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Long term maintenance of weight loss with non-surgical interventions in obese adults: systematic review and meta-analyses of randomised controlled trials

BMJ 2014; 348 doi: (Published 14 May 2014) Cite this as: BMJ 2014;348:g2646
  1. S U Dombrowski, lecturer in health psychology12,
  2. K Knittle, health psychology research associate13,
  3. A Avenell, clinical chair in health services research4,
  4. V Araújo-Soares, senior lecturer in health psychology1,
  5. F F Sniehotta, reader in health psychology1
  1. 1Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne NE2 4AX, UK
  2. 2School of Natural Sciences, University of Stirling, Cottrell Building, Stirling FK9 4LA, UK
  3. 3MoveLab - Physical Activity and Exercise Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
  4. 4Health Services Research Unit, Health Sciences Building, University of Aberdeen, Aberdeen AB25 2ZD, UK
  1. Correspondence to: F F Sniehotta falko.sniehotta{at}
  • Accepted 24 March 2014


Objective To systematically review and describe currently available approaches to supporting maintenance of weight loss in obese adults and to assess the evidence for the effectiveness of these interventions.

Design Systematic review with meta-analysis.

Data sources Medline, PsycINFO, Embase, and the Cochrane Central Register of Controlled Trials.

Study selection Studies were identified through to January 2014. Randomised trials of interventions to maintain weight loss provided to initially obese adults (aged ≥18) after weight loss of ≥5% body weight with long term (≥12 months) follow-up of weight change (main outcome) were included.

Study appraisal and synthesis Potential studies were screened independently and in duplicate; study characteristics and outcomes were extracted. Meta-analyses were conducted to estimate the effects of interventions on weight loss maintenance with the inverse variance method and a random effects model. Results are presented as mean differences in weight change, with 95% confidence intervals.

Results 45 trials involving 7788 individuals were included. Behavioural interventions focusing on both food intake and physical activity resulted in an average difference of −1.56 kg (95% confidence interval −2.27 to −0.86 kg; 25 comparisons, 2949 participants) in weight regain compared with controls at 12 months. Orlistat combined with behavioural interventions resulted in a −1.80 kg (−2.54 to −1.06; eight comparisons, 1738 participants) difference compared with placebo at 12 months. All orlistat studies reported higher frequencies of adverse gastrointestinal events in the experimental compared with placebo control groups. A dose-response relation for orlistat treatment was found, with 120 mg doses three times a day leading to greater weight loss maintenance (−2.34 kg, −3.03 to −1.65) compared with 60 mg and 30 mg three times a day (−0.70 kg, 95% confidence interval −1.92 to 0.52), P=0.02.

Conclusions Behavioural interventions that deal with both diet and physical activity show small but significant benefits on weight loss maintenance.


  • Contributors: FFS and AA conceived the review. FFS, SUD, AA, and VAS developed the review protocol. All authors were involved in data extraction. SUD and FFS analysed the data. All authors reviewed and contributed to the manuscript drafted by SUD. All authors read and agreed the final version. FFS is guarantor.

  • Funding: FFS is funded by Fuse, the Centre for Translational Research in Public Health, a UKCRC Public Health Research Centre of Excellence. Fuse gratefully acknowledges funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, and the National Institute for Health Research, under the auspices of the UK Clinical Research Collaboration. The Health Services Research Unit, University of Aberdeen, is funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorate. The views expressed are not necessarily those of the funding bodies. This research was conducted independently of the funders, and the funders had no influence on the research process.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: Not required.

  • Data sharing: No additional data available.

  • Transparency: The lead author (the manuscript’s guarantor) affirms that the manuscript is an honest, accurate, and transparent account of the review being reported; that no important aspects of the review have been omitted; and that any discrepancies from the study as planned have been explained.

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