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Clinical nutrition

Effects of cognitive behavioral therapy on weight maintenance after successful weight loss in women; a randomized clinical trial




Weight regain after weight loss is a main challenge in obesity management. Cognitive behavioral therapy (CBT) has been introduced as an option for achieving weight loss but not tested for weight maintenance. The aim of this study was to evaluate the effects of CBT on weight maintenance after successful weight loss.


Female adults [n = 113, BMI = 23–30 kg/m²; age = 18–45 years], who had lost at least 10% of their body weight by using a weight loss program, were randomly allocated to either CBT or control group for a further 24-week weight-maintenance period.


Compared with control group, CBT treatment improved weight loss maintenance (mean difference, −2.2 kg [95% CI, −3.50, −0.94]; P = 0.001), BMI (mean difference, −0.77 kg/m²; [95% CI, −1.25, −0.28]; P = 0.002), and waist circumference (mean difference, −2.08 cm; [95% CI, −3.31, −0.844]; P = 0.001) at the end of the 24-week period intervention. Estimated energy intake showed a significant reduction over time in CBT group, while it increased in control group (P < 0.001). There was also a significant group × time interaction for mean daily steps over the 24-week period with CBT having a higher level (P < 0.001). However, changes in lipid profiles and carbohydrate metabolism were not significantly different between the groups.


Cognitive behavioral therapy is an effective tool for weight maintenance over a 24-week period in successful weight losers, with corresponding maintenance of a reduced energy intake and doing more physical activity which may helpful for weight maintenance in the long term.

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We thank the staff of NovinDiet Clinic, Mansoureh Pahlevani, Rahil Ahmadi, for their assistance in data collection, Elham Zamani and Sahar Shahemi for doing dietary consultation and CBT and Masoud Solaymani for his statistical consultation. Thanks also go to Asadi at Jaam e Jam Laboratory for the analysis of blood samples. The authors’ responsibilities were as follows—AM, and HRF: contributed to the initial study design, study protocol setup, and data collection; AM: provided data analysis and wrote the first draft of the manuscript; HRF: designed the research, conducted the research, contributed to data interpretation, revised the manuscript, and provided medical supervision; MAT and IAM: refined the study design and contributed to data interpretation and redrafting of the manuscript; AD and RM: provided advice and consultation for the study design and conducted the research; and all authors: read and approved the final manuscript.



This study was supported by The School of Life Sciences, The University of Nottingham, UK and The Digestive Disease Research Institute (DDRI), affiliated to Tehran University of Medical Sciences (TUMS).

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Correspondence to Ameneh Madjd or Hamid R. Farshchi.

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IAM is a member of the UK Scientific Advisory Committee on