Factors Influencing Weight Loss Attempts and Long Term Weight Loss Maintenance

Abstract

Background: A cross-sectional study aimed to determine the factors association with repeated weight loss attempts, and weight loss maintenance. Methods: The study was conducted in the main public hospitals in Benghazi, Libya. A total sample of 300 participants who suffered from weight gain or/ obesity and had a history of trying of weight loss. The data were collected by using a questionnaire that include all the factors that may affect the weight loss process such as social, psychological, health, factors related to diet , and daily behavior factors. Results: The majority of participants 78% were found at age group between 15-35 years, 81.7% of them were female and 18.3% were male. More than half of participants 56% had less than four times of weight loss attempts, while 43.6% of them had more than four attempts. The repetition of weight loss attempts was associated with genetic, binge eating, tension, anxiety, negative body image, duration of weight loss maintenance, watching TV or online hours, and eating rate. Around half of participant 55.6% had less than one of successful attempts, while 44.3% had more than one attempts. The factors associated with the successful attempt of weight loss were using weight loss medications, the rate of weight loss, aware food serving, eating breakfast, and exercise. The higher number of attempts of weight lose was associated with higher successful attempt (more than one attempt) P=(0.031). Conclusions: Psychological factors were the most factors affected on repeating weight loss attempts followed by behavior related factors. Practices related to self-control, mental control, stress reduction, and behavior modification should be considered at any weight loss management program. Body weight loss programs need strike follow up by dietician in order to avoid the fluctuations in body weight. Key words: The factors weight loss, weight loss attempts, successful weight loss attempts, weight loss maintenance.

Full text

International Journal of Health Sciences and Research
DOI: https://doi.org/10.52403/ijhsr.20211227
Vol.11; Issue: 12; December 2021
Website: www.ijhsr.org
Original Research Article ISSN: 2249-9571
International Journal of Health Sciences and Research (www.ijhsr.org) 205
Vol.11; Issue: 12; December 2021
Factors Influencing Weight Loss Attempts and Long
Term Weight Loss Maintenance
Souad El-mani1, Ali Ateia Elmabsout1, Abdullah Sheikhi2, Reima Mansour3,
Fawzia M Salem Bozaid1, Hind Alkadiky1, Hajer Albarghati1, Sara Benghazy1,
Nada Jamal1
1Department of Nutrition, Faculty of Public Health, University of Benghazi, Libya
2Curtin University, Perth, Western Australia
3School of Science and Health, Western Sydney University, Australia
Corresponding Author: Souad El-mani
ABSTRACT
Background: A cross-sectional study aimed to determine the factors association with repeated weight
loss attempts, and weight loss maintenance.
Methods: The study was conducted in the main public hospitals in Benghazi, Libya. A total sample of
300 participants who suffered from weight gain or/ obesity and had a history of trying of weight loss.
The data were collected by using a questionnaire that include all the factors that may affect the weight
loss process such as social, psychological, health, factors related to diet, and daily behavior factors.
Results: The majority of participants 78% were found at age group between 15-35 years, 81.7% of
them were female and 18.3% were male. More than half of participants 56% had less than four times
of weight loss attempts, while 43.6% of them had more than four attempts. The repetition of weight
loss attempts was associated with genetic, binge eating, tension, anxiety, negative body image,
duration of weight loss maintenance, watching TV or online hours, and eating rate. Around half of
participant 55.6% had less than one of successful attempts, while 44.3% had more than one attempts.
The factors associated with the successful attempt of weight loss were using weight loss medications,
the rate of weight loss, aware food serving, eating breakfast, and exercise. The higher number of
attempts of weight lose was associated with higher successful attempt (more than one attempt)
P=(0.031).
Conclusions: Psychological factors were the most factors affected on repeating weight loss attempts
followed by behavior related factors. Practices related to self-control, mental control, stress reduction,
and behavior modification should be considered at any weight loss management program. Body
weight loss programs need strike follow up by dietician in order to avoid the fluctuations in body
weight.
Keywords: The factors weight loss, weight loss attempts, successful weight loss attempts, weight loss
maintenance.
INTRODUCTION
In the recent years, obesity is
considered as a chronic disease being also
as a severe individual health condition and
an important public health issue. Obesity
results from accumulation of body fat
which leads to severe complications and a
significant increase of mortality rate.1 In
2017-2018 the prevalence of obesity in
United States was increased among all the
age group of adult people that include ,
adults aged 20-39, adults aged 40-59, and
adults aged 60 and over, about40%
44.8%,42.8%, respectively. The prevalence
of obesity was also high among the
childhood period, in 2009 about 38 million
of children under the age of 5years in the
United States were overweight or obese.2

