Improving maintenance of lost weight following a commercial liquid meal replacement program: A preliminary study

• Maintenance of lost weight remains a significant problem in obesity treatment.
• Innovative weight loss maintenance programs in real-world settings are needed.
• Small Changes Maintenance (SCM) offered alternative to traditional maintenance.
• SCM was feasible to implement and acceptable to participants.
• SCM resulted in significantly less weight regain compared to historical controls.

Clinic-based liquid meal replacement (800 kcals/day) programs produce substantial weight loss. Nevertheless, long-term maintenance remains a challenge. A limitation of maintenance programs is that they continue to promote large behavior changes that are initially required to induce weight loss which may be unsustainable long-term. The study aims were to conduct a preliminary assessment of the feasibility, acceptability, and effectiveness of a small changes maintenance intervention (SCM) for 30 patients who completed liquid meal replacement program (LMR). The 20-session SCM delivered over 52 weeks offered no preset goals for maintenance behaviors and all changes in behavior were self-selected. Participants had a median BMI of 40.9 kg/m2 and weight of 111 kg at the start of LMR. At LMR completion, they lost 18% (21 kg) of body weight. The SCM was completed by 22 patients (73%); 19 completers (86%) attended ≥ 17 of 20 sessions with a median satisfaction rating of 9 (on a scale of 1 to 9). Completers were asked to record self-selected maintenance behaviors daily (median 351 days recorded). The most commonly reported daily behaviors were self-weighing, use of meal replacements and step counting. Median percent regain at week 52 was 14% (2.8 kg) of lost weight (range, − 42 to 74%), significantly less than a median of 56% (11 kg) percent regain of lost weight (range, − 78 to 110%) in a demographically similar historical control group with no maintenance intervention after LMR completion (P < 0.001). Thus, SCM holds promise for improving weight maintenance. Future research should compare SCM to standard maintenance programs that promote large program-directed changes.