A systematic review with meta‐analyses of text message‐delivered behaviour change interventions for weight loss and weight loss maintenance

Short Message Service (SMS)‐delivered behaviour change interventions are frequently used to support weight management. This systematic review examines the effectiveness of SMS‐delivered behaviour change interventions for weight management. Electronic databases were searched for randomised controlled trials (RCTs) comparing SMS‐delivered adult weight management interventions to control groups, published between 1990 and 2018. Weight change was examined using random effects meta‐analyses at intervention cessation and postintervention follow‐up. Subgroup analyses examined intervention duration, SMS frequency, theory use, SMS interactivity, and SMS tailoring. Fifteen studies met inclusion criteria (2705 participants). For weight loss interventions (n = 12, 1977 participants), the mean difference in weight change was ?2.28 kg (95% confidence interval [CI] ?3.17 to ?1.36 kg). No studies reported postintervention follow‐up. For weight loss maintenance interventions (n = 3, 728 participants), the mean difference in weight change was ?0.68 kg (95% CI, ?1.31 to ?0.05 kg), and postintervention follow‐up (n = 2, 498 participants) effects were ?0.57 kg (95% CI, ?1.67 to 0.53 kg). No subgroup differences were found. SMS‐delivered behaviour change interventions for weight loss led to significant small to moderate weight loss and weight loss maintenance compared with control groups. Evidence on long‐term effects is limited. SMS‐delivered behaviour change interventions are a potentially effective and scalable intervention option for obesity treatment.     

Effects of lifestyle interventions and long‐term weight loss on lipid outcomes – a systematic review

Weight and lipids are critical components of the metabolic syndrome, diabetes and cardiovascular disease. Past reviews considering weight loss on lipid profiles have been for ≤1 year follow‐up and/or were for very overweight, obese or morbidly obese participants. This systematic review includes lifestyle interventions for adults (18–65 years), with a mean baseline BMI < 35 kg/m², with weight and lipid differences over 2 years. Between 1990 and 2010, 14 studies were identified. Mean differences for weight and lipids were modest. However, weight loss at 2–3 years follow‐up, produced significant beneficial lipid profile changes. These were similar to previous reviews conducted on heavier target groups and/or over shorter follow‐up periods; cholesterol (1.3% decrease per kg lost) and triglycerides (1.6% fall per kg). Weight loss sustained longer than 3 years was not associated with beneficial lipid changes, suggesting that other lifestyle changes not just weight loss needs maintaining. Evidence linking lifestyle induced sustained weight loss with lipid profile changes in the long‐term for this group is limited. Probable within‐group differences (treatment vs prevention), would make further group separation prudent. Individual patient data analysis would facilitate this, uncover baseline, medication and confounding effects, and may identify successful program components enabling more effective obesity prevention and treatment strategies.     

Should we recommend low‐fat diets for obesity?

Dietary fat intake has been blamed for the increase in adiposity and has led to a worldwide effort to decrease the amount of fat in the diet. However, the comparative efficacy of this approach is debatable. Whilst short‐term dietary intervention studies show that low‐fat diets lead to weight loss in both healthy and overweight individuals, it is less clear if a reduction in fat intake is more efficacious than other dietary restrictions in the long term. The purpose of this systematic review was to determine the effectiveness of low‐fat diets in achieving sustained weight loss when used for the express purpose of weight loss in obese or overweight people. A comprehensive search identified six studies that fulfilled our criteria for inclusion (randomized controlled trial, participants either overweight or obese, comparison of a low‐fat diet with another type of weight‐reducing diet, follow‐up period that was at least 6 months in duration and inclusion of participants 18 years or older without serious disease). There were a total of 594 participants in the six trials. The duration of the intervention varied from 3 to 18 months with follow‐up from 6 to 18 months. There were no significant differences between low‐fat diets and other weight‐reducing diets in terms of sustained weight loss. Furthermore, the overall weight loss at the 12–18‐month follow‐up in all studies was very small (2–4 kg). In overweight or obese individuals who are dieting for the purpose of weight reduction, low‐fat diets are as efficacious as other weight‐reducing diets for achieving sustained weight loss, but not more so.     

