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Question: If I refer my patients to a reputable weight-loss program, how much weight can I realistically expect them to lose, and how long are they likely to maintain their weight loss?
Answer: First, it is important to establish what is meant by "reputable." It is widely accepted that the most effective weight-control programs include behavior therapy and elements of lifestyle modification. Broadly speaking, this means incorporating education and problem-solving skills related to eating, physical activity, and thinking habits, which are part and parcel of weight management.1
High-quality programs, whether delivered individually or in groups, provide a knowledge base that includes self-monitoring (eating, activity, and weight), nutrition education, programmed and lifestyle physical activity, understanding behavioral cues or triggers, and the basic concept of energy balance (calories in/calories out). Teaching that acknowledges the obstacles to applying these basics day in and day out follows. Additional lessons address planning ahead and problem solving, relapse prevention, and managing motivational plateaus, boredom, negative thoughts, stress, and social cues.2–4
Patients treated with a state-of-the-art behavioral approach can lose approximately 20–22 lb, or 10% of initial body weight, in roughly 4–6 months of weekly sessions or 16–24 core sessions.3,5 Thus, a 200-lb patient with a baseline body mass index (BMI) of 33 realistically may lose an average of 1–2 lb per week over the course of 16 weeks, achieving a total weight loss of 20 lb and a BMI of 30.
Evidence suggests that peak weight loss occurs within the first 6 months of treatment.3
Weight regain invariably follows, such that the model patient initially treated for 20–30 weeks may regain 30–35% of the lost weight within a year. Weight regain plateaus after the first year, but by 5 years of follow-up, as many as 50% of patients will have returned to their baseline weight.1,4
Initial weight loss achieved with behavioral treatment tends to be somewhat less in population-based, multicenter randomized clinical trials, showing around 5–7% reductions during the initial 6 months of treatment.5,6 However, since many of these trials involve ongoing contact with patients, the more modest weight losses have been sustained for periods of 3 years and clearly are associated with positive health outcomes.
Obesity increasingly is viewed as a chronic problem,7 which has stimulated exploration of new features to enhance on-site treatments, such as food provision, monetary incentives, structured meal plans, periodic booster sessions, training to optimally structure physical activity, motivational strategies such as recruitment with friends and group competitions, and increased access to programs via telephone, mail, and Internet contacts.3
Although long-term maintenance presents a challenge, practitioners should
continue to convey a genuinely hopeful message to their patients about the
efficacy and health benefits of high-quality programs that result in modest
weight loss and increases in moderate physical activity. 
Footnotes
Do you have a clinical question? Send it to docnews{at}diabetes.org.
References
2. Brownell KD: The LEARN program for weight management 2000. Dallas, American Health Publishing Company, 2000.
3. Jeffery RW, Wing RR, Mayer RR: Are smaller weight losses or more achievable weight loss goals better in the long term for obese patients? J Consult Clin Psychol 66:641–645, 1998.[Medline]
4. Wadden TA, Sternberg, JA, Letizia KA, et al.: Treatment of obesity by very low calorie diet, behavior therapy, and their combination: A five-year perspective. Int J Obes 13 (Suppl. 2): 39–46, 1989.
5. Knowler WC, Barrett-Conner E, Fowler SE, et al. for the Diabetes
Prevention Program Research Group: Reduction in the incidence of type 2
diabetes with lifestyle intervention or metformin. N Engl J
Med 346:393–403, 2002.
6. Whelton PK, Appel LJ, Espeland MA, et al. for the TONE
Collaborative Research Group: Sodium reduction and weight loss in the
treatment of hypertension in older persons: A randomized controlled trial of
nonpharmacologic interventions in the elderly (TONE).
JAMA 279:839–846, 1998.
7. National Institutes of Health/National Heart, Lung, and Blood Institute: Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: The evidence report. Obes Res 6:51S-210S, 1998.[Medline]
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