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Vol.11; Issue: 12; December 2021
Globally, The prevalence of overweight and
obesity as a public health concern is well
established and reflects the overall lack of
success in the ability to achieve and
maintain a healthy body weight. There are
many factors affect the ability of obese
patients to lose weight and maintain a
healthy body weight.2
First of all social factors, Most of the
previous studies that focused on weight loss
indicated that there are variation between
weight loss and body composition, age,
occupation , and socioeconomic status of
patients. American studies showed that there
was significant difference between age
group and the percentage of excess BMI
loss, the better results of weight loss and
reducing of complications were observed
among younger patients.3,4 A number of
characteristics of men and women that also
contribute to the difference in weight loss
success. According to the National Health
and nutrition Examination survey III
(NHANES III) showed that female aged
between 12to 80 years had higher
percentage of Fat Mass (FM) than male ,
the estimated of total body weight and Free
Fat Mass increased in all racial_ ethnic
groups and in all age group of female.5 A
cohort study found that there was effect of
exercise on the body weight and body
composition of both male and female, the
men who did the exercises lost 5.2 kg of
weight, equivalent to 6% of the basic
weight. As for the women, the exercises did
not lead to weight loss but prevented an
increase weight about 3kg for the control
group.6 Another American study was
conducted to assess the relationship between
dieting and weight change and race
/ethnicity adolescence and young adulthood
reported that dieting to lose weight was
ineffective, and it is actually associated with
greater weight gain, particularly among
female adolescent. There was variation also
among participants in the number of
attempts times of weight lose, Hispanics
(58.0%) were more likely than whites
(55.2%) to be trying to lose weight .7
The second factors that affect weight
loss are heath factors, the obese people with
other diseases such as diabetes mallets,
cancers or breast cancer, and ovarian cysts
thyroid diseases are needed to weight loss to
improve clinical results, reduce
complications, and accelerate treatment
effect.8 American study indicated that
increased BMI >40kg/m2 was associated
with increased death rates for all cancer
types.9 Spanish study also found that the
weight of hypothyroid patients decreased
from 70.93±10.06 kg to 68.68±10.14
(p=0.000), while the weight of hyperthyroid
patients increased from 65.45±11.64 kg to
68.37±12.80 (p=0.000). 10 The results of this
study showed that there was an association
between obesity and BMI (>30 kg/m2) and
slightly elevated serum TSH levels (p
0.001).10 Another previous study suggest
that use of pharmacological treatment could
be benefit to loss of body weight. American
studies describe use of pharmacotherapy
like (Fluoxetine, orlistat, and sibutramine)
in weight loss for diabetic patients and use
orlistat for ovarian cysts patients. These
drugs achieved statistically significant
weight loss for 26 to 52 weeks, Fluoxetine
(5.8 kg at 52 weeks), orlistat (2.6 kg at 52
weeks). 11.12
Psychological factors are considered
as important effective factors on weight lose
and maintenance. A previous study was
conducted in United States indicated that
weight gain was associated with increasing
levels of psychosocial stress related to job-
related demands (P < 0.001), that include
lack of skill discretion, lack of decision
authority and difficulty paying bills among
male while Among women were strain in
relations with family.13 Furthermore,
Tunisian study was conducted to determine
the satisfaction rate of female on their body
shape, this study found that almost two-
thirds of all women were dissatisfied with
their current body size. A normal body size
(BMI 20–24 kg/m) was seen in the most
positive light by Tunisian women.14 The
other psychological factors is increases the
desire to eat, especially among those follow

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restricted diet compared with non-dieters.. 15
According to experiment study found that
(71%) of participants are restrained eaters
(i.e., dieters) report increasing food
consumption when stressed than are people
who under eat or who do not change the
amount they eat when stressed (35%).16
The last factors are dietary and
behavioral factors, there are a large number
of dietary programs that are available in
different websites. Many of these dietary
programs are based on scientific evidence of
weight loss. However, qualitative research
suggests that successful dieters depend on
their understandings about dietary intake
(quality and quantity), emotional challenges,
and surrounding environment.17 A previous
study found that long-term diet attempts
were not functional in the general
population, as BMI and WC showed an
increase in dieters than non-dieters. 18
Another study was conducted in America
that showed that only 31% of the people
reported successful weight loss attempts,
and this study recommended that self-
monitoring strategies such as weighing
oneself, choosing an appropriate meals,
exercising 30 or more minutes daily, may be
important in successful weight loss
maintenance.19 European study showed that
increase of protein content in diet and
deceasing high glycemic index led to an
improvement in maintenance of weight loss.
The weight regain was 0.93 kg less in the
groups followed a high-protein diet than in
those followed a low-protein diet
(P=0.003).20
Life style behavior such as watching
TV contributes to affecting on weight loss
or maintaining weight loss. Raynor and
et.al found that that the number of hours of
sitting on TV associated with weight loss,
increases in TV watching hours were
significant predictors for regain weight of
one year.21 furthermore, skipping breakfast
led to increase prevalence of obesity.
According to previous study found that
around half of participants who are
breakfast skipper suffered from obesity.22
Clinical studies confirmed that regular
consumption of meals reduced the risk of
obesity and chronic diseases.23 In addition,
number of previous studies concluded that
obesity is associated with a self-reported
short sleep duration and sleep disturbances.
The short sleep duration is caused by
emotional stress as reported by obese
people. 24,25
Because obesity is a chronic disease,
maintenance of weight loss is included as a
standard of success, and the response to
obesity treatment varies according to
different factors. There are few studies
targeting the factors that defined weight loss
successful, therefore, this study aimed to
determine factors influencing weight loss
success and long term weight loss
maintenance, and to
1. study the personal and social aspect and
its effect on the number of weight loss
attempt.
2. know the effect of health conditions and
diseases (chronic diseases) on the
number of weight loss attempt.
3. study of the psychological factors and
its effect on the weight loss attempt.
METHOD AND MATERIAL
Study Population: A cross-sectional study
was conducted in Benghazi, Libya in 2020
to determine the factors affecting weight
loss process for a specific age group from
15 to 65years. The total numbers of
participants were 300 participants, including
51 men and 249 women.
Data collection methods: questionnaire
that was prepared and distributed to the
participants in some public hospitals as well
as over the Internet. This questionnaire
contains 34 questions covering all aspects
related to the process of weight loss, 4
elements were about personal information
such as (age, gender, educational level,
profession, working hours). In addition,
other questions asked about the health
condition that include presence of diseases,
type of medication, and duration of intake.
Other questions asked about aspects related
to the situation (social, psychological,
genetic) and its impact on repeated weight

