Gradual vs. Rapid Weight Loss and Long-Term Weight Management

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Weight regain was about the same for people who lost weight gradually vs. quickly.

Losing weight gradually does not decrease the amount of weight regain when compared with rapid weight loss, data published in The Lancet Diabetes & Endocrinology suggest.

Worldwide guidelines currently recommend gradual weight loss for obesity, which is backed by the theory that losing weight quickly results in greater weight regain.

To investigate this premise, lead researcher Joseph Proietto, PhD, Sir Edward Dunlop Professor of Medicine at the University of Melbourne and head of the Weight Control Clinic at Austin Health in Australia, and colleagues randomly assigned 200 obese adults (BMI, 30-45) to a 12-week rapid weight loss program or a 36-week gradual weight loss program.

The rapid weight loss program involved a very low-calorie diet of 450 kcal to 800 kcal per day. The gradual weight loss program decreased caloric intake by about 500 kcal per day, which is in accordance with current weight loss guidelines.

Those who lost more than 12.5% of their body weight were placed on a maintenance diet for 3 years.

Eighty-one percent of participants in the rapid weight loss group lost at least 12.5% of their body weight compared with 50% in the gradual weight loss group, according to study results.

 After 3 years, participants in both weight loss programs who entered the maintenance period regained most of their lost weight (gradual weight loss, 71.2% regain vs. rapid weight loss, 70.5% regain). Results from an intention-to-treat analysis were similar (gradual weight loss, 76.3% regain vs. rapid weight loss, 76.3% regain).

One participant in the rapid weight loss group developed cholecystitis during the initial weight loss period, and two participants in the rapid weight loss group developed cancer during the weight maintenance period.

Katrina Purcell, BSc, a dietician and first author of the study, noted that their results are in contrast with generally accepted notions about weight loss.

“Across the world, guidelines recommend gradual weight loss for the treatment of obesity, reflecting the widely held belief that fast weight loss is more quickly regained,” she said in a press release. “However, our results show that achieving a weight loss target of 12.5% is more likely, and drop-out is lower, if losing weight is done quickly.”

Although unclear why the rapid weight loss program was more effective in achieving target weight loss, the researchers speculate that limited carbohydrate intake of a very low-calorie diet may promote greater satiety and less food intake by inducing ketosis. Additionally, rapid weight loss may motivate participants to stick to their diets to achieve results.

In a linked comment, Corby K. Martin, PhD, and Kishore M. Gadde, MD, both of the Pennington Biomedical Research Center in Baton Rouge, Louisiana, pointed out that these results may help clinicians tailor weight loss treatments to the individual patient.

“The study … indicates that for weight loss, a slow and steady approach does not win the race, and the myth that rapid weight loss is associated with rapid weight regain is no more true than Aesop’s fable,” they wrote.

“Clinicians should bear in mind that different weight loss approaches might be suitable for different patients in the management of clinical obesity, and that efforts to curb the speed of initial weight loss might hinder their ultimate weight loss success.


  1. Purcell K et al. Lancet Diabetes Endocrinol. 2014;doi:10.1016/S2213-8587(14)70200-1.
  2. Martin CK, Gadde KM. Lancet Diabetes Endocrinol. 2014;doi:10.1016/S2213-8587(14)70153-6.