A self-regulation program for maintenance of weight loss
Open accessAbstract
BACKGROUND: Since many successful dieters regain the weight they lose, programs that teach maintenance skills are needed. We developed a maintenance program based on self-regulation theory and tested the efficacy of delivering the program face to face or over the Internet. METHODS: We randomly assigned 314 participants who had lost a mean of 19.3 kg of body weight in the previous 2 years to one of three groups: a control group, which received quarterly newsletters (105 participants), a group that received face-to-face intervention (105), and a group that received Internet-based intervention (104). The content of the programs in the two intervention groups was the same, emphasizing daily self-weighing and self-regulation, as was the frequency of contact with the groups. The primary outcome was weight gain over a period of 18 months. RESULTS: The mean (+/-SD) weight gain was 2.5+/-6.7 kg in the face-to-face group, 4.7+/-8.6 kg in the Internet group, and 4.9+/-6.5 kg in the control group, with a significant difference between the face-to-face group and the control group (2.4 kg; 95% confidence interval [CI], 0.002 to 10.8; P=0.05). The proportion of participants who regained 2.3 kg or more over the 18-month period was significantly higher in the control group (72.4%) than in the face-to-face group (45.7%; absolute difference, 27%; 95% CI, 14 to 39; P<0.001) or the Internet group (54.8%; absolute difference, 18%; 95% CI, 5 to 30; P=0.008). Daily self-weighing increased in both intervention groups and was associated with a decreased risk of regaining 2.3 kg or more (P<0.001). CONCLUSIONS: As compared with receiving quarterly newsletters, a self-regulation program based on daily weighing improved maintenance of weight loss, particularly when delivered face to face. (ClinicalTrials.gov number, NCT00067145 [ClinicalTrials.gov].)
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Although research is mixed, several studies show improved weight loss outcomes in patients receiving weight maintenance-specific training compared with those receiving only traditional weight loss training.
“Although the research is mixed, several studies show improved weight loss outcomes in patients receiving weight maintenance-specific training, compared with those who only receive traditional weight loss training76–79.”
From Maintenance of Lost Weight and Long-Term Management of Obesity (2018) · cites this paper as [79]
The Discussion (page not provided) reports that maintenance-specific self-regulation interventions were more effective than newsletters at maintaining weight loss. The study did not compare them with traditional weight-loss training, so it does not support the stated comparator. (LLM, conf=0.88)
Experimental — accuracy not yet measuredProviding a weight loss maintenance intervention over an extended period can support clinically meaningful weight loss for as long as 8 years, which is two to three times longer than previous randomized trials examined.
“Look AHEAD, however, has demonstrated that the extended provision of a weight loss maintenance intervention can facilitate clinically meaningful weight loss for up to 8 years – two to three times the duration examined in previous randomized trials.30,37,38”
From Eight-year weight losses with an intensive lifestyle intervention: The look AHEAD study (2014) · cites this paper as [30]
The Abstract describes STOP Regain as a randomized weight-loss-maintenance trial lasting 18 months, so it supports citing this paper as a previous, shorter trial. It does not support the stated two-to-three-times comparison: eight years is more than five times 18 months. The Look AHEAD result is not a finding of this paper. (LLM, conf=0.88)
Experimental — accuracy not yet measuredBehavioral inertia plays a role: without sustained lifestyle changes, appetite-suppression wanes and old dietary patterns return.
“Behavioral inertia also plays a role: without sustained lifestyle changes, appetite-suppression wanes and old dietary patterns return [84].”
From Obesity: Clinical Impact, Pathophysiology, Complications, and Modern Innovations in Therapeutic Strategies (2025) · cites this paper as [84]
The Discussion (page not available) says that preventing weight regain is important and that even small regains are difficult to reverse; the Behavioral Changes section links self-monitoring with less regain in the intervention groups. But the paper does not establish that appetite suppression wanes or that old dietary patterns return without sustained lifestyle changes. (LLM, conf=0.84)
Experimental — accuracy not yet measuredSeveral recent trials have shown that continued contact with participants after weight loss is associated with less regain.
