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Behaviour Changes Plus Diet Better Than Diet Alone for Long-Term Weight Loss: Presented at ECO

By Shazia Qureshi

AMSTERDAM, Netherlands -- May 9, 2009 -- Following initial weight loss, the combination of high-intensity behavioural change techniques with changes in diet was more successful at keeping the weight off than changes in diet alone, according to findings reported here at the 17th European Congress on Obesity (ECO).

Scottish researchers conducted a systematic review of weight-loss trials to determine which weight-loss interventions were most effective at maintaining an initial weight loss of >=10% of body weight. The weight-loss trials included in the review had evaluated lifestyle, behavioural, pharmacological, or surgical interventions. Lead author Susan Murray, MA, a PhD student in the School of Psychology, University of Aberdeen, Aberdeen, Scotland, presented the findings May 7.

Only randomised controlled trials evaluating 1 or more lifestyle, behavioural, pharmacological, or surgical interventions published between 1996 and 2007 were included in the review. In addition, to be included, studies had to have a minimum weight-loss period of 4 weeks and randomisation of participants after the weight-loss period. The overall duration of the study had to be at least 1 year, which could include either the weight-loss and weight-maintenance period only or an unsupervised follow-up period.

Participant inclusion criteria included age >18 years, a pre-weight-loss body mass index of >=30 kg/m², and a weight loss of >=10% of body weight during the initial weight-loss period. Studies that included participants with existing eating disorders or patients on antipsychotic drug treatment were excluded from the review.

The investigators identified 11 studies, which included 20 intervention groups and a total of 1,975 participants. No surgical-intervention studies were identified in the final 11, and 4 of the 11 studies did not include a control group.

Murray conducted a meta-analysis of participants' (n = 660) weight change but did not include the 4 studies with no control group. The meta-analysis showed that, at the end of the weight-maintenance period, participants in the intervention groups showed a significant weight loss of 2.19 kg (95% CI, 1.29-3.09 kg) compared with those in the control groups.

The investigators also found that the studies that combined high-intensity behavioural change techniques with changes in diet were the most successful at keeping the weight off during the weight-maintenance period; using these combined interventions, 89.5% of the initial weight loss was maintained. Diet-only trials showed the lowest maintenance rate, with 60.4% of the initial weight loss maintained. Pharmacological trials showed a rate of 81.5%, but drug interventions were always accompanied by dietary or behavioural advice.

The most commonly reported behavioural change techniques, which were also associated with the most successful interventions, included self-monitoring (eg, food diaries), instructions to the participant (eg, how to make better food choices), and identifying barriers to success (eg, pinpointing difficult situations).

The study was funded by LighterLife Ltd UK.

[Presentation title: Systematic Review of Weight Maintenance Following Weight Loss. Abstract T1:OS1.1]

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