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loss attempts and the number of successful
weight loss attempts. The next questions
asked about dietary history that include:
(source of diet, duration of follow-up, diet
sources, weight loss per week, duration of
maintains weight loss). The questionnaire
also contains information about the daily
behaviors such as hours on TV or online,
water consumption, regularity in breakfast,
exercise, place of eating, sharing eating,
eating duration, and hours of sleep.
Measurement:
Weight and height were measured
by the researchers after completion of the
questionnaires. Height was measured to the
nearest 0.1cm using standard calibrated
scale attached to the balance against wall.
Weight was measured to the nearest 0.2kg
using weighting machine. During measuring
body weight, participants were wearing light
clothes and thin socks or bare feet, BMI was
computed as body weight in (Kg) divided
by body height in (m) squared and the body
mass index was calculated and classified
according to WHO classification.
Statistical analysis:
The Statistical Package for the
Social Sciences (SPSS) version 21.0 was
used to analyze the data. Descriptive
statistical tests were conducted to make
comparison including frequencies and Chi
square test with (95%) confidence intervals.
Chi-squared analysis was used to compare
different factors with number of weight loss
attempt and number of successful weight
loss attempt. All p values <0.05 were
considered statistically significant.
Ethical statement:
This study was approved by
university of Benghazi and all
questionnaires were anonymous and
unidentified to ensure the confidentiality of
collected information.
RESULT
Demographical characteristics of
participants:
Total participants in this study were
N=300 persons, 81.7 % of them were
females and 18.3% were males with ages
range from 15 to 55 years. The majority of
participants 78% were with age 15-35 year
while only 2% of them were with an age
group more than 55 years. The most of
participants 87% were with high educated
level (university degree), while 1% of them
were uneducated. less than half of
participants 47% were officers, and 51% of
them worked for period range from 4-
6hours. More than half of participants 57%
were with income 500-1000, and more than
half of them also 56.3% were unmarried.
See table 1
Percent
Frequency
Characteristics
Age
78%
243
15 – 35
20%
60
35 – 55
2%
6
> 55
Sex
81.70%
245
Female
18.30%
55
Male
Education level
1.3%
4
Uneducated
7%
2
primary
11%
33
Secondary
87%
261
University
Occupation
1.3%
4
Unemployed
19.3%
58
Student
47%
141
Officer
26%
78
house wife
6.3%
19
free business
Work hours
28.3%
85
1 – 3
51.3%
154
4 – 6
16.7%
50
7 – 9
3.7%
11
10 – 12
Income level
19%
57
500
57%
171
500 – 1000
24%
72
> 1000
Social status
56.3%
169
Single
43.7%
131
Married
100%
300
Total
In regarding to BMI, female
presented the highest numbers of over
weight than male 26.90% vs.
5.90%respectively. Obese grade I was
higher than other grads among female
participants and also female still shown
highest percentages 24.90% vs. 5.60%,
11.90%vs. 3% and 3.50%vs. 1.40% for
obese I , grade II and grade III respectively.
There was clear relation between working
hours, marital status, and number of
children, p. value= 0.000, 0.008, and 0.017
respectively. There was also relationship

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Vol.11; Issue: 12; December 2021
between BMI level with weight loss attempts p=(0.003).
Figure 2: Distribution of BMI level among participants
Medical history of participants: -
In regarding to medical history of
participants, table 2 showed that more than
half of participants 68.6% did not have any
health problems, and 31% of them had some
health problems that include (30.8% ovarian
polycystic,12.7% thyroid disease, and 7%
diabetes). Half of the participants 50% were
taking treatment that include (25% weight
loss drugs, 9.7% contraindications drugs,
and 47.2% other drugs). Also more than half
of participants 67.6% had obesity in their
family history.
Table 2: Description of Health history among participants
P value
Total
weight loss attempts >4
weight loss attempts <4
Health factors
Health problems
0.053
94 ( 31.3% )
48 ( 36.6% )
46 ( 27.2% )
Yes
206 ( 68.6% )
83 ( 63% )
123 ( 72.7% )
No
Diseases
0.299
7 ( 7.4% )
4 ( 8.3% )
3 ( 6.5% )
Diabetes mellitus
12 ( 12.7% )
4 ( 8.3% )
8 ( 17.3% )
Thyroid diseases
29 ( 30.8% )
15 ( 31.2% )
14 ( 30.4% )
ovarian polycystic
46 ( 48.9% )
25 ( 52.0% )
21 ( 45.6% )
other diseases
Treatment
0.081
150 ( 50% )
72 ( 54.9% )
78 ( 46.1% )
Yes
150 (50% )
59 ( 45.0% )
91 ( 53.8% )
No
Type of treatments
0.309
23 ( 15.3% )
7 ( 9.7% )
16 ( 20.5% )
Contraindications
9 ( 6% )
5 ( 6.94% )
4 ( 5.1% )
Diabetes drugs
7 ( 4.6% )
4 ( 5.5% )
3 ( 3.8% )
Cortisol
11 ( 7.3% )
4 ( 5.5% )
7 ( 8.9% )
Thyroid drugs
30 ( 20% )
18 ( 25% )
12 ( 15.3% )
weight loss drugs
70 ( 46.6% )
34 ( 47.2% )
36 (46.1% )
other drugs
Heredity*
0.007
203 ( 67.6% )
99 ( 98.5% )
104 ( 61.5% )
Yes
97 (32.3% )
32 (18.9% )
65 ( 38.4% )
No
300
131
169
Total
*Statistical differences p.value ‹0.05 by Chi. Square test.
This study was based on studying
some factors that include medical history to
determine the extent of their influence on
the frequency of weight loss attempts. From
the total of participants n= 300 who had
repeated experiences of weight loss, 56.3%
of them had less than 4 times of weight loss
attempts , and 43.6% of them had more than
4 times of weight loss attempts. Table 2
indicted that there was no significant
relationship between weight loss attempts
times and medical history that include
health problems, taking medicine and types
of treatment with exception with hereditary
factors. There was a significant relationship
between weight loss attempts and hereditary