“Several recent trials have also shown that continued contact with participants after weight loss is associated with less regain.12,24,37,38”
From Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates (2009) · cites this paper as [37]
Experimental — accuracy not yet measuredThe long-term weight loss maintenance program in Look AHEAD was based on the Diabetes Prevention Program and similar protocols.
“Look AHEAD’s long-term weight loss maintenance intervention, which included monthly or twice monthly individual contacts combined with periodic group meetings (i.e., refresher groups and national campaigns), was modeled on the DPP11,21 and similar protocols.30,37”
From Eight-year weight losses with an intensive lifestyle intervention: The look AHEAD study (2014) · cites this paper as [30]
Prior research has linked long-term weight control to several behaviors: increasing physical activity, monitoring body weight, reducing calorie and fat intake, and using meal replacements.
“All participants also reported at baseline and years 1–4, as well as at year 8, the number of weeks in the prior year that they engaged in behaviors previously determined to be associated with long-term weight control: 1) increasing physical activity;27–29 2) monitoring body weight;30,31 3) reducing calorie and fat intake;32,33 and 4) using meal replacements.33”
From Eight-year weight losses with an intensive lifestyle intervention: The look AHEAD study (2014) · cites this paper as [30]
In an 18-month trial focused on prevention of weight regain, both intervention groups increased daily self-weighing, which was significantly associated with a lower risk of weight regain.
“Results revealed that both of the intervention groups increased their daily self-weighing, which was significantly associated with a lower risk of weight regain.”
From Self-monitoring in weight loss: a systematic review of the literature (2011) · cites this paper as [32]
Regular self-monitoring facilitates increased physical activity.
“Regular self-monitoring also facilitates increased physical activity [8–12].”
From The Role of Lifestyle Modification with Second-Generation Anti-obesity Medications: Comparisons, Questions, and Clinical Opportunities (2023) · cites this paper as [10]
Ongoing contact is needed to sustain adherence and the associated long-term weight loss.
“The smaller weight loss observed in the current study, which was due to weight regain in the latter months, reinforces the consistent finding that ongoing contact is needed to sustain adherence and the associated long-term weight loss.10, 11”
From Using mHealth Technology to Enhance Self-Monitoring for Weight Loss (2012) · cites this paper as [11]
Frequent self-weighing is associated with better weight loss and weight maintenance results.
“Frequent self-weighing has been found to be associated with better weight loss and weight maintenance results [11,12].”
From Personal Health Technologies in Employee Health Promotion: Usage Activity, Usefulness, and Health-Related Outcomes in a 1-Year Randomized Controlled Trial (2013) · cites this paper as [11]
Wing 2006 assumed all dropouts regained 2.3 kg or more for their analysis.
“Wing 2006 assumed all dropouts regained 2.3 kg or more for their analysis.”
From Interactive computer-based interventions for weight loss or weight maintenance in overweight or obese people (2012) · cites this paper as Wing 2006
The fourth weight maintenance study (Wing 2006) recruited participants who had lost at least 10% of their body weight during the last two years, randomly assigned the participants to computer-based or control intervention groups, and followed them for 18 months.
“The fourth study (Wing 2006) recruited participants who had lost at least 10% of their body weight during the last two years, randomly assigned the participants to computer-based or control intervention groups, and followed them for 18 months.”
From Interactive computer-based interventions for weight loss or weight maintenance in overweight or obese people (2012) · cites this paper as Wing 2006
Wing 2006 reported that there were no serious adverse events.
“Wing 2006 reported that there were no serious adverse events.”
From Interactive computer-based interventions for weight loss or weight maintenance in overweight or obese people (2012) · cites this paper as Wing 2006
Compared to participants in minimal or no treatment conditions, participants in computer interventions regained less weight at six months (MD −0.7 kg, 95% CI −1.2 to −0.2; P = 0.004; 897 participants; two trials).