Post‐operative behavioural management in bariatric surgery: a systematic review and meta‐analysis of randomized controlled trials

Recent research has provided evidence that bariatric surgery maximizes long‐term weight loss in patients with severe obesity. However, a substantial number of patients experience poor weight loss outcome and weight regain over time. Post‐operative behavioural management may facilitate long‐term weight control in bariatric surgery population. The objective of this systematic review and meta‐analysis was to determine the effects of post‐operative behavioural management on weight loss following bariatric surgery. Eligible articles were systematically searched in electronic databases. Among the 414 citations, five randomized controlled trials, two prospective and eight retrospective cohort trials analysing behavioural lifestyle interventions and support groups fulfilled the inclusion criteria. The main finding is that behavioural management had a positive effect on weight loss following surgery. In 13 studies, patients receiving behavioural management had greater weight loss than patients receiving usual care or no treatment. A meta‐analysis of five randomized controlled trials suggests greater weight loss in patients with behavioural lifestyle interventions compared with control groups. Post‐operative behavioural management has the potential to facilitate optimal weight loss following bariatric surgery, but conclusions were limited by the small and heterogeneous samples of studies. A more rigorous empirical evaluation on its clinical significance is warranted to improve effectiveness of bariatric surgery.     

Is weight regain after bariatric surgery associated with psychiatric comorbidity? A systematic review and meta‐analysis

Bariatric surgery has been recognized as the gold standard treatment for severe obesity. Although postbariatric surgery patients usually achieve and maintain substantial weight loss, a group of individuals may exhibit weight regain. Several factors are proposed to weight regain, including psychiatric comorbidity. The objective of the study is to conduct a systematic review and meta‐analysis of studies investigating the relationship between psychiatric comorbidity and weight regain. A systematic review through PubMed, Web of Science, Cochrane Library, Scopus, and PsycINFO was performed, following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA). After a stepwise selection, 13 articles were included in the qualitative analysis and 5 were included for a meta‐analysis. Women was majority in most of the studies (87.6%), and a bypass procedure was the bariatric intervention most evaluated (66.8%), followed by gastric banding (32.1%) and sleeve (1.1%). Higher rates of postbariatric surgery eating psychopathology were reported in patients with weight regain. However, the association between general psychopathology and weight regain was not consistent across the studies. In the meta‐analysis, the odds of eating psychopathology in the weight regain group was higher compared with the nonweight regain group (OR = 2.2, 95% CI 1.54‐3.15). Postbariatric surgery eating psychopathology seems to play an important role in weight regain.     

Maintenance interventions for overweight or obesity in children: a systematic review and meta‐analysis

Childhood obesity is associated with significant health consequences. Although several intervention programmes for children result in weight loss or stabilization in the short‐term, preventing relapse after treatment remains an important challenge. This systematic review summarizes the evidence about maintenance interventions after treatment in childhood obesity. Studies were identified by searching PubMed, Embase, Cochrane Library, Scopus, Web of Science, PsycINFO, CINAHL and SocINDEX. The primary outcome measure for this review was body mass index standard deviation score (BMI‐Z‐score). Data were pooled using quality effect models. Eleven studies (1,532 participants, age 2–18 years) were included, covering a wide range of maintenance approaches. Included studies varied widely in methodological quality. Pooled analysis showed that the BMI‐Z‐score of maintenance intervention participants remained stable, whereas control participants experienced a slight increase. No differences were observed regarding intensity and duration of therapy. A slight preference for ‘face‐to‐face’ versus ‘on distance’ interventions was shown. In summary, this review shows that, although there is limited quality data to recommend one maintenance intervention over another, continued treatment does have a stabilizing effect on BMI‐Z‐score. Considering the magnitude of the problem of childhood obesity, this is an important finding that highlights the need for further research on weight loss maintenance.     

Persistence of improvement in insulin sensitivity following a dietary weight loss programme

