Long-Term Effect of Weight Regain Following Behavioral Weight Management Programs on Cardiometabolic Disease Incidence and Risk: Systematic Review and Meta-Analysis
Open accessAbstract
Background: Behavioral weight management programs (BWMPs) enhance weight loss in the short term, but longer term cardiometabolic effects are uncertain as weight is commonly regained. We assessed the impact of weight regain after BWMPs on cardiovascular risk factors, diabetes, and cardiovascular disease. Methods: Trial registries, 11 databases, and forward-citation searching (latest search, December 19) were used to identify articles published in English, from any geographical region. Randomized trials of BWMPs in adults with overweight/obesity reporting cardiometabolic outcomes at ≥12 months at and after program end were included. Differences between more intensive interventions and comparator groups were synthesized using mixed-effects, meta-regression, and time-to-event models to assess the impact of weight regain on cardiovascular disease incidence and risk. Results: One hundred twenty-four trials reporting on ≥1 cardiometabolic outcomes with a median follow-up of 28 (range, 11–360) months after program end were included. Median baseline participant body mass index was 33 kg/m 2 ; median age was 51 years. Eight and 15 study arms (7889 and 4202 participants, respectively) examined the incidence of cardiovascular disease and type 2 diabetes, respectively, with imprecise evidence of a lower incidence for at least 5 years. Weight regain in BWMPs relative to comparators reduced these differences. One and 5 years after program end, total cholesterol/HDL (high-density lipoprotein) ratio was 1.5 points lower at both times (82 studies; 19 003 participants), systolic blood pressure was 1.5 mm mercury and 0.4 mm lower (84 studies; 30 836 participants), and HbA1c (%) 0.38 lower at both times (94 studies; 28 083 participants). Of the included studies, 22% were judged at high risk of bias; removing these did not meaningfully change results. Conclusions: Despite weight regain, BWMPs reduce cardiometabolic risk factors with effects lasting at least 5 years after program end and dwindling with weight regain. Evidence that they reduce the incidence of cardiovascular disease or diabetes is less certain. Few studies followed participants for ≥5 years. Registration: URL: https://www.crd.york.ac.uk/PROSPERO/ ; Unique identifier: CRD42018105744.
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The benefits of weight loss on diabetes and other cardiovascular disease risk markers were attenuated by weight regain.
“The benefits of weight loss on diabetes and other cardiovascular disease risk markers were, however, attenuated by weight regain.10”
From Weight regain after cessation of medication for weight management: systematic review and meta-analysis (2026) · cites this paper as [10]
The Discussion (page unavailable) reports that weight regain reduced improvements in cardiometabolic risk factors, but explicitly excepts glycemic control. The Results (Effects of Interventions; page unavailable) found no evidence of an association between weight regain and glycemic control, so the claim overgeneralizes the attenuation to diabetes-related markers. (LLM, conf=0.84)
Experimental — accuracy not yet measuredOur systematic review of weight change in randomized controlled trials after the cessation of behavioral weight management programs estimated weight regain to be between 0.12 and 0.32 kg/year.
“Indeed, our systematic review of weight change in RCTs after the cessation of behavioral weight management programs estimated weight regain to be between 0.12 and 0.32 kg/year.”
From The societal implications of using glucagon-like peptide-1 receptor agonists for the treatment of obesity (2025) · cites this paper as [81]
The What the Study Adds section reports weight regain of 0.12–0.32 kg/year after program end, depending on the model. That estimate is explicitly *more than the comparator group*, a qualifier the citing sentence omits. (LLM, conf=0.88)
Experimental — accuracy not yet measuredA review of behavioral weight management programs found benefits for cardiometabolic health lasting approximately 5 years after program end, which has so far not been indicated following the cessation of weight loss using the new pharmacological agents.
“A review of behavioral weight management programs found benefits for cardiometabolic health lasting ∼5 years after program end, which has so far not been indicated following the cessation of weight loss using the new pharmacological agents.”
