Preventing Weight Regain After a Diet

Contrary to popular belief, dietary interventions to produce weight loss are quite efficacious. However the rate of recidivism is high at roughly 85%, with research demonstrating a substantial portion of weight lost being regained within just a few years (1). This is not simply a result of lapses in adherence, and in fact has strong genetic, biological, environmental and psychological influences. Given the audience this article will be seen by, the focus will revolve around strategies to optimize body composition both from a muscularity and leanness standpoint. The objective of this article is to understand why weight regain is so prevalent by exploring the various mechanisms (both direct and indirect) involved. From there we can compile a series of recommendations and strategies to bypass or at least minimize negative repercussions associated with dieting and the feared rebound. Although this article is not specifically geared toward bodybuilders or physique competitors, the majority of the information and recommendations still apply. I want to be clear that these are suggestions for individuals who are healthy with no medical conditions. And as always, ensure you seek help from a qualified professional such as a dietician or physician before making any changes based on the recommendations contained in this article.

KEY POINTS

As you restrict energy and lose body fat metabolic adaptations occur as a biological response to prevent starvation. Virtually all of the down-regulation in BMR at the end of a diet are due to changes in NEAT. This is a natural process and is not necessarily indicative of any sort of metabolic damage.

Exploiting high energy flux (where both energy intake and expenditure are high) can help slow down the metabolic adaptations and can increase adherence and reduce psychological distress. Introducing low grade physical activity (LIPA) is an effective method of increasing energy expenditure without creating an interference effect or exacerbating metabolic down-regulation. Ensuring consumption of protein within the range of 2.3-3.1g/kg of lean body mass will maximally retain muscle. The recommended rate of weight loss is 0.5-1% of your bodyweight lost per week while sustaining regular resistance training to minimize muscle loss during a diet.

Dieting is not directly associated with disordered eating, however within certain contexts it may exacerbate disordered eating behavior. Therefore, individuals who present with disordered eating behavior should seek out help from a qualified professional. The history of the individual should be taken into consideration to determine the most effective approach for that particular person.

Maintenance phases are an intentional break away from dieting to remain weight stable. The objective during this phase is to reverse metabolic adaptations, give the individual a psychological reprieve from dieting and help them establish good nutritional habits to remain weight stable.

Autoregulatory eating is an effective method to maintain physique and athletic goals. Similar to the RPE scale in powerlifting it’s effectiveness increases in tangent with a dieters level of experience. This is an acquired skill that can be developed in incremental stages over time and may be especially relevant in free living scenarios.

Dieting, Metabolic Adaptations and Other Considerations:

In order to fully appreciate the complexity of the weight rebound we need to first understand dieting and the various metabolic adaptations that can occur during a hypocaloric diet. Weight loss is a simple concept in theory, maintain a negative energy balance for long enough to see a reduction in bodyweight (2). However, in practice there’s much more nuance involved in this process. Including various factors which can crop up and blunt the weight loss process. Generally speaking, an individual who has a weight loss goal simultaneously has a body composition goal. With the primary focus being to reduce body fat while preserving or in some cases increasing lean body mass.

Unfortunately our bodies are not a closed system and a simple input-output equation is likely not the stand alone feature of an effective body composition intervention. This section will highlight the various metabolic adaptations that can occur during sustained caloric restriction.

The thyroid gland has various functions including regulating basal metabolic rate (BMR) (1). Decreased circulation of thyroid hormones have been shown to down regulate thermogenesis and metabolic rate (2). Leptin, often referred to as the satiety hormone is an anorexigenic hormone that is associated with high energy availability. Research has also shown BMI to be correlated with circulating leptin concentrations (3). One reason for this is because leptin is primarily synthesized in adipocytes (cells specialized for fat storage) and therefore is able to evaluate energy availability. Therefore as an individual reduces body fat leptin concentrations decrease as a countermeasure to promote appetite (2).

Ghrelin, a pro hunger hormone, has an inverse relationship to leptin. During energy restriction as leptin concentrations decrease and ghrelin secretion increases (4)(5). This upregulation in orexigenic pathways may also increase reward seeking behaviour specifically for calorically dense, highly palatable foods (6). This increased dopaminergic drive for high fat, high carbohydrate laden foods can pose a significant barrier to dietary adherence (7).

