What does it actually take to maintain a weight loss?

Sebastian Zabell

27/3/2025

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min reading

Weight loss is incredibly popular.

Right now, approximately 45% of the world's population is actively trying to lose weight [1]. At the same time, countless diets and weight loss solutions can be found throughout society, all promising a "lifestyle change" and sustainable weight loss. Often, they are based on the premise that their specific program, diet composition, or method is "the magic bullet."

In this article, we will examine what it really means to achieve sustainable weight loss, why very few people can maintain their weight loss, and what it truly requires – both from the individual but also from the healthcare professional.

What does it really take to maintain your weight loss?

The fact is that, regardless of the program chosen, most people will experience weight loss during the process.

But then it happens. The weight comes back, and weight maintenance – often the period when the healthcare professional “lets go” of the individual – fails. And maintaining weight loss is an extremely difficult task.

Interestingly, however, both healthcare professionals and individuals looking to lose weight rarely focus on or show much interest in the maintenance process. In our coaching work with weight loss (especially weight maintenance), we often see that people underestimate what it actually takes to prevent regained weight. Health and fat loss educator Ben Carpenter highlights this in his book ‘Everything Fat Loss’ [2]:

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> "During all my client consultations, do you know how many people have said: ‘I want to lose weight and keep it off forever?’ Zero.”

What does it really mean to maintain your weight loss?

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The most cited definition in the literature for successful weight loss dates back to 2003. It defines weight loss as successful when an individual has ‘intentionally lost 10% of their body weight and maintained it for one year [3]’. This 10% threshold is based on the fact that weight loss of this magnitude leads to significant improvements in risk factors for developing diabetes and cardiovascular disease [4].

However, weight maintenance appears to have a success rate of only 5–20%, depending on the study and how long participants were followed [3, 4, 5].

It is great to maintain weight loss for a year.

But statistics show that 85% of people regain the lost weight within two years, and within three years, 95% have regained it all.

That is a very low success rate.

Can the success criteria be different?

Many people attempt weight loss outside of research studies and statistics. Therefore, the researchers who defined the “10% threshold and one year” also established the National Weight Control Registry in the USA. This registry allows individuals to sign up if they have maintained weight loss for over a year [6].

In this registry, various dietary strategies are used, some low-carb, others low-fat, showing that no single diet is superior for long-term weight loss. Instead, there is a clear link between weight maintenance and the ability to adhere to behavioral patterns. In other words, if the weight loss behavior is not sustained, weight increases.

The best “diet” or nutritional strategy is, therefore, the one you can maintain over time [7].

Is one year enough as a success criterion?

The one-year success criterion can be misleading – especially when we see that weight regain often happens over a longer period. Most clinical studies show stable body weight for a year after weight loss, but then weight often increases again (if participants are even followed for that long).

In fact, research suggests that the most critical periods are between two and four to five years after weight loss [8, 9, 10]. The longer a person maintains their weight loss, the lower the risk of regaining it in the future [8].

But what about 10% weight loss as a success criterion for weight maintenance? As we will explore later, this threshold may be too high – or at least ambitious in practice.

What about weight loss medication?

Most studies referenced in this article are based on weight loss programs without medication such as Wegovy or Mounjaro. However, long-term weight maintenance after weight loss medication is still a relatively unexplored field.

Clinical trials show that people using weight loss medication experience significantly greater weight loss compared to placebo [11]. However, when treatment stops, participants are often divided into two groups: one that continues the medication and one that switches to placebo. In the placebo group, weight regain of approximately 12% is observed – though with a net weight loss of about 5% [12].

If participants continue the medication, weight loss is maintained for up to four years [13]. This suggests that medical weight loss requires continuous treatment to achieve lasting results.

Many of the conclusions in this article likely apply to both medication-assisted and non-medication-assisted weight loss programs. However, given the public’s understanding of weight loss medication [14], it is crucial to consider how medical weight loss programs can implement the long-term strategies we will discuss in the remainder of this article.

Are there any studies showing that maintenance is possible?

To make meaningful conclusions about weight maintenance – and whether a treatment creates lasting results – it is essential to follow participants both during weight loss and in the period afterward.

One example is a 2015 study [15] involving 200 participants in a 17-week weight loss program using a VLCD (very low-calorie diet, exact caloric intake not specified) with weekly expert-led sessions. After 17 weeks, participants were divided into two groups:

- One group was “released” without further follow-up

- The other group received monthly coaching for one year

The weekly sessions during weight loss were the same for both groups and included:
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- Tracking food intake and physical activity

- Goal setting

- Regular weigh-ins and structured meals

- Eating more slowly and being mindful of portion sizes

- Managing overeating, food impulses, and high-risk situations

- Focusing on social support and relapse prevention

- Problem-solving and addressing negative thoughts

- Information on fat, fiber, sugar, alcohol, and energy density

- Encouragement for daily movement and pedometer use
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Both groups achieved nearly the same weight loss – about -12.9% (ranging from −11.7% to -14.1%). However, the study's focus was not just on weight loss but on what happened afterward.

