Controversy exists regarding the optimal rate of weight loss for long-term weight management success.
This study examined whether gradual initial weight loss was associated with greater long-term weight reduction than rapid initial loss.
Groups were drawn from participants in the TOURS trial, which included a sample of middle-aged (mean = 59.3 years) obese women (mean BMI = 36.8) who received a 6-month lifestyle intervention followed by a 1-year extended care program. Participants were encouraged to reduce caloric intake to achieve weight losses of 0.45 kg/week. Groups were categorized as “FAST” (≥0.68 kg/week, n = 69), “MODERATE” (≥0.23 and <0.68 kg/week, n = 104), and “SLOW” (<0.23 kg/week, n = 89) based on rate of weight loss during first month of treatment.
The FAST, MODERATE, and SLOW groups differed significantly in mean weight changes at 6 months (−13.5, −8.9, and −5.1 kg, respectively, ps < 0.001), and the FAST and SLOW groups differed significantly at 18 months (−10.9, −7.1, and −3.7 kg, respectively, ps < 0.001). No significant group differences were found in weight regain between 6 and 18 months (2.6, 1.8, and 1.3 kg, respectively, ps < 0.9). The FAST and MODERATE groups were 5.1 and 2.7 times more likely to achieve 10% weight losses at 18 months than the SLOW group.
Collectively, findings indicate both short- and long-term advantages to fast initial weight loss. Fast weight losers obtained greater weight reduction and long-term maintenance, and were not more susceptible to weight regain than gradual weight losers.
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National Heart, Lung and Blood Institute. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. Obes Res. 1998;6:51S–209.
Wing RR, Hill JO. Successful weight loss maintenance. Annu Rev Nutr. 2001;21:323–41.
Jeffery RW, Epstein LH, Wilson GT, Drewnowski A, Stunkard AJ, Wing RR. Long-term maintenance of weight loss: current status. Health Psychol. 2000;19 Suppl 1:5–16.
Perri MG, Fuller PR. Success and failure in the treatment of obesity: where do we go from here? Med Exerc Nutr Health. 1995;4:255–72.
Wadden TA, Butryn ML, Byrne KJ. Efficacy of lifestyle modification for long-term weight control. Obes Res. 2004;12:151S–62.
Perri MG. The maintenance of treatment effects in the long-term management of obesity. Clin Psychol: Sci Pract. 1998;5:526–43.
Klein S. Outcome success in obesity. Obes Res. 2001;9:354S–8.
Krebs JD, Evans S, Cooney L, et al. Changes in risk factors for cardiovascular disease with body fat loss in obese women. Diab Obes Metab. 2002;4:379–87.
Moore LL, Visioni JJ, Wilson PW, D’Agostino RB, Finkle WD, Ellison RC. Can sustained weight loss in overweight individuals reduce the risk of diabetes mellitus? Epidemiology. 2000;11:269–73.
Elfhag K, Rössner S. Who succeeds in maintaining weight loss? A conceptual review of factors associated with weight loss maintenance and weight regain. Obes Rev. 2005;6:67–85.
Vogels N, Diepvens K, Westerterp-Plantenga MS. Predictors of long-term weight maintenance. Obes Res. 2005;13:2162–8.
Wadden TA, Foster GD, Wang J, et al. Clinical correlates of short- and long-term weight loss. Am J Clin Nutr. 1992;56:271S–4.
Carels RA, Cacciapaglia HM, Douglass OM, Rydin S, O’Brien WH. The early identification of poor treatment outcome in a women’s weight loss program. Eat Behav. 2003;4:265–82.
Fogelholm M, Kukkonen-Harjula K, Oja P. Eating control and physical activity as determinants of short-term weight maintenance after a very-low-calorie diet among obese women. Int J Obes. 1999;23:203–10.
Jeffery RW, Wing RR, Mayer RR. Are smaller weight losses or more achievable weight loss goals better in the long term for obese patients? J Consult Clin Psychol. 1998;66:641–5.