Aim: Short‐term dietary weight loss can improve insulin resistance but long‐term studies are lacking. We sought to quantify the degree to which maintenance of weight loss after a short‐term dietary intervention was associated with persistent metabolic benefits. Methods: Fifty‐seven insulin‐resistant obese subjects had insulin‐mediated glucose disposal quantified through the steady‐state plasma glucose (SSPG) test, and associated metabolic risk markers quantified at baseline, after a 16‐week dietary weight loss intervention, and in 25 subjects, at follow‐up of 28.8 ± 13 months. Changes in metabolic variables over time were analysed and correlation with weight loss ascertained. Those with greatest vs. least long‐term SSPG response (responders vs. non‐responders) were compared. Multivariate analysis was performed for predictors of persistent SSPG response. Results: At follow‐up, the 25 subjects who returned for metabolic testing had, on average, maintained their weight loss. Insulin‐mediated glucose disposal remained significantly improved vs. baseline, as did plasma triglyceride and HDL cholesterol (HDL‐C) concentrations, and improvement correlated with total amount of weight lost. Comparison of SSPG responders to non‐responders showed no difference in amount of weight lost and SSPG change during the 16‐week dietary intervention; however, SSPG non‐responders regained 2.6% of weight lost, whereas responders lost an additional 1.5% at follow‐up (p < 0.05 vs. non‐responders). Non‐responders had baseline characteristics consistent with more severe insulin resistance, including higher fasting plasma glucose (p = 0.03). Long‐term SSPG change was independently predicted by both total weight loss (p = 0.005) and baseline fasting plasma glucose (p = 0.007). Conclusions: Improvement in insulin sensitivity is maintained for 2–3 years following dietary weight loss if weight is not regained. Triglyceride and HDL‐C concentrations also remain improved over time, consistent with improvement in insulin sensitivity. Fasting glucose and weight regain predict less long‐term response in insulin sensitivity. These results highlight the potential long‐term benefits of weight loss and importance of preventing weight regain among high‐risk individuals.     

A review of web‐based weight loss interventions in adults

Unprecedented obesity rates are changing the burden of disease worldwide and obesity‐related health complications are increasing healthcare costs. In response, researchers, clinicians and public health practitioners are seeking new and effective tools such as the Internet to effect weight loss. This review highlights peer‐reviewed literature on randomized controlled trials that examine Internet‐delivered weight loss and maintenance programmes. The scope of this review is broader than previous reviews, including more males and non‐Caucasian participants. The reviewed studies show intervention results ranging from no weight loss to an average loss of 7.6 kg. It is difficult to draw a definitive conclusion on the potential impact of Internet‐based weight loss as study methods are highly variable between papers, low adherence was recorded and not all studies include a control group. As the demand for low‐cost, efficacious interventions that yield statistically significant and/or clinically relevant results grows, more rigorous, population‐specific research is needed to determine if Internet‐delivered interventions may slow or reverse with weight gain and obesity and the associated health consequences.     

Effective strategies for weight loss in post‐partum women: a systematic review and meta‐analysis

Post‐partum weight loss is critical to preventing and managing obesity in women, but the results from lifestyle interventions are variable and the components associated with successful outcomes are not yet clearly identified. This study aimed to identify lifestyle intervention strategies associated with weight loss in post‐partum women. MEDLINE, EMBASE, PubMed, CINAHL and four other databases were searched for lifestyle intervention studies (diet or exercise or both) in post‐partum women (within 12 months of delivery) published up to July 2014. The primary outcome was weight loss. Subgroup analyses were conducted for self‐monitoring, individual or group setting, intervention duration, intervention types, the use of technology as a support, and home‐ or centre‐based interventions. From 12,673 studies, 46 studies were included in systematic review and 32 randomized controlled trials were eligible for meta‐analysis (1,892 women, age 24–36 years). Studies with self‐monitoring had significantly greater weight lost than those without (?4.61 kg [?7.08, ?2.15] vs. ?1.34 kg [?1.66, ?1.02], P = 0.01 for subgroup differences). Diet and physical activity when combined were significantly more effective on weight loss compared with physical activity alone (?3.24 kg [?4.59, ?1.90] vs. ?1.63 kg [?2.16, ?1.10], P < 0.001 for subgroup differences). Lifestyle interventions that use self‐monitoring and take a combined diet‐and‐exercise approach have significantly greater weight loss in post‐partum women.     

Narrative review of reviews of preconception interventions to prevent an increased risk of obesity and non‐communicable diseases in children

Evidence for the effect of preconception and periconceptional risk factors on childhood outcomes such as obesity and other non‐communicable diseases (NCDs) in later life is growing. Issues such as maternal malnutrition need to be addressed before pregnancy, to prevent a transgenerational passage of risk of NCDs. The aim of this review was to evidence for preconception interventions to prevent obesity and other risk factors for NCDs in children. A search for systematic reviews of interventions in the preconception period published between 2006 and 2018 was conducted on academic databases. Fifteen reviews were included, two of the reviews also included pregnant women. None of the reviews directly reported on obesity or NCD outcomes in children. Results suggest that exercise‐ and diet‐based interventions significantly reduced maternal weight postpartum, weight gain during pregnancy, and improved prevention and control of gestational diabetes. Balanced protein energy supplementation during and before pregnancy was associated with an increase in mean birth weight and reduction of low birth weight babies. There is a dearth of evidence for preconception programmes that follow up on childhood outcomes related to a risk of NCDs. Nevertheless, results suggest that women who received preconception interventions were more likely to have improved pregnancy‐related and behavioural outcomes.     

