**6. Conclusion**

*Weight Management*

Physical activity Focus

Required Willpower

Help & support

**Table 3.**

Main goal Body weight reduction (fat mass reduction)

Dietary focus Calorie reduction ("less") Rigid adherence

Time frame 3–6 months 3+ years

(improvements of health, quality of life,

Decreasing sedentary times Adhere to exercise plans

Motivation Continuous success due to weight loss

self-perception) Group support Compliments

Very high at beginning Later context dependent

Regular external monitoring Multi-professional treatment Exchange with others

stimulus control techniques, social skills, and mindfulness eating might help these patients to gain back control over externally triggered hedonic eating motives.

to be referred to psychotherapy to treat an underlying affective disorder.

*Example for how weight loss maintenance can be emphasized as a separate challenge to patients.*

ence a lack of control over eating in the absence of clear external or emotional causes. A training comprising of acceptance-based and cognitive-behavioral techniques, proven effective for the treatment of binge eating disorder, might be

A second intervention should be targeted towards patients who primarily report emotional problems, lack of time management, or negative beliefs about weight management. Stress prevention and reduction trainings might help these patients to free the resources necessary to pursue healthy behaviors again and to not rely on emotional eating as a coping mechanism. Of note, some of these patients may need

**Weight loss period Weight loss maintenance period**

person")

freedom

composition)

High at beginning Later intermittently

Like-minded people and groups Professional consultation

Identity change ("healthily living

High-grade ("better") Planning & remaining flexible

Habitual physical activity Enjoying physical activity/exercise

Improved mobility, new choices, new

Healthy lifestyle as a hobby (experiences, insights, exchange, role model) Continuous success due to exercise (improvements of physical fitness, body

A third intervention should be made available to patients who primarily experi-

A fourth intervention should be made available for patients whose primary issue is a directly experienced lack of motivation or who are demoralized by the experience of barriers seemingly out of their control such as bad weather conditions, poor health and sickness, financial problems at home, a lack of social support, or poor body image. Training these patients in problem-solving might enable them to find solutions for their respective issues and more importantly, may increase their self-efficacy and beliefs in long-term success. Self-efficacy can be further promoted by applying methods such as mentoring, adequate goal setting, action planning, and motivational interviewing. With respect to body weight, it should be considered that stabilization of a partly regained weight is a more realistic goal for recovery

A fifth intervention should be made available for patients who are experiencing identity conflicts as their primary issue such as discomfort with the new body, social insecurities, or inhibition by past stigmatizing experiences. Cognitive-behavioral techniques can be used to dispute potentially idealizing of the former obese self or

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than anew weight loss [40].

helpful.

Weight loss maintenance is a complex physiological and psychological challenge associated with a high risk of failure. Studies on patient perspective have revealed valuable information on how this process is experienced. Although generally experienced as an ongoing burden, the underlying psychological tension is variable and moderated by a number of now well-defined barriers, facilitators, and strategies. With this novel information, a more tailored long-term support can be provided which may help improve weight loss maintenance.