From The societal implications of using glucagon-like peptide-1 receptor agonists for the treatment of obesity (2025) · cites this paper as [81]
Split into 2 atoms — 1 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredCounselling by a dietitian and/or implementation of weight management programs is associated with improvements in cardiometabolic risk factors including reductions in dyslipidemia (total cholesterol, low-density lipoprotein and triglycerides), blood pressure, glycosylated hemoglobin, fasting blood glucose and insulin resistance.
“other studies have reported improvements in risk factors for cardiometabolic disease including reductions in dyslipidemia (total cholesterol, low-density lipoprotein and triglycerides), blood pressure, glycosylated hemoglobin, fasting blood glucose and insulin resistance following counselling by a dietitian and/or implementation of weight management programs [[104], [105], [106]].”
From Application of nutrition interventions with GLP-1 based therapies: A narrative review of the challenges and solutions (2025) · cites this paper as [105]
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Sorted by citations
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“10-12 With the continued development of new incretin mimetic related treatments, 13 the use of WMMs is likely to become more common.”
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“Mean-while, there were studies showing that weight regain can cause some metabolic indicators to revert back such as plasma lipids, blood pressure, fasting glucose, and insulin concentrations [18, 19].”
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“33 Practice Implication: Potential concerns about providing overweight and obesity interventions highlight the importance of overcoming obesity bias when delivering health care and actively fi ghting weight stigma.”
BackgroundText Messages With Financial Incentives for Men With Obesity
Hoddinott, P., O’Dolan, C., Macaulay, L., Dombrowski, S. U., Swingler, J., Cotton, S. C., Avenell, A., Getaneh, A. M., Gray, C. M., Hunt, K., et al. (2024) · JAMA · doi:10.1001/jama.2024.7064 · Cited by 28 · see citing works
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Self-citationWeight Management Strategies to Reduce Metabolic Morbidity in Women With Polycystic Ovary Syndrome
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Embracing the Pros and Cons of the New Weight Loss Medications (Semaglutide, Tirzepatide, Etc.)
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“…will be as critical as ever, because they also have legacy effects on their own, even when reduced or discontinued that need to be embraced [99–103], just as much as these novel pharmacologic weight loss interventions, which as of this moment have not demonstrated similar such effects when…”
BackgroundScragg, J., Koutoukidis, D. A., Dirksen, C., Heitmann, B. L., & Jebb, S. A. (2025) · Med · doi:10.1016/j.medj.2025.100805 · Cited by 16 · see citing works
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“(2) another action that can reduce the risk is increasing BW [63], but it should be noted that increasing BW itself is one of the risk factors that can lead to many other diseases [64,65], so increasing BW cannot be used as a logical and correct solution.”
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Maltos-Gómez, F., Brito-López, A., Uriarte-Ortiz, J. B., Guízar-Sánchez, D., Muñoz-Comonfort, A., & Sampieri-Cabrera, R. (2024) · Cureus · doi:10.7759/cureus.66561 · Cited by 14 · see citing works
“Similarly, ultra-processed foods rich in sugars and trans fats are associated with an increase in depressive symptoms owing to their negative effects on metabolic and neuropsychological health [43].”
BackgroundThe role of intermittent fasting and ketogenic diet in metabolic syndrome and type 2 diabetes
Delrue, C., Speeckaert, R., & Speeckaert, M. M. (2025) · Acta Clinica Belgica · doi:10.1080/17843286.2025.2540287 · Cited by 7 · see citing works
“Long-term studies suggest that without continuous behavioral support and flexible, patient-centered adaptations, both IF and KD may result in partial or complete reversal of initial weight loss and metabolic improvements [56,63,64].”