After 121 weeks (approximately 2.3 years), both groups had regained weight, resulting in a net weight loss of −3.2% from their starting weight. In other words, both groups experienced weight regain regardless of follow-up.

However, participants did not regain all the weight they had lost. And given what we know about weight loss, this should actually be considered a success.

In general, studies show that participants almost always regain weight, both in control and intervention groups, but rarely all the way back to their starting weight [16].

And as mentioned earlier, following people for just two years is not enough to determine whether weight loss is truly maintained. We need longer-term data.

A rare long-term Study: LOOK AHEAD

One of the most important studies on the duration of weight loss treatment is the LOOK AHEAD study [9, 10]. It examined how lifestyle changes could prevent type 2 diabetes and followed participants for a full eight years.

The study divided participants into two groups:

A control group that received standard treatment
An intensive group with a holistic approach

The weight loss program lasted one year and was based on the Diabetes Prevention Program [17]. It included behavioral changes, meal planning, daily physical activity, and a calorie-restricted diet (1,200-1,800 kcal).

After the first year, the intensive group received ongoing lifestyle counseling—focusing on daily movement and healthy eating habits.

Results:

After one year, participants in the intensive group had lost an average of 8.5% of their body weight.
After four years, weight loss had declined to 4.7%.
However, from year four to year eight, weight remained stable.
Even more importantly, among those who lost more than 10% in the first year:
- 42% maintained their weight loss after four years.
- 39% maintained it after eight years.

This study is therefore one of the most successful long-term weight maintenance trials to date.

Post-weight loss treatment is crucial

LOOK AHEAD is also considered an example of "extended treatment" - a concept increasingly highlighted as necessary to prevent weight regain after an intervention [18].
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The Obesity Treatment Guidelines also emphasize this point [19]:
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"Weight loss interventions should include comprehensive, long-term weight maintenance programs lasting at least one year after weight loss."
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But what made LOOK AHEAD so unique? The intensity of the treatment after weight loss.
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The control group received:

Three one-hour sessions per year for the first four years
One annual meeting from year five to eight

The intensive group received:

Small group sessions (10–20 people) meeting three times a month for six months
Then twice a month until year one
Afterward, monthly meetings up to year eight
Individual counseling sessions with dietitians, psychologists, and exercise experts each month
Contact via email or phone every two weeks
Use of techniques such as motivational interviewing and problem-solving-based coaching

A more traditional approach for comparison

Another study compared rapid weight loss with gradual weight loss and their impact on maintenance over three years [20].

Participants met with a dietitian every other week during the weight loss phase:

The rapid group had six meetings.
The gradual group had 18 meetings (due to a longer weight loss period).
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Then followed a maintenance phase over 144 weeks, where all participants had follow-ups with a dietitian at week four, week 12, and then every three months.

Result? Regardless of whether weight loss was rapid or gradual, participants regained most of their lost weight within 48 weeks.

Why is it so difficult to maintain weight loss?

Even though people are slightly more active and burn about the same amount of energy as past populations, we still see a general increase in body weight in the population [21].

This is partly because we live in an environment that promotes weight gain – often referred to an "obesogenic environment." One key factor is the increasing availability and consumption of calorie-dense foods [22]. Ultra-processed foods such as cakes, snacks, and sweets play a significant role. They are often cheaper, more accessible, and easier to consume in large quantities – making them hard to resist [23, 24].

Additionally, consumers are increasingly influenced by advertising, product placement in stores, and other psychological ‘tricks’ [25], making it even harder to consistently make healthy choices.

But it's not just the environment – our bodies also resist weight loss through physiological compensatory mechanisms.

Our metabolism is not constant. When we lose weight, we weigh less, meaning it requires less energy to move and maintain body functions [26]. This means that over time, calorie intake must be adjusted, or activity must increase to sustain weight loss.

At the same time, several metabolic adaptations occur:

Daily energy expenditure decreases, partly because spontaneous movement (such as step count) often declines when intentional exercise increases [27].
The body increases hunger and appetite signals to restore lost weight [28].
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In short, biologically, the body wants to return to its "old" weight, and the environment makes it even harder to resist.

Let's take a closer look at what studies reveal about the behaviors of those who successfully maintain their weight loss.

What do successful weight maintainers have in common?

Can weight be maintained if it requires such a significant effort – from both the individual and the healthcare provider?

