Association between characteristics of behavioural weight loss programmes and weight change after programme end: systematic review and meta-analysis
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Objective: To determine if the characteristics of behavioural weight loss programmes influence the rate of change in weight after the end of the programme. Design: Systematic review and meta-analysis. Data sources: Trial registries, 11 electronic databases, and forward citation searching (from database inception; latest search December 2019). Randomised trials of behavioural weight loss programmes in adults with overweight or obesity, reporting outcomes at ≥12 months, including at the end of the programme and after the end of the programme. Review methods: Studies were screened by two independent reviewers with discrepancies resolved by discussion. 5% of the studies identified in the searches met the inclusion criteria. One reviewer extracted the data and a second reviewer checked the data. Risk of bias was assessed with Cochrane’s risk of bias tool (version 1). The rate of change in weight was calculated (kg/month; converted to kg/year for interpretability) after the end of the programme in the intervention versus control groups by a mixed model with a random intercept. Associations between the rate of change in weight and prespecified variables were tested. Results: Data were analysed from 249 trials (n=59 081) with a mean length of follow-up of two years (longest 30 years). 56% of studies (n=140) had an unclear risk of bias, 21% (n=52) a low risk, and 23% (n=57) a high risk of bias. Regain in weight was faster in the intervention versus the no intervention control groups (0.12-0.32 kg/year) but the difference between groups was maintained for at least five years. Each kilogram of weight lost at the end of the programme was associated with faster regain in weight at a rate of 0.13-0.19 kg/year. Financial incentives for weight loss were associated with faster regain in weight at a rate of 1-1.5 kg/year. Compared with programmes with no meal replacements, interventions involving partial meal replacements were associated with faster regain in weight but not after adjustment for weight loss during the programme. Access to the programme outside of the study was associated with slower regain in weight. Programmes where the intensity of the interaction reduced gradually were also associated with slower regain in weight in the multivariable analysis, although the point estimate suggested that the association was small. Other characteristics did not explain the heterogeneity in regain in weight. Conclusion: Faster regain in weight after weight loss was associated with greater initial weight loss, but greater initial weight loss was still associated with reduced weight for at least five years after the end of the programme, after which data were limited. Continued availability of the programme to participants outside of the study predicted a slower regain in weight, and provision of financial incentives predicted faster regain in weight; no other clear associations were found. Study registration: PROSPERO CRD42018105744.
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The rate of weight regain was faster after WMMs than after BWMPs, and greater initial weight loss was typically associated with faster weight regain.
“However, the rate of weight regain was faster after WMMs than after BWMPs and greater initial weight loss was typically associated with faster weight regain.11”
From Weight regain after cessation of medication for weight management: systematic review and meta-analysis (2026) · cites this paper as [11]
The Results (‘Change in weight during the programme’; page not provided) report that greater initial weight loss was associated with faster regain. The paper examines behavioural weight-loss programmes, but the passages do not establish that regain was faster after weight-management medications (WMMs) than after behavioural weight-management programmes (BWMPs). (LLM, conf=0.88)
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“11 Nevertheless, in our sensitivity analysis (fig 4), we still observed faster weight regain after WMM for a fixed amount of initial weight loss.”
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Self-citation
- Authors
- Hartmann-Boyce, J., Theodoulou, A., Oke, J. L., Butler, A. R., Scarborough, P., Bastounis, A., Dunnigan, A., Byadya, R., Hobbs, F. D. R., Sniehotta, F. F., Jebb, S. A., & Aveyard, P.
- Affiliations
- University of Oxford (GB)
- NIHR Oxford Biomedical Research Centre (GB)
- University of Nottingham (GB)
- Royal Free London NHS Foundation Trust (GB)
- World Food Programme (IT)
- Newcastle University (GB)
- ORCID
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2021-08-17
- Volume
- 374
- Pages
- n1840
- ISSN
- 1756-1833 (ISSN-L)
- PMC
- PMC8369384
- OpenAlex
- W3195371408
- Cited by
- 55
- References
- 24
- Citations by year
- 2026: 7 · 2025: 9 · 2024: 14 · 2023: 13 · 2022: 11 · 2021: 1
- FWCI
- 1.74
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- BMJ (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Repository@Nottingham (University of Nottingham) (publishedVersion, other-oa)
- University of Twente Research Information (publishedVersion, cc-by)
- Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by-nc)
- University of Twente Research Information (submittedVersion, cc-by-nc)
- Newcastle University ePrints (Newcastle Univesity) (cc-by-nc)
- Funders
- National Institute for Health and Care Research (15/09/04)
- British Heart Foundation (PG/17/68/33247)
- Department of Health and Social Care
- NIHR School for Primary Care Research
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Pharmacology › Pharmacology and Obesity Treatment
- Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
- Keywords
- weight regain, obesity, overweight, financial incentives, meal replacement, weight loss maintenance, long-term follow-up, intervention characteristics, adults with obesity, risk of bias in trials
- MeSH terms
- Body-Weight Trajectory, Adult, Behavior Therapy, Female, Humans, Male, Middle Aged, Obesity, Program Evaluation, Weight Loss, Randomized Controlled Trials as Topic, Treatment Outcome, Overweight, Weight Reduction Programs
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