Our understanding of weight loss maintenance comes not only from the study of successful weight losers but also from randomized clinical trials evaluating specific treatment components. These trials are stronger scientifically because participants are randomly assigned to treatment conditions and all aspects of the intervention are kept constant except the factor under investigation. However, these studies are limited by their short duration (typically 1 or 2 years) and their relatively small sample size (usually 100-200 participants).
In experimental studies of weight loss maintenance, the primary focus is usually on overall weight loss (from baseline to the end of the study), usually defined as long-term weight loss, rather than on maintenance of weight loss from the end of the initial treatment (typically 6 months) to study end. Overall weight loss is selected as the variable of interest because it is most strongly associated with health impact. In addition, focusing on weight change from end of treatment to follow-up would make those who lost small amounts of weight but maintained that weight loss in full appear to be more successful than those who lost large amounts of weight and regained some.
Experimental research has focused on three main ways to increase long-term weight loss (Figure 2). The first is to increase the rate of initial weight loss so that a greater amount of weight loss occurs during the first 6 months of treatment. A second focus is to improve maintenance of weight loss achieved after the first 6 months of treatment. Finally, combining both of these approaches is considered the ideal approach.
Several strategies have been tested in experimental studies of weight loss maintenance, including focusing on energy balance, in which changes in diet and/ or physical activity are used to create larger energy deficits that produce greater weight loss, or focusing on intensifying behavioral components of interventions so that skills necessary for sustaining weight loss can be maintained over a longer period. These strategies have been implemented during the initial weight loss treatment phase and the weight loss maintenance phase.
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