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International Journal of Health Sciences and Research (www.ijhsr.org) 210
Vol.11; Issue: 12; December 2021
factor p.value ‹ 0.05. The number of weight
loss attempts ‘times were more among
participants who had obesity in their family
history than who did not have hereditary
obesity, (67.6% vs. 32.3%, p.value=0.007).
See table
Table 3: The relation between psychological factors and number of attempts to weight loss among participants.
P value
Total
weight loss attempts > 4
weight loss attempts <4
Psychological factors
psychosocial problems*
0.002
89 ( 29.6% )
51 ( 38.9% )
38 ( 22.4% )
Yes
211 ( 70.3% )
80 (61.0% )
131 (77.5% )
No
desire to eat during diet
0.057
133 ( 44.3% )
68 ( 51.9% )
65 ( 38.4% )
increase
71 ( 23.6% )
25 ( 19.0% )
46 (27.2% )
decrease
96 ( 32% )
38 ( 29.0% )
58 ( 34.3% )
no change
increase eating rate during stress*
0.000
197 (65.6% )
100 ( 76.3% )
97 ( 57.3% )
Yes
103 ( 34.3% )
31 ( 23.6% )
72 (42.6% )
No
does weight loss require?*
0.001
284 ( 94.6% )
130 ( 99.2% )
154 ( 91.1% )
Yes
16 ( 5.3% )
1 ( 0.7% )
15 ( 8.8% )
No
successful attempts in weight loss*
0.000
167 ( 55.6% )
46 ( 35.1% )
121 ( 71.5% )
<1
133 ( 44.3% )
85 ( 64.8% )
48 ( 28.4% )
>1
300
131
169
Total
*Statistical differences p. value ‹0.05 by Chi. Square test.
As shown in Table (3), there was
significant relation between psychological
factors and number of weight loss attempts.
First of all, there was a relationship between
the number of trying to lose weight and
psychological problems, (22.4% of
participants had fewer than 4 attempts of
weight lose vs.38.9% had more than 4
attempts of weight loss, P =0.002.
Approximately half of participant 44.3%
had increase desire to eat during following
specific diet, 51.9%of them had more than 4
attempts of weight loss, while 38.4% of
them had less than 4 attempts of weight
loss. Additionally, more than half of
participants 65.6% were eating more during
stress. There was a significant correlation
between participants’ psychological status
and number of attempts to weight loss,
76.3% of participants had more than 4
attempt and 57.3% of them had less than 4
attempts P = (0.000). More fore, the
majority of participants 94.6% believed that
weight loss is needed, there was a
relationship between their need to lose
weight and attempts to lose weight.
Participants who believed weight loss is
required had more attempts (> 4 times) of
weight loss than those did not believe that,
(99.2% vs. 0.7%, P =0.001). There was also
association between successful weight loss
and number of attempts of weight loss, more
than half of participants 64.8% who had
increase number of successful weight loss
had more number of weight loss attempts
than who had less number of successful
weight loss (64.8% vs. 35.1%, p=0.000).
See Table 3
Dietary pattern and behavior of
participants:-
In regarding to dietary factors, the
minority of participants 7% were followed
diet that is described by nutritionists and
18% of them by their self, while the
majority of participants 75% were
followed described diet by both nutritionist
and by theirself. The majority of
participants 82% also had diet from
different sources of foods (an integrated
diet), 83.4% of them had less than 4
attempts, and 80.1% had more than 4
attempts. Less than half of participants 39%
followed a diet for less than a year, and
48.6% of them lose weight from 0.5 -1kg in
a week. There was significant association
between number of attempts weight loss and
weight loss maintenance. Most of
participants 50.8% who have weight loss
maintained for less than one years had
increase number of weight loss attempts
(more than 4 times) than those maintained