Insulin is a peptide hormone secreted by the pancreas that functions primarily to regulate blood glucose levels by facilitating cellular glucose uptake. Caloric restriction has been shown to reduce insulin concentration which blunts anabolic signalling for hypertrophy (8)(9). With simultaneous increases in ghrelin, your physiology can shift into a metabolic state of preservation where fat maintenance and/or accretion is prioritized over muscle retention. Insulin also plays an important role in muscle protein synthesis (MPS) through the mTORC1 signalling pathway (9). With protein synthetic response blunted, there is an increased risk of muscle loss and further reduction in metabolic rate.

Cortisol is a glucocorticoid that has several functions including managing blood glucose levels, macronutrient metabolism, inflammatory responses and is most notably known for controlling stress responses (10). Normal cortisol concentrations play an important role in proteolysis, however elevated levels have been shown to increase muscle protein breakdown (MPB) (11)(12). Caloric restriction during a diet presents a significant stress on your body since in essence it’s controlled starvation. Caloric restriction has been shown to increase cortisol concentrations presenting a further risk to muscle loss (13)(14). Some research even suggests that glucocorticoids can inhibit the action of leptin (15).

The hypothalamic-pituitary-adrenal axis HPA-Axis is a collection of structures that mediate the response to stress (16). Corticotropin-releasing factor (CRF) is secreted in response to stress and is the primary regulator of the HPA-Axis (17). The magnitude of the resulting stress response to energy restriction is largely influenced by the severity and duration of the restriction. One study found “Stress-induced activation of the hypothalamic–pituitary–adrenal (HPA) stress axis and release of CRF increases reward-seeking behaviours” (6). This is in line with the broader evidence that suggests the physiological adaptations induced from sustained energy restriction creates a negative feedback loop that can inhibit further attempts to reduce adiposity.

Testosterone is an anabolic hormone serving various biological functions including stimulating MPS and inhibiting protein degradation. Testosterone also has anti-catabolic effects believed to include inhibition of cortisol signalling by blocking the glucocorticoid receptor (18)(19). However, caloric restriction has been shown to reduce concentrations of testosterone (20)(21). It’s estimated that protein turnover accounts for roughly 20% of BMR. Thus reduced testosterone results in decreased BMR, decreased MPS, and decreased ability to mediate MPB making muscle retention during a diet more difficult (22). This is increasingly true the leaner the athlete is.

Your mitochondria are the working organelles that generate cellular energy (23). This is where the majority of adenosine triphosphate (ATP) production takes place through a process known as oxidative phosphorylation (24). ATP synthesis has a significant measure of inefficiency. One study found mitochondrial energy transduction oxidative phosphorylation process is roughly 40% (24). Essentially with all the available energy approximately 60% does not get converted into ATP and is lost through heat.

However this level of efficiency is responsive to various internal and external cues. There’s a phenomena known as the “proton leak”. One study found “coupling of ATP synthesis and substrate oxidation is not complete, as protons can return to the matrix independently of ATP synthase…… the basal leak accounts for ~20–30% of the resting metabolic rate of hepatocytes and up to ~50% of the respiration of skeletal muscle of a rat” (23).

These findings suggest a significant impact on energy expenditure since mitochondrial uncoupling is responsible for a significant portion of BMR (25). Decreased proton leak with mitochondria efficiency likely occurs as an evolutionary adaptation to conserve energy in instances where food availability is low. So as the mitochondria becomes more efficient, you require less energy to function which results in a reduction in BMR. Thermic effect of food (TEF) accounts for roughly 10% of energy consumed (26). However researchers have found that caloric restrictions during a diet did not meaningfully reduce TEF, so at this point the evidence remains conflicting (26).

These metabolic adaptations can in some cases persist well beyond the termination of caloric restriction. The most commonly known example of this is The Biggest Loser study where participants on a reality television show lost a substantial amount of weight in a relatively short period time. At the end of the intervention the individuals who had lost the most weight had the biggest reductions in BMR (27). These and other findings have lead to the popularization of the term metabolic damage, which suggests permanent irreversible damage.

However, labeling these changes metabolic damage isn’t accurate and what you are in fact observing is actually just an entirely normal process of metabolic adaptations. It’s not a “disease” you catch, but rather something that occurs as a natural and vital response to low energy availability. Fat free mass (FFM) is the largest determinant of energy expenditure at rest, estimated at roughly 80% (28)(29). It’s common to see reductions in energy expenditure resulting from decreased lean mass. However, several papers looking at metabolic adaptations found that while factoring in changes in lean mass there was still a small but non negligible reduction in energy expenditure (30)(31)(32)(33).