Non-Interventional Weight Changes Are Associated with Alterations in Serum Uric Acid Levels
Weinstein, S., Maor, E., Bleier, J., Kaplan, A., Hod, T., Leibowitz, A., Grossman, E., & Shlomai, G. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13082314 · Cited by 7 · see citing works
Weight regain after cessation of GLP-1 drugs
Sun, Q. (2026) · BMJ · doi:10.1136/bmj.r2586 · Cited by 6 · see citing works
Theodoulou, A., Hartmann‐Boyce, J., Gorenberg, J., Oke, J. L., Butler, A. R., Bastounis, A., Jebb, S. A., & Aveyard, P. N. (2023) · Clinical Obesity · doi:10.1111/cob.12575 · Cited by 6 · see citing works
“Behavioural weight management programmes (BWMPs) lead to weight loss and at 1 year there is evidence of improved physical health.(1) A recent systematic review investigated the impact of BWMPs on mental health related outcomes and reported improvements in depression, mental health-related quality-of-life (QoL) and sel…”
BackgroundMethodInfluentialSelf-citationObesity as a modifiable risk factor in patients with chronic kidney disease
Morales, E., Jenssen, T. G., Bevc, S., Miglinas, M., Martin, W. P., Theodorakopoulou, M. P., Jørgensen, M. B., & Trillini, M. (2025) · Nephrology Dialysis Transplantation · doi:10.1093/ndt/gfaf231 · Cited by 8 · see citing works
Is weight cycling clinically harmful?
Magkos, F., & Stefan, N. (2026) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(26)00037-9 · Cited by 3 · see citing works
Weight management with orlistat in type 2 diabetes: an electronic health records study
Ghosal, S., Heron, N., Mason, K. J., Bailey, J., & Jordan, K. P. (2024) · British Journal of General Practice · doi:10.3399/bjgp.2023.0684 · Cited by 3 · see citing works
Mehran, L., Honarvar, M., Masoumi, S., Khalili, D., Azizi, F., Blaha, M. J., & Amouzegar, A. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2024.1345781 · Cited by 3 · see citing works
Birch, J. M., Mueller, J., Damery, S. L., Sharp, S. J., Jones, R. A. P., Kelly, M. P., Anderson, A. S., Astbury, N. M., Aveyard, P. N., Beeken, R. J., et al. (2025) · BMJ Public Health · doi:10.1136/bmjph-2024-001382 · Cited by 2 · see citing works
Self-citationPatient Empowerment for Lifestyle Changes in Metabolic-Bariatric Surgery—A German Nationwide Survey
Finze, A., Reißfelder, C., Blank, S., Otto, M., Stier, C. K., Meier, R., Schreiter, J., Nicolli, A., Quenstedt, T., Tigiser, E., et al. (2025) · Obesity Surgery · doi:10.1007/s11695-025-07989-0 · Cited by 2 · see citing works
“Exercise tracking was found to be subjectively less significant as a smartphone feature in patients that had MBS > 1 year prior Results for long-term weight loss and weight loss maintenance via lifestyle interventions only over more than 1 year are very poor [24, 25].”
Galavazi, M., Wallenius, V., Schnecke, V., Ericsson, Å., Björklund, H., & JENDLE, J. H. (2025) · Obesity · doi:10.1002/oby.24232 · Cited by 1 · see citing works
“As such, the results from this modeling study were expected to mirror that of the real-world setting in which long-term sustained weight loss remains challenging even with bariatric surgery [46 – 48].”
Alexander, S. E., & Howden, E. J. (2026) · Current Opinion in Clinical Nutrition & Metabolic Care · doi:10.1097/mco.0000000000001232 · Cited by 1 · see citing works
Stamatiou, A., Theodorakopoulou, M. P., Iatridi, F., Koufakis, T., Kotsa, K., & Sarafidis, P. A. (2026) · Diabetes Obesity and Metabolism · doi:10.1111/dom.70997 · Cited by 1 · see citing works
Voils, C. I., Shaw, R. J., Gavin, K. L., Hetzel, S., Lewis, M. A., Pabich, S., Johnson, H. M., Elwert, F., Mao, L., Gray, K. E., et al. (2024) · BMC Public Health · doi:10.1186/s12889-024-19464-z · Cited by 1 · see citing works
“Evidence-based weight management programs incorporating behavioral strategies and focusing on dietary change and physical activity can lead to clinically significant weight loss of at least 5% and corresponding improvements in blood pressure, lipids, and blood sugar [5].”
BackgroundWoolley, A. K., Sumner, A., Gupta, M., Sathanapally, H., Bodicoat, D. H., Khunti, K. K., & Seidu, S. (2025) · Primary care diabetes · doi:10.1016/j.pcd.2025.01.008 · Cited by 4 · see citing works
Long-Term Outcomes Following Behavioral Weight Management Programs: Worth the Weight
Rao, V. N., & Pagidipati, N. J. (2023) · Circulation Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.123.009965
Weight loss even associated with weight regain is shown to improve cardiovascular risks
IDRIS, I. R. (2023) · Diabetes Obesity and Metabolism Now · doi:10.1002/doi2.48
Non-interventional weight changes are associated with alterations in uric acid levelsPreprint
Weinstein, S., Maor, E., Kaplan, A., Hod, T., Leibowitz, A., Grossman, E., & Shlomai, G. (2023) · Research Square · doi:10.21203/rs.3.rs-3339380/v1
Weight Loss Maintenance After Financial Incentives End—Reply
Hoddinott, P., Dombrowski, S. U., & Kee, F. (2024) · JAMA · doi:10.1001/jama.2024.17414
Dombrowski, S. U., Hoddinott, P., Swingler, J., Macaulay, L., O’Dolan, C., Cotton, S. C., Avenell, A., Getaneh, A. M., Gray, C. M., Hunt, K., et al. (2024) · medRxiv · doi:10.1101/2024.12.12.24318921
Eklou, M., Kpotoufe, K., Mélila, M., Awaga, K. L., Kilimou, M., & Amouzou, K. (2025) · International Journal of Nutrition and Food Sciences · doi:10.11648/j.ijnfs.20251406.14
Voils, C. I., Shaw, R. J., Gavin, K. L., Hetzel, S., Lewis, M. A., Pabich, S., Johnson, H. M., Elwert, F., Mao, L., Gray, K. E., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26341983
Voils, C. I., Shaw, R. J., Gavin, K. L., Hetzel, S., Lewis, M. A., Pabich, S., Johnson, H. M., Elwert, F., Mao, L., Gray, K. E., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26341941
Lyus, R., & Logue, M. (2026) · Health Promotion International · doi:10.1093/heapro/daag008
The Inadvertent Use of Weight-loss Medications may Result in Adverse Health Outcomes
Chowdhury, C. R. (2026) · The British Journal of Translational Global Health · doi:10.5005/bjotgh-11016-0035
Meza-Miranda, E. R. (2025) · Memorias del Instituto de Investigaciones en Ciencias de la Salud · doi:10.18004/mem.iics/1812-9528/2025.e23122507
Annemans, L., Johansson, E., Spaepen, E., van Hest, N., Grist, J., Zimner‐Rapuch, S., & Wilding, J. P. H. (2026) · Journal of Medical Economics · doi:10.1080/13696998.2026.2646079 · Cited by 1 · see citing works
Kudlek, L., Hennig, H. Z., Haumann, H., & Sniehotta, F. F. (2026) · Obesity Facts · doi:10.1159/000552226
“Importantly, recent evidence suggests that such programmes can reduce cardiometabolic risk factors despite weight regain, suggesting health benefits independent of weight loss maintenance [10].”
