title: Long term maintenance of weight loss with non-surgical interventions in obese adults: systematic review and meta-analyses of randomised controlled trials.
abstract: OBJECTIVE
  To systematically review and describe currently available approaches to supporting maintenance of weight loss in obese adults and to assess the evidence for the effectiveness of these interventions.
  
  
  METHODS
  Systematic review with meta-analysis.
  
  
  METHODS
  Medline, PsycINFO, Embase, and the Cochrane Central Register of Controlled Trials.
  
  
  METHODS
  Studies were identified through to January 2014. Randomised trials of interventions to maintain weight loss provided to initially obese adults (aged ≥ 18) after weight loss of ≥ 5% body weight with long term (≥ 12 months) follow-up of weight change (main outcome) were included.
  
  
  METHODS
  Potential studies were screened independently and in duplicate; study characteristics and outcomes were extracted. Meta-analyses were conducted to estimate the effects of interventions on weight loss maintenance with the inverse variance method and a random effects model. Results are presented as mean differences in weight change, with 95% confidence intervals.
  
  
  RESULTS
  45 trials involving 7788 individuals were included. Behavioural interventions focusing on both food intake and physical activity resulted in an average difference of -1.56 kg (95% confidence interval -2.27 to -0.86 kg; 25 comparisons, 2949 participants) in weight regain compared with controls at 12 months. Orlistat combined with behavioural interventions resulted in a -1.80 kg (-2.54 to -1.06; eight comparisons, 1738 participants) difference compared with placebo at 12 months. All orlistat studies reported higher frequencies of adverse gastrointestinal events in the experimental compared with placebo control groups. A dose-response relation for orlistat treatment was found, with 120 mg doses three times a day leading to greater weight loss maintenance (-2.34 kg, -3.03 to -1.65) compared with 60 mg and 30 mg three times a day (-0.70 kg, 95% confidence interval -1.92 to 0.52), P=0.02.
  
  
  CONCLUSIONS
  Behavioural interventions that deal with both diet and physical activity show small but significant benefits on weight loss maintenance.
authors.affiliation: Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne NE2 4AX, UK School of Natural Sciences, University of Stirling, Cottrell Building, Stirling FK9 4LA, UK.
authors.forename: S U
authors.initials: SU
authors.lastname: Dombrowski
authors.affiliation: Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne NE2 4AX, UK MoveLab - Physical Activity and Exercise Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne NE2 4HH, UK.
authors.forename: K
authors.initials: K
authors.lastname: Knittle
authors.affiliation: Health Services Research Unit, Health Sciences Building, University of Aberdeen, Aberdeen AB25 2ZD, UK.
authors.forename: A
authors.initials: A
authors.lastname: Avenell
authors.affiliation: Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne NE2 4AX, UK.
authors.forename: V
authors.initials: V
authors.lastname: Araújo-Soares
authors.affiliation: Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne NE2 4AX, UK falko.sniehotta@ncl.ac.uk.
authors.forename: F F
authors.initials: FF
authors.lastname: Sniehotta
mesh_terms: D001521:Behavior Therapy / Q000379:methods; D001835:Body Weight; D004038:Diet, Reducing; D015444:Exercise; D015438:Health Behavior; D006801:Humans; D009765:Obesity / Q000517:prevention & control* / Q000523:psychology; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss