Applied Evidence

10 proven strategies to help patients maintain weight loss

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Patients’ chances of keeping off weight long-term improve with evidence-based interventions, such as a sound diet, more exercise, and attention to more thoughtful eating habits.


› Encourage patients to lose more weight early in their effort, which is ­predictive of successful long-term maintenance. B

› Support patients’ efforts to maintain weight loss by encouraging them to consume fewer calories and eat more nonglycemic fruits and vegetables A, eat at home and avoid processed foods B, work with you in addressing mental health concerns B, and increase time spent exercising A.

› Consider the potential value of prescribing a US Food and Drug ­Administration–indicated medication for weight maintenance. B

Strength of recommendation (SOR)

A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series



New studies show that many people who lose weight can maintain that loss for longer than a few months by utilizing strategies that can be undertaken upon your recommendation and with your ongoing support. In this article, I review the evidence that supports the effectiveness of those interventions and activities for helping patients keep off the weight they’ve lost.

Prolonging the duration of weight maintenance

Until recently, most studies that focused on weight maintenance after weight loss followed subjects for only a few months or a year after the goal was achieved. With that limited window of follow-up, the belief arose in weight-loss medicine that most people gain back lost weight within 2 years. Findings that are emerging from recent studies with longer follow-up, however, suggest that weight loss can be maintained for as long as 8 years.1

The National Health and Nutrition Examination Survey2 and the Action in Health for Diabetes (Look AHEAD) trial3,4 reported that, among adults who lost 10% or more of body weight, approximately 60% maintained that weight loss at 1 year. Look AHEAD had a much longer duration: 42% of participants who lost at least 10% of body weight by the end of Year 1 maintained at least that 10% loss by the end of Year 4.5 In addition, Look AHEAD demonstrated that extended provision of maintenance interventions after weight loss can facilitate clinically meaningful weight loss for as long as 8 years—2 or 3 times longer than what was reported in earlier randomized trials.4

We have evidence-based guidance for achieving long-term weight maintenance and good reason to believe that success is achievable for patients. The 10 strategies that follow can help you to guide patients to become successful “maintainers.”

Overweight woman next to same woman that lost weight IMAGE: @JOE GORMAN

1. Emphasize more weight loss in the first 3 months of a program

Losing more weight initially seems to point to more success in relation to maintenance. This suggests that more intensive help, such as more frequent visits with a physician and a dietitian during the first 3 months might be an important step to help patients lose and maintain weight.

These 10 strategies can help guide patients to become successful "maintainers."

Much of our information on successful maintainers comes from the National Weight Control Registry (NWCR) at the Warren Alpert Medical School at Brown University.1 This research study has gathered information from more than 10,000 people who successfully lost ≥ 30 lb (average, 60 lb) and kept it off for at least 1 year. To challenge the widespread belief that only a few people who attempt weight loss succeed long term, the NWCR identifies and investigates the characteristics of individuals who have succeeded.

A new and encouraging finding is from a small study that showed that people can maintain weight loss brought about by either medical or surgical means: Those who lost > 15% of their starting weight and were followed closely by health care professionals maintained their weight loss at 1 year.5

Continue to: 2. Advise patients to consume fewer calories and eat more nonglycemic fruits and vegetables


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