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their weight loss more than one years. (50.8% vs. 24.3%, p=0.002).See Table 4
Table 4:The relation between dietary factors and number of attempts to weight loss among participants.
P value
Total
weight loss attempts >4
weight loss attempts <4
Dietary factors
Source of diet
0.218
21 ( 7% )
11 ( 8.39% )
10 ( 5.9% )
dietitian
56 ( 18.6%)
19 ( 14.5% )
37 ( 21.8% )
yourself
223 (74.3%)
101 ( 77.0% )
122 ( 72.1% )
both
Diet sources
0.586
23 ( 7.6% )
9 ( 6.8% )
14 ( 8.28% )
protein
6 ( 2% )
3 ( 2.29% )
3 (1.7% )
fat
25 ( 8.3% )
14 ( 10.6% )
11 ( 6.5% )
protein and CHO
246 ( 82% )
105 ( 80.1% )
141 ( 83.4% )
integrated diet
follow up diet
0.168
53 ( 17.6% )
26 ( 19.8% )
27 ( 15.9% )
less than a month
78 ( 26% )
36 ( 27.4% )
42 ( 24.8% )
a month
117 ( 39% )
47 ( 35.8% )
70 ( 41.4% )
less than one year
26 ( 8.6% )
7 ( 5.3% )
19 ( 11.2% )
year
26 ( 8.6% )
15 ( 11.4% )
11 ( 6.5% )
more than one year
weight loss per week
0.421
146 (48.6%)
61 ( 46.5% )
85 ( 50.2% )
0.5 - 1 kg
126 ( 42% )
60 ( 45.8% )
66 ( 39.0% )
2 - 4 kg
28 ( 9.3% )
10 ( 7.6% )
18 ( 10.6% )
> 4 kg
Maintenance weight loss*
0.002
177 ( 59% )
91 ( 69.4% )
86 ( 50.8% )
less than one year
50 ( 16.6% )
20 (15.2% )
30 ( 17.7% )
one year
73 ( 24.3% )
20 ( 15.2% )
53 ( 31.3% )
more than one year
300
131
169
Total
*Statistical differences p.value ‹0.05 by Chi. Square test.
Table 5 focuses on behavioral
factors, showed that there is association
between participants’ behavior and the
number of weight loss attempts. The
participants who were watching TV for long
period of time had more number of weight
loss’ attempts than those watching TV for 1-
2 hrs (43.5% vs. 21.3%, p.value =0.01).
Approximately, half of participants 50.6%
were eating food on the ground compared to
those eating food in a chair, and more than
half of participants 56.3% were sharing food
with their family. Additionally, the majority
of participants 74% were drinking enough
water, and more than half of participants
62% were eating Breakfast regularly. The
most of participants 62.3% were practicing
sports, and 41.3% of people slept less than 8
hours. There was no relation between eating
pattern, sleeping hours, and exercise with
number of weight loss attempts. On other
hand, there was a clear relationship between
weight loss attempts and duration of eating,
P=(0.023).
Table 5 Description the relation between participants’ behavior and weight loss attempts .
P value
Total
weight loss attempts >4
weight loss attempts <4
Behavior factors
hours on TV or internet*
0.01
81 ( 27% )
28 ( 21.3% )
53 ( 31.3% )
1 -2 hours
116 ( 38.6% )
46 ( 35.1% )
70 ( 41.4% )
2 - 5 hours
103 ( 78.6% )
57 ( 43.5% )
46 ( 27.2% )
more than 5
Water Consumption
0.35
222 ( 74% )
95 ( 72.5% )
127 ( 75.1% )
Yes
78 ( 26% )
36 ( 27.4% )
42 ( 24.8% )
No
Breakfast
0.38
186 ( 62% )
83 ( 63.3% )
103 ( 60.9% )
Yes
144 ( 38% )
48 ( 36.6% )
66 ( 39.0% )
No
Exercise
0.122
187 ( 62.3% )
87 ( 66.4% )
100 ( 59.17% )
Yes
113 ( 37.6% )
44 ( 33.5% )
69 ( 40.8% )
No
place of eating
0.419
148 ( 49.3% )
66 ( 50.3% )
82 ( 48.5% )
Chair
152 ( 50.6% )
65 ( 49.6% )
87 ( 51.4% )
Ground
Sharing eating
0.107
169 ( 56.3% )
68 ( 51.9% )
101 ( 59.7% )
Family
131 ( 43.6% )
63 ( 48.0% )
68 ( 40.3% )
Alone
Eating duration*
0.023
137 ( 45.6% )
69 ( 52.6% )
68 ( 40.2% )
10 min

Souad El-mani et.al. Factors influencing weight loss attempts and long term weight loss maintenance.
International Journal of Health Sciences and Research (www.ijhsr.org) 212
Vol.11; Issue: 12; December 2021
108 ( 36% )
36 ( 27.4% )
72 ( 42.6% )
15 min
33 ( 11% )
13 ( 9.9% )
20 ( 11.8% )
20 min
22 ( 7.3% )
13 ( 9.9% )
9 ( 5.3% )
More
Hours of sleep
0.54
124 ( 41.3% )
56 ( 42.7% )
68 ( 40.2% )
less than 8 hours
97 ( 32.3% )
38 ( 29.0% )
59 ( 34.9% )
8 hours
79 ( 26.3% )
37 ( 28.2% )
42 ( 24.8% )
more than 8 hours
300
131
169
Total
* Statistical differences p.value ‹0.05 by Chi. Square test
Relation between successful weight loss and other factors:
Table 6 : Relationship between the study factors with successful weight loss attempts.
P value
Total
successful attempts >1
successful attempts <1
Variables
Type of drug*
0.030
23(15.3%)
4 ( 5.7%)
19 ( 23.4%)
Contraindications
11 ( 7.3%)
4 ( 5.7%)
7 ( 8.6%)
Diabetes drugs
5 ( 3.3%)
3 ( 4.3% )
2 ( 2.4%)
Cortisol
11 ( 7.3%)
7 ( 10.1% )
4 ( 4.9%)
Thyroid drugs
30 ( 20%)
18 ( 26.0% )
12 ( 14.8%)
weight loss drugs
70 ( 46.6%)
33 (47.8% )
37 ( 45.6%)
other drugs
weight loss per week*
0.001
146 ( 48.6% )
49 ( 36% )
97 ( 58% )
0.5 - 1 kg
126 ( 42% )
70 ( 52.6% )
56 (33.5% )
2 - 4 kg
28( 9.3% )
14 ( 10.5% )
14 ( 8.3% )
> 4 kg
diet successful by dietitian*
0.031
97( 32.3% )
53 ( 39.8% )
44 ( 26.3% )
Yes
149 ( 49.6% )
56 ( 42.1% )
93( 55.6% )
No
food serving*
0.047
148 ( 49.3% )
76 ( 57.1% )
72 ( 43.11% )
Yes
131 ( 43.6% )
48 ( 36.0% )
83 ( 49.7% )
No
Breakfast*
0.027
186 ( 62% )
91 ( 68.4% )
95( 56.8%)
Yes
114 ( 38% )
42 ( 31.5% )
72 ( 43.11% )
No
Exercise*
>0.034
187 ( 62.3% )
91 ( 30.3% )
96 ( 57.4%)
Yes
113( 37.6% )
42 ( 14% )
71 ( 42.5 % )
No
300
133
167
Total
According to successful weight loss,
there were a number of relationship between
the number of successful weight loss
attempts and other factors. The first relation
was between successful weight loss
attempts and type of treatment among
participants. participants who were taking
special medications for weight loss had
more successful weight loss attempts than
other types of treatments (26% vs. 5.7%
p=0.03) the second relation was between
the number of weight loss by kilogram and
number of weight loss attempts P=( 0.001).
The number of successful weight loss
attempts was increase among patients who
loss more than 1 kilogram (from 2-4
kg/week) of their weight (52.6% vs.36%).
The third relation was number of successful
weight loss attempts and described diet by
dietitians. (26.3 % of participants had a
success attempts less than one times and
39.8% of them had successful attempts
more than one, p=0.031. The next
relationship was between awareness of
participant about food serving and number
of successful weight loss. (57% vs. 36% had
more than one successful weight loss
attempts, p= 0.047). The another relation
was between number of successful weight
loss and breakfast consumption, (30% vs.
14%, p= 0.027) There the last relationship
was between exercise and the number of
successful weight loss attempts,(30.3 % vs.
14% had more than one successful weight
loss attempts P=(0.034).
DISCUSSION
The factors that lead to obesity differ
according to the condition of people and the
environment around them. The sex and age
distribution of the participants in the current
study was similar to the criteria for previous
studies (26-28). The proportion of females was
about 1: 5 more than males, with ages

