What’s your weight loss “style”? The role of heterogeneity in weight management

puzzleA new perspective on data from the National Weight Control Registry (NWCR) by Ogden et al. (2012) (1) suggests that individuals who successfully maintain weight loss fall into four distinct categories, each with unique characteristics. This is an essential step towards recognizing the importance of heterogeneity for successful weight management and will hopefully help break the stereotypic weight loss advice to simply eat less and move more, allowing for development of weight management programs that are tailored to the unique needs of individuals.

Previous studies from the registry have identified common behaviours and strategies used by successful weight loss maintainers, including:

  • low calorie, low fat diets
  • high levels of physical activity
  • self-monitoring of body weight and food intake
  • eat breakfast regularly
  • high dietary restraint

However, there is a large degree of variability in the behaviours of successful weight loss maintainers (for example with regards to amount of calories consumed, amount of exercise, etc…). In order to understand this variability better, the researchers sought to identify unique sub-groups of participants that share common characteristics, for example, medical and weight history, reliance on exercise and diet, and use of resources and supports.

Ogden et al categorized NWCR participants into four distinct clusters (Table 1). For additional descriptions of the four clusters, I highly recommend Dr. Arya Sharma’s thoughtful discussions here: Mark, the Golden Boy of Weight Loss, Julie, the Fitness EnthusiastGertrude, the Poor Eater, and Janice, the Struggler.

nwcr_cluster_tableWhile the clusters may conjure up the idea of a “What’s your weight loss style” quiz found in your favourite health magazine, the authors hope that identifying these different clusters will help enable personalization of weight management strategies.  How can this information be useful to health care practitioners and patients?

Weight management strategies, despite a wide range of “packaging”, frequently focus on the simple advice to “eat less, move more” and ignore the complex interactions between various psychological, social and biological factors. For each individual, only some of these factors are relevant. Identifying these four clusters is a first step in moving beyond a one size fits all approach. However, there is still considerable variability with each cluster; can we do even better in identifying factors relevant for an individual and applying them to further personalization of care?

Translating this into practice requires strategies and tools to help determine which specific factors contributing to obesity are relevant to a particular individual. For example, a card sort tool (2) that enables individuals to select cards with statements about factors relevant to weight management (e.g. self-efficacy, disinhibition, physical activity, social and environmental factors, etc…) that best describes them. Such a tool, administered to patients seeking help with weight management would allow practitioners to tailor interventions based on the factors identified by the patients as most relevant for them. Such a tool also has the potential to examine and identify “why” individuals select certain behaviours, increasing the usefulness to the health care provider.

It is important to also consider the limitations, both of this study, and future endeavours. The study is based on data that is self-reported, and participants self-select for inclusion in the database. These individuals are unique in their own right, as successful weight loss maintenance is uncommon. Additionally, as highlighted by the data from the NWCR, there are many individuals who do not seek the help of structured programs or health care providers. Is it possible to reach these individuals too?

References

ResearchBlogging.org 1. Ogden, L., Stroebele, N., Wyatt, H., Catenacci, V., Peters, J., Stuht, J., Wing, R., & Hill, J. (2012). Cluster Analysis of the National Weight Control Registry to Identify Distinct Subgroups Maintaining Successful Weight Loss Obesity, 20 (10), 2039-2047 DOI: 10.1038/oby.2012.79

2. Merth, T. et al. “Dealing” with complexity: Construction and analysis of a card-based communication tool for obese patients. CON: 2nd Annual Obesity Summit Poster Abstracts http://www.diabetes.ca/documents/for-professionals/CJD–May_2011–CON_Abstracts.pdf

Also recommended:

In addition to the four posts exploring the characteristics of the individuals with each of the four clusters, Dr. Arya Sharma also provides an insightful summary of the article: Why Are Some People Successful At Maintaining Weight Loss? and What Works For You May Not Work For Me.

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