Behavioural weight management interventions consistently produce 8-10% reductions in body weight, yet most participants regain weight after treatment ends. One strategy for extending the effects of behavioural interventions has been the provision of extended care. The current study is a systematic review and meta-analysis of the literature on the effect of extended care on maintenance of weight loss. Through database searches (using PubMED, PsychInfo and Cochrane Reviews) and manual searches through reference lists of related publications, 463 studies were identified. Of these, 11 were included in the meta-analysis and an additional two were retained for qualitative analysis. The average effect of extended care on weight loss maintenance was g=0.385 (95% confidence interval: 0.281, 0.489; P<0.0001). This effect would lead to the maintenance of an additional 3.2 kg weight loss over 17.6 months post-intervention in participants provided extended care compared with control. There was no significant heterogeneity between studies, Q=5.63, P=0.845, and there was minimal evidence for publication bias. These findings suggest that extended care is a viable and efficacious solution to addressing long-term maintenance of lost weight. Given the chronic disease nature of obesity, extended care may be necessary for long-term health benefits.

Objective Despite the proliferation of newer self-monitoring technology (e.g., activity monitors and smartphone apps), their impact on weight loss outside of structured in-person behavioral intervention is unknown. Methods A randomized, controlled pilot study was conducted to examine efficacy of self-monitoring technology, with and without phone-based intervention, on 6-month weight loss in adults with overweight and obesity. Eighty participants were randomized to receive standard self-monitoring tools (ST, n=26), technology-based self-monitoring tools (TECH, n=27), or technology-based tools combined with phone-based intervention (TECH+PHONE, n=27). All participants attended one introductory weight loss session and completed assessments at baseline, 3 months, and 6 months. Results Weight loss from baseline to 6 months differed significantly between groups p=.042; there was a trend for TECH+PHONE (−6.4±1.2kg) to lose more weight than ST (−1.3±1.2kg); weight loss in TECH (−4.1±1.4kg) was between ST and TECH+PHONE. Fewer ST (15%) achieved ≥5% weight losses compared to TECH and TECH+PHONE (44%), p=.039. Adherence to self-monitoring caloric intake was higher in TECH+PHONE than TECH or ST, ps<.05. Conclusion These results suggest use of newer self-monitoring technology plus brief phone-based intervention improves adherence and weight loss compared to traditional self-monitoring tools. Further research should determine cost-effectiveness of adding phone-based intervention when providing self-monitoring technology.

Background Controversy exists regarding the optimal rate of weight loss for long-term weight management success. Purpose This study examined whether gradual initial weight loss was associated with greater long-term weight reduction than rapid initial loss. Methods 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. Results 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. Conclusion 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.

Objective To determine whether an Acceptance-Based Behavioral Intervention (ABBI) produces better weight losses than standard behavioral treatment (SBT) among individuals reporting high internal disinhibition. Methods Participants were 162 adults with overweight or obesity (mean BMI 37.6) randomly assigned to ABBI or SBT. Both interventions provided the same calorie intake target, exercise goal, and self-monitoring skills training. SBT incorporated current best practice interventions for addressing problematic thoughts and emotions. ABBI utilized acceptance-based techniques based on Acceptance and Commitment Therapy. ABBI and SBT were compared on weight change and internal disinhibition change over 24 months. Results Mixed models analysis showed mean weight loss at 24 months was −4.1% (SE=0.88) for ABBI and −2.4% (SE=0.87) for SBT (p=.204). Secondary analyses showed that the ABBI group regained less weight from the end of treatment to the final follow-up (4.6 vs. 7.1kg; p=.005), and that a significantly higher proportion of ABBI participants achieved a 5% weight loss (38% vs. 25%; p=.038) at 24 months. Conclusions Results suggest that ABBI could be helpful for improving the maintenance of weight loss for individuals who report high internal disinhibition.