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The Association Between Rate of Initial Weight Loss and Long-Term Success in Obesity Treatment: Does Slow and Steady Win the Race?
Open accessAbstract
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" (> or =0.68 kg/week, n = 69), "MODERATE" (> or =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.
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“In subjects with obesity, more rapid initial weight loss has been associated with greater long-term weight loss [41–43]”
From International Society of Sports Nutrition position stand: diets for body weight reduction (2026) · cites this paper as [41]
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“Further, research suggests that it may be possible to identify such individuals early, i.e., during treatment [16].”
From Introduction to SMART designs for the development of adaptive interventions: with application to weight loss research (2014) · cites this paper as [16]
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“In this example, the 5 lbs cutoff is based on previous research [16], which is corroborated by clinical experience, suggesting that weight loss of less than 5 lbs during the first 5 weeks of behavioral therapy treatment is associated with longer-term insufficient weight loss (<5-10 % of body weight at the end of 26 weeks), thereby indicating a need for subsequent (changes or”
From Introduction to SMART designs for the development of adaptive interventions: with application to weight loss research (2014) · cites this paper as [16]
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Metadata
- Authors
- Nackers, L. M., Ross, K. M., & Perri, M. G.
- Affiliations
- University of Florida Health (US)
- Corresponding author
- Nackers, Lisa M.
- Venue
- International Journal of Behavioral Medicine
- Published
- 2010-05-05
- Volume
- 17
- Issue
- 3
- Pages
- 161-167
- ISSN
- 1070-5503 (ISSN-L)
- 1532-7558
- PMC
- PMC3780395
- OpenAlex
- W2158253734
- Cited by
- 166
- References
- 34
- Citations by year
- 2026: 7 · 2025: 8 · 2024: 7 · 2023: 10 · 2022: 7 · 2021: 12 · 2020: 18 · 2019: 16 · 2018: 14 · 2017: 11 · 2016: 12 · 2015: 10 · 2014: 14 · 2013: 7 · 2012: 6
- FWCI
- 6.34
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.springer.com/tdm (tdm)
- Locations
- International Journal of Behavioral Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (P30AG028740)
- National Heart, Lung, and Blood Institute (R18HL073326)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Pharmacology (medical) › Pharmacology and Obesity Treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity and Health Practices
- Keywords
- obesity treatment, rapid weight loss, long-term weight maintenance, weight regain, lifestyle intervention, caloric restriction, middle-aged women
- MeSH terms
- Aged, Energy Intake, Diet, Reducing, Female, Humans, Middle Aged, Motor Activity, Obesity, Patient Compliance, Time Factors, Weight Loss, Body Mass Index, Risk Reduction Behavior
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