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Aug 3

Long-term weight-loss maintenance: a meta-analysis of US …

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2001 American Society for Clinical Nutrition James W Anderson, Elizabeth C Konz, Robert C Frederich, and Constance L Wood 1From the VA Medical Center, Graduate Center for Nutritional Sciences, University of Kentucky Health Management Resources Weight Management Program, Lexington, and the Departments of Internal Medicine and Biostatistics, University of Kentucky, Lexington. Abstract

Background: Current perception is that participants of a structured weight-loss program regain all of their weight loss within 5 y.

Objective: The objective was to examine the long-term weight-loss maintenance of individuals completing a structured weight-loss program.

Design: Studies were required to 1) have been conducted in the United States, 2) have included participants in a structured weight-loss program, 3) have provided follow-up data with variance estimates for 2 y. Primary outcome variables were weight-loss maintenance in kilograms, weight-loss maintenance as a percentage of initial weight loss, and weight loss as a percentage of initial body weight (reduced weight).

Results: Twenty-nine studies met the inclusion criteria. Successful very-low-energy diets (VLEDs) were associated with significantly greater weight-loss maintenance than were successful hypoenergetic balanced diets (HBDs) at all years of follow-up. The percentage of individuals at 4 or 5 y of follow-up for VLEDs and HBDs were 55.4% and 79.7%, respectively. The results for VLEDs and HBDs, respectively, were as follows: weight-loss maintenance, 7.1 kg (95% CI: 6.1, 8.1 kg) and 2.0 (1.5, 2.5) kg; percentage weight-loss maintenance, 29% (25%, 33%) and 17% (13%, 22%); and reduced weight, 6.6% (5.7%, 7.5%) and 2.1% (1.6%, 2.7%). Weight-loss maintenance did not differ significantly between women and men. Six studies reported that groups who exercised more had significantly greater weight-loss maintenance than did those who exercised less.

Conclusions: Five years after completing structured weight-loss programs, the average individual maintained a weight loss of >3 kg and a reduced weight of >3% of initial body weight. After VLEDs or weight loss of 20 kg, individuals maintained significantly more weight loss than after HBDs or weight losses of <10 kg.

Obesity is a chronic disease that is a major health problem in the United States and is emerging as a health problem in many developed and developing countries (1). Current treatment programs for obese individuals are not very effective over the long term, leading to the common wisdom that persons who successfully lose weight will regain it all within 5 y (2,3).

The combination of very-low-energy diets (VLEDs) with behavior modification represents an important advance in enabling obese individuals to initially lose substantial amounts of weight, typically 2025 kg (4). However, the National Task Force on the Prevention and Treatment of Obesity (5) indicated that long-term maintenance of weight loss after VLEDs is no better than after other forms of obesity treatment. The present meta-analysis critically examines that contention by examining available US reports of weight-loss maintenance from 2 to 5 y after successful weight loss in structured weight-loss programs. Furthermore, because the recommended rate and amount of weight loss is a focus of debate (6), we examined long-term weight-loss maintenance and weight reduction at 5 y after either VLEDs or hypoenergetic balanced diets (HBDs).

In evaluating the literature for studies of weight-loss maintenance, we defined 3 initial inclusion criteria. First, only US studies were evaluated because of differences in weight-management practices and the availability of medical care in different countries. Second, subjects must have participated in a structured weight-loss program instead of in self-help activities. Third, follow-up weights with variance estimates must have been available for 2 y. We performed a thorough literature search by using MEDLINE (National Library of Medicine, Bethesda, MD) for the period of 19701999 to identify candidate studies and also used the ancestry approach (7) by consulting reference lists from single studies and pertinent literature reviews. We reviewed data from primary scientific reports and in review articles. Thirty-one separate published reports (4,8,37) met the initial criteria. We excluded 2 reports (19,22) because they did not provide specific weight-loss information at follow-up times. A study conducted by Wing et al (38) was also excluded from the analysis because the study included only children of persons with type 2 diabetes, a group shown to be atypical of the general population (39).

The primary outcome measures were weight-loss maintenance in kilograms, weight-loss maintenance as a percentage of initial weight loss (percentage weight-loss maintenance), and weight loss as percentage of initial body weight (reduced weight). Follow-up values were assessed at 1, 2, 3, 4, and 5 y. We analyzed results as reported and did not adjust for self-reported weights. Most investigators used VLEDs of <800 kcal/d (3347 kJ/d) or HBDs during the weight-loss phase. One group (34,35) used VLEDs and HBDs for comparison; these groups were considered to be mixed and were not analyzed in either diet group but were included in other comparisons.

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