Adherence to the Mediterranean lifestyle pattern is associated with favorable weight loss outcomes: the MedWeight study

Individual lifestyle targets have been associated with weight loss outcomes, yet few studies have examined associations of one's total lifestyle with weight loss maintenance. We aimed to examine the relationship between lifestyle patterns and weight loss outcomes in weight loss maintainers and regainers. We hypothesized that higher adherence to a broader healthy lifestyle favors maintenance (over regain). This is a cross-sectional analysis of 470 adults (62% women) with a history of overweight/obesity and significant weight loss 12 months before study entry. Participants were classified as maintainers (current weight ≤90% maximum weight) or regainers. They were asked to fill in a series of questionnaires on demographics and lifestyle habits (dietary intake and eating behaviors through two 24-hour recalls, physical activity, and sleep). A total Mediterranean Lifestyle Index (total-MLI, range 0-13) was generated by summing up ratings in the lifestyle domain quartiles (diet quality, physical activity, and sleep habits) and dietary behaviors (seasonal food and vegetable intake, intake of traditional foods, responsibility for food preparation, conviviality). Maintainers scored higher in the total-MLI than regainers (6.93 ± 2.31 vs 5.78 ± 2.49, P.001). Adherence to the total-MLI was associated with 28% higher odds for weight loss maintenance (per unit increment) in linear analyses. Being in the highest total-MLI quartile was associated with 5.27 (95% CI, 2.77-10.02) odds for maintenance. Higher adherence to a comprehensive Mediterranean lifestyle pattern was associated with higher odds for weight loss maintenance. Our findings suggest that even modest shifts toward a healthier living may contribute to favorable weight loss outcomes.