Behavioral Weight Loss Interventions to Prevent Obesity-Related Morbidity and Mortality in Adults: US Preventive Services Task Force Recommendation Statement
Open accessAbstract
Importance: More than 35% of men and 40% of women in the United States are obese. Obesity is associated with health problems such as increased risk for coronary heart disease, type 2 diabetes, various types of cancer, gallstones, and disability. Obesity is also associated with an increased risk for death, particularly among adults younger than 65 years. Objective: To update the US Preventive Services Task Force (USPSTF) 2012 recommendation on screening for obesity in adults. Evidence Review: The USPSTF reviewed the evidence on interventions (behavioral and pharmacotherapy) for weight loss or weight loss maintenance that can be provided in or referred from a primary care setting. Surgical weight loss interventions and nonsurgical weight loss devices (eg, gastric balloons) are considered to be outside the scope of the primary care setting. Findings: The USPSTF found adequate evidence that intensive, multicomponent behavioral interventions in adults with obesity can lead to clinically significant improvements in weight status and reduce the incidence of type 2 diabetes among adults with obesity and elevated plasma glucose levels; these interventions are of moderate benefit. The USPSTF found adequate evidence that behavior-based weight loss maintenance interventions are of moderate benefit. The USPSTF found adequate evidence that the harms of intensive, multicomponent behavioral interventions (including weight loss maintenance interventions) in adults with obesity are small to none. Therefore, the USPSTF concludes with moderate certainty that offering or referring adults with obesity to intensive behavioral interventions or behavior-based weight loss maintenance interventions has a moderate net benefit. Conclusions and Recommendation: The USPSTF recommends that clinicians offer or refer adults with a body mass index of 30 or higher to intensive, multicomponent behavioral interventions. (B recommendation).
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Weight loss was a major contributor to the reduction in diabetes incidence in the ILS and metformin groups.
“Weight loss was a major contributor to the reduction in diabetes incidence in the ILS and metformin groups.17, 18”
From Long-term effects and effect heterogeneity of lifestyle and metformin interventions on type 2 diabetes incidence over 21 years in the US Diabetes Prevention Program randomised clinical trial (2025) · cites this paper as [18]
The Behavior-Based Weight Loss and Weight Loss Maintenance Interventions section (page unavailable) reports lower diabetes incidence and greater weight loss in behavioral intervention groups. It does not say that weight loss was a major contributor to the incidence reduction, or establish that relationship for the metformin group. (LLM, conf=0.85)
Experimental — accuracy not yet measuredEvidence-based obesity treatment includes interventions addressing 5 major categories: behavioral interventions, nutrition, physical activity, pharmacotherapy, and metabolic/bariatric procedures.
“Evidence-based obesity treatment includes interventions addressing 5 major categories: behavioral interventions, nutrition, physical activity, pharmacotherapy, and metabolic/bariatric procedures.”
From Obesity Management in Adults (2023) · cites this paper as [13]
The Behavioral Counseling Interventions section describes dietary changes and physical activity, and the paper also reviews pharmacotherapy. But the Scope of Review section excludes surgical weight-loss interventions; the paper does not present the claimed five-category treatment framework or assess metabolic/bariatric procedures as part of it. (LLM, conf=0.88)
Experimental — accuracy not yet measuredModerate- to high-intensity behavioral programs include 12 or more sessions in the first year (ideally ≥14 sessions in 6 months), followed by a maintenance phase for up to 24 months.
“Moderate- to high-intensity programs include 12 or more sessions in the first year (ideally ≥14 sessions in 6 months), followed by a maintenance phase for up to 24 months.5,11,13”
From Obesity Management in Adults (2023) · cites this paper as [13]
The Behavioral Counseling Interventions section (page not provided) says most intensive interventions lasted 1–2 years and a majority had at least 12 sessions in the first year. It does not recommend at least 14 sessions in 6 months. Only one-third had a core phase followed by a maintenance phase, so it does not establish that programs generally followed that schedule for up to 24 months. (LLM, conf=0.89)
Experimental — accuracy not yet measuredHealth coaching in lifestyle medicine factors such as diet and physical activity increases adherence to behavioral changes and assists with obesity if delivered as part of an intensive, multicomponent program.
“Health coaching in lifestyle medicine factors such as diet and physical activity has been shown to increase adherence to behavioral changes and assist with obesity if delivered as part of an intensive, multicomponent program [19,316].”
