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 (< 1,000 kcal/d). DESIGN: 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 3,017 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 to 16 wk). Compared with controls, anti-obesity drugs improved weight-loss maintenance by 3.5 kg (95% CI 1.5 to 5.5 kg; median duration 18 mo (12 to 36 mo)), meal replacements by 3.9 kg (95% CI 2.8 to 5.0 kg; median duration 12 mo (10 to 26 mo)), and high-protein diets by 1.5 kg (95% CI 0.8 to 2.1 kg; median duration 5 mo (3 to 12 mo)). Exercise (0.8 kg; 95% CI -1.2 to 2.8 kg; median duration 10 mo (6 to 12 mo)) and dietary supplements (0.0 kg; 95% CI -1.4 to 1.4 kg; median duration 3 mo (3 to 14 mo)) did not significantly improve weight-loss maintenance compared with control. CONCLUSION: 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.
Copyright by the American Society for Clinical Nutrition.

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