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Primary weight maintenance – a new way to prevent overweight and obesity

One and the same message for everyone does not work if the goal is to prevent overweight and obesity in the population.

It is also important to reach groups that are normally regarded as being at low risk of gaining weight. This is what Kristina Lindvall shows in her doctoral dissertation at Umeå University in Sweden. Participants in her study come from Västerbotten in northern Sweden and from New York State in the US.

It is often difficult for people to maintain their weight after weight loss. Instead people tend to gain back just as much or more. This is why Kristina Lindvall, a dietitian and doctoral candidate at the Section for Epidemiology and Global Health, maintains it is important for society to broaden the focus from treatment of overweight and obesity to include preventive work on weight gain.

– This is why I chose to focus on primary weight maintenance in my research, that is, the possibility of preventing weight gain among people of normal weight and overweight individuals, says Kristina Lindvall.

All participants in the study were 30-65 years of age and were recruited because they had twice participated in Västerbotten Health Study (VHU), which is carried out in Västerbotten, Sweden, or in the Upstate Health and Wellness Study, in New York State in the US.

The dissertation shows that of all the people who were of normal weight or overweight and took part in the VHU study in 1990-2004, only about one third did not gain weight. One surprising result was that younger individuals of normal weight, without type-2 diabetes, and with no risk factors for cardiovascular disease were those least likely to maintain their weight.

– This means that measures to prevent overweight and obesity may also need to include these groups, groups that are normally regarded as being at low risk for weight gain, says Kristina Lindvall.

Research interviews with VHU participants that managed to maintain their weight after weight loss showed that weight stability was seen as maintaining a balance, not only in stabilizing weight but also regarding other factors in life. Four main strategies for maintaining weight were described: “relying on your heredity,” “finding joy,” “finding routines,” and “being in control.” Kristina Lindvall claims that as a result of these findings it is important to adapt advice to fit not only those wishing to lose weight but also those wanting to maintain their weight.

In a questionnaire created to identify attitudes and behaviors that were key to maintaining weight in all groups based on age, gender, and body-mass index (BMI), major differences were revealed among the groups in the responses they provided.

– This emphasizes the importance of tailoring interventions that strive for primary weight stability in a population to age groups, gender, and BMI, says Kristina Lindvall.

Finally, American and Swedish female study participants were compared. The Swedish women gained an average of 3.5 kg in weight during the years 1999-2009, while the American women gained nearly twice as much. A partial explanation for this may be that significantly more of the Swedish women stated that they exhibited healthy behaviors. On the other hand, the difference was greater in terms of weight gain among the American women if they chose healthy behaviors over unhealthy ones.

Kristina Lindvall originally comes from Skellefteå and is a dietitian and doctoral candidate at the Department of Public Health and Clinical Medicine, Umeå University.
She can be reached at:
Mobile: +46 (0)70- 584 59 52
Portrait photo for downloading:
On September 20, 2013, Kristina Lindvall, Department of Public Health and Clinical Medicine, will publicly defend her dissertation "Being able to stable" - Exploring primary weight maintenance as a public health strategy for obesity prevention.
External examiner: Mai-Lis Hellenius, professor, Karolinska institutet, Stockholm.
Main supervisor: Lars Weinehall.
The public defense will take place at 9.00 a.m. in the Auditorium at the Vårdvetarhuset.
The dissertation is published electronically.

Karin Wikman | idw
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