BACKGROUND: Current perception is that participants of a structured weight-loss program regain all of their weight loss within 5 y. OBJECTIVE: The objective was to examine the long-term weight-loss maintenance of individuals completing a structured weight-loss program. DESIGN: Studies were required to (1) have been conducted in the United States, (2) have included participants in a structured weight-loss program, (3) have provided follow-up data with variance estimates for >= 2 y. Primary outcome variables were weight-loss maintenance in kilograms, weight-loss maintenance as a percentage of initial weight loss, and weight loss as a percentage of initial body weight (reduced weight). RESULTS: Twenty-nine studies met the inclusion criteria. Successful very-low-energy diets (VLEDs) were associated with significantly greater weight-loss maintenance than were successful hypoenergetic balanced diets (HBDs) at all years of follow-up. The percentage of individuals at 4 or 5 y of follow-up for VLEDs and HBDs were 55.4% and 79.7%, respectively. The results for VLEDs and HBDs, respectively, were as follows: weight-loss maintenance 7.1 (95% CI 6.1 to 8.1 kg) and 2.0 (1.5 to 2.5) kg; percentage weight-loss maintenance 29% (25% to 33%) and 17% (13% to 22%); and reduced weight 6.6% (5.7% to 7.5%) and 2.1% (1.6% to 2.7%). Weight-loss maintenance did not differ significantly between women and men. Six studies reported that groups who exercised more had significantly greater weight-loss maintenance than did those who exercised less. CONCLUSIONS: Five years after completing structured weight-loss programs, the average individual maintained a weight loss of > 3 kg and a reduced weight of > 3% of initial body weight. After VLEDs or weight loss of >= 20 kg, individuals maintained significantly more weight loss than after HBDs or weight losses of < 10 kg.
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