Understanding the impact of rural weight loss interventions: A systematic review and meta‐analysis

Rural adults have a higher risk of developing obesity than urban adults. Several evidence‐based interventions have targeted rural regions, but their impact, defined as reach (number and representativeness of participants) by effectiveness, has not been examined. The purpose of this review was to determine the impact of rural weight loss interventions and the availability of data across dimensions of the reach, effectiveness, adoption, implementation, and maintenance (RE‐AIM) framework. A systematic review was conducted to identify rural weight loss interventions that targeted adults. RE‐AIM‐related data were abstracted from each article. We performed a meta‐analysis to examine effectiveness. Sixty‐four articles reported on rural weight loss interventions, describing 50 unique interventions. The median number of participants was 107. Median participation rate differed between values reported by the authors (62%) and values computed using a standard method (32%). Two studies reported on sample representativeness; none reported comparisons made between target and actual delivery settings. Median weight loss per participant was 3.64 kg. Meta‐analyses revealed the interventions achieved a significant weight reduction, and longer‐duration interventions resulted in greater weight loss. Rural weight loss interventions appear to be effective in supporting clinically meaningful weight loss but reach and cost outcomes are still difficult to determine.     

Short‐term intermittent energy restriction interventions for weight management: a systematic review and meta‐analysis

This systematic review synthesized the available evidence on the effect of short‐term periods of intermittent energy restriction (weekly intermittent energy restriction; ≥7‐d energy restriction) in comparison with usual care (daily continuous energy restriction), in the treatment of overweight and obesity in adults. Six electronic databases were searched from inception to October 2016. Only randomized controlled trials of interventions (≥12 weeks) in adults with overweight and obesity were included. Five studies were included in this review. Weekly intermittent energy restriction periods ranged from an energy intake between 1757 and 6276 kJ/d^?1. The mean duration of the interventions was 26 (range 14 to 48) weeks. Meta‐analysis demonstrated no significant difference in weight loss between weekly intermittent energy restriction and continuous energy restriction post‐intervention (weighted mean difference: ?1.36 [?3.23, 0.51], p  = 0.15) and at follow‐up (weighted mean difference: ?0.82 [?3.76, 2.11], p  = 0.58). Both interventions achieved comparable weight loss of >5 kg and therefore were associated with clinical benefits to health. The findings support the use of weekly intermittent energy restriction as an alternative option for the treatment of obesity. Currently, there is insufficient evidence to support the long‐term sustainable effects of weekly intermittent energy restriction on weight management.     

Effect of diet‐induced weight loss on muscle strength in adults with overweight or obesity – a systematic review and meta‐analysis of clinical trials

We conducted a systematic review and meta‐analysis to identify how diet‐induced weight loss in adults with overweight or obesity impacts on muscle strength. Twenty‐seven publications, including 33 interventions, most of which were 8–24 weeks in duration, were included. Meta‐analysis of seven interventions measuring knee extensor strength by isokinetic dynamometry in 108 participants found a significant decrease following diet‐induced weight loss (?9.0 [95% confidence interval: ?13.8, ?4.1] N/m, P < 0.001), representing a 7.5% decrease from baseline values. Meta‐analysis of handgrip strength from 10 interventions in 231 participants showed a non‐significant decrease (?1.7 [?3.6, 0.1] kg, P = 0.070), with significant heterogeneity (I² = 83.9%, P < 0.001). This heterogeneity may have been due to diet type, because there was a significant decrease in handgrip strength in seven interventions in 169 participants involving moderate energy restriction (?2.4 [?4.8, ?0.0] kg, P = 0.046), representing a 4.6% decrease from baseline values, but not in three interventions in 62 participants involving very‐low‐energy diet (?0.4 [?2.0, 1.2] kg, P = 0.610). Because of variability in methodology and muscles tested, no other data could be meta‐analyzed, and qualitative assessment of the remaining interventions revealed mixed results. Despite varying methodologies, diets and small sample sizes, these findings suggest a potential adverse effect of diet‐induced weight loss on muscle strength. While these findings should not act as a deterrent against weight loss, due to the known health benefits of losing excess weight, they call for strategies to combat strength loss – such as weight training and other exercises – during diet‐induced weight loss. © 2016 World Obesity     

