The same message to everyone does not work if the goal is to prevent overweight and obesity in the population. It is also important to reach groups normally considered as being at low risk for gaining in weight. This is what Kristina Lindvall shows in her doctoral thesis at Umeå University, Sweden. Participants in the study come from Västerbotten County in northern Sweden and from New York State in the US.

It is often difficult for people to maintain their weight following weight loss. Instead people tend to return to the same weight that they were at before the weight loss or gain even more. This is why Kristina Lindvall, a dietitian and doctoral candidate at the Unit for Epidemiology and Global Health, suggests that it is important for society to broaden the focus from treatment of overweight and obesity to prevention of initial weight gain.

"That is why I chose to focus on primary weight maintenance in my research, i.e, the possibility of preventing weight gain among normal weight and overweight individuals," says Kristina Lindvall.

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

The thesis shows that of all VIP-participants 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 without risk factors for cardiovascular disease were those least likely to maintain weight.

"This means that interventions and programs aiming at prevention of overweight and obesity may need to be broadened to also include these groups that are normally regarded as being at low risk for weight gain," says Kristina Lindvall.

Research interviews with VIP participants that managed to maintain their weight after weight loss showed that weight maintenance was seen as balancing act, not only to maintain weight but also to manage other factors in life. Four main strategies for maintaining weight were described: "to rely on heritage," "to find the joy," "to find the routine" and "to be in control." Kristina Lindvall claims that these results indicate that it is important to tailoradvice given not only to individuals wishing to lose weight but also to those wanting to maintain their weight.

A questionnaire study conducted to identify attitudes and behaviors that were of importance for weight maintenance in different subgroups of age, gender, and body-mass index (BMI) showed that there were major differencesin terms of which attitudes and behaviour that were of importance depending on which subgroup that was examined.

"This further emphasizes the importance of tailoring interventions based on an individual's demographic (age, sex and baseline BMI) when aiming at primary weight maintenance in a population," says Kristina Lindvall.

Finally, American and Swedish female study participants were compared in terms of ten year weight change. 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. One explanation to 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.