Souad El-mani et.al. Factors influencing weight loss attempts and long term weight loss maintenance.
International Journal of Health Sciences and Research (www.ijhsr.org) 213
Vol.11; Issue: 12; December 2021
ranging from 15 to 35 years. There was a
significant correlation between body mass
index and body weight with many social
factors that were addressed in the current
study such as gender, hours of work, marital
status, and number of children. These results
have been proven by previous studies. (5-
6,26,29-30) Despite these correlations, there
was no relationship between these factors
and the frequency of weight loss attempts.
The health problems of chronic diseases and
taking special medicines are one of the
reasons that effect the process of losing
weight in many previous studies11-13,, but
the results of this study showed only a
association between the presence of health
problems, especially ovarian cysts, and BMI
(p=0.000) . Regarding medications, unlike
other studies, the current study did not
record any association between
consumption of contraceptives or endocrine
medications with body weight or body mass
index, or even with repeated weight loss.
However, all patients with thyroid
dysfunction particularly if they are
overweight, they should receive dietary
advice.31
Among the factors that are
associated with the frequency of weight loss
attempts, genetic factor was the most
affecting, as more than four weight-loss
attempts were reported by participants who
are obese and have obesity family history.
These findings have confirmed by a number
of published studies. (32,33) It was also found
in this study a statistically significant
relationship between trying to lose weight
and psychological problems. Those who
complain with an increased desire to eat
during a diet or when feeling stressed or
suffer from dissatisfaction and a negative
outlook on the body, reported an increase in
the number of attempts to lose Weight along
with its correlation to BMI P= (0.000).
Similar results from the previous
evidences.5,34 A Dutch study examined
whether mindfulness-based strategies can
effectively reducing the desire to eating
more ,and reduction of automatic relations
between urge and reaction.(Participants who
were exposed to a 7-week acceptance-based
craving intervention reported significantly
lower food desiring compared to
participants who did not receive this
training.).29
In this study less than half of
participants followed diet by themselves and
only 7% followed diet is described by
dietitian. In fact, this study found a
relationship between dietary inquiries
during the visit and the success of the diet
P= (0.000). The success of the diet linked to
the attempts to lose weight and the attempts
to succeed the diet, the people who reported
the success of the diet, had the lowest rate of
attempts to lose weight, and the most in the
number of successful attempts. This study
indicates that the duration of the most
frequent diet was at least a year, followed
by a month, and less than a month. The
maintenance of losing a period starting from
6 months, as the previous studies reported.35
there is no relationship between the duration
of the diet and the number of attempts, but
there is a relationship between the period of
follow-up and the duration of weight
maintenance P=(0.000).
There are a number of diet
behavioral factors that linked to an effect on
weight loss. As mentioned in previous
literature, these factors included TV hours
and a fast eating rate have shown to be
associated with the frequency of weight loss
attempts. (21,36-37). Therefore, it is important
to considered it in weight management
additionally to follow diet with appropriate
amount and type of food. Study was
conducted in Bangladesh found that
skipping breakfast is associated with
greater chance to gain weight.23 The current
study confirmed this result and found
relation also between skipping breakfast and
the number of attempts of successful
weight loss diet. Exercise is one of the
factors that have proven effective in weight
loss program. most of previous studies
confirmed that exercise has many roles
including increase the rate of metabolism,
improving digestion and helping to achieve
weight loss and maintain it.38,39 The current

