Two recent and quite different trials have looked into weight maintenance after intervention.

The first trial is published in Nutrients, which is a bit concerning as quality control is not always stellar at MDPI but some very established researchers were involved in the trial. In the trial, 126 659 participants started a very low-calorie diet with face-to-face consultations every two weeks with a trained dietitian. The participants had to pay for the meal-replacements (so first selection here). At start of maintenance there was sufficient data for 56 093 participants. At main endpoint, after 4 years, data was available for 2395. These 2395 (4.2% of an already selected population) were able to more or less maintain the initial 12.7% weight loss. This trial shows that there exist sub-groups that can lose weight and keep the weight of, with “only” life-style” support, but they represent a minority of the patients with obesity. https://www.mdpi.com/2072-6643/18/20/3364

The second trial is a pilot trial comparing 1) usual care, 2) Noom (the behavioral program) and 3) meal replacement after GLP-1 assisted weight loss. This was a small trial with in total 39 participants, so one needs to interpret the results cautiously. At baseline, there were differences in sex distribution, employment, education, baseline weight/BMI and % weight loss while being on GLP-1-treatment. These are all factors that may influence weight trajectory. It is also noteworthy that several participants reported having used CagriSema, which is still under FDA review. That weight regain was slower with Noom and meal replacement compared to usual care is perhaps not a big surprise, but the magnitude given (about 7% difference at 4 months) may have inflated the real difference. https://onlinelibrary.wiley.com/doi/full/10.1002/osp4.70194

There are not many trials looking at blood pressure maintenance after cessation of intervention, so why are we looking into maintenance for obesity? As we all know, it’s not clinical judgement and patient health that steers treatment in obesity, it’s cost and access. So, for the near future, we need to find pragmatic ways to deal with the lack of proper long-term treatment. Because we know what happens when you stop treatment, https://www.bmj.com/content/392/bmj-2025-085304 https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(26)00043-X/fulltext

#ObesityCare #WeightMaintenance #GLP1 #ClinicalResearch #AccessToCare