There are several reasons for this reduction, one of them being a reduction in exercise activity thermogenesis (EAT). As you reduce your bodyweight the amount of energy required to produce locomotion also decreases (34). Similar to exercising with a weight vest then removing it, the energy demand just isn’t as high. However, non exercise activity thermogenesis (NEAT) is a critical component to adaptive thermogenesis. Researchers have observed variations as high as 2000kcal per day between individuals of similar size (35). As one paper noted, a significant variation in individual NEAT is due to a multitude of factors including but not limited to “environmental and biological factors… different occupations and leisure-time activities, as well as molecular and individual genetic factors” (35).

In fact, a paper by Rosenbaum and colleagues cited a reduction in total energy expenditure (TEE) of 10-15% which was unexplained by changes in body composition. Of this 10-15% reduction, roughly 85% could be explained by reductions in non resting energy expenditure of which NEAT is the largest contributor (36). At this point the vast majority of the energy gap has been accounted for. However since NEAT is largely unconscious we run into the problem of how to influence NEAT to allow an increase in energy intake while maintaining energy balance to avoid weight regain.

Although this may seem daunting, there are several variables we can actively control to blunt a significant amount of these adaptive responses. The rate of weight loss seems to be an important factor, even more so for lean individuals with regard to preserving lean mass. Research shows that neither fast or slow rates of weight loss was correlated with weight regain (37). And research consistently shows that lifestyle interventions that focus on promoting changes in exercise as well as dietary behaviour show more promising results for successful weight management (38)(39). A critical factor here is the inclusion of physical activity to the intervention. It’s well established that resistance training effectively preserves muscle mass, therefore its inclusion can minimize risk of muscle loss during this period of energy restriction (40)

A 2017 study wanted to determine “whether manipulation of dietary protein intake during a marked energy deficit in addition to intense exercise training would affect changes in body composition” (39). One group was fed a high protein diet and the other was fed a low protein diet. All participants performed resistance training combined with high intensity interval training six days per week. The high protein intervention increased lean body mass (1.2 ± 1.0 kg) compared to the low protein group (0.1 ± 1.0 kg). The high protein group also lost more fat (PRO: −4.8 ± 1.6 kg; CON: −3.5 ± 1.4kg; P < 0.05) (39). As you can see there was a significant difference in LBM and fat mass validating the efficacy of a high protein diet in conjunction with resistance training to mitigate FFM loss.

A 2014 paper by Helms and colleagues found that in order to minimize muscle loss during a contest prep diet the rate of loss should be roughly 0.5-1% of your bodyweight lost per week (40). Additionally protein intake should be roughly 2.3-3.1g/kg of lean body mass to maximally retain muscle (40). Fat intake is also relevant for maintaining normal sex hormone concentrations. One paper found reducing fat intake from 40% of total caloric intake to 25% meaningfully reduced free testosterone levels (41). Because of this some researchers suggest a daily fat intake between 20-30% of total calories (42). However, within the context of a caloric restriction this may not be feasible and therefore it is recommended that 15-20% of caloric intake come from fat (40). As one paper stated “While dieting, low carbohydrate diets may degrade performance and lead to lowered insulin and IGF-1 which appear to be more closely correlated to LBM preservation than testosterone” (40).

In the 2017 protein restriction study mentioned above the intervention called for a 40% reduction in calories. The difference in losses of FFM were significant, but a large contributor was likely the severity of the caloric restriction. The rate of weight loss is important because the greater the severity of caloric restriction the greater the risk for muscle loss. So a more graded approach can preserve muscle mass and may act as a buffer to metabolic adaptations stemming from sudden radical alterations in energy availability (40).

LIPA is a new term coined by Leigh Peele. I recently attended a strength symposium where she gave a fantastic lecture, one of the topics of her presentation was Low Intensity Physical Activity (LIPA). She highlighted the +80% failure rate of dieting and what potential interventions could mediate the outcome (22). Her lecture addressed metabolic adaptations similar to what is covered in this article.

This is a dramatic difference and it’s estimated that NEAT “is responsible for 6-10% of TEE in individuals with a mainly sedentary lifestyle and for 50% or more in highly active subjects” (43). Compare this to EAT (exercise related activity thermogenesis) which is said to account for roughly 15-30% of TEE (total energy expenditure). It’s well established that physical exercise specifically resistance training plays a crucial role in productive body composition alterations (39), however the role of NEAT just hasn’t gained as much traction in popular fitness culture.