In the previous sections, we looked at various studies and interventions for weight maintenance. Most, except for LOOK AHEAD, focused on diet and physical activity.

However, newer research shows that obesity is a complex condition [29], and treatment must be more holistic. The psychological aspect is often overlooked in existing trials – and perhaps this is the key to long-term weight loss?

So, what do people who successfully maintain their weight have in common? Let's examine behavioral and psychological factors highlighted in research.

A study on behavior over time

A 2004 study provides insight into the psychological factors required for weight maintenance [30].

Participants in a weight loss program completed questionnaires at the start, after 10 weeks, and at years one, two, and three. They were measured on eight psychological parameters:

Rigid vs. flexible eating behavior (whether participants completely eliminated certain foods)
Stable meal patterns
Meal situations (e.g., eating speed and mindfulness)
Food choices (preference for fruits and vegetables over sweets)
Portion control
Amount of physical activity
Stress and emotional management
Ability to cope with emotional eating

Participants who changed behaviors in 5–8 of these areas had the highest likelihood of maintaining their weight loss.

In other words, there are many "invisible" processes that individuals must navigate – both during and after weight loss.

Physical activity plays a central role

Physical activity is a common theme in many weight maintenance studies. According to data from the National Weight Control Registry, successful weight maintainers burn nearly 2,000 calories per week through physical activity [31].

Recent research from the University of Copenhagen also shows that physical activity is crucial for maintenance after de-escalating weight loss medication [32].

But physical activity alone is not enough.

For example, one study compared a simple walking program (150 min/week) with a program based on Cognitive Behavioral Therapy (CBT). The CBT program was significantly more effective at preventing weight regain:

+5.2 kg (walking group) vs. +3.1 kg (CBT group) [33].

What does the large review articles say?

A 2018 review led by prominent researcher Kevin Hall examined the literature and highlighted the following common factors among individuals who maintain long-term weight loss [34]:

Self-monitoring (weighing, calorie counting)
Reduced calorie intake
Increased physical activity
Breakfast as a routine
More homemade meals and less takeout
Less screen time
Portion control or use of meal replacements

Most people who have attempted weight loss are familiar with these recommendations. The challenge isn’t knowing them – it's maintaining them.

As we saw earlier, lack of consistency in behavior is strongly linked to relapse and weight regain.

Why do some persist while others don't?

It’s not just about what you do, but what the behavior means.

Many experience declining motivation or become impatient. This reflects that weight-loss behaviors often don’t feel meaningful enough in themselves.

That’s why it’s worth asking:
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What is the function of the behavior?
Why do some persist – even when it’s difficult?
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Kevin Hall and colleagues emphasize the concept of cognitive restructuring:

“Recognizing and restructuring the core beliefs and thought patterns underlying these behaviors to recognize and restructure the core beliefs and thought processes that underlie these patterns (e.g., all-or-nothing thinking or emotional eating (my words) helps minimize behavioral fatigue and prevent or productively manage slips and lapses.
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They also highlight cognitive flexibility:
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“Learning to accept that rigid expectations and perfect adherence to behavioral goals is unrealistic, and building cognitive flexibility to take in stride when one’s plans do not go according to plan is a core competency for long term sustainable behavioral changes and weight management.”

Identity, values, and meaning

Another study [35] concluded:

Reframing the dietary regimen as about healthy eating and a new way of life made weight control seem less burdensome for these participants and they felt able to maintain their efforts.(…) In some cases, these changes were bolstered by change in self-identity.

A third study [36] found that:

“Making the behaviour changes required for weight loss maintenance generates psychological ‘tension’ due to the need to override existing habits, and incompatibility of the new behaviours with the fulfilment of psychological needs. Successful maintenance involves management or resolution of this tension. (..) Resolution may be achieved through changing habits, finding non-obesogenic methods for addressing needs, and potentially through change in self-concept.”

Summary: What does it take?

People who successfully maintain weight loss over time often:
✔ Change their core beliefs and thought patterns
✔ Develop cognitive flexibility: the ability to handle setbacks without giving up
✔ Find a new identity and a new meaning in the behavior
✔ Learn to manage the internal tension that comes with behavior change

These elements are well-known in psychology and particularly central to approaches like Acceptance and Commitment Therapy (ACT).
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A 2015 study [37] highlighted that the treatment goal in ACT psychological flexibility could play a major role in weight maintenance. ACT has shown promising early results in weight maintenance and weight-loss treatment [38, 39] – though the number of studies are limited.

Why do so few succeed?

It may not be surprising that maintenance fails when most weight-loss programs are led by professionals focused on diet or exercise – such as dietitians, personal trainers, or even doctors.

Few programs offer extended treatment or integrate the psychological aspect.

