The aims of this study were to assess means and typical changes in eating habits associated with successful long-term weight loss. Results Half of the participants (48%) reported that they lost weight slowly primarily with dietary changes. Self-weighing frequency was high, 92% was weighing themselves at least once a week during the weight loss phase, and 75% during the maintenance phase. Dietary aspects associated with successful weight loss and weight maintenance included an increase in intake of vegetables, a reduction in frequency of eating candies and fast food, regular meal frequency and application of the Plate model. Conclusions Both slow and fast weight loss may lead to successful long-term results and weight maintenance. A decrease in energy intake was achieved by reducing intake of energy-dense food, applying the Plate model and by regular meal frequency.

Received 2 September 2015 Revised 16 December 2015 Accepted 17 December 2015 Published online 21 January 2016 KEYWORDS

Diet; eating habits; long-term weight loss; meal frequency; weighing; weight gain; weight maintenance

KEY MESSAGES

 Successful long-term weight loss is associated with a reduction in intake of energy-dense food. A more regular meal frequency and a high frequency of self-weighing seem to be helpful.

Introduction A rising trend in obesity is well documented particularly in the Western world. Therefore, identifying successful long-term weight loss methods are of utmost importance. It is well known that weight regain after successful weight loss is common regardless of weight loss methods applied (1). Overweight and obesity are consequences of an energy intake that is larger than energy expenditure. Therefore, overweight people have to make dietary changes in order to lose weight. One important question is what type of changes is optimal in order to achieve long-term weight loss. A large number of studies have been focusing upon successful weight loss and maintenance, many of those based on various intervention CONTACT Sirpa Soini Helsinki, Finland ß 2016 Taylor & Francis

[email protected]

methods or specific dietary interventions (2). One recent systematic review summarized that reduction in energy and fat intake together with increased physical activity and self-monitoring are the key factors contributing to healthy long-term weight loss (3). The Plate model has been launched in the nutritional recommendations in the Scandinavian countries (4,5). The traditional Plate model proposes that half of the plate should be covered with vegetables, a quarter with protein and a quarter with carbohydrates. Based on previously reported findings from the Finnish Weight Control Registry (FWCR) among people with an average baseline Body Mass Index (BMI) of 35.9 kg/m2, we have reported that regular exercise, lower alcohol consumption and lower prevalence of

Department of General Practice and Primary Health Care, University of Helsinki, P.O Box 20, 00014

2

S. SOINI ET AL.

smoking compared to the general population in Finland, were some of the main determinants of maintenance after successful weight loss (6). The overall aims of this study were to describe the changes in diet and eating habits, to study the means by which a long-term weight loss has been achieved, to study typical motivational factors associated with successful weight loss and to study methods employed in weight loss and weight control. This study focuses upon methods used to lose weight, eating habits after achieving successful weight loss, previous weight loss attempts and frequency of self-weighing.

variables were analysed using cross-tabulation and Pearson’s chi-square test or Fisher’s test. Changes in diet and self-weighing frequency before and after weight loss was tested with McNemar test (binary variables). Statistical analysis was carried out using IBM SPSS Statistics for Windows, version 21 (IBM Corp., Armonk, NY). p Values less than 0.05 were considered statistically significant.

Results Weight loss methods

Downloaded by [University of California, San Diego] at 02:42 31 January 2016

Methods Study design and recruitment This study was based upon a weight loss registry, which was developed based upon a web-based questionnaire. The study design and recruitment procedures have been described in detail previously (6). Briefly, the study participants were recruited through articles in larger Finnish newspapers between January 2012 and August 2013. The inclusion criteria were age 18–60 years, body mass index  30 kg/m2 before initiating weight loss and weight loss  10% lasting at least for 2 years. The exclusion criteria included bariatric surgery and drug treatment for obesity. Ethical Approval for this study was obtained from the Ethics Committee, Department of Medicine, Helsinki University Hospital (number 196/13/03/01/2011). All participants gave informed consent.

Data collection All data was based on self-reported information from the participants (n ¼ 158, male 58, female 100). Information was collected through electronic forms. BMI before and after weight loss was calculated as weight in kilograms divided by height in meters squared (kg/m2). The questionnaire included questions on methods to lose weight, changes in diet, eating habits and physical activity. The questions were structured and included both single and multiple choice questions, but free text was also allowed. The structured questions included 5–6 options which describe diet especially frequency of use before and after weight loss. Participants were instructed to choose only one or in some cases two or more options which best described their eating habits.