Souad El-mani et.al. Factors influencing weight loss attempts and long term weight loss maintenance.
International Journal of Health Sciences and Research (www.ijhsr.org) 214
Vol.11; Issue: 12; December 2021
study indicated that there is a relationship
between exercise and the number of
successful attempts on the diet . Drinking
enough water had great resonance in
previous literature to improve digestion and
promote weight loss40, but this study did not
show a correlation between drinking water
and the number of weight loss attempts or
success. Other factors that have effect on
weight loss and gain, short sleep duration
and record of sleep disturbances are a
feature of obesity24,25. In contrast this study
did not find a relationship between short
sleep rate and body mass index or number
of attempts.
That behavior modification may
represent a significant progress in obesity
treatment, as the groups who lost weight
with the behavior modification reported a
greater weight loss than other groups,
therefore it is important to consider behavior
modification in the treatment of obesity.41,42
CONCLUSION AND
RECOMMENDATIONS
This study indicates that female
presented the highest numbers of over
weight than male, and there was clear
relation between working hours, marital
status and BMI. There was also significant
between weight loss attempts and hereditary
factor. Psychological factors were the most
influential factors on repeated weight loss
attempts followed by behavior related
factors, so practices related to self-control,
mental control, stress reduction practices,
and behavior modification must be
considered when starting to manage weight.
Further studies are recommended also to
assess and determine the factors affecting
weight loss. Establish educational program
to improve and raise awareness about
healthy eating habits and eating practicing.
Acknowledgement: None
Conflict of Interest: None
Source of Funding: None
Ethical Approval: Approved
REFERENCES
1. WHO - Obesity and overweight. Fact sheet
Nr. 311, Updated March 2011.
2. Finkelstein EA, Khavjou OA, Thompson H,
Trogdon JG, Pan L, Sherry B, Dietz W.
Obesity and severe obesity forecasts
through 2030. American journal of
preventive medicine. 2012 Jun 1;42(6):563-
70.
3. Contreras JE, Santander C, Bravo J.
Correlation between age and weight loss
after bariatric surgery. Obesity surgery.
2013 Aug 1;23(8):1286-9.
4. St Peter SD, Craft RO, Tiede JL, Swain JM.
Impact of advanced age on weight loss and
health benefits after laparoscopic gastric
bypass. Archives of Surgery. 2005 Feb
1;140(2):165-8.
5. Wu B, O’Sullivan A. Sex differences in
energy metabolism need to be considered
with lifestyle modifications in humans. J
Nutr Metab 2011; 2011: doi:
10.1155/2011/391809; [Epub 2011 Jun .
6. Donnelly JE, Hill JO, Jacobsen DJ et al.
Effects of a 16-month randomized
controlled exercise trial on body weight and
composition in young, overweight men and
women: the Midwest ExerciseTrial. Arch
Intern Med 2003; 163: 1343–1350.
7. Field AE, Aneja P, Austin SB, Shrier LA,
De Moor C, Gordon‐Larsen P. Race and
gender differences in the association of
dieting and gains in BMI among young
adults. Obesity. 2007 Feb;15(2):456-64.
8. Zhang C, Rexrode KM, van Dam RM, Li
TY, Hu FB. Abdominal obesity and the risk
of all-cause, cardiovascular, and cancer
mortality: sixteen years of follow-up in US
women. Circulation. 2008;117:1658–1666.
9. Calle EE, Rodriguez C, Walker-Thurmond
K, Thun MJ. Overweight, obesity, and
mortality from cancer in a prospectively
studied cohort of US adults. New England
Journal of Medicine. 2003 Apr
24;348(17):1625-38.
10. Ríos-Prego M, Anibarro L, Sánchez-
Sobrino P. Relationship between thyroid
dysfunction and body weight: a not so
evident paradigm. International Journal of
General Medicine. 2019;12:299.
11. Norris SL, Zhang X, Avenell A, Gregg E,
Schmid CH, Kim C, Lau J. Efficacy of

Souad El-mani et.al. Factors influencing weight loss attempts and long term weight loss maintenance.
International Journal of Health Sciences and Research (www.ijhsr.org) 215
Vol.11; Issue: 12; December 2021
pharmacotherapy for weight loss in adults
with type 2 diabetes mellitus: a meta-
analysis. Archives of Internal Medicine.
2004 Jul 12;164(13):1395-404.
12. Panidis D, Farmakiotis D, Rousso D,
Kourtis A, Katsikis I, Krassas G. Obesity,
weight loss, and the polycystic ovary
syndrome: effect of treatment with diet and
orlistat for 24 weeks on insulin resistance
and androgen levels. Fertility and sterility.
2008 Apr 1;89(4):899-906.
13. Block JP, He Y, Zaslavsky AM, Ding L,
Ayanian JZ. Psychosocial stress and change
in weight among US adults. American
journal of epidemiology. 2009 Jul
15;170(2):181-92.
14. Tlili F, Mahjoub A, Lefevre P, Bellaj T, Ben
Romdhane H, Eymard-Duvernay S,
Holdsworth M. Tunisian women's
perceptions of desirable body size and
chronic disease risk. Ecology of food and
nutrition. 2008 Aug 1;47(4):399-414.Social
factors
15. Massey A, Hill AJ. Dieting and food
craving. A descriptive, quasi-prospective
study. Appetite. 2012 Jun 1;58(3):781-5.
16. Zellner DA, Loaiza S, Gonzalez Z, Pita J,
Morales J, Pecora D, Wolf A. Food
selection changes under stress. Physiology
& behavior. 2006 Apr 15;87(4):789-93.
17. Green AR, Larkin M, Sullivan V. Oh stuff
it! The experience and explanation of diet
failure: an exploration using interpretative
phenomenological analysis. Journal of
Health Psychology. 2009 Oct;14(7):997-
1008.
18. Sares‐Jäske L, Knekt P, Männistö S,
Lindfors O, Heliövaara M. Self‐report
dieting and long‐term changes in body mass
index and waist circumference. Obesity
science & practice. 2019 Aug;5(4):291-303.
19. Kruger J, Blanck HM, Gillespie C. Dietary
and physical activity behaviors among
adults successful at weight loss
maintenance. International Journal of
Behavioral Nutrition and Physical Activity.
2006 Dec 1;3(1):17.
20. Larsen TM, Dalskov SM, van Baak M, Jebb
SA, Papadaki A, Pfeiffer AF, Martinez JA,
Handjieva-Darlenska T, Kunešová M,
Pihlsgård M, Stender S. Diets with high or
low protein content and glycemic index for
weight-loss maintenance. New England
Journal of Medicine. 2010 Nov
25;363(22):2102-13.
21. Raynor DA, Phelan S, Hill JO, Wing RR.
Television viewing and long‐term weight
maintenance: results from the National
Weight Control Registry. Obesity. 2006
Oct;14(10):1816-24.
22. Islam MS, Goon S. Breakfast Skipping and
Obesity Risk Among Urban Adults in
Bangladesh. International Journal of Public
Health Science.2014Mar;3(1):7174.
23. Timlin MT, Pereira MA. Breakfast
frequency and quality in the etiology of
adult obesity and chronic diseases. Nutrition
reviews. 2007 Jun 1;65(6):268-81.
24. Vgontzas AN, Bixler EO, Chrousos GP,
Pejovic S. Obesity and sleep disturbances:
meaningful sub-typing of obesity. Archives
of physiology and biochemistry. 2008 Jan
1;114(4):224-36.
25. Vgontzas AN, Lin HM, Papaliaga M,
Calhoun S, Vela-Bueno A, Chrousos GP,
Bixler EO. Short sleep duration and obesity:
the role of emotional stress and sleep
disturbances. International journal of
obesity. 2008 May;32(5):801-9.
26. Au N, Hauck K, Hollingsworth B.
Employment, work hours and weight gain
among middle-aged women. International
Journal of Obesity. 2013 May;37(5):718-24
27. Alberts HJ, Mulkens S, Smeets M,
Thewissen R. Coping with food cravings.
Investigating the potential of a mindfulness-
based intervention. Appetite. 2010 Aug
1;55(1):160-3.
28. Troisi A. Patients‘ Motivations,
Expectations, and Experiences. InBariatric
Psychology and Psychiatry 2020 (pp. 13-
21). Springer, Cham.
29. Olson CM, Strawderman MS, Hinton PS,
Pearson TA. Gestational weight gain and
postpartum behaviors associated with
weight change from early pregnancy to 1 y
postpartum. International journal of obesity.
2003 Jan;27(1):117-27.
30. Bobrow KL, Quigley MA, Green J, Reeves
GK, Beral V. Persistent effects of women‘s
parity and breastfeeding patterns on their
body mass index: results from the Million
Women Study. International journal of
obesity. 2013 May;37(5):712-7.
31. O´Malley B, Hickey J, Nevens E. Thyroid
dysfunction-weight problems and the
psyche: the patientes´perspective. J Hum
Nutr Diet.2000;13:243–248.
doi:10.1046/j.1365-277x.2000.00238.x .