From Lifestyle Medicine for Obesity in the Era of Highly Effective Anti-Obesity Treatment (2025) · cites this paper as [19]
The Behavioral Counseling Interventions section describes effective intensive programs combining dietary changes and physical activity for weight loss, and lists lifestyle coaches among the interventionists. It reports generally high participant adherence to interventions, but does not show that coaching increased adherence to behavioral changes specifically. (LLM, conf=0.84)
Experimental — accuracy not yet measuredAccording to the USPSTF, the evidence supports referring all adults with obesity to intensive, multicomponent behavioral interventions for both weight reduction and weight maintenance.
“According to the USPSTF, the evidence supports referring all adults with obesity to intensive, multicomponent behavioral interventions for both weight reduction and weight maintenance.”
Some randomized controlled trials had relatively poor follow-up rates or short durations.
“Fourth, some RCTs had relatively poor follow-up rates or short durations.13,64”
From Obesity Management in Adults (2023) · cites this paper as [13]
Maximal weight loss with behavioral interventions is achieved between 6 and 12 months.
“with maximal loss achieved between 6 and 12 months.5,13,64,66”
From Obesity Management in Adults (2023) · cites this paper as [13]
The Behavior-Based Weight Loss and Weight Loss Maintenance Interventions section reports weight loss at 12–18 months, while Behavioral Counseling Interventions describes core phases lasting 3–12 months. Neither passage identifies when weight loss was maximal; searches for a 6–12-month peak found no such statement in our copy. Page numbers were not available. (LLM, conf=0.70)
Experimental — accuracy not yet measuredAlmost 40% of patients with obesity take obesity-promoting medications for other medical conditions.
“almost 40% of patients with obesity take obesity-promoting medications for other medical conditions; 25”
From Approach to Obesity Treatment in Primary Care: A Review (2024) · cites this paper as [25]
Lifestyle modification has limited availability outside of academic medical centers (and some commercial and community-based programs), making it virtually impossible for primary care providers to offer all patients with obesity intensive, multicomponent behavioral interventions as recommended by the US Preventive Services Task Force.
“A final shortcoming of lifestyle modification is its limited availability outside of academic medical centers (and some commercial and community-based programs), making it virtually impossible for primary care providers to offer all patients with obesity “intensive, multicomponent behavioral interventions,” as recommended by the US Preventive Services Task Force [36].”
From The Role of Lifestyle Modification with Second-Generation Anti-obesity Medications: Comparisons, Questions, and Clinical Opportunities (2023) · cites this paper as [36]
Without a restriction on minimum BMI, these findings are less relevant from a policy perspective because behavioural weight management programmes are intended for adults with overweight/obesity.
“Moreover, without a restriction on minimum BMI, these findings are less relevant from a policy perspective because behavioural weight management programmes are intended for adults with overweight/obesity.19, 20”
From Third‐wave cognitive behaviour therapies for weight management: A systematic review and network meta‐analysis (2020) · cites this paper as [20]
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- Authors
- US Preventive Services Task Force, Curry, S. J., Krist, A. H., Owens, D. K., Barry, M. J., Caughey, A. B., Davidson, K. W., Doubeni, C. A., Epling, J. W., Grossman, D. C., Kemper, A. R., Kubik, M., Landefeld, C. S., Mangione, C. M., Phipps, M. G., Silverstein, M., Simon, M. A., Tseng, C.-W., & Wong, J. B.
- Affiliations
- University of Iowa (US)
- Virginia Commonwealth University (US)
- Harvard University (US)
- Oregon Health & Science University (US)
- Columbia University (US)
- Carilion Clinic (US)
- Kaiser Permanente Washington Health Research Institute (US)
- Nationwide Children's Hospital (US)
- University of Alabama at Birmingham (US)
- University of California, Los Angeles (US)
- Boston University (US)
- Northwestern University (US)
- University of Hawaiʻi at Mānoa (US)
- Tufts University (US)
- Corresponding author
- Curry, Susan J.
- ORCID
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2018-09-18
- Volume
- 320
- Issue
- 11
- Pages
- 1163
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2891307323
- Cited by
- 563
- References
- 42
- Citations by year
- 2026: 52 · 2025: 79 · 2024: 101 · 2023: 73 · 2022: 71 · 2021: 67 · 2020: 66 · 2019: 46 · 2018: 6 · 2017: 1
- FWCI
- 44.03
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Keywords
- obesity, behavioral weight loss, weight loss maintenance, type 2 diabetes prevention, obesity screening, primary care, pharmacotherapy, obesity-related morbidity and mortality, body mass index
- MeSH terms
- Obesity Management, Adult, Behavior Therapy, Combined Modality Therapy, Diabetes Mellitus, Type 2, Female, Humans, Male, Obesity, Preventive Health Services, United States, Weight Loss, Health Behavior, Anti-Obesity Agents
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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