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Practice Uncertainties Page

What is the most effective way to maintain weight loss in adults?

BMJ 2011; 343 doi: (Published 28 December 2011) Cite this as: BMJ 2011;343:d8042
  1. Sharon A Simpson, senior research fellow1,
  2. Christine Shaw, reader in nursing research2,
  3. Rachel McNamara, senior trial manager1
  1. 1South East Wales Trials Unit, School of Medicine, Cardiff University, Cardiff CF14 4XN, UK
  2. 2Faculty of Health and Sports Science, University of Glamorgan, Pontypridd, CF37 1DL
  1. Correspondence to: simpsonsa{at}
  • Accepted 29 September 2011

Although weight loss is achievable for many adults, weight maintenance is elusive. After completing weight loss programmes, around a third of the weight lost is regained in the following year, with small differences between groups that received an intervention and controls1 Randomised controlled trials have suggested that maintenance interventions can improve longer term weight loss maintenance2 3 but it is unclear what form these interventions should take and how they should be delivered. NICE guidance4 currently recommends a low fat, fibre rich diet, increasing physical activity, minimising sedentary activities and regular self monitoring of weight or waist size.

What is the evidence of the uncertainty?

We searched PubMed, the Cochrane Library, and PsychInfo to identify clinical trials or systematic reviews using the search terms: “weight loss maintenance”, “maintain* weight loss” and “overweight”, “obes*”. We excluded trials targeting pregnant women and patients with an eating disorder. We included trials with a distinct focus on maintenance of weight already lost, as well as those which include long term weight loss with at least a year of follow-up. This approach was in line with US Institute of Medicine guidance,5 which defines successful long term weight loss as losing at least 5% of body weight for at least one year. After reviewing abstracts of 918 papers we identified 67 potentially relevant published trials and 12 systematic reviews or meta-analyses. Four additional systematic reviews were identified from reference list searches.

Lifestyle and behavioural interventions

Lifestyle and behavioural changes are key to weight loss maintenance. A systematic review and meta-analysis of 30 randomised controlled trials, most of which included behavioural plus other strategies (13 on diet alone, four on diet and exercise, four on exercise alone, seven on meal replacements, and two on very low energy diets) found that diet alone, diet and exercise, and meal replacements led to weight loss at 12 …

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