Statistical analysis Categorical variables are described as frequencies (percentages). The associations between categorical

Of the participants 48% reported that they lost weight slowly primarily with dietary changes. This was more commonly reported among women than among men (56% versus 34%, p ¼ 0.009; Table 1). One fifth (20.3%) of the participant reported losing weight fast primarily with dietary changes. These included either their own dietary modifications, low carbohydrate diet (LCHD) and very low calorie diet (VLCD). Among those who reported losing weight with other methods than dietary changes only (31.6%), the majority of these (65.0%) reported increasing physical activity alone or in combination with dietary changes. Eight percent reported using the Weight Watchers format. Neither age and marital status nor previous weight loss attempts were related to the method applied in order to achieve weight loss. Socio-economic factors were however associated with the method applied to lose weight. Among those reporting losing weight faster 24.4% had shorter and 75.6% longer educational attainment (p50.001). A similar association was observed in relation to monthly earnings. Among those reporting a faster weight loss 19.5% had monthly earnings 52000 E versus 80.5% with earnings 42000 E (p50.006). However, socioeconomic status did not affect the overall weight loss result.

Self-weighing Of the participants 92% reported weighing themselves at least once a week during the weight loss period. During weight maintenance almost half of the participants (48.7%) reported self-weighing daily or at least twice a week. One fourth (24.7%) reported weighing themselves once a week during weight maintenance. Of those who were weighing themselves at least once a week half (51%) reported that their weight did not change after achieving the result, 34% reported that their weight increased. Weighing frequency was not associated with weight gain after weight loss.

ANNALS OF MEDICINE

3

Downloaded by [University of California, San Diego] at 02:42 31 January 2016

Table 1. Methods to lose weight (Chi-square test). Male n (%)

Female n (%)

Total n (%)

Weight loss method Slowly, mainly dietary changes* Fast, mainly dietary changes LCHD VLCD Other (most commonly exercise)

(n ¼ 58) 20 (34.5) 7 (12) 10 (17.2) 1 (1.7) 20 (34.5)

(n ¼ 100) 56 (56) 5 (5) 7 (7) 2 (2) 30 (30)

(n ¼ 158) 76 (48) 12 (7.6) 17 (10.8) 3 (2) 50 (31.6)

Previous attempts to lose weight None or did not answer Once 2 or 3 times 4 times or more

17 9 19 12

33 10 22 35

(n ¼ 157) 50 (31.8) 19 (12) 41 (26) 47 (30)

Changes in weight after successful weight loss No change** Weight increase*** Weight decrease

27 (46.5) 23 (39.7) 8 (13.8)

22 (22) 58 (58) 20 (20)

(n ¼ 158) 49 (31) 81 (51.3) 28 (17.7)

If increase, amount* 3 kg 43 kg

(n ¼ 23) 14 (61) 9 (39)

(n ¼ 57) 21 (36.8) 36 (63.2)

(n ¼ 80) 35 (43.8) 45 (56.2)

(30) (15.8) (33.3) (21)

(33) (10) (22) (35)

*p50.01. **p ¼ 0.001. ***p50.05.

Figure 1. Changes in dietary habits: (a) meal frequency (p ¼ 0.006), (b) frequency of intake of fast food (p50.001) and (c) candies (p50.001).

Eating habits Based upon the structured multiple choice questions about weight loss two-thirds of the participants reported that they reduced their intake of sweet pastries, candies, fast food and fast carbohydrates (e.g. white bread, sugar). Sixty-four percent reported eating candies at least once a week before weight loss, after weight loss

the corresponding number was 36% (p50.001). Those reporting eating candies once a month or less frequently increased from 12% to 38% (p50.001). A similar trend was observed in relation to intake of fast food, 64% reported that they had fast food at least once a week before weight loss, after weight loss 7% (p50.001). Approximately 80% reported eating fast food once a

4

S. SOINI ET AL.

Table 2. Changes in diet during weight loss, when asked about how did they lose weight?. Change in diet Increase in intake of vegetables Decrease in intake of sweet pastries Decrease in intake of candies Decrease in intake of fast food Decrease in intake of fast carbohydrates Reduction in meal size More regular meal frequency Decrease in intake of soft drinks Decrease in intake of high-fatty cold cuts and sausages Decrease in intake of alcohol* Decrease in intake of high-fatty cheeses Other changes