Research often shows one of the primary reasons for stalled weight loss to be an intermittent lack of dietary adherence (44). However, this is often a point of contention because in free living studies we’re faced with a significant increase in reporting error. One 2017 Systematic review found “having a body mass index ⩾30 is associated with significant under-reporting of food intake” (45). So acknowledging the failure rate of dietary interventions to be roughly 80% means the interventions themselves are to some degree incomplete.

Let me be clear, energy balance still applies and a caloric deficit will always reduce bodyweight. However, if during application we don’t see high success rates it’s clear that other psychological and environmental variables are not being effectively addressed. NEAT consists of things like body posture, fidgeting, ambulation, tone of voice etc. During caloric restriction down regulation of NEAT impacts these factors largely without conscious awareness (35). However We can still impact total daily energy expenditure through consciously increasing LIPA. Something as simple as tracking your steps and making a concerted effort to reach a specific step count each day creates an objective measurement for success.

An additional benefit is the ability to maintain a higher caloric intake due to elevated energy expenditure through low grade physical activity. This higher energy flux could potentially offer more flexibility and a psychological reprieve for individuals who feel constrained by rigid dietary guidelines (46). Low grade in this case is defined as less than 50% of max heart rate. Due to the nature of step tracking it does not present enough of a stimulus to cause an interference effect on positive adaptations to strength or hypertrophy (47).

Diet History And Psychosocial Factors:

An individuals baseline is a critical factor to evaluate prior to entering into a diet. Research has shown several associations between dieting and self esteem, disordered eating behaviour, body distortions etc. Although these findings are correlational and not mechanistic, they remain highly relevant and should be considered carefully when developing a dietary intervention. These relationships are complex and are influenced by multiple factors including an individuals psychology, environment, age, gender, ethnicity, culture etc (48).

For instance, a 2006 paper looking at the correlations between chronic dieting and multi-ethnic groups in the US found chronic dieting among women was associated with low self esteem scores, distorted body image, disordered eating behaviour and greater psychopathology than non dieting females (48). Because of the correlational nature of this data it’s difficult to determine whether dietary restraint produces these effects or if individuals with eating disorders, low self esteem and various other psychopathologies have a higher propensity to diet. Additionally, excessive concern regarding bodyweight is associated with the development and maintenance of various eating disorders (49).

Dichotomous thinking is a term used to describe “black and white” “all or nothing” thinking. A 2003 paper by Byrne and colleagues found dichotomous thinking was strongly associated with weight regain (50). These findings were verified in a follow up study in 2004 (51). In particular, dichotomous thinking with regard to food and bodyweight was correlated with greater propensity to regain weight. In this regard an inability to reach the desired bodyweight goal can be viewed as failure, in spite of making significant progress. The classification of good and bad foods, or being perfectly adherent to ones diet are further examples of rigid beliefs associated with dichotomous thinking.

Eating to regulate mood is an additional barrier some individuals experience. Rather than eating for satiety, these individuals eat to alleviate emotional stress or discomfort (52). Unsurprisingly, these individuals often experience a greater propensity to regain weight as was found in a 2004 paper by Golay et al. (53). A 1996 paper by Mussell et al found binge eating was associated with negative affect states which incited cravings unrelated to hunger (54).

A longitudinal study published in 2005 set out to identify predictors of successful long term weight maintenance in 91 male and female participants. The researchers found that increased dietary restraint during the weight loss period was one of the best predictors of weight maintenance (55). Dietary restraint is the intent to restrict food intake where dietary restriction is the actual restriction of food. Because restraint is the intent to restrict it is cognitive in nature, where restriction is the action making it behavioural. These distinctions are important because of the implications they may have on the dieters themselves. Therefore the context and application of dietary restraint to a large degree determines whether or not it will be beneficial or could potentiate pathology (56).

A study reviewing the psychological factors influencing weight loss maintenance found “a higher level of disinhibition, or uncontrolled eating, was associated with weight regain and a lower level with weight loss maintenance. They also found greater dietary restraint, or consciously restricting intake, was associated with weight loss maintenance” (57). Let me be clear, from a weight loss standpoint caloric restriction absolutely works. However, whether or not an individual should diet and how they should approach a diet can vary dramatically.

