ArticlesThe effect of rate of weight loss on long-term weight management: a randomised controlled trial
Introduction
During the past decade, the prevalence of obesity has increased significantly, and it now represents a major health problem in both low-income and high-income countries.1 Dietary weight loss is generally unsuccessful in the long-term,2, 3 and optimum non-invasive methods to achieve and maintain weight loss remain elusive. Guidelines worldwide recommend gradual weight loss for the treatment of obesity,4, 5, 6 reflecting a widely-held opinion that rapid weight loss is associated with poorer long-term outcomes than is gradual weight loss. This notion probably stems from the belief that obesity is caused by bad social habits and that gradual weight loss allows more time to change such habits.
The widespread belief in the superiority of gradual over rapid weight loss has recently been questioned,7, 8 and scientific evidence does not support the superiority of a gradual approach in achieving or maintaining weight loss.9 Findings of a non-randomised study10 showed that participants who lost weight rapidly achieved and maintained greater weight loss than did those who lost weight gradually. However, individuals who chose rapid weight loss might have been more motivated than those who did not.
We aimed to investigate whether the rate of weight loss affects the rate of regain, and whether weight loss-induced changes in circulating appetite-mediating hormones and subjective appetite are affected by the rate of weight loss.
Section snippets
Study design and participants
We did a two-phase, randomised, non-masked, dietary intervention trial between August, 2008, and July, 2013, in a Clinical Research Unit at a Melbourne metropolitan hospital.
We recruited volunteers using radio and newspaper advertisements and by word of mouth. Eligible patients at screening were obese (BMI 30·0–45·0 kg/m2), otherwise healthy, and aged between 18 and 70 years. Key exclusion criteria included use of a very low energy diet or weight loss drugs in the previous 3 months, pregnancy
Results
204 participants were randomly assigned to either the rapid weight loss or gradual weight loss group; 200 participants started the diet (figure 1). Table 1 shows baseline characteristics of the two groups.
179 (89·5%) participants completed phase 1. Significantly more participants discontinued the gradual weight loss programme than the rapid weight loss programme (18 [18%] vs three [3%], p=0·002). The main reason given for withdrawal in both groups was difficulty adhering to the diet.
Figure 2
Discussion
By contrast with the widely-held belief that weight lost rapidly is more quickly regained,16, 17 our findings show that regain is similar after gradual or rapid weight loss. Moreover, achievement of a weight loss target was more likely and attrition was lower when weight loss was undertaken rapidly rather than gradually in phase 1. Several possible reasons exist for this finding. Rapid weight loss might motivate participants, which could explain why participants in the rapid group spontaneously
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