The majority of people with severe obesity have a lonely and prolonged struggle with their weight. In one study spanning more than 10 years, 83 percent report that they constantly strive to lose weight or prevent weight gain.

"The study shows that people with severe obesity constantly try to reduce or control their weight and do so for a long time. If one believes that this group is not trying to lose weight, these results contradict those views," says Ingrid Larsson, a clinical nutritionist and associate professor at Sahlgrenska Academy, University of Gothenburg, Sweden.

The study, published in the journal Obesity, is based on what is known as the SOS Study (Swedish Obese Subjects). This time, however, the focus was not on the surgical weight loss group. Instead, the spotlight was on the control group -- that is, those who have not had surgery for their severe obesity.

The questions were specifically about weight loss attempts of people in the control group. The results are based on what they have reported at each follow-up occasion during a 10-year period.

The participants reported on the different methods they have used to lose weight or keep their weight down: commercial weight loss programs, anti-obesity medications, low energy liquid diets, exercise, support from health and medical services, and weight loss on ones own.

"They use a variety of methods, the most common one being an attempt to lose weight on their own, demonstrating that weight loss attempts are a lonely journey for many," says Ingrid Larsson.

None of these methods was better or worse than the others in terms of weight loss. Those who had reduced their weight by more than 10 percent over a 10-year period had used the same methods as those who had gained an equal amount of weight.

Consequently, it was not the methods that were decisive, but rather the ability to maintain a lower caloric intake over a period of time. The degree of success varied greatly. Some in the group gained a lot of weight in 10 years; other lost a great deal.

Among carefully screened patients, weight loss surgery is a method that has proven to be effective for reducing weight in the long term and lowering the risk of disease. Surgery is not suitable for everyone, however, and according to the researchers, health care should offer a knowledge-based and structured treatment approach.