Weight suppression (WS) is a concept that has been increasingly studied in the context of weight loss, particularly in relation to eating disorders (ED) and ultra-processed food addiction (UPFA). Traditionally, weight suppression has been defined as diet-induced weight loss, operationalized as the difference between one’s highest and current weight. However, its value in predicting treatment outcomes has been inconsistent, which may be partially attributed to its calculation. This article explores the traditional understanding of weight suppression, introduces a novel approach to calculating it, and discusses the implications of both methods for individuals seeking weight loss and treatment for disordered eating.
The Traditional Approach to Weight Suppression
Early work in the field of abnormal eating identified three important factors to consider when evaluating dietary restraint: one’s history/frequency of dieting and overeating, current dieting behavior, and weight suppression (WS). Weight suppression was defined as “significant diet-induced weight loss” sustained over time. The most utilized method of calculating WS is the difference between the highest (excluding pregnancy) and lowest adult weight.
The traditional WS calculation has been associated with increased odds of future onset of anorexia nervosa (AN), bulimia nervosa (BN), and purging disorder, but not binge eating disorder (BED). WS may capture certain physiological facets of EDs (e.g., undernourishment), whereas dietary restraint captures psychological factors (e.g., obsessional thinking and compulsive behaviors), and both seem to be uniquely related to future ED diagnosis.
However, most of the existing research using the traditional approach for calculating WS has related primarily to WS predicting ED treatment outcomes (e.g., weight gain, abstinence from ED behaviors) and has yielded inconsistent findings. Some researchers have partially attributed these inconsistent findings to limitations in the traditional approach to calculating WS. For example, a 22-year-old female with AN who is 5′ 8″, currently at her lifetime adult lowest weight of 100 lbs. and 120 lbs. at her highest, would be assigned the same weight suppression score (i.e., 20) as a 42-year-old male with BN who is 5′ 8″, currently at his lifetime adult lowest weight of 200 lbs. and 220 lbs.
A Novel Weight Suppression Score (NWSS)
Given the limitations of the traditional weight suppression (TWS) calculation, a novel weight suppression score (NWSS) has been proposed. This score reflects the midpoint between the lowest and highest adult weights. The NWSS may be a more sensitive indicator of clinically relevant weight suppression. Compared to the traditional approach, this measurement approach was associated with a higher number of eating disorder symptoms and a lower number of ultra-processed food addiction symptoms.
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The novel weight suppression score was significantly associated with meeting criteria for both eating disorders and ultra-processed food addiction and was more sensitive to detecting clinically relevant eating disorder symptomatology. However, the novel weight suppression score (vs. traditional weight suppression) was associated with fewer ultra-processed food addiction symptoms.
Comparing Traditional WS and NWSS
To model the differential distributions of the traditional WS (TWS) calculation and the novel weight suppression score (NWSS), a simulated dataset was used. A random set of 1,566 observations was created. Given that the average weight of adults (ages 20+) in the US is approximately 185 pounds, three separate Poisson distributions (N = 1566 each) with means approximately equal to 185 were created.
The simulation was conducted prior to the analysis of the observational data to conceptualize the difference between the two approaches. A dataset was then created by removing all implausible values: simulated observations were kept only if the lowest adult weight was less than the highest adult weight and if the current weight was less than or equal to the highest weight and greater than or equal to the lowest weight.
The distribution of traditional weight suppression using simulated data is not normally distributed (median < mean). This variable may be used as a linear predictor, but the approach poses methodological challenges for dichotomizing the variable for indicator analysis. This method is also flawed because it would assign the same value to someone with a lifetime high of 200 lbs. who is currently 100 lbs. (reduced weight by 50%) as it would to someone with a lifetime high of 400 lbs. who is currently 300 lbs. (reduced weight by 25%).
The distribution of lifetime midpoint using simulated data is normally distributed (the median is approximately equal to the mean). The distribution of novel weight suppression score using simulated data is again normally distributed (the median is approximately equal to the mean), which may lend itself to use as a linear outcome or a dichotomized variable for indicator analysis. Conceptually, this captures a more notable phenomenon of weight suppression, which might be associated with a different clinical picture.
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Implications for Weight Loss and Treatment
The novel weight suppression score may be particularly relevant for those with eating disorders and ultra-processed food addiction, with more relevance to individual eating disorder compared to ultra-processed food addiction symptoms. Consideration of the novel weight suppression score in future research on eating behaviors should extend beyond just those with diagnosed eating disorders.
If a patient has a goal weight less than their low/high midpoint, ED-informed professionals might view this goal as unrealistic/disordered and provide psychoeducation about the long-term stability of weight and the associated harms of weight cycling.
Additional Factors in Weight Loss
Beyond the concept of weight suppression, several other factors play a crucial role in successful and healthy weight loss. These include understanding common terminology, the physiological impact of weight loss, and the importance of support systems.
Understanding Bariatric Terminology
Navigating the world of weight loss, especially weight loss surgery, often involves encountering a unique set of abbreviations and acronyms. Understanding these terms is essential for anyone participating in bariatric support groups, online forums, or medical consultations. Here are some common terms:
- BMI (Body Mass Index): A measure of body fat based on height and weight.
- NSV (Non-Scale Victory): Achievements beyond weight loss, such as fitting into smaller clothes, improved mobility, or increased energy levels.
- VSG (Vertical Sleeve Gastrectomy): A popular bariatric surgery option that removes most of the stomach, leaving a sleeve-like structure.
- RNY/RYGB (Roux-en-Y Gastric Bypass): A surgery that creates a small stomach pouch and reroutes the small intestine for weight loss.
- IGB (Intragastric Balloon): A non-surgical procedure involving the insertion of a balloon into the stomach to reduce hunger.
- GERD (Gastroesophageal Reflux Disease): A condition where stomach acid flows back into the esophagus.
- CPAP (Continuous Positive Airway Pressure): A treatment for sleep apnea, often linked to obesity.
The Physiology of Weight Loss
Weight loss is not simply about reducing food intake; it involves complex physiological processes. Restrictive dieting can lead to a reduced metabolic rate and increased appetite, making it harder to sustain weight loss. The hormone leptin, produced by fat cells, plays a crucial role in regulating appetite and metabolism. Lower leptin levels, often seen after significant weight loss, can increase hunger and decrease the ability to engage in dietary restraint.
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Changes in the affective response and the rewarding properties of highly palatable food likely contribute to a decreased ability to engage in dietary restraint, thereby increasing loss-of-control food consumption. Further, diminished leptin and glucagon-like peptide 1 (GLP-1) may contribute to alterations in reward valuation (i.e., increased salience) and the associated increased motivation to achieve satiation (both homeostatic and hedonic).
The Importance of Support Systems
Weight loss journeys can be challenging, and having a strong support system is crucial for success. This can include:
- Support Groups: Online and in-person communities where individuals can share their experiences, challenges, and successes.
- Healthcare Professionals: Doctors, nutritionists, and therapists who can provide guidance and support.
- Family and Friends: Loved ones who can offer encouragement and understanding.