The impact of extended care on the long-term maintenance of weight loss: a systematic review and meta-analysis

Behavioural weight management interventions consistently produce 8-10% reductions in body weight, yet most participants regain weight after treatment ends. One strategy for extending the effects of behavioural interventions has been the provision of extended care. The current study is a systematic review and meta-analysis of the literature on the effect of extended care on maintenance of weight loss. Through database searches (using PubMED, PsychInfo and Cochrane Reviews) and manual searches through reference lists of related publications, 463 studies were identified. Of these, 11 were included in the meta-analysis and an additional two were retained for qualitative analysis. The average effect of extended care on weight loss maintenance was g=0.385 (95% confidence interval: 0.281, 0.489; P<0.0001). This effect would lead to the maintenance of an additional 3.2 kg weight loss over 17.6 months post-intervention in participants provided extended care compared with control. There was no significant heterogeneity between studies, Q=5.63, P=0.845, and there was minimal evidence for publication bias. These findings suggest that extended care is a viable and efficacious solution to addressing long-term maintenance of lost weight. Given the chronic disease nature of obesity, extended care may be necessary for long-term health benefits.     

The effect of weight regain on cardiometabolic health in children with obesity: A systematic review of clinical studies

AimsChildren with obesity are treated by a lifestyle intervention to obtain weight loss. Nevertheless, weight regain often occurs. This systematic review examines the effect of weight regain on cardiometabolic health and summarizes these results in the metabolic syndrome prevalence as integrated endpoint.Data synthesisA literature search was performed in PubMed and Web of Science. Studies were selected if they included participants aged <18 years with obesity and presented data before and after weight loss and after weight regain hereby reporting minimally 1 cardiovascular risk factor at every assessment. After screening, nine articles remained.Generally, the diastolic BP re-increased after weight regain, whereas for systolic BP a sustained result for 6 months was reported with an increase during longer follow-up. No significant changes in fasting glucose were reported after weight regain compared to baseline. Regarding triglycerides, a complete weight regain re-increased the lowered values to baseline, whereas a partial regain resulted in a sustained decrease in triglycerides in 2 studies and an increase to intermediate levels in 1 paper. HDL-cholesterol only rose several months after initiating treatment. Hs-CRP remained lowered for a longer period than the moment where the weight loss nadir was achieved.ConclusionResearch on weight regain and cardiometabolic health in children with obesity is scarce. No convincing evidence was found for a worsening of the cardiometabolic profile after weight regain. Some benefits even persisted despite weight recovery. Subsequently, the metabolic syndrome prevalence seems temporarily lowered after weight loss, despite weight regain.     

Effectiveness of web‐based interventions in achieving weight loss and weight loss maintenance in overweight and obese adults: a systematic review with meta‐analysis

The objectives of this systematic review are to evaluate the effectiveness of web‐based interventions on weight loss and maintenance and identify which components of web‐based interventions are associated with greater weight change and low attrition rates. A literature search from 1995 to April 2008 was conducted. Studies were eligible for inclusion if: participants were aged ≥18 years with a body mass index ≥25, at least one study arm involved a web‐based intervention with the primary aim of weight loss or maintenance, and reported weight‐related outcomes. Eighteen studies met the inclusion criteria. Thirteen studies aimed to achieve weight loss, and five focused on weight maintenance. Heterogeneity was evident among the studies with seven research questions examined across interventions of varying intensity. Seven studies were assessed for effectiveness based on percentage weight change, with four studies deemed effective. Although the four meta‐analyses suggest meaningful weight change, it is not possible to determine the effectiveness of web‐based interventions in achieving weight loss or maintenance due to heterogeneity of designs and thus the small number of comparable studies. Higher usage of website features may be associated with positive weight change, but we do not know what features improve this effect or reduce attrition.     