Lutes LD, Winett RA, Barger SD, et al. Small changes in nutrition and physical activity promote weight loss and maintenance: 3-month evidence from the ASPIRE randomized trial. Ann Behav Med. 2008;35:351–7.
Sbrocco T, Nedegaard RC, Stone JM, Lewis EL. Behavioral choice treatment promotes continuing weight loss: preliminary results of a cognitive-behavioral decision-based treatment for obesity. J Consult Clin Psychol. 1999;67:260–6.
Kumanyika SK, Espeland MA, Bahnson JL, et al. Ethnic comparison of weight loss in the trial of nonpharmacologic interventions in the elderly. Obes Res. 2002;10:96–106.
Stevens VJ, Obarzanek E, Cook NR, et al. Long-term weight loss and changes in blood pressure: results of the trials of hypertension prevention, phase II. Ann Intern Med. 2001;134:1–11.
Wassertheil-Smoller S, Langford HG, Blaufox MD, et al. Effective dietary intervention in hypertensives: sodium restriction and weight reduction. J Am Diet Assoc. 1985;85:423–30.
Astrup A, Rössner S. Lessons from obesity management programmes: greater initial weight loss improves long-term maintenance. Obes Rev. 2000;1:17–9.
Wadden TA, Foster GD, Letizia KA. One-year behavioral treatment of obesity: comparison of moderate and severe caloric restriction and the effects of weight maintenance therapy. J Consult Clin Psychol. 1994;62:165–71.
McGuire MT, Wing RR, Klem ML, Lang W, Hill JO. What predicts weight regain in a group of successful weight losers? J Consult Clin Psychol. 1999;67:177–85.
Weiss EC, Galuska DA, Kettel Khan L, Gillespie C, Serdula MK. Weight regain in U.S. adults who experienced substantial weight loss; 1999–2002. Am J Prev Med. 2007;33:34–40.
Perri MG, Limacher MC, Durning PE, et al. Extended-care programs for weight management in rural communities: the treatment of obesity in underserved rural settings (TOURS) randomized trial. Arch Intern Med. 2008;168:2347–54.
Perri MG, Corsica JA. Improving the maintenance of weight lost in behavioral treatment of obesity. In: Wadden TA, Stunkard AJ, editors. Handbook of obesity treatment. New York: Guilford Press; 2001. p. 357–79.
Jeffery RW, Drewnowski A, Epstein LH, et al. Long-term maintenance of weight loss: current status. Health Psychol. 2008;19:5–16.
Wadden TA, Berkowitz RJ, Sarwer DB, Prus-Wisniewski R, Steinberg C. Benefits of lifestyle modification in the pharmacologic treatment of obesity. Arch Intern Med. 2001;161:218–27.
Wadden TA, Berkowitz RI, Womble LG, et al. Randomized trial of lifestyle modification and pharmacotherapy for obesity. N Engl J Med. 2005;353:2111–20.
Stotland SC, Larocque M. Early treatment response as a predictor of ongoing weight loss in obesity treatment. Br J Health Psychol. 2005;10:601–14.
Latner JD, Stunkard AJ, Wilson GT, Jackson ML, Zelitch DS, Labouvie E. Effective long-term treatment of obesity: a continuing care model. Int J Obes. 2000;24:893–8.
Toubro S, Astrup A. Randomised comparison of diets for maintaining obese subjects’ weight after major weight loss: ad lib, low fat, high carbohydrate diet v fixed energy intake. Br Med J. 1997;4:314–29.
This research was supported by grant R18HL073326 from the National Heart, Lung, and Blood Institute.
The authors declare no conflict of interest.
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Nackers, L.M., Ross, K.M. & Perri, M.G. The Association Between Rate of Initial Weight Loss and Long-Term Success in Obesity Treatment: Does Slow and Steady Win the Race?. Int.J. Behav. Med. 17, 161–167 (2010). https://doi.org/10.1007/s12529-010-9092-y
- Weight loss
- Lifestyle modification