Eating disorders in extreme cases can be life threatening and are often accompanied by several comorbidities such as depression, anxiety, low self esteem etc. Anorexia nervosa is a behavioural and psychological disorder often characterized by restriction of food, preoccupation with maintaining a low bodyweight, intense fear of gaining bodyweight and fat and body image distortions (58).

Binge eating disorder refers to when an individual experiences episodes of uncontrolled eating of large quantities of food (59). This can be further categorized into two distinct disorders, bulimia nervosa and binge eating disorder. One paper by Hudson et al found “Lifetime prevalence estimates of DSM-IV anorexia nervosa, bulimia nervosa, and binge eating disorder are .9%, 1.5%, and 3.5% among women, and .3% .5%, and 2.0% among men” (60). Several risk factors exist in the development of bulimia nervosa including childhood obesity, weight related teasing, negative self evaluation, parental history of eating disorder or substance abuse (ie. alcoholism) (61).

Loss of control eating (LOC) “occurs when individuals perceive an inability to control their eating, regardless of the amount consumed” (62). One study published in 2011 found “Compared with children who never reported LOC eating or reported LOC only at baseline, those with persistent LOC experienced significantly greater increases in disordered eating attitudes and depressive symptoms over time” (63). Bulimia nervosa also involves the drive toward responsive behaviour to correct their binge feeding cycles. Often manifesting as binge-purge cycles.

The potential downsides of neglecting an eating disorder in favour of sustained dieting can be serious. In the case that you may be dealing with disordered eating it’s crucial to seek out help from a qualified professional such as a registered dietician, physician and/or a psychologist with clinical experience in this matter.

Maintenance Phases And Recovery After A Diet

Typically the word maintenance is interpreted as being synonymous with a plateau or devoid of progress. However, this is absolutely not the case as there are several objectives of a maintenance block:

Increase calories to maintenance or slightly above maintenance levels
Give the dieter a psychological reprieve from dieting
Reverse the various metabolic adaptations which occurred during the diet and establish a new settling point
Learn to effectively maintain your bodyweight more intuitively and without tracking macros

During this time, it’s common for individuals to be somewhat fearful of losing progress. However, it’s important to understand that dieting is by definition an imbalance and maintenance is actually more reflective of day to day living. Therefore it’s critical to appreciate that diets must have an end date, at which point you need to learn how to manage weight effectively. Researchers have identified consistent physical activity and regular self weigh-ins as being strongly correlated to successful weight maintenance (64)(65).

One study titled Physical Activity in an Old Order Amish Community set out to observe the level of physical activity in relation to levels of adiposity. The typical lifestyle of a member of the Amish community generally involves higher levels of physical activity than the average North American. The researchers found “The average number of steps per day was 18,425 for men versus 14,196 for women (P < 0.05). Men reported 10.0 h·wk−1 of vigorous PA, 42.8 h·wk−1 of moderate PA, and 12.0 h·wk−1 of walking. Women reported 3.4 h·wk−1 of vigorous PA, 39.2 h·wk−1 of moderate PA, and 5.7 h·wk−1 of walking. Men had higher levels of energy expenditure than women (P < 0.001). A total of 25% of the men and 27% of the women were overweight (BMI ≥ 25), and 0% of the men and 9% of the women were obese (BMI ≥ 30)” (66).

The low prevalence of overweight and obese individuals within the study highlights just how important physical activity is for maintaining bodyweight. Additionally, the significance of consistent weigh-ins allows the individual to utilize the feedback to adjust their behaviour around eating and physical activity (64). Within the literature there’s a disparity between whether or not daily weight monitoring is associated with eating disorders. This is a complex subject, however I’ll attempt to give a succinct answer. For individuals who have demonstrated an unhealthy preoccupation with bodyweight or various other precursors to disordered eating, daily weight monitoring may be detrimental. However, for those who do not have pre-existing issues there seems to be no reliable association between daily weight monitoring and eating disorders (67). A parallel example would be the implementation of squats with an existing injury. It’s likely going to end poorly for that person, however this is circumstantial and therefore can not be extrapolated to mean squats are detrimental to an otherwise healthy individual.

