title: Effects of anti-obesity drugs, diet, and exercise on weight-loss maintenance after a very-low-calorie diet or low-calorie diet: a systematic review and meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Weight-loss maintenance remains a major challenge in obesity treatment.
  
  
  OBJECTIVE
  The objective was to evaluate the effects of anti-obesity drugs, diet, or exercise on weight-loss maintenance after an initial very-low-calorie diet (VLCD)/low-calorie diet (LCD) period (<1000 kcal/d).
  
  
  METHODS
  We conducted a systematic review by using MEDLINE, the Cochrane Controlled Trial Register, and EMBASE from January 1981 to February 2013. We included randomized controlled trials that evaluated weight-loss maintenance strategies after a VLCD/LCD period. Two authors performed independent data extraction by using a predefined data template. All pooled analyses were based on random-effects models.
  
  
  RESULTS
  Twenty studies with a total of 27 intervention arms and 3017 participants were included with the following treatment categories: anti-obesity drugs (3 arms; n = 658), meal replacements (4 arms; n = 322), high-protein diets (6 arms; n = 865), dietary supplements (6 arms; n = 261), other diets (3 arms; n = 564), and exercise (5 arms; n = 347). During the VLCD/LCD period, the pooled mean weight change was -12.3 kg (median duration: 8 wk; range 3-16 wk). Compared with controls, anti-obesity drugs improved weight-loss maintenance by 3.5 kg [95% CI: 1.5, 5.5 kg; median duration: 18 mo (12-36 mo)], meal replacements by 3.9 kg [95% CI: 2.8, 5.0 kg; median duration: 12 mo (10-26 mo)], and high-protein diets by 1.5 kg [95% CI: 0.8, 2.1 kg; median duration: 5 mo (3-12 mo)]. Exercise [0.8 kg; 95% CI: -1.2, 2.8 kg; median duration: 10 mo (6-12 mo)] and dietary supplements [0.0 kg; 95% CI: -1.4, 1.4 kg; median duration: 3 mo (3-14 mo)] did not significantly improve weight-loss maintenance compared with control.
  
  
  CONCLUSIONS
  Anti-obesity drugs, meal replacements, and high-protein diets were associated with improved weight-loss maintenance after a VLCD/LCD period, whereas no significant improvements were seen for dietary supplements and exercise.
authors.affiliation: Clinical Epidemiology Unit (KJ and MN) and the Obesity Center (EH), Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Kari
authors.initials: K
authors.lastname: Johansson
authors.forename: Martin
authors.initials: M
authors.lastname: Neovius
authors.forename: Erik
authors.initials: E
authors.lastname: Hemmingsson
mesh_terms: D019440:Anti-Obesity Agents / Q000627:therapeutic use*; D031204:Caloric Restriction; D016208:Databases, Factual; D002149:Energy Intake; D015444:Exercise; D005247:Feeding Behavior; D006801:Humans; D062407:Meals; D009765:Obesity / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D015431:Weight Loss / Q000187:drug effects*
chemical_list: D019440:Anti-Obesity Agents