Souad El-mani et.al. Factors influencing weight loss attempts and long term weight loss maintenance.
International Journal of Health Sciences and Research (www.ijhsr.org) 216
Vol.11; Issue: 12; December 2021
32. Calugi S, Marchesini G, El Ghoch M,
Gavasso I, Dalle Grave R. The association
between weight maintenance and session-
by-session diet adherence, weight loss and
weight-loss satisfaction. Eating and Weight
Disorders-Studies on Anorexia, Bulimia and
Obesity. 202Feb;25(1):127-33.
33. Calugi S, Marchesini G, El Ghoch M,
Gavasso I, Dalle Grave R. The influence of
weight-loss expectations on weight loss and
of weight-loss satisfaction on weight
maintenance in severe obesity. Journal of
the Academy of Nutrition and Dietetics.
2017 Jan 1;117(1):32-8.
34. Heber D. An Integrative View of Obesity.
Am J ClinNutr. 2010;9:280S-283S.
35. Elfhag K, Rössner S. Who succeeds in
maintaining weight loss? A conceptual
review of factors associated with weight
loss maintenance and weight regain. Obesity
reviews. 2005 Feb;6(1):67-85.
36. Ohkuma T, Hirakawa Y, Nakamura U,
Kiyohara Y, Kitazono T, Ninomiya T.
Association between eating rate and obesity:
a systematic review and meta-analysis.
International journal of obesity. 2015
Nov;39(11):1589-96.
37. Ohkuma T, Fujii H, Iwase M, Kikuchi Y,
Ogata S, Idewaki Y, Ide H, Doi Y,
Hirakawa Y, Mukai N, Ninomiya T. Impact
of eating rate on obesity and cardiovascular
risk factors according to glucose tolerance
status: the Fukuoka Diabetes Registry and
the Hisayama Study. Diabetologia. 2013 Jan
1;56(1):70-7.
38. Miller WC, Koceja DM, Hamilton EJ. A
meta-analysis of the past 25 years of weight
loss research using diet, exercise or diet plus
exercise intervention. International journal
of obesity. 1997 Oct;21(10):941-7.
39. Andrade AM, Coutinho SR, Silva MN,
Mata J, Vieira PN, Minderico CS, Melanson
KJ, Baptista F, Sardinha LB, Teixeira PJ.
The effect of physical activity on weight
loss is mediated by eating self-regulation.
Patient Education and Counseling. 2010 Jun
1;79(3):320-6.
40. Dennis EA, Dengo AL, Comber DL, Flack
KD, Savla J, Davy KP, Davy BM. Water
consumption increases weight loss during a
hypocaloric diet intervention in middle‐aged
and older adults. Obesity. 2010 Feb;
18(2):300-7.
41. Penick SB, Filion R, Fox S, Stunkard AJ.
Behavior modification in the treatment of
obesity. Psychosomatic Medicine. 1971 Jan
1;33(1):49-56.
42. Toulabi T, Nikoo MK, Amini F, Nazari H,
Mardani M. The influence of a behavior
modification interventional program on
body mass index in obese adolescents.
Journal of the Formosan Medical
Association. 2012 Mar 1;111(3):153-9.
How to cite this article: Souad El-mani, Ali
Ateia Elmabsout, Abdullah Sheikhi et.al.
Factors influencing weight loss attempts and
long term weight loss maintenance. Int J Health
Sci Res. 2021; 11(12): 205-216. DOI: https://
doi.org/10.52403/ijhsr.20211227
******