Self-citationGalavazi, M., Shahed, Q., Hesser, H., Cao, Y., Jansson, S. P. O., van Nieuwenhoven, M. A., & JENDLE, J. H. (2026) · Diabetes Obesity and Metabolism · doi:10.1111/dom.70865
Grabias, N., Gryko, R., Rajkowska, M., Włodarczyk, A., Jarząbek, P., Mieszkowska, J. W., Tejchma, A. K., Woźniak, Ł. D., Myszewski, B., & Piotrowski, J. (2026) · International Journal of Innovative Technologies in Social Science · doi:10.31435/ijitss.2(50).2026.5033
Parretti, H. M., Hughes, C. A., Erskine, S. E., Steel, N., & Jennings, A. (2026) · Clinical Obesity · doi:10.1111/cob.70096
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“Moreover, the cardiometabolic risk factor improvements observed with weight loss wane over 5 years with weight regain [13, 23], highlighting the importance of long-term weight maintenance.”
Barbosa, B. C. R., Fróis, L. F., Vidigal, M. C. A., Sabbagh, M. I. R., Souza, D. R. D. O., de Aguiar, A. S., Machado, Í. E., & Meireles, A. L. (2026) · Revista Brasileira de Epidemiologia · doi:10.1590/1980-549720260028.2
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“The association between frequent intake of UPF and increased levels of depressive symptoms 27 can be explained by the adverse effects of these foods on metabolic health and neuropsychological functioning 28 .”
Sarebanhassanabadi, M., Mohammadi, A., Marques-Vidal, P. M., Seyedhosseini, S., Namayandeh, S. M., Hedesh, H. M., & Mozafari, S. (2026) · Food Science & Nutrition · doi:10.1002/fsn3.72249
Elshakankiry, A. M., Hunter, G. R., Martins, C., Fisher, G., Garvey, W. T., & Howell, C. R. (2026) · Obesity · doi:10.1002/oby.70291
“Previous studies have shown that cardiometabolic improvements are attenuated when weight is regained, reinforcing the need to understand the rebound in metabolic risk associated with weight regain following successful weight loss interventions [9, 10].”
Gryspeerdt, D., Samyn, L., Willems, R. P., Kafyra, M., Kalafati, I. P., Annemans, L., Dedoussis, G. V., & Verhaeghe, N. (2026) · Obesity Reviews · doi:10.1111/obr.70234
- Authors
- Hartmann-Boyce, J., Theodoulou, A., Oke, J. L., Butler, A. R., Bastounis, A., Dunnigan, A., Byadya, R., Cobiac, L. J., Scarborough, P., Hobbs, F. D. R., Sniehotta, F. F., Jebb, S. A., & Aveyard, P.
- Affiliations
- Nuffield Department of Primary Care Health Sciences (J.H.-B., A.T., A.R.B., A.B., R.B., F.D.R.H., S.A.J., P.A.), University of Oxford, United Kingdom.
- 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)
- Corresponding author
- Aveyard, Paul
- ORCID
- Venue
- Circulation: Cardiovascular Quality and Outcomes
- Published
- 2023-04
- Volume
- 16
- Issue
- 4
- Pages
- e009348-e009348
- ISSN
- 1941-7705 (ISSN-L)
- 1941-7713
- PMC
- PMC10106109
- OpenAlex
- W4361190087
- Cited by
- 53
- References
- 145
- Citations by year
- 2026: 19 · 2025: 13 · 2024: 14 · 2023: 7
- FWCI
- 1.90
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Circulation Cardiovascular Quality and Outcomes (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Griffith Research Online (submittedVersion, cc-by)
- Newcastle University ePrints (Newcastle Univesity) (cc-by)
- Greater South Information System
- Funders
- National Institute for Health and Care Research (15/09/04, NIHR203808)
- British Heart Foundation (PG/17/68/33247, FS/15/34/31656)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Keywords
- weight regain, obesity, overweight, cardiometabolic risk, cardiovascular disease incidence, type 2 diabetes, cardiovascular risk factors, TC/HDL-C ratio, systolic blood pressure, HbA1c, long-term follow-up
- MeSH terms
- Adult, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Humans, Middle Aged, Weight Gain, Incidence, Weight Reduction Programs
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