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Cited by 201Obesity, Physical Activity, DietPharmacology and Obesity TreatmentBariatric Surgery and Outcomes

The effect of rate of weight loss on long-term weight management: a randomised controlled trial

Purcell, Katrina, Sumithran, Priya, Prendergast, Luke A, Bouniu, Celestine J, Delbridge, Elizabeth, Proietto, Joseph·2014·The Lancet Diabetes & Endocrinology
DOI 10.1016/s2213-8587(14)70200-1
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Abstract

Background Guidelines recommend gradual weight loss for the treatment of obesity, indicative of a widely held opinion that weight lost rapidly is more quickly regained. We aimed to investigate the effect of the rate of weight loss on the rate of regain in obese people.Methods For this two phase, randomised, non-masked, dietary intervention trial in a Melbourne metropolitan hospital, we enrolled 204 participants (51 men and 153 women) aged 18–70 years with a BMI between 30 and 45 kg/m2. During phase 1, we randomly assigned (1:1) participants with a block design (block sizes of 2, 4, and 6) to account for sex, age, and BMI, to either a 12-week rapid weight loss or a 36-week gradual programme, both aimed at 15% weight loss. We placed participants who lost 12·5% or more weight during phase 1 on a weight maintenance diet for 144 weeks (phase 2). The primary outcome was mean weight loss maintained at week 144 of phase 2. We investigated the primary outcome by both completers only and intention-to-treat analyses. This study is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12611000190909.Findings 200 participants were randomly assigned to the gradual weight loss (n=103) or rapid weight loss (n=97) programme between Aug 8, 2008, and March 9, 2010. After phase 1, 51 (50%) participants in the gradual weight loss group and 76 (81%) in the rapid weight loss group achieved 12·5% or more weight loss in the allocated time and started phase 2. At the end of phase 2, both gradual weight loss and rapid weight loss participants who completed the study (n=43 in gradual weight loss and n=61 in rapid weight loss) had regained most of their lost weight (gradual weight loss 71·2% regain, 95% CI 58·1–84·3 vs rapid weight loss 70·5%, 57·8–83·2). Intention-to-treat analysis showed similar results (gradual weight loss 76·3% regain, 95% CI 65·2–87·4 vs rapid weight loss 76·3%, 65·8–86·8). In phase 1, one participant in the rapid weight loss group developed cholecystitis, requiring cholecystectomy. In phase 2, two participants in the rapid weight loss group developed cancer.Interpretation The rate of weight loss does not affect the proportion of weight regained within 144 weeks. These findings are not consistent with present dietary guidelines which recommend gradual over rapid weight loss, based on the belief that rapid weight loss is more quickly regained.Funding The Australian National Health and Medical Research Council and the Sir Edward Dunlop Medical Research Foundation.

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Crossref · 10.1016/s2213-8587(14)70200-1

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  • Many patients have an initial large weight loss, but weight regain often occurs unless a structured weight-maintenance program is followed.

    “Many patients have an initial large weight loss, but weight regain often occurs 6,7 unless a structured weight-maintenance program is followed.”

    From Healthy Weight Loss Maintenance with Exercise, Liraglutide, or Both Combined (2021) · cites this paper as [6]

  • Weight reduction, regardless of rate, typically leads to a reduction in lean mass as well as fat mass, and these effects are typically proportional to the amount of weight reduction achieved.

    “Weight reduction, regardless of rate, typically leads to a reduction in lean mass as well as fat mass, and these effects are typically proportional to the amount of weight reduction achieved [95,98].”

    From Nutritional considerations with antiobesity medications (2024) · cites this paper as [98]

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Authors
Purcell, K., Sumithran, P., Prendergast, L. A., Bouniu, C. J., Delbridge, E., & Proietto, J.
Affiliations
The University of Melbourne (AU)
Corresponding author
Proietto, Joseph
ORCID
Venue
The Lancet Diabetes & Endocrinology
Publisher
Elsevier BV
Published
2014-12
Volume
2
Issue
12
Pages
954-962
ISSN
2213-8587 (ISSN-L)
DOI
10.1016/s2213-8587(14)70200-1
OpenAlex
W2116285179
Cited by
201
References
36
Citations by year
2026: 9 · 2025: 14 · 2024: 8 · 2023: 17 · 2022: 27 · 2021: 20 · 2020: 16 · 2019: 15 · 2018: 19 · 2017: 13 · 2016: 23 · 2015: 16 · 2014: 4
FWCI
18.50
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • The Lancet Diabetes & Endocrinology (publishedVersion)
  • PubMed (publishedVersion)
  • Minerva Access (University of Melbourne) (submittedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Health Sciences › Medicine › Pharmacology › Pharmacology and Obesity Treatment
  • Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
Keywords
rapid weight loss, weight regain, obesity, weight management, weight-maintenance diet, dietary intervention, weight loss rate, long-term weight maintenance, intention-to-treat analysis, sex differences
MeSH terms
Adult, Body Weight, Diet Therapy, Female, Humans, Male, Middle Aged, Obesity, Time Factors, Weight Loss, Body Mass Index, Treatment Outcome

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