A patient regained weight despite continuing some of the behaviors that led to initial loss. Which evaluation best integrates metabolic adaptation, environmental triggers, and behavioral fatigue to explain the regain?

• A. Regain must be caused solely by a lack of willpower because physiological and environmental factors have minimal impact once behaviors are established.
• B. Physiological adaptations (reduced energy expenditure and increased hunger signals) combined with persistent environmental triggers (easy access to energy-dense foods) and gradual behavioral fatigue (reduced adherence over time) create a multidimensional risk for regain; therefore, addressing only one aspect is unlikely to sustain maintenance.
• C. Regain occurs only when there is concurrent disease and is unrelated to any behavioral or environmental factors; therefore, no behavioral intervention would be effective.
• D. If the patient continued behaviors but regained, the only explanation is that their initial weight loss was purely fluid and never reflected true fat loss.

Answer: (B)