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Clinical Research

Habit-based interventions for weight loss maintenance in adults with overweight and obesity: a randomized controlled trial



The objective of this study was to determine whether habit-based interventions are clinically beneficial in achieving long-term (12-month) weight loss maintenance and explore whether making new habits or breaking old habits is more effective.


Volunteer community members aged 18–75 years who had overweight or obesity (BMI ≥ 25 kg/m2) were randomized in a single-blind, three-arm, randomized controlled trial. Ten Top Tips (TTT), Do Something Different (DSD), and the attention-only waitlist (WL) control groups were conducted for 12 weeks from July to October 2015. Participants were followed up post-intervention (all groups) and at 6 and 12-month post-intervention (Ten Top Tips and Do Something Different only). The primary outcome was weight-loss maintenance at 12-month follow-up. Secondary outcomes included weight loss at all time points, fruit and vegetable consumption, exercise, wellbeing, depression, anxiety, habit strength, and openness to change.


Of the 130 participants assessed for eligibility, 75 adults (mean BMI 34.5 kg/m2 [SD 6.2]), with a mean age of 51 years were recruited. Assessments were completed post-intervention by 66/75 (88%) of participants and by 43/50 (86%) at 12 months. At post-intervention, participants in the Ten Top Tips (−3.3 kg; 95% CI −5.2, −1.4) and Do Something Different (−2.9 kg; 95% CI −4.3, −1.4) interventions lost significantly more weight (P = < .001) than those on the waitlist control (−0.4 kg; 95% CI −1.2, 0.3). Both intervention groups continued to lose further weight to the 12-month follow-up; TTT lost an additional −2.4 kg (95% CI −5.1, 0.4) and DSD lost −1.7 kg (95% CI −3.4, −0.1). At 12-month post-intervention, 28/43 (65%) of participants in both intervention groups had reduced their total body weight by ≥5%, a clinically important change.


Habit-based weight-loss interventions—forming new habits (TTT) and breaking old habits (DSD), resulted in clinically important weight-loss maintenance at 12-month follow-up.

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  1. Roqué i Figuls M, Martínez García L, Martinez-Zapata M, Pacheco R, Mauricio D, Bonfill Cosp X. Interventions for treating overweight or obesity in adults: an overview of systematic reviews. Cochrane Database of Syst Rev. 2013;CD010665.

  2. Cooper Z, Fairburn CG. A new cognitive behavioural approach to the treatment of obesity. Behav Res Ther. 2001;39:499–511.

    Article  CAS  PubMed  Google Scholar 

  3. Quinn JA, Pascoe A, Wood W, Neal DT. Can’t control yourself? monitor those bad habits. Pers Soc Psychol Bull. 2009;36:499–511.

    Article  Google Scholar 

  4. Gardner B, Lally P, Wardle J. Making health habitual: the psychology of ‘habit-formation’ and general practice. Br J Gen Pract. 2012;62:664–6.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Christensen BJ, Iepsen EW, Lundgren J, Holm L, Madsbad S, Holst JJ, et al. Instrumentalization of eating improves weight loss maintenance in obesity. Obes Facts. 2017;10:633–47.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Avenell A, Brown TJ, McGee MA, Campbell MK, Grant AM, Broom RT, et al. What are the long-term benefits of weight reducing diets in adults? A systematic review of randomised controlled trials. J Hum Nutr Diet. 2004;17:317–35.

    Article  CAS  PubMed  Google Scholar 

  7. Barte JC, ter Bogt NC, Bogers RP, Teixeira PH, Blissmer B, Mori TA, et al. Maintenance of weight loss after lifestyle interventions for overweight and obesity, a systematic review. Obes Rev. 2010;11:899–906.