This could be a key reason why long-term weight loss remains the exception rather than the rule.

The process of change

A common factor among those who successfully maintain weight loss is a shift in identity.

Identity can be understood as:
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“The reflective activities an individual engages in daily that shape their self-identity” [40].
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‍In other words: We aren’t just what we think – we are what we do. And over time, what we do shapes who we are.

However, behavior doesn’t occur in a vacuum. We are always in a context. Our choices are influenced by our environment and available stimuli.

We learn that certain actions bring rewards – and we repeat them.

This is why weight loss often creates a state of tension – a behavioral imbalance. We try to change something but constantly compare it to where we started. Our current behavior serves as a reference point. The greater the distance from our old habits, the harder it becomes to stick with the new ones.

Behavior persists because it serves a purpose

All behavior is performed because it works – not necessarily in the big picture, but in the moment.

It provides some form of reward – not just taste or enjoyment, but a change of state. It soothes, distracts, reduces or removes the emotional state, or creates happiness.

We might eat sweets in the afternoon, even though we know it doesn’t help us toward our overall goal.

We might skip a workout, even though we planned it. We don’t do this because we are weak or lazy – but because the behaviour of eating sweets or staying home relieves us of tension.

This means that even “bad” habits serve a purpose.

If we try to replace them without understanding what they provided, we won’t know if the new behavior offers the same – or something better. This makes it easy to fall back into old patterns. Because the old ones worked – in their own way [39].

Diet mentality: When health becomes about rules

In many weight-loss programs, behavior becomes a means to an end.

We don’t eat to feel full – we eat to lose weight. We exercise to "earn" food—or avoid eating, even when hungry. Food choices and movement are dictated by what fits best into a calorie budget, without asking whether it makes sense for us.

This mindset is called the diet mentality, described by dietitians Evelyn Tribole and Elyse Resch [41].

Here, health is not about well-being, but about rules, control, and performance. And in this way of thinking, we often lose touch with why we do what we do.

At the same time, many lack a basic understanding of habits and how to change them sustainably.

Moving away from something – or toward something?

Many try to lose weight to escape something - feeling overweight, uncomfortable, or "wrong."

But behavior driven by avoidance is rarely sustainable. Its power fades once the discomfort disappears – or changes form.

There is a big difference between exercising to get rid of guilt versus exercising because it gives you energy and a break in a busy day.

Just as there is a difference between eating healthy to avoid feeling disgusting – and eating healthy to take care of your body [42].

The thoughts that hold us back

For many, weight loss is also about trying to eliminate uncomfortable thoughts—about their body, food, skipped workouts, or inadequacy [43].

What many call “food peace” is often an attempt to silence mental chatter.

But our minds are designed to find problems. When weight is no longer the focus, it finds something else that isn’t "good enough."

If we spend all our energy trying to get rid of these thoughts, we often lose touch with the life we actually want to live [44].

Meaning lasts longer than motivation

The key question remains: Why do some people persist? The answer is not willpower – but meaning.

We only stick with difficult things if they feel meaningful.

It’s easy to think we just need more motivation. That "it’ll be easier when work is less busy" or "when the days are longer."
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But motivation comes and goes. Meaning lasts. You’re not “motivated” to be with your kids or friends – you do it because it matters to you.

That’s how health should feel too: meaningful, not forced.

Those who maintain weight loss find meaning in the process – not just because it gives them results, but because they enjoy the journey.

And that’s the real point:

No amount of motivation, willpower, or "you should" can sustain a lifestyle you don’t enjoy.

That is why we often hear the sentence: "I know what to do to lose weight." And that is true. Men very few people know how they should do it, in a way that is sustainable and meaningful.

Conclusion

To summarize: Maintaining weight loss is incredibly difficult.

The most commonly used definition of success is losing 10% of one’s body weight and keeping it off for a year. But perhaps we should only talk about success after two years - or even longer.

Very few people truly understand what it takes to keep the weight off. The results from randomized trials are, to say the least, concerning, and highlight a clear need: a follow-up after the initial program.

Many treatment programs focus primarily on diet and physical activity. But that is rarely enough. Weight loss treatment often lacks nuance. Both in relation to the individual and the way we approach change. It’s not just about what you eat or how much you move.

This places great demands on healthcare professionals. Not just in terms of nutrition and exercise but also in understanding psychology and behavior change. Because once the weight is lost, the real challenge begins: maintaining it. And without support for that, without extended treatment focused on habits, motivation, and purpose, there is a high risk of regaining the weight.

We must therefore rethink how we define successful weight loss. Not as a temporary achievement, but as a process that requires long-term support, an understanding of psychological mechanisms, and, most importantly, a journey that feels meaningful to the individual.

References

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