Male n (%)

Female n (%)

Total n (%)

45 41 33 40 39 39 30 33 28 26 17 15

78 67 68 61 60 58 58 52 43 29 35 26

123 (77.8) 108 (68.4) 101 (63.9) 101 (63.9) 99 (62.7) 92 (58.2) 88 (55.7) 85 (53.8) 71 (44.9) 55 (34.8) 54 (32.9) 41 (25.9)

(77.6) (70.7) (56.9) (69.0) (67.2) (58.6) (51.7) (56.9) (48.3) (44.8) (29.3) (25.9)

(78.0) (67.0) (68.0) (61.0) (60.0) (58.0) (58.0) (52.0) (43.0) (29.0) (35.0) (26.0)

Downloaded by [University of California, San Diego] at 02:42 31 January 2016

*p50.05.

month or less frequently after weight loss (Figure 1). More than half of the participants (54%) reduced their intake of soft drinks, before weight loss 44% consumed soft drinks at least once a week, the corresponding number after weight loss was 17% (p50.001). Among the participants 58% reported a reduction in portion size and 56% reported that they more often followed a 3–5 times/day meal frequency than before weight loss (Table 2). Also frequency of alcohol intake decreased, 40% reported using alcohol at least once a week before weight loss; the corresponding number was 23% after weight loss (p50.001). The number of participants consuming alcohol once a month or less often was 37% before weight loss and 60% after weight loss (p50.001). Men reported more commonly a reduction in their frequency of alcohol intake. After successful weight loss the most commonly daily meal frequency was 3–5 meals (meals or snacks in total) a day, an increase from 61% to 76% (p ¼ 0.006). Of the participants 89%, reported that they eat breakfast daily, one-tenth (10%) reported that they used the Plate model before weight loss and 54% after weight loss (p50.001). The majority (85%) reported that they do not take a second portion during a meal. Half of the participants (53%) reported that their diet did not differ between weekdays and weekend, and 45% reported that the diet did not differ between weekdays and holiday.

Knowledge Before weight loss 40% reported that they knew little or not very much about energy or nutritional content of food and were not interesting in it. After successful weight loss the number dropped to 7% (p50.001); 27% reported that they knew much before weight loss, and 71% reported that their knowledge had strengthened during weight loss. Participants who lost weight for the first time reported more often knowing little or not much about

energy or nutritional content of food before weight loss compared to those who had one or more previous attempt (58% versus 32%, p ¼ 0.002). Among participants who reported having at least one previous attempt 31% reported knowing much while the corresponding number was 18% among those participants who had no previous weight loss attempts.

Discussion In this study, based on findings from the Finnish Weight Control Registry (FWCR), successful long-term weight loss was associated with healthy lifestyle changes which include more regular meal frequency, applying the Plate model, a reduction in intake of delicacies and energydense food, increase in nutritional knowledge and frequent self-weighing. Traditionally, a slow weight loss has been suggested to be associated with better long-term results and lower risk for rapid weight re-gains (7). However, this assumption has been challenged by several studies using VLCD (2,8,9). Similarly our findings as well as several previous studies (8–10) do not support this hypothesis. Our findings report gender differences in achieving the results. Similarly, socio-economic factors seem to influence the choice of weight loss methods. These factors should be taken into account when planning interventions and when providing clinical guidance for overweight and obese people. In other words, the weight loss methods must be planned individually and health care professional should be encouraged to individualize weight loss methods. Gender differences should be taken into account when planning weight loss groups. However, this might create challenges both when assembling weight loss groups and when training health care professional. One potential underlying cause for poor long-term results commonly reported could be due gender related factors, as well as not individualizing the weight loss methods applied.