“Compared to participants in the minimal or no treatment conditions, participants in the computer interventions regained less weight at six months (MD −0.7 kg (95% CI −1.2 to −0.2); P = 0.004; 897 participants; two trials; Analysis 5.1)”
From Interactive computer-based interventions for weight loss or weight maintenance in overweight or obese people (2012) · cites this paper as Wing 2006
At 18 months, participants in computer intervention continued to have regained less weight (−0.7 kg, 95% CI −1.6 to 0.1; P = 0.10; 897 participants; two trials), although the difference was not statistically significant.
“Participants in the computer intervention continued to have regained less weight at 18 months (−0.7 kg (95% CI −1.6 to 0.1); P = 0.10; 897 participants; two trials; Analysis 5.3), although the difference was not statistically significant.”
From Interactive computer-based interventions for weight loss or weight maintenance in overweight or obese people (2012) · cites this paper as Wing 2006
At 12 months, participants in computer interventions regained less weight (MD −0.8 kg, 95% CI −1.4 to −0.2; P = 0.01; 1004 participants; three trials).
“and 12 months (MD −0.8 kg (95% CI −1.4 to −0.2); P = 0.01; 1004 participants; three trials; Analysis 5.2)”
From Interactive computer-based interventions for weight loss or weight maintenance in overweight or obese people (2012) · cites this paper as Wing 2006
In Wing 2006, attendance at the chat-room sessions and the percentage of participants who reported their weight each week both decreased significantly over time (P < 0.001).
“Wing 2006 measured attendance at the chat-room sessions and the percentage of participants who reported their weight each week, and both measures decreased significantly over time (P < 0.001).”
From Interactive computer-based interventions for weight loss or weight maintenance in overweight or obese people (2012) · cites this paper as Wing 2006
None of the three studies (Harvey-Berino 2002; Svetkey 2008; Wing 2006) explored within-group relationships between adherence or dose of the intervention, and weight outcomes.
“None of the three studies explored within-group relationships between adherence or dose of the intervention, and weight outcomes.”
From Interactive computer-based interventions for weight loss or weight maintenance in overweight or obese people (2012) · cites this paper as Wing 2006
In Wing 2006, there was no assessment of relationships between either measure and weight maintenance.
“There was no assessment of relationships between either measure and weight maintenance.”
From Interactive computer-based interventions for weight loss or weight maintenance in overweight or obese people (2012) · cites this paper as Wing 2006
In Wing 2006, weekly reporting of weight decreased over time, and was consistently higher among participants in the in-person intervention, but the difference between the in-person and computer-based groups was not statistically significant.
“Weekly reporting of weight also decreased over time, and was consistently higher among participants in the in-person intervention, but the difference between the in-person and computer-based groups was not statistically significant.”
From Interactive computer-based interventions for weight loss or weight maintenance in overweight or obese people (2012) · cites this paper as Wing 2006
At 18 months, the computer group regained more weight than the face-to-face group (MD 1.1 kg, 95% CI −0.2 to 2.5; P = 0.10; 897 participants; two trials).
“This difference was also seen at 18 months (MD 1.1 kg (95% CI −0.2 to 2.5); P = 0.10; 897 participants; two trials; Analysis 6.3).”
From Interactive computer-based interventions for weight loss or weight maintenance in overweight or obese people (2012) · cites this paper as Wing 2006
At 12 months, the computer group regained more weight than the face-to-face group, and the difference was near to statistical significance (MD 1.6 kg, 95% CI −0.1 to 3.2; P = 0.07; 955 participants; three trials).
“At 12 months, the computer group regained more weight than the face-to-face group, and the difference was near to statistical significance (MD 1.6 kg (95% −0.1 to 3.2); P = 0.07; 955 participants; three trials; Analysis 6.2)”
From Interactive computer-based interventions for weight loss or weight maintenance in overweight or obese people (2012) · cites this paper as Wing 2006
In Wing 2006, while attendance at both the in-person and the Internet chat-room sessions decreased over time, the percentage of sessions attended was significantly higher in the in-person group throughout the trial.
