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Guidelines on Overweight and Obesity: Electronic Textbook
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Weight Maintenance at Lower Weight

Once the goals of weight loss have been successfully achieved, maintenance of a lower body weight becomes a major challenge. In the past, obtaining the goal of weight loss has been considered the end of weight loss therapy. Unfortunately, once patients are dismissed from clinical therapy, they frequently regain the lost weight. This report recommends that observation, monitoring, and encouragement of patients who have successfully lost weight be continued on a long-term basis.

Evidence Statement: After 6 months of weight loss treatment, efforts to maintain weight loss through diet, physical activity, and behavior therapy are important. Evidence Category B.

Rationale: After 6 months of weight loss, the rate of weight loss usually declines and plateaus (395, 507, 555). The primary care practitioner and patient should recognize that at this point, weight maintenance, the second phase of the weight loss effort, should take priority. Successful weight maintenance is defined as a weight regain of 3 kg (6.6 lb) in 2 years and a sustained reduction in waist circumference at at least 4 cm. If a patient wishes to lose more weight after a period of weight maintenance, the procedure for weight loss outlined above can be repeated.

Recommendation: A weight maintenance program should be a priority after the initial 6 months of weight loss therapy. Evidence Category B.

Evidence Statement: Lost weight usually will be regained unless a weight maintenance program consisting of dietary therapy, physical activity, and behavioral therapy is continued indefinitely. Drug therapy can also be used; however, drug safety and efficacy beyond 1 year of total treatment have not been established. Evidence Category B.

Rationale: After a patient has achieved the goals of weight loss, the combined modalities of therapy (dietary therapy, physical activity, and behavior therapy) must be continued indefinitely; otherwise excess weight will likely be regained. Numerous strategies are available for motivating the patient; all of these require that the practitioner continue to communicate frequently with the patient. Long-term monitoring and encouragement can be accomplished in several ways: by regular clinic visits, at group meetings, or via telephone or E-mail. The longer the weight maintenance phase can be sustained, the better the prospects for long-term success in weight reduction. Drug therapy may also be helpful during the weight maintenance phase. 

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