During the diet phase the objective is to maximize fat loss while preserving muscle mass and athletic performance. However, during a maintenance block the goals necessarily shift. Rather than fat loss or body recomposition the objective is weight maintenance and due to the incremental elevation of calories athletic performance should also see a boost. Therefore the two primary goals of the athlete during a maintenance phase are:

Focus on enhancing performance in training.
Develop the ability to remain weight stable with minimal or no tracking of macros and calories.

Let me reiterate, the objective of a maintenance phase is not to continue weight loss or improve body composition. This is the objective of a diet, and the maintenance phase is an intentional shift away from this and onto the two points highlighted above. This is a point that many individuals struggle with often because the behaviour doesn’t have as clear of a reward. With weight loss, the number on the scale and how you look in the mirror are clear rewards that come at a similar pace as your productive behaviours accumulate. However, because you can’t exactly feel your testosterone, leptin and other hormones normalize the rewards of a maintenance phase sometimes aren’t as evident. Therefore, it’s critical to understand that bodyweight and composition is (at least for the time being) no longer the goal.

Energy balance is the relationship between energy expenditure and energy intake. However, energy flux refers to the absolute level of energy balance which is variable and includes energy intake, energy expenditure and energy storage (68). As mentioned earlier in this article sustained caloric restriction eventually leads to a down regulation of the various components of NEAT. Therefore with decreased energy expenditure the requisite deficit becomes more dramatic to allow for continued weight loss. High energy flux presents a mediating effect to this that is especially relevant during a maintenance phase where one of the objectives is to restore baseline metabolic function without regaining excessive amounts of weight.

Below is a visual representation of high energy flux vs low energy flux.

As you can see from the graph, the same individual can maintain energy balance at a high energy flux or low energy flux. A 2016 paper by Hume et al found that low energy flux (ie. low energy intake and low energy expenditure) was predictive of gaining body fat in the future (69). This finding is in line with current literature supporting regular physical activity as being one of the best predictors of long term weight maintenance (70). Overfeeding studies also show an increase in BMR acutely, that seems to slow and become more incremental over time (71). Although this is not a recommendation to intentionally overfeed in an attempt to boost your BMR, it is indicative of how incrementally increasing your energy intake over time can aid in metabolic restoration. This is especially relevant in free-living scenarios during a maintenance phase where the intention is to alleviate some of the psychological burden of tracking macros. This reduction in data collection will necessarily lead to a decrease in precision of energy intake. However this lack of precision can largely be mediated by intuitively maintaining a higher energy flux.

As demonstrated by Dulloo et al metabolic suppression is closely related to an existing energy deficit and lost fat mass (72). Therefore, an increase in calories is one of the most critical aspects of reversing these adaptive responses. The thermic effect of food accounts for roughly 10% of energy expenditure, therefore as total caloric load increases so does the thermic effect of food (TEF) (73). This increase alone however is not enough to prevent weight regain as more calories are reintroduced, but activation of NEAT can substantially impact energy expenditure. A 2001 overfeeding study by Vanltallie aimed to highlight the role of NEAT in regulating energy expenditure during an intentional period of overfeeding. The subjects included 12 male and 4 female non-obese individuals whose age ranged from 25-36. They were fed 1000kcal in excess of their maintenance caloric intake for 8 weeks. Diets were standardized at 40% fat, 40% carbohydrates and 20% protein. Subjects were also instructed to keep volitional physical exercise to a low during this time.

The researchers found “Among the 16 volunteers, overfeeding was associated with a mean increase in total energy expenditure of 554 kcal/day. Of This increment, approximately 14% (79 kcal) was attributable to a rise in resting energy expenditure and approximately 25% (136 kcal) was attributable to a rise in thermic effect of food. The remaining proportion of the increment (6 1 % or approximately 336 kcal/day) was attributable to an increase in physical activity thermogenesis” (74). The authors also noted that the maximum increase in NEAT detected accounted for 69% of the 1000kcal surplus. It should be noted that increases in NEAT resulting from increased energy intake are largely unconscious. NEAT consists of several things including changing posture, ambulation, fidgeting, spontaneous muscle contraction, standing and various other activities of daily life. However it does not include moderate or vigorous physical activity and therefore accumulates over the course of the day. As mentioned previously, NEAT has been shown to vary up to 2000kcal per day for individuals of the same size. This presents a unique opportunity to capitalize on the natural inclination to move more.