Efficacy of very low‐energy diet programs for weight loss: A systematic review with meta‐analysis of intervention studies in children and adolescents with obesity

The objective of this review was to evaluate the efficacy and safety of very low‐energy diet (VLED) programs for weight loss in children and adolescents with obesity. Six electronic databases were searched identifying 24 eligible studies (16 pre‐post studies, four nonrandomized trials, two randomized controlled trials [RCTs], and two chart reviews) published up to October 2018. Studies were in English, implemented a VLED (≤3360 kJF/day [≤800 kcal/day] or <50% estimated energy requirements) in 5‐ to 18‐year‐olds with obesity, and reported at least one weight‐related outcome. Weight‐related outcomes significantly improved postintervention in all studies. Meta‐analysis of 20 studies indicated a mean 10.1 kg (95% confidence interval [CI], 8.7‐11.4 kg, P < 0.001; I² = 92.3%) weight loss following interventions lasting 3 to 20 weeks. Moderator analysis indicated greater weight loss in adolescent‐only studies (10‐18 years) and formulated meal replacement interventions and inpatient settings. Meta‐analysis of seven studies reporting weight at follow‐up (5‐14.5 months from baseline) indicated 5.3 kg mean weight loss (CI, 2.5‐8.0 kg, P < 0.001; I² = 50.6%). Details of adverse events were limited. VLED programs are effective for treating children and adolescents with obesity. However, conclusions on their safety cannot be drawn from the existing literature at this time. Future studies should include long‐term follow‐up with ongoing support and comprehensive monitoring of all adverse events.     

Maintenance of weight loss after lifestyle interventions for overweight and obesity,a systematic review

Lifestyle interventions can reduce body weight, but weight regain is common and may particularly occur with higher initial weight loss. If so, one may argue whether the 10% weight loss in clinical guidelines is preferable above a lower weight loss. This systematic review explores the relation between weight loss during an intervention and weight maintenance after at least 1 year of unsupervised follow‐up. Twenty‐two interventions (during at least 1 month) in healthy overweight Caucasians were selected and the mean percentages of weight loss and maintenance were calculated in a standardized way. In addition, within four intervention groups (n > 80) maintenance was calculated stratified by initial weight loss (0–5%, 5–10%, >10%). Overall, mean percentage maintenance was 54%. Weight loss during the intervention was not significantly associated with percentage maintenance (r = ?0.26; P = 0.13). Percentage maintenance also not differed significantly between interventions with a weight loss of 5–10% vs. >10%. Consequently, net weight loss after follow‐up differed between these categories (3.7 vs. 7.0%, respectively; P < 0.01). The analyses within the four interventions confirmed these findings. In conclusion, percentage maintenance does not clearly depend on initial weight loss. From this perspective, 10% or more weight loss can indeed be encouraged and favoured above lower weight loss goals.     

Dietary and lifestyle interventions for weight management in adults from minority ethnic/non‐White groups: a systematic review

Minority ethnic/non‐White populations are more prone to weight gain and more susceptible to obesity‐related complications. The objective of this study was to systematically review dietary and lifestyle interventions for weight management in minority ethnic groups. Electronic databases and reference lists of original studies and reviews were searched for studies on dietary and lifestyle weight management interventions published. Randomized clinical trials with ≥6‐month duration were included. Nineteen studies met the inclusion criteria. Fourteen studies involved African–Americans, one in non‐White Hispanics, one in Japanese Americans and three in both African–Americans and non‐White Hispanics. Most of the interventions proved relatively effective. However, significant drawbacks were noted for several of these studies, such as small sample size, high attrition rates and lack of follow‐up data. Better quality and long‐term trials are required in order to investigate in detail the effectiveness of lifestyle changes for weight management in these populations and eventually support evidence‐based recommendations.     

Effects of weight loss in overweight/obese individuals and long-term lipid outcomes – a systematic review

This paper aims to review the evidence for long‐term effectiveness of weight loss on cholesterol, high‐density lipoprotein (HDL), low‐density lipoprotein (LDL) and triglycerides in overweight/obese people. Current evidence is mostly based on short‐term studies. A systematic review of long‐term lipid outcomes of weight loss in studies published between 1966 and 2001, was conducted. Inclusion criteria included all cohort studies and trials carried out on participants with body mass index of greater than or equal to 28 kg m^?2. Studies had at least two weight change measurements and follow‐up of more than 2 years. Thirteen long‐term studies with a follow‐up of more than 2 years were included. Cholesterol has a significant positive linear relationship with weight change (r = 0.89) where change in weight explains about 80% of the cholesterol difference variation (Adj R² = 0.80). For every 10 kg weight loss a drop of 0.23 mmol L^?1 in cholesterol may be expected for a person suffering from obesity or are grossly overweight. Weight loss has long‐term beneficial effects especially on LDL and cholesterol. Weight loss in obese patients should be encouraged and sustained.