    Article  CAS  PubMed  Google Scholar 

  8. Baumeister RF, Masicampo EJ, Vohs KD. Do conscious thoughts cause behavior? Annu Rev Psychol. 2011;62:331–61.

    Article  PubMed  Google Scholar 

  9. Wood W, Witt MG, Tam L. Changing circumstances, disrupting habits. J Pers Soc Psychol. 2005;88:918–33.

    Article  PubMed  Google Scholar 

  10. Ouellette JA, Wood W. Habit and intention in everyday life: The multiple processes by which past behavior predicts future behavior. Psychol Bull. 1998;124:54–74.

    Article  Google Scholar 

  11. Cleo G, Isenring L, Thomas R, Glasziou P. Could habits hold the key to weight loss maintenance? A narrative review. J Hum Nutr Diet. 2017;30:655–64.

    Article  CAS  PubMed  Google Scholar 

  12. Lally P, Van Jaarsveld CHM, Potts HWW, Wardle J. How are habits formed: modelling habit formation in the real world. Eur J Soc Psychol. 2010;40:998–1009.

    Article  Google Scholar 

  13. Fletcher BC, Hanson J, Page N, Pine K. FIT - do something different: a new behavioral program for sustained weight loss. Swiss J Psychol. 2011;70:25–34.

    Article  Google Scholar 

  14. Lally P, Gardner B. Promoting habit formation. Health Psychol Rev. 2013;7(Sup1):S137–5.

    Article  Google Scholar 

  15. Lally P, Chipperfield A, Wardle J. Healthy habits: efficacy of simple advice on weight control based on a habit-formation model. Int J Obes (Lond). 2008;32:700–7.

    Article  CAS  Google Scholar 

  16. Beeken RJ, Leurent B, Vickerstaff V, Wilson R, Croker H, Morris S, et al. A brief intervention for weight control based on habit-formation theory delivered through primary care: results from a randomised controlled trial. Int J Obes. 2017;41:246–54.

    Article  CAS  Google Scholar 

  17. Miller BML, Brennan L. Measuring and reporting attrition from obesity treatment programs: a call to action! Obes Res Clin Pract. 2015;9:187–202.

    Article  PubMed  Google Scholar 

  18. Burke LE, Wang J, Sevick MA. Self-monitoring in weight loss: a systematic review of the literature. J Am Diet Assoc. 2011;111:92–102.

    Article  PubMed  PubMed Central  Google Scholar 

  19. VanWormer J, French S, Pereira M, Welsh E. The impact of regular self-weighing on weight management: a systematic literature review. Int J Behav Nutr Phys Act. 2008;5:1–10.

    Article  Google Scholar 

  20. Fletcher BC, Penman D, Pine K. The no diet diet- do something different. 2nd ed. London, UK: Orion Publishing Group Ltd; 2007.

    Google Scholar 

  21. Fletcher B, Page N, Pine K. A new behavioural intervention for tackling obesity: do something different. Agro Food Ind Hi-Tech. 2007;18:8–9.

    Google Scholar 

  22. National Health and Medical Research Council. Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia. Canberra, Australia: Australian National Dept. of Health; 2013.

    Google Scholar 

  23. National Health and Medical Research Council. Australian Dietary Guidelines. Canberra, Australia: Australian National Dept. of Health and Ageing; 2013.

    Google Scholar 

  24. Charlton N, Kingston J, Petridis M, Fletcher B. Flexibility, personality and subjective wellbeing in the context of behaviour change interventions. Paper presented at 7th International Conference on Digital Health, London, UK; 2017.

  25. Curioni CC, Lourenco PM. Long-term weight loss after diet and exercise: a systematic review. Int J Obes. 2005;29:1168–74.

    Article  CAS  Google Scholar 

  26. Anderson JW, Konz EC, Frederich RC, Wood CL. Long-term weight-loss maintenance: a meta-analysis of US studies. Am J Clin Nutr. 2001;74:579–84.

    Article  CAS  PubMed  Google Scholar 

  27. Gardner B, de Bruijn GJ, Lally P. A systematic review and meta-analysis of applications of the Self-Report Habit Index to nutrition and physical activity behaviors. Ann Behav Med. 2011;42:174–87.

