Successful weight loss maintenance: A systematic review of weight control registries
Open accessAbstract
Summary: Weight loss maintenance is a major challenge for obesity treatment. Weight control registries can be useful in identifying psychological and behavioural factors that could contribute to better long‐term success. The objective of this study is to describe the existing weight control registries and their participants and identify correlates of weight loss maintenance. A comprehensive search of peer‐reviewed articles published until November 2018 was conducted in PubMed, Web of Science, and Scopus. Studies that reported results from weight control registries were considered. Fifty‐two articles, corresponding to five registries (the United States, Portugal, Germany, Finland, and Greece), were included. Registries differed in inclusion criteria and procedures. Of 51 identified weight loss and maintenance strategies, grouped in 14 domains of the Oxford Food and Activity Behaviors taxonomy, the following were the most frequently reported: having healthy foods available at home, regular breakfast intake, increasing vegetable consumption, decreasing sugary and fatty foods, limiting certain foods, and reducing fat in meals. Increased physical activity was the most consistent positive correlate of weight loss maintenance. To our knowledge, this is the first systematic review of information about successful weight loss maintenance obtained from weight control registries. Key common influential characteristics of success were identified, which can inform future prospective studies and weight management initiatives.
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In non-GLP-1 weight reduction studies, access to healthy food at home is associated with weight maintenance.
“Consistent with this, in non‐GLP‐1 weight reduction studies, access to healthy food at home is associated with weight maintenance [280].”
From Nutritional priorities to support <scp>GLP</scp> ‐1 therapy for obesity: A joint Advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society (2025) · cites this paper as [280]
The Results section reports that having healthy foods available at home was associated with the magnitude of weight-loss maintenance, but only in women. The Discussion also identifies it as a commonly reported strategy among weight-loss maintainers. The citing sentence omits the women-only qualification; the review does not explicitly classify its studies as non-GLP-1. (LLM, conf=0.88)
Experimental — accuracy not yet measuredEvidence from the national weight loss registry suggests participants kept weight off through increased walking.
“evidence from the national weight loss registry does suggest participants kept weight off through increased walking”
From Lifestyle Medicine for Obesity in the Era of Highly Effective Anti-Obesity Treatment (2025) · cites this paper as [280]
The Results section (page unavailable) identifies walking instead of driving or taking public transportation as positively associated with the magnitude of weight-loss maintenance. It does not identify that finding as coming specifically from the US National Weight Control Registry. The Strengths and limitations section also cautions that the observational data cannot establish whether walking caused participants to keep weight off. (LLM, conf=0.82)
Experimental — accuracy not yet measuredIn longitudinal observational studies, people who successfully maintain weight loss often use behavioral strategies such as physical activity, regular self-weighing, a reduced-calorie diet, and a consistent eating pattern.
“In longitudinal observational studies, people who successfully maintain weight often use behavioral strategies, such as physical activity, regular self-weighing,67 a reduced-calorie diet, and a consistent eating pattern.124,125”
From Obesity Management in Adults (2023) · cites this paper as [125]
The Results section reports regular meal frequency and dietary restrictions among weight-loss maintainers; the Discussion also links physical activity, lower energy intake, and self-weighing with maintenance. However, the Discussion’s Strengths and limitations section says most included studies had cross-sectional designs, so describing this evidence as coming from longitudinal observational studies overstates the source. (LLM, conf=0.88)
Experimental — accuracy not yet measuredA systematic analysis of weight control registries found a consistent association between physical activity volume and weight maintenance.
“A systematic analysis of weight control registries also found a consistent association between physical activity volume and weight maintenance.”
Physical activity is prominent in weight maintenance for participants in weight control registries in the US and other countries.
“This is further supported by the prominence of physical activities in the role of weight maintenance for participants in weight control registries in the US and other countries”
From Lifestyle Medicine for Obesity in the Era of Highly Effective Anti-Obesity Treatment (2025) · cites this paper as [280]
Up to 78% of individuals maintaining weight loss outcomes weighed themselves at least once per week, and 44% did so daily.
“Up to 78% of individuals maintaining weight loss outcomes weighed themselves at least once per week, and 44% did so daily [132].”
From Dietary and Behavioral Strategies for Weight Loss and Weight Loss Maintenance: A Narrative Review (2025) · cites this paper as [132]
The most frequently reported form of activity was walking, often supplemented with other forms of moderate-intensity movement.
“The most frequently reported form of activity was walking, often supplemented with other forms of moderate-intensity movement [132].”
From Dietary and Behavioral Strategies for Weight Loss and Weight Loss Maintenance: A Narrative Review (2025) · cites this paper as [132]
Monitoring included tracking energy intake and physical activity, which enabled early detection of deviations from established targets.
“Monitoring also included tracking energy intake and physical activity, which enabled early detection of deviations from established targets [12,132].”
From Dietary and Behavioral Strategies for Weight Loss and Weight Loss Maintenance: A Narrative Review (2025) · cites this paper as [132]
Their diets were generally characterized by moderate energy density and a predominance of minimally processed foods.
“Their diets were generally characterized by moderate energy density and a predominance of minimally processed foods [12,132,133].”
From Dietary and Behavioral Strategies for Weight Loss and Weight Loss Maintenance: A Narrative Review (2025) · cites this paper as [132]
Individuals maintaining weight loss outcomes consumed meals at regular intervals, which supported appetite regulation and reduced the likelihood of impulsive eating.
“These individuals consumed meals at regular intervals, which supported appetite regulation and reduced the likelihood of impulsive eating [12,132].”