That being said there remains concern surrounding weight regain especially during the initial calorie increase post diet. So lets address the elephant in the room. Yes, you will almost certainly regain some weight as you reintroduce calories into your diet. However, contrary to what most people believe this is not exclusively fat. As discussed earlier leptin plays a significant role in mediating various signalling pathways. Leptin is largely influenced by both short term and long term energy availability, but also carbohydrate availability (75). Since carbohydrates play a mediating role in both performance and leptin concentrations they are likely to be preferentially increased. Glycogen can store as much as 300% of their weight as water (76). So, this additional weight gain post diet is largely water retention, glycogen, and food volume. The target of a successful maintenance plase is to remain within 2-5Lb from your final bodyweight at the termination of your diet. Fluctuations in weight during this time are normal, and if you remain within this range you are making great progress even though the scale may reflect a slight increase in bodyweight.

Set point theory is a concept that initially assumed bodyweight was regulated by an internal control centre. Although there is legitimacy to the bodies internal drive to preserve homeostasis, this balance depends on the complex interaction of genetic, environmental and psychological variables (77). The image below was taken from research conducted by Loeffelholz in his 2014 paper demonstrating variance of NEAT can range as much as 2000kcal between individuals of similar size (78).

Metabolic adaptations in response to energy restriction and surplus are highly individual. While some individuals experience a natural increase in NEAT directly proportional to the energy surplus, others may experience only a minor increase in energy expenditure (78). Therefore it’s more likely that the body has what are called “settling points” that can be altered and exist as more of a range influenced by the reciprocal relationship between genetics, environment and psychology. Since this is largely individual there is no way of knowing preemptively where you fall on this spectrum of responsiveness to caloric intake. But generally speaking, most individuals will see some form of increase in energy expenditure although the magnitude will likely vary. This is also why a return to maintenance followed by a slow and conservative incremental elevation in energy intake is recommended as a strategy to reverse some of these adaptive responses.

However because at the cessation of a diet you are primed both psychologically and physiologically to regain weight, certain measures should be taken to mitigate a drastic rebound in weight. One of the goals of this phase is to return energy intake to maintenance or slightly above. Maintenance in this case is not the same as your maintenance energy intake prior to starting the diet. During the diet, loss of tissue and metabolic adaptations alter your homeostatic baseline. Therefore a new energy balance must be determined based on your new bodyweight. After a few days or weeks of maintenance you should begin feeling better. You may notice your energy throughout the day is higher and your level of food obsession is either diminishing or gone entirely. At this point you may slowly increase energy intake and monitor your bodyweight for no less than two weeks before making another increase in energy intake.

Keeping your weight within the guidelines established above you can slowly begin to push calories to the maximum end of your settling point. For some people this may be over 1000kcal more than their starting maintenance, for other people it may be just a modest increase. In either case, this process allows you to reverse the physiological adaptations as well as decay the psychological fatigue accumulated from dieting. Then as you enter into your next dieting phase (assuming you’re not yet at your goal) you will be starting at the maximum level of energy intake available to you which makes the whole process much more manageable. I typically prescribe maintenance phases at a 1:1 ratio of dieting to maintenance for most people. If the athlete is more experienced and appears well prepared I will adjust the duration of the maintenance phase down to ⅔ of the length of the diet.

The level of preparedness of the individual for less stringent monitoring is also an important factor to consider. A 2019 systematic review found “The available literature to date shows that having a body mass index ⩾30 is associated with significant under-reporting of food intake” (79). This in conjunction with the literature on restraint eating suggests that individuals with substantial weight loss goals or those who struggle with adherence may in fact do better to maintain some form of objective measuring during a maintenance phase.

Intuitive Eating And Weight Maintenance:

Intuitive eating has become a fairly popular term although its broad application has created a discrepancy between its original purpose and how it’s used colloquially. The term “intuitive eating” was initially put forward to refer to eating behaviour that relied on physical hunger cues rather than environmental or emotional cues. Used by the healthy at every size (HAES) movement, it is distinctly different from dieting in that intuitive eating was not initially introduced as a diet tool. Its utility was in fact meant for improving peoples relationship with food and thereby improving quality of life irrespective of bodyweight or shape. In this vein the current research on intuitive eating is promising (80)(81). One of the reasons this approach has shown promise is it often helps to disentangle the individuals feelings of self worth and negative affect from bodyweight.

