Skip to main page content
U.S. flag
See More

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2025 Sep 2;8(9):e2532681.
doi: 10.1001/jamanetworkopen.2025.32681.

Adaptive vs Monthly Support for Weight-Loss Maintenance: A Randomized Clinical Trial

Kathryn M Ross  1   2   3 , Meena N Shankar  1 , Peihua Qiu  4 , Zibo Tian  4 , Jaime Ruiz  5 , Lisa Anthony  5 , Michael G Perri  1
Affiliations
Randomized Controlled Trial

Adaptive vs Monthly Support for Weight-Loss Maintenance: A Randomized Clinical Trial

Kathryn M Ross et al. JAMA Netw Open. .

Abstract

Importance: Weight regain is common after the end of initial weight-loss treatment. Existing extended care programs (which typically provide sessions once per month) improve long-term weight-loss outcomes, but with only modest effect vs control.

Objective: To determine whether weight regain is reduced via provision of telephone-based extended care on an adaptive (triggered by a study algorithm that estimates when individuals are at high risk for weight regain) vs static (provided once per month) schedule.

Design, setting, and participants: A randomized clinical trial conducted between October 2019 and November 2024 in areas within driving distance of Gainesville, Florida. Adults with obesity enrolled in a 16-week weight-loss program; those who lost 5% or more of their baseline weight were eligible for randomization to 1 of 2 maintenance care conditions.

Intervention: Participants received 20 months of telephone-based extended care support, delivered individually by a trained interventionist, either on an adaptive or static schedule.

Main outcomes and measures: The primary outcome was weight change from month 4 (end of initial intervention) to month 24.

Results: The 255 participants (mean [SD] age, 50.6 [11.3] years; 209 [82.0%] women; 51 [20.0%] Black, 25 [9.8%] Hispanic or Latino, and 170 [66.7%] non-Hispanic White) were randomized to an adaptive (128 participants) or static (127 participants) group. Weight regain from month 4 to 24 was 1.27 (95% CI, 0.07 to 2.47) kg in the adaptive vs 1.75 (95% CI, 0.43 to 3.06) kg in the static group, with no difference by condition. At month 24, adaptive participants maintained a mean (SD) weight loss of 8.1% (7.8%) from initial intervention baseline while static participants maintained 7.9% (8.5%); there was not a significant difference in the proportion of participants maintaining weight loss of 5% or more (adaptive, 59.5%; static, 59.8%).

Conclusions and relevance: In this randomized clinical trial, participants in both conditions were successful at maintaining initial weight loss 20 months after the end of a weight-loss program, but providing extended care on an adaptive schedule did not confer additional benefit vs the once-per-month static schedule. Future research should investigate whether more precise algorithms of high-risk periods for weight regain can be developed and whether these models can improve weight maintenance outcomes. Moreover, given success of participants in both conditions at maintaining initial weight loss, future research should also investigate methods of improving the implementation and dissemination potential of telephone-based extended care interventions.

Trial registration: ClinicalTrials.gov Identifier: NCT04116853.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Ross reported receiving grants from the National Institutes of Health (NIH) outside the submitted work. Dr Shankar reported receiving grants from the National Institute of Diabetes and Digestive and Kidney Diseases of the NIH during the conduct of the study. Dr Ruiz reported receiving grants from the National Science Foundation, the US Department of Defense, and the NIH during the conduct of the study. Dr Anthony reported receiving grants from the National Science Foundation and the NIH during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Participant Flow Diagram
Figure 2.
Figure 2.. Model-Estimated Mean Change in Percentage Body Weight Over Time by Condition
Error bars indicate 95% CIs.
See this image and copyright information in PMC

Comment in

  • doi: 10.1001/jamanetworkopen.2025.32689

References

    1. Jensen MD, Ryan DH, Apovian CM, et al. ; American College of Cardiology/American Heart Association Task Force on Practice Guidelines; Obesity Society . 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults. Circulation. 2014;129(25)(suppl 2):S102-S138. - PMC - PubMed
    1. MacLean PS, Wing RR, Davidson T, et al. NIH working group report: innovative research to improve maintenance of weight loss. Obesity (Silver Spring). 2015;23(1):7-15. doi: 10.1002/oby.20967 - DOI - PMC - PubMed
    1. Jeffery RW, Drewnowski A, Epstein LH, et al. Long-term maintenance of weight loss: current status. Health Psychol. 2000;19(1S):5-16. doi: 10.1037/0278-6133.19.Suppl1.5 - DOI - PubMed
    1. National Heart, Lung, Blood Institute, National Institute of Diabetes, Digestive, Kidney Diseases (US) . Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report. National Heart, Lung, and Blood Institute; 1998.
    1. Perri MG, Ariel-Donges AH. Maintenance of weight loss in behavioral treatment of obesity. In: Wadden TA, Bray GA, eds. Handbook of Obesity Treatment. 2nd ed. The Guilford Press; 2018:393-410.

Publication types

Associated data