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Structured low-energy diet maintenance prevents post-weight-loss regain and sustains long-term weight reduction after major loss.
A structured low-energy diet maintenance programme prevents weight regain and sustains more than 15 kg weight loss for up to 78 weeks, with the 5:2 total diet replacement outperforming daily meal replacement at 26 weeks—according to new randomized trial data.
This 78-week randomized trial enrolled 63 adults (75% female; body mass index 23–61 kg/m²) who had lost over 8 kg through diets, behavioral programs, or weight-loss medications. Participants previously treated with anti-obesity medications, including orlistat and liraglutide, were eligible if they were weight-stable or regaining weight following medication withdrawal. The enrolled subjects were randomized to one of two formula low-energy diets (LED) maintenance strategies:
Both interventions were delivered within a structured, dietitian-led weight-loss maintenance programme. The key endpoint was weight alteration at 26 weeks after randomization. Analyses used repeated ANCOVA adjusted for baseline weight, applying intention-to-treat (ITT), per-protocol, and as-treated approaches. Qualitative interviews were completed with 6 dietitians and 25 participants (40%) at 26 weeks.
At 26 weeks, data were available for 97% of participants in both groups. Notably, 4 participants continued pre-existing weight-loss pharmacotherapy (3 using orlistat up to 78 weeks and 1 using liraglutide up to 52 weeks); sensitivity analyses excluding these individuals exhibited similar findings (Table 1).
Weight losses from the start of the pre-study period remained substantial, with both groups maintaining reductions exceeding 15 kg at 26, 52, and 78 weeks. Adherence and acceptance were high across both dietary approaches. Dietitians successfully adapted the interventions to help participants navigate social and environmental challenges, and outcomes were consistent even when excluding participants on weight-loss medications.
In conclusion, structured dietary programs delivered lasting weight-loss success, effectively preventing post-loss regain. Both intermittent 5:2TDR and DMR approaches were practical, widely accepted, and maintained substantial weight reductions over the long term, even after stopping glucagon-like peptide-1 (GLP-1) medications.
Clinical Nutrition
Diet strategies for maintaining substantial therapeutic weight loss: 78-week mixed methods randomised trial
Naomi Brosnahan et al.
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