Downloaded by [University of California, San Diego] at 02:42 31 January 2016

ANNALS OF MEDICINE

Interestingly one study (7) reported that it might even interfere with the results if the participant is recommended to lose weight slowly if he or she would prefer a faster method. Another interesting area is how previous attempts or methods to lose weight correlate with future success. The knowledge of energy and nutritional content of food might help to make the right dietary choices during weight loss and management. However, only few studies have focused upon this subject (11). Self-weighing frequency during and after weight loss is frequently discussed in studies focusing upon successful weight loss. A regular self-weighing frequency seemed to help during the weight loss phase and helped in avoiding weight re-gain after achieving the result (12–22). In this study, self-weighing frequency did not correlate with weight changes after successful weight loss. Overall consistent self-weighing seems to be one key factor to good long term results and lower self-weighing frequency is associated with higher risk for weight re-gain as shown in previous studies (12–22). The Plate model describes the meal as a pie chart in order to show proportions of the plate that should be covered by various food groups. Naturally, one key point in successful weight loss is low energy-dense meals and snacks (23). Important means to lose weight is reducing intake of delicacies, reducing portion size (23) and following meal frequency (15). Obviously reduction in intake of soft drinks, candies, sweet pastries, fast food, products rich in sugars and fat help achieve positive result (5,24,25). This was also the case in this study. The majority of the participants did reduce their intake of these products showing that it is possible to reach success also when the diet include a small amounts of delicacies, soft drinks and fast food. Reducing the amount of food intake means either smaller portion sizes or not taking an extra portion of food during the meal. These changes are relevant and have gained support in many previous studies (23,26–28). However, portion size is not the only factor that matters when focusing upon a reduction in energy intake. When reducing the amount of energy-dense food, portion size does not necessarily decrease (23). An interesting finding was that half of the participants followed a meal frequency of 3–5 meals/day and decreased portion size, however almost half did not. The Plate model has been developed as a simple means to aid in weight control (4). In this study, the participants used the Plate model after successful weight loss substantially more often than before. As a matter of fact, only few participants used it before weight loss, despite the fact that it was launched almost 20 years ago in Finnish nutritional recommendations (4,5). Still, the Plate model

5

should be further emphasized in weight control guidelines because of its positive influence on long-term results. Nearly half of the participants reported that they were not eating differently during weekends or holidays compared with weekdays. Similar results have been published in a study on US NWCR participants and in Germany (12,13). It appears that eating flexibly during weekdays, holidays and weekends can be as effective as eating in a similar way throughout the week and year. Finnish nutritional recommendations advice people to eat 3–5 times a day (29), in this study, the majority of the participants did this after successful weight loss. Women ate more frequently before weight loss than generally recommended, this has been shown in previous studies as well (30). Eating breakfast is commonly associated with successful weight management (31–35) and skipping breakfast (26,35) or keeping it very light (30) has been associated overweight and obesity. In this study, the participants skipped breakfast more often than in the US NWCR registry (10% versus 4%)(34). Increasing knowledge of energy content of the diet is undoubtedly one of the success factors in long-term weight control. Weight control is also a learning process. The more knowledge one has, the easier it is to achieve the optimal diet and avoid weight re-gain. Participants who were dieting for the first time reported more often knowing little or very little about nutritional factors. Still it is interesting that many of those who had previous attempts reported lack of knowledge about nutritional and energy content in food, less than one-third reported that they knew much or very much. This might suggest that those who try to lose weight, even several times, might follow some kind of structured diet or format without taking care of nutritional knowledge-associated factors. However, 71% reported increased knowledge, which clearly means that those who were successful in achieving long-term weight loss increase their nutritional knowledge. This has been reported in one previous study where knowledge was associated with greater weight loss among low-income women (11). There are some weaknesses in this study. The overall number of participants is rather small. Similar registers collecting information from successful weight losers exist in the US (NWCR), Portugal (PWCR) and German (GWCR) (12,13,36). Interestingly, the Finnish register is the biggest in proportion to the number of inhabitants in the countries. Nutritional as well as other data are all self-reported which is usually the case in these kinds of studies and therefore recollection bias might be a problem. The retrospective characteristic of this study is one obvious limitation because of problems with memory recall.

6

S. SOINI ET AL.

Downloaded by [University of California, San Diego] at 02:42 31 January 2016

However, this is the case in all studies with a similar design. In conclusion successful long-term weight loss is associated with a low calorie diet and a meal frequency of 3–5 meals/day. Furthermore, reduction in intake of energy-dense food, such as candies, sweet pastries or fast food, and more specifically frequency of use seems to be essential in order to achieve long-term weight loss. High frequency of self-weighing and increasing nutritional knowledge is also helpful. Long-term results of weight loss can be achieved both by slower and faster methods however, holistic changes towards a healthier lifestyle are needed.

Disclosure statement

10.

11.

12. 13.

14.