From Dietary and Behavioral Strategies for Weight Loss and Weight Loss Maintenance: A Narrative Review (2025) · cites this paper as [132]
Strategies aimed at reducing the risk of returning to previous behaviors were reported, such as meal planning, preparing food in advance, using shopping lists, and limiting the availability of high calorie foods.
“Strategies aimed at reducing the risk of returning to previous behaviors were also reported, such as meal planning, preparing food in advance, using shopping lists, and limiting the availability of high calorie foods in the environment [132,133,134].”
From Dietary and Behavioral Strategies for Weight Loss and Weight Loss Maintenance: A Narrative Review (2025) · cites this paper as [132]
Episodes of increased energy intake or reduced physical activity led to a quick return to established routines, often through temporarily increasing activity or more attentive monitoring of intake.
“Episodes of increased energy intake or reduced physical activity led to a quick return to established routines, often through temporarily increasing activity or more attentive monitoring of intake [132,133].”
From Dietary and Behavioral Strategies for Weight Loss and Weight Loss Maintenance: A Narrative Review (2025) · cites this paper as [132]
Approximately 78% of individuals maintaining weight loss outcomes reported regular breakfast consumption.
“Approximately 78% of individuals maintaining weight loss outcomes reported regular breakfast consumption [12,132].”
From Dietary and Behavioral Strategies for Weight Loss and Weight Loss Maintenance: A Narrative Review (2025) · cites this paper as [132]
In groups of individuals who maintained long-term weight loss, regular physical activity was reported significantly more frequently.
“In groups of individuals who maintained long-term weight loss, regular physical activity was reported significantly more frequently [12,125,132].”
From Dietary and Behavioral Strategies for Weight Loss and Weight Loss Maintenance: A Narrative Review (2025) · cites this paper as [132]
More pronounced and predictable effects have been observed when physical activity is combined with dietary changes.
“More pronounced and predictable effects have been observed when physical activity is combined with dietary changes [12,132].”
From Dietary and Behavioral Strategies for Weight Loss and Weight Loss Maintenance: A Narrative Review (2025) · cites this paper as [132]
Preventive strategies, such as meal planning, preparing food in advance, using shopping lists, and limiting the availability of high-calorie foods in the environment, were more frequently reported by long-term weight loss maintainers.
“Preventive strategies, such as meal planning, preparing food in advance, using shopping lists, and limiting the availability of high-calorie foods in the environment, were more frequently reported [132,133,134].”
From Dietary and Behavioral Strategies for Weight Loss and Weight Loss Maintenance: A Narrative Review (2025) · cites this paper as [132]
Diets of long-term weight loss maintainers tended to be moderate in energy density and predominantly minimally processed.
“Diets tended to be moderate in energy density and predominantly minimally processed [132,133].”
From Dietary and Behavioral Strategies for Weight Loss and Weight Loss Maintenance: A Narrative Review (2025) · cites this paper as [132]
Individuals who maintained long-term weight loss were more likely to systematically monitor their weight and behaviors, engage in regular physical activity, and maintain a consistent pattern of eating habits.
“This population was more likely to systematically monitor their weight and behaviors, engage in regular physical activity, and maintain a consistent pattern of eating habits [12,132,133].”
From Dietary and Behavioral Strategies for Weight Loss and Weight Loss Maintenance: A Narrative Review (2025) · cites this paper as [132]
In non-GLP-1 weight reduction studies, access to healthy food at home is associated with weight maintenance.
“Consistent with this, in non-GLP-1 weight reduction studies, access to healthy food at home is associated with weight maintenance [272].”
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- Authors
- Paixão, C., Dias, C. M., Jorge, R., Carraça, E. V., Yannakoulia, M., de Zwaan, M., Soini, S., Hill, J. O., Teixeira, P. J., & Santos, I.
- Affiliations
- University of Lisbon (PT)
- National Institute of Health Dr. Ricardo Jorge (PT)
- Universidade Politécnica de Santarém (PT)
- Harokopio University of Athens (GR)
- Department of Psychosomatic Medicine and Psychotherapy Hannover Medical School Hannover Germany
- University of Helsinki (FI)
- University of Alabama at Birmingham (US)
- Corresponding author
- Santos, Inês
- ORCID
- Venue
- Obesity Reviews
- Publisher
- Wiley
- Published
- 2020-02-12
- Volume
- 21
- Issue
- 5
- Pages
- e13003-e13003
- ISSN
- 1467-7881 (ISSN-L)
- 1467-789X
- PMC
- PMC9105823
- OpenAlex
- W3006107641
- Cited by
- 158
- References
- 98
- Citations by year
- 2026: 16 · 2025: 26 · 2024: 25 · 2023: 19 · 2022: 33 · 2021: 25 · 2020: 14
- FWCI
- 3.81
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Obesity Reviews (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (acceptedVersion)
- Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, other-oa)
- Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, cc-by-nc-nd)
- Funders
- Fundação para a Ciência e a Tecnologia (PTDC/DES/72317/2006, 2008‐2011)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Keywords
- weight loss maintenance, obesity treatment, behavioral factors, dietary behaviour, physical activity, breakfast consumption, vegetable consumption, long-term weight management
- MeSH terms
- Body Weight Maintenance, Diet, Healthy, Dietary Sugars, Adult, Dietary Fats, Female, Humans, Male, Middle Aged, Registries, Vegetables, Weight Loss, Exercise, Cognitive Behavioral Therapy, Breakfast
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