“Wing 2006 reported that while attendance at both the in-person and the Internet chat-room sessions decreased over time, the percentage of sessions attended was significantly higher in the in-person group throughout the trial.”
From Interactive computer-based interventions for weight loss or weight maintenance in overweight or obese people (2012) · cites this paper as Wing 2006
At six months, the computer intervention group regained slightly more weight than the face-to-face group, although the difference was not statistically significant (MD 0.5 kg, 95% CI −0.5 to 1.6; P = 0.32; 897 participants; two trials).
“At six months, the computer intervention group regained slightly more weight than the face-to-face group, although the difference was not statistically significant (MD 0.5 kg (95% CI −0.5 to 1.6); P = 0.32; 897 participants; two trials; Analysis 6.1).”
From Interactive computer-based interventions for weight loss or weight maintenance in overweight or obese people (2012) · cites this paper as Wing 2006
Omitting the one very large trial (Wing 2006) from weight maintenance analyses did not make large differences to the estimate of effect or the statistical significance of those analyses.
“Likewise, omitting the one very large trial (Wing 2006) from weight maintenance analyses did not make large differences to the estimate of effect or the statistical significance of those analyses.”
From Interactive computer-based interventions for weight loss or weight maintenance in overweight or obese people (2012) · cites this paper as Wing 2006
Wing and colleagues observed that 65.7% of web sessions attended were attended in months zero to six and 34.2% in months 13 to 18.
“Finally, Wing and colleagues observed that 65.7% of web sessions attended were attended in months zero to six and 34.2% in months 13 to 18 (Wing 2006).”
From Interactive computer-based interventions for weight loss or weight maintenance in overweight or obese people (2012) · cites this paper as Wing 2006
Wing et al suggested the use of the Internet for prevention of weight regain but that more intensive face-to-face intervention may be required if weight is regained.
“A recent study by Wing et al suggested the use of the Internet for prevention of weight regain but that more intensive face-to-face intervention may be required if weight is regained [34].”
From The Internet for weight control in an obese sample: results of a randomised controlled trial (2007) · cites this paper as [34]
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“10, 11 Although improved self-monitoring adherence did not result in better weight loss maintenance, when subgroups by level of adherence were examined, method of self-monitoring was notably related to self-monitoring adherence, and that, in turn, was related to weight loss maintenance (Table 1).”
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“A recent study by Wing et al suggested the use of the Internet for prevention of weight regain but that more intensive face-to-face intervention may be required if weight is regained [34].”
Background
- Authors
- Wing, R. R., Tate, D. F., Gorin, A. A., Raynor, H. A., & Fava, J. L.
- Affiliations
- Brown University (US)
- University of North Carolina at Chapel Hill (US)
- Miriam Hospital (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2006-10-12
- Volume
- 355
- Issue
- 15
- Pages
- 1563-1571
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2144948858
- Semantic Scholar
- c11743e8a56b73a56eaa4ad1c1bd81382c134ccb
- Cited by
- 830
- References
- 23
- Citations by year
- 2026: 7 · 2025: 17 · 2024: 14 · 2023: 15 · 2022: 31 · 2021: 42 · 2020: 28 · 2019: 38 · 2018: 46 · 2017: 42 · 2016: 68 · 2015: 43 · 2014: 57 · 2013: 63 · 2012: 70
- FWCI
- 70.27
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
- UNC Libraries
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (DK57413, R01DK057413)
- Topics
- Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Keywords
- weight loss maintenance, weight regain, self-regulation, online intervention, face-to-face intervention, behavioral weight management
- MeSH terms
- Body Weight, Female, Humans, Male, Middle Aged, Periodicals as Topic, Self Care, Social Control, Informal, Social Support, Weight Gain, Weight Loss, Internet
About these checks
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