However, one of the concerns is that although this approach may improve quality of life it specifically avoids addressing bodyweight. As a result, intuitive eating may simply neglect that in the case of overweight or obese individuals weight loss must occur to mediate the various comorbidities. This doesn’t necessarily seem to be the case though. A 2005 paper found “Cognitive restraint decreased in the health at every size group and increased in the diet group, indicating that both groups implemented their programs. Attrition (6 months) was high in the diet group (41%), compared with 8% in the health at every size group. Fifty percent of both groups returned for 2-year evaluation. Health at every size group members maintained weight, improved in all outcome variables, and sustained improvements. Diet group participants lost weight and showed initial improvement in many variables at 1 year; weight was regained and little improvement was sustained” (80). Thus there do appear to be benefits of intuitive eating that extend beyond its initial purview.

Therefore I suggest we create a derivation of the intuitive eating approach that includes an aspect related to weight management and dieting. For clarity purposes we can refer to it as Autoregulatory Eating. This approach assumes integration of hunger cues while acknowledging the significance of diet composition and its effects on the athletic performance, body composition and bodyweight goals of the individual. One assumption that often comes attached to this approach is the idea that dietary autoregulation is just guess work. This is a misconception since autoregulation is a form of data collection and feedback that requires experience and guidance before you can experience its full utility. A parallel example is the RPE model popularized by Mike Tuchscherer. That approach is subjective in nature, but it relies on objective feedback of performance metrics that refine the accuracy of the evaluation. Autoregulatory eating is (at least in my estimation) a dietary parallel to the RPE system with the objective feedback being bodyweight and composition.

This is an alternative to sustained tracking during a maintenance phase that can be psychologically tedious for some. Through the dieting phase, if you are tracking macros you gain an appreciation for the caloric and macronutrient content of various foods. This exposure increases the precision of your estimations when weighing and tracking is no longer the selected method. A 2017 study looked at factors associated with adherence to lifestyle based interventions directed toward weight management. The researchers found several associations between attrition rates and self monitoring, psychosocial factors, self efficacy, depression, BMI, previous weight loss attempts etc (82). Although the exact magnitude of effect each of these variables have on adherence is still unclear, it’s safe to say that individual circumstances and best practices can vary significantly. While some individuals may thrive on more flexible restraint, others may require more stringent guidelines to mitigate regression.

For those individuals who struggle without more rigorous structure and guidelines implementing a graded exposure can allow the individual to develop the requisite skill in learning about hunger cues, differentiating hunger from emotional triggers, accurately assessing satiety, establishing command over portion control and increasing dietary adherence over the long term. The following is just one potential example of an incremental approach to autoregulatory eating. This is by no means the only way, it’s simply an example to highlight some of the potential stages you may go through to reach a higher level of ability.

Stage 1: Learning

During this stage the goal is to pay attention to environmental and psychological triggers, biological hunger and satiety cues, and just general habits around nutrition. Because the individual is tracking during this time it permits learning and identification of productive and unproductive behaviours while also allowing them to make significant progress toward their goals. In most cases I recommend using this strategy throughout the first diet and maintenance phase.

Stage 2: Introduction To Autoregulatory Eating

This strategy would be implemented during a maintenance phase. I usually only do this with individuals who have previous experience and/or demonstrate good awareness around their eating behaviours. While the initial stage is more like shadowing someone at work, this stage is your first actual exposure to autoregulatory eating without tracking macros. However, even within this phase you can take a graded approach. Maybe you choose to track calories and protein but not carbs or fat. Then as you progress throughout the maintenance phase you reduce tracking altogether as your ability to accurately assess intake improves.

Stage 3: Autoregulatory Eating While Dieting

Implementation of this stage requires a strong history of dieting. Utilizing this approach assumes you have already gone through a complete maintenance and successfully maintained your weight and body composition without tracking. Similar to the previous stage you may start by only tracking calories and protein and then phase it out entirely as you progress and demonstrate a strong ability to diet effectively. This stage requires much more precision because during a diet you risk losing muscle in addition to fat mass. Therefore this stage requires a higher degree of awareness and experience.

Stage 4: Unconscious Integration Of Autoregulatory Eating At All Times

This stage is where an individual can successfully achieve performance or body composition goals with minimal or no tracking whatsoever. This denotes an advanced level of ability likely gained through years of effective implementation.

During each of these stages, consistent tracking of bodyweight is strongly recommended. As it can help guide your decision making as you progress. I hope you gained some new insight into the process of weight loss and how to effectively maintain weight after a diet. Good luck!

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