The authors declare no conflict of interest. 15.

Funding information This study was supported by grants from Finska la¨karesa¨llskapet Liv och Ha¨lsa and Samfundet Folkha¨lsan. 16.

References 1. Dombrowski SU, Knittle K, Avenell A, Arau´jo-Soares V, Sniehotta FF. Long term maintenance of weight loss with non-surgical interventions in obese adults: systematic review and meta-analyses of randomised controlled trials. BMJ. 2014;348:g2646. doi: 10.1136/bmj.g2646. 2. Marinilli Pinto A, Gorin AA, Raynor HA, Tate DF, Fava JL, Wing RR. Successful weight-loss maintenance in relation to method of weight loss. Obesity (Silver Spring). 2008;16:2456–61. 3. Ramage S, Farmer A, Eccles KA, McCargar L. Healthy strategies for successful weight loss and weight maintenance: a systematic review. Appl Physiol Nutr Metab. 2014;39:1–20. 4. Camelon KM, Ha˚dell K, Ja¨mse´n PT, Ketonen KJ, Kohtama¨ki HM, Ma¨kimattila S, et al. The Plate Model: a visual method of teaching meal planning. DAIS Project Group. Diabetes Atherosclerosis Intervention Study. J Am Diet Assoc. 1998;98:1155–8. 5. Fogelholm M, Anderssen S, Gunnarsdottir I, Lahti-Koski M. Dietary macronutrients and food consumption as determinants of long-term weight change in adult populations: a systematic literature review. Food Nutr Res. 2012;2012:56. doi: 10.3402/fnr.v56i0.19103. 6. Soini S, Mustajoki P, Eriksson J. Lifestyle related factors associated with successful weight loss. Ann Med. 2015;47:88–93. doi: 10.3109/07853890.2015.1004358. 7. Casazza K, Fontaine KR, Astrup A, Birch LL, Brown AW, Bohan Brown MM, et al. Myths, presumptions, and facts about obesity. N Engl J Med. 2013;368:446–54. 8. McGuire MT, Wing RR, Klem ML, Hill JO. Behavioral strategies of individuals who have maintained long-term weight losses. Obes Res. 1999;7:334–41. 9. Nackers LM, Ross KM, Perri MG. The association between rate of initial weight loss and long-term success in

17.

18.

19.

20.

21.

22.

23. 24.

25.

26.

obesity treatment: does slow and steady win the race? Int J Behav Med. 2010;17:161–7. Purcell K, Sumithran P, Prendergast LA, Bouniu CJ, Delbridge E, Proietto J. The effect of rate of weight loss on long-term weight management: a randomised controlled trial. Lancet Diabetes Endocrinol. 2014;2:954–62. Klohe-Lehman DM, Freeland-Graves J, Anderson ER, McDowell T, Clarke KK, Hanss-Nuss H, et al. Nutrition knowledge is associated with greater weight loss in obese and overweight low-income mothers. J Am Diet Assoc. 2006;106:65–75. quiz 76–9. Wing RR, Phelan S. Long-term weight loss maintenance. Am J Clin Nutr. 2005;82:222S–5S. Feller S, Mu¨ller A, Mayr A, Engeli S, Hilbert A, de Zwaan M. What distinguishes weight loss maintainers of the German Weight Control Registry from the general population? Obesity (Silver Spring). 2015;23:1112–18. Thomas JG, Bond DS, Phelan S, Hill JO, Wing RR. Weight-loss maintenance for 10 years in the National Weight Control Registry. Am J Prev Med. 2014;46:17–23. Fuglestad PT, Jeffery RW, Sherwood NE. Lifestyle patterns associated with diet, physical activity, body mass index and amount of recent weight loss in a sample of successful weight losers. Int J Behav Nutr Phys Act. 2012;9:79. doi: 10.1186/1479-5868-9-79. Madigan CD, Aveyard P, Jolly K, Denley J, Lewis A, Daley AJ. Regular self-weighing to promote weight maintenance after intentional weight loss: a quasirandomized controlled trial. J Public Health (Oxf). 2014;36:259–67. Oshima Y, Matsuoka Y, Sakane N. Effect of weight-loss program using self-weighing twice a day and feedback in overweight and obese subject: a randomized controlled trial. Obes Res Clin Pract. 2013;7:e361–6. Casazza K, Brown A, Astrup A, Bertz F, Baum C, Brown BM, et al. Weighing the evidence of common beliefs in obesity research. Crit Rev Food Sci Nutr. 2015;55:2014–53. Madigan CD, Jolly K, Lewis AL, Aveyard P, Daley AJ. A randomised controlled trial of the effectiveness of self-weighing as a weight loss intervention. Int J Behav Nutr Phys Act. 2014;11:125. doi: 10.1186/s12966014-0125-9. Helander EE, Vuorinen AL, Wansink B, Korhonen IK. Are breaks in daily self-weighing associated with weight gain? PLoS One. 2014;9:e113164. Butryn ML, Phelan S, Hill JO, Wing RR. Consistent selfmonitoring of weight: a key component of successful weight loss maintenance. Obesity (Silver Spring). 2007;15:3091–6. Wing RR, Tate DF, Gorin AA, Raynor HA, Fava JL, Machan J. STOP regain: are there negative effects of daily weighing? J Consult Clin Psychol. 2007;75:652–6. Ledikwe JH, Ello-Martin JA, Rolls BJ. Portion sizes and the obesity epidemic. J Nutr. 2005;135:905–9. Phelan S, Wyatt HR, Hill JO, Wing RR. Are the eating and exercise habits of successful weight losers changing? Obesity (Silver Spring). 2006;14:710–16. Kruger J, Blanck HM, Gillespie C. Dietary practices, dining out behavior, and physical activity correlates of weight loss maintenance. Prev Chronic Dis. 2008;5:A11. Berg C, Lappas G, Wolk A, Strandhagen E, Tore´n K, Rosengren A, et al. Eating patterns and portion size

