Maintaining Incremental Weight Loss and Diets: David Rometo, MD

A weight loss journey with incremental weight loss, healthy eating habits, and physical activity is important for lasting results.

David Rometo, MD, clinical associate professor of medicine at UPMC Division of Endocrinology and Metabolism, in Pittsburgh, PA, spoke with The American Journal of Managed Care® about incremental weight loss behaviors and implementations that he’s seen produce lasting results. Rometo also presented his research on obesity medicine clinics and comprehensive lifestyle programs at the UPMC Pop Health Institute for Value-Based Medicine® event.

Incremental weight loss, Rometo says, introduces patients to healthy habits in moderation. This method allows them to assess what they can do, what they can maintain, and adjust as they continue to progress. It’s also advantageous for when patients decide to increase their habits—like double the minutes of physical activity they do each week—and are then unable to maintain it, they can fall back onto their previous healthy habits, which were still beneficial to their weight loss.

For patients with a medical or psychiatric condition who decide to pursue an aggressive diet, medical supervision is required. The frequent screening aims to monitor for any conditions that may be exacerbated by the diet, given a patient’s comorbidities, such as gallstones or gout. The intensity of such screenings, Rometo says, is comparable to that of someone who’s receiving cancer therapy or just presented with organ failure. Its necessity stems from the safety of said aggressive diets when combined with a patient’s comorbidities, given the level of severity, something primary care physicians are not likely to recommend due to safety concerns.

Incremental weight loss programs have shown sustainable results when maintained. However, when more aggressive diet programs are introduced, medical supervision is essential to monitor the health of patients and continue to evaluate the efficacy of said program and whether it’s best to continue or cease treatment.

This transcript has been lightly edited. Captions are auto-generated.

How do you communicate weight loss milestones to patients in a way that motivates rather than discourages them?

In terms of the patient doing things incrementally—not because losing all the weight in six months is a bad thing, and sometimes we do want patients to lose as much weight as they can in six months, and there is health benefit to that, we'll talk about that later—but the incremental changes that they make allows those changes to last, and become more foundational. Having a patient just focus on eating healthy with no effort to eat less, and having a patient increase their physical activity in terms of how much time they spend, like “how much time am I going to set aside in a week being physically active,” and that is the minimum standard of about 150 minutes a week. The intensity of the exercise, if you’re doing core strength, or resistance vs cardio, or how fast is your heart rate, [doesn’t matter] if they can't just eat the healthiest diet that they can and spend 150 minutes on activity, then there's no point in asking someone to do something harder than that in the future, right?

It's foundational for health, but it's also the foundation of other changes that they're going to make in the future and when they can't do the harder things, if they try, then they say, “now I'm going to try to measure everything or stay under 2000 calories, or stop eating at 6 pm,” when they can't do that, they at least can fall back to the stuff that they could do, which was already a tremendous improvement into their health. That incremental behavior change is really beneficial for a lot of people.

What strategies have proven most effective in preventing recurrence after initial success?

The most important aspect of maintenance is actually continuing every sustainable thing that you did to lose the weight in the first place. So many people have been told by the culture and the weight loss industry, which completely ignores the fact that your body wants to regain the weight after you lose it. If you took a medicine to lose weight, the best thing to do is continue taking that medicine or another weight loss or weight maintenance medication to maintain it.

If you were in a program with frequent visits to lose the weight and that was a component of why you did so well, then being in a maintenance program that also has visits [is beneficial], so you're still following up. If you measured your portions or if you use a calorie-counting app, continue to do that so you do not regain the weight. If you just made diet changes and said, “I stopped eating after 6 pm, I started following a Mediterranean diet, and I cut out sugary soda.” You say, " I'm going to do that for the rest of my life.