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In today’s calorie-rich, ultra-processed, movement-sparing, chronic stress-inducing environment, losing weight is hard work. And implementing a healthy and sustainable approach that keeps the weight off is even harder.

Most of us can successfully achieve weight loss in the short term. But those who hop from one fad diet to the next often experience the metabolic roller coaster known as yo-yo dieting that jacks up our hunger hormones, plummets our metabolic rates, and causes a vicious circle of weight loss and regain.

Even most medical interventions to help treat obesity produce the typical trajectory of rapid weight loss followed by weight plateau and then progressive weight regain.

In a meta-analysis of 29 long-term weight loss studies, more than half of the lost weight was regained within two years, and by five years more than 80% of lost weight was regained.

This means that based on our best estimates, only one in five individuals who is overweight is successful in long-term weight loss.

What is different about weight loss maintainers?

Based on studies from the National Weight Control Registry — a database of more than 4,000 individuals who have maintained at least 10% body weight loss for at least one year — we have insight into some tried and true tactics.

These include various behaviors to reduce energy intake — limiting calorie-dense foods and sugar-sweetened beverages, increased fruit and vegetable consumption, portion control and a consistent eating pattern across days — as well as boosted energy expenditure from being physically active for at least an hour per day.

Successful weight loss necessitates greater energy expenditure and less energy intake (a net negative energy balance).

But how do people actually sustain those weight loss-promoting behaviors over time, creating a lifestyle that does not leave them feeling persistently deprived, lethargic and “hangry” (hungry + angry)?

As more recent evidence confirms, the proper psychology for weight loss is critical for regulating the physiology that supports weight loss.

Self-regulation, self-efficacy are key to long-term success

Only recently have we started to evaluate the psychological and cognitive determinants of weight loss maintenance. The data to date confirms the importance of self-regulation — in particular, self-monitoring of the day-to-day behaviors that drive energy intake and energy expenditure, especially eating behaviors.

Those who have high self-efficacy (belief in your capacity to execute certain behaviors) for exercise in particular are more successful at sustaining weight loss.

And more recently, researchers have been decoding elements of the proper mindset that instills high self-efficacy for the larger constellation of important weight management behaviors.

One recent study used machine learning and natural language processing to identify the major behavioral themes — motivations, strategies, struggles and successes — that were consistent across a group of over 6,000 people who had successfully lost and maintained more than 20 pounds of weight for at least a year.

Among this large group, they consistently advised perseverance in the face of setbacks, and consistency in food tracking and monitoring eating behaviors, as key behavior strategies. And most of them stayed motivated by reflecting on their improved health and appearance at their lower weight.

Studies miss many people

The evidence suggests that age, gender and socioeconomic status are not significant factors in predicting weight loss maintenance. But most weight loss studies oversubscribe white, educated and mid-level income earning females.

Given that the prevalence of obesity and its related comorbidities is disproportionately higher in more socially disadvantaged and historically marginalized populations, we need more representative data to paint a full, inclusive picture of a successful weight loss psychology.

What we can say for certain is that for any and all of us, maintaining weight loss requires getting comfortable with discomfort — the discomfort of occasionally feeling hungry, of exercising instead of stress eating, of honestly deciphering reward-seeking versus real hunger, and resisting the ubiquitous lure of ultrapalatable foods.

This is no easy task, as it often goes against environmental cues, cultural customs, family upbringing, social influences and our genetic wiring.

To help each other achieve health and weight loss, we need to learn and practice the psychological tools that help us not only accept but eventually embrace this inevitable discomfort.

© 2023 Harvard University. Distributed by Tribune Content Agency, LLC.