ANNALS OF MEDICINE

27.

28. 29.

30.

Downloaded by [University of California, San Diego] at 02:42 31 January 2016

31.

32.

associated with obesity in a Swedish population. Appetite. 2009;52:21–6. Berte´us Forslund H, Lindroos AK, Sjo¨stro¨m L, Lissner L. Meal patterns and obesity in Swedish women-a simple instrument describing usual meal types, frequency and temporal distribution. Eur J Clin Nutr. 2002;56:740–7. Matthiessen J, Fagt S, Biltoft-Jensen A, Beck AM, Ovesen L. Size makes a difference. Public Health Nutr. 2003;6:65–72. The National Nutrition Council (2014–2017). Finnish Nutrition Recommendations 2014. Tampere: Juvenes Print, Suomen Yliopistopaino Oy, 2014. Berte´us Forslund H, Torgerson JS, Sjo¨stro¨m L, Lindroos AK. Snacking frequency in relation to energy intake and food choices in obese men and women compared to a reference population. Int J Obes (Lond). 2005;29:711–19. Timlin MT, Pereira MA. Breakfast frequency and quality in the etiology of adult obesity and chronic diseases. Nutr Rev. 2007;65:268–81. Chen J, Cheng J, Liu Y, Tang Y, Sun X, Wang T, et al. Associations between breakfast eating habits and

33.

34.

35.

36.

7

health-promoting lifestyle, suboptimal health status in Southern China: a population based, cross sectional study. J Transl Med. 2014;12:348. doi: 10.1186/s12967-014-0348-1. Huang CJ, Hu HT, Fan YC, Liao YM, Tsai PS. Associations of breakfast skipping with obesity and health-related quality of life: evidence from a national survey in Taiwan. Int J Obes (Lond). 2010;34:720–5. Wyatt HR, Grunwald GK, Mosca CL, Klem ML, Wing RR, Hill JO. Long-term weight loss and breakfast in subjects in the National Weight Control Registry. Obes Res. 2002;10:78–82. Keski-Rahkonen A, Kaprio J, Rissanen A, Virkkunen M, Rose RJ. Breakfast skipping and health-compromising behaviors in adolescents and adults. Eur J Clin Nutr. 2003;57:842–53. Vieira PN, Silva MN, Mata J, Coutinho SR, Santos TC, Sardinha LB, Teixeira PJ. Correlates of health-related quality of life, psychological well-being, and eating selfregulation after successful weight loss maintenance. J Behav Med. 2013;36:601–10.

Weight loss methods and changes in eating habits among successful weight losers.

Changes in several lifestyle related factors are required for successful long-term weight loss. Identification of these factors is of major importance...
838KB Sizes 3 Downloads 5 Views