ABSTRACT

All weight loss interventions except bariatric surgery have poor long-term efficacy. Longitudinal, naturalistic studies of weight loss efforts undertaken by people in the "real world" find that weight loss efforts predict long-term weight gain and the onset of obesity even in previously normal or underweight individuals. Unhealthful or eating disordered behaviors, such as fasting, self-induced vomiting, or use of laxatives, predict greater weight gain, but all efforts, even more appropriate or healthful behaviors like exercise or eating more fruits and vegetables, predict weight gain. Long-term trials often research strategies to help people maintain weight loss. Dieting behavior and dietary restraint is a robust predictor of overeating and weight gain. Clinicians and clients wonder whether "healthy lifestyle change," that is, increased exercise and dietary modifications intended to be healthful, will help them lose weight, even though strict or prescribed dietary restriction is ineffective. However, there is little evidence that lifestyle modification leads to long-term weight loss, either.