    Article  PubMed  Google Scholar 

  28. Kliemann N, Vickerstaff V, Croker H, Johnson F, Nazareth I, Beeken RJ. The role of self-regulatory skills and automaticity on the effectiveness of a brief weight loss habit-based intervention: secondary analysis of the 10 top tips randomised trial. Int J Behav Nutr Phys Act. 2017;14:119.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Lally P, Wardle J, Gardner B. Experiences of habit formation: a qualitative study. Psychol Health Med. 2011;16:484–9.

    Article  PubMed  Google Scholar 

  30. Lange D, Richert J, Koring M. Self-regulation prompts can increase fruit consumption: a one-hour randomised controlled online trial. Psychol Health. 2013;28:533–45.

    Article  PubMed  Google Scholar 

  31. World Health Organization. Global Recommendations on Physical Activity for Health. Geneva, Switzerland: World Health Organization; 2010.

    Google Scholar 

  32. Poobalan A, Aucott L, Smith WCS, Avenell A, Jung R, Broom J, et al. Effects of weight loss in overweight/obese individuals and long-term lipid outcomes – a systematic review. Obes Rev. 2004;5:43–50.

    Article  CAS  PubMed  Google Scholar 

  33. Ross R, Bradshaw AJ. The future of obesity reduction: beyond weight loss. Nat Rev Endocrinol. 2009;5:319–25.

    Article  PubMed  Google Scholar 

  34. Klein S, Allison DB, Heymsfield SB, Kelley D, Leibel R, Nonas C, et al. Waist circumference and cardiometabolic risk: a Consensus Statement from Shaping America’s Health: Association for Weight Management and Obesity Prevention; NAASO, The Obesity Society; the American Society for Nutrition; and the American Diabetes Association. Obesity. 2007;15:1061–7.

    Article  PubMed  Google Scholar 

  35. Wing RR, Phelan S. Long-term weight loss maintenance. Am J Clin Nutr. 2005;82:222–5.

    Article  Google Scholar 

  36. Metzga CJ, Perston AG, Miller DL, Nickol Richardson SM. Facilitators and barriers to weight loss and weight loss maintenance: a qualitative exploration. J Hum Nutr Diet. 2014;28:593–603.

    Article  Google Scholar 

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We thank our wonderful research assistant Ms. Simӧna Sterling for conducting our anthropometric measurements. We also thank Professor Ben Fletcher for his involvement and support with the psychometric measures. Finally, we gratefully acknowledge the 75 individuals who participated in this study.


GC was supported by an Australian Government Research Training Program Scholarship. RT and EB are supported by NHMRC grants (APP1104136, APP1044904). PG is supported by an NHMRC Australian Fellowship grant (GNT1080042). EI received no funding with respect to this study.

Author contributions

GC had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: GC, PG. Acquisition of data: GC. Analysis and interpretation of data: GC, RT, EB. Drafting of the manuscript: GC, PG, RT, EI. Critical revision of the manuscript for important intellectual content: GC, RT, EB, EI, PG. Statistical analysis: GC, RT, EB.

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Correspondence to Gina Cleo.

Ethics declarations


This study complied with the ethics guidelines recommended by the National Health and Medical Research Council (NHMRC) and Bond University Research Ethics Committee (BUHREC). This study was granted ethical approval by BUHREC (No. RO1888B) on 17 February, 2015.

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Registered clinical trial: This study was registered on 10 February 2015 through the Australian New Zealand Clinical Trials Registry (ANZCTR). The allocated Australian Clinical Trial Registry Number (ACTRN) is: ACTRN12615000114549.

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Cleo, G., Glasziou, P., Beller, E. et al. Habit-based interventions for weight loss maintenance in adults with overweight and obesity: a randomized controlled trial. Int J Obes 43, 374–383 (2019).

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