EARLY TWO-THIRDS OF US adults are overweight or obese. 1 Together overweight and obesity are the second leading cause of preventable death, primarily through effects on car-diovascular disease (CVD) risk factors (hypertension, dyslipidemia, and type 2 diabetes). 2 Weight loss improves these risk factors, and evidence suggests that benefits persist as long as weight loss is maintained. [3][4][5][6][7][8] Relatively short-term (ie, 4-6 months) behavioral interventions for adults re-sult in clinically significant weight loss, but regain is an intractable problem. [9][10][11] Given the vast scope of the over-Author Affiliations are listed at the end of this article.

Over 18 months, persons with prehypertension and stage 1 hypertension can sustain multiple lifestyle modifications that improve control of blood pressure and could reduce the risk for chronic disease.

Background-To improve methods for long-term weight management, the Weight Loss Maintenance (WLM) trial, a four-center randomized trial, was conducted to compare alternative strategies for maintaining weight loss over a 30-month period. This paper describes methods and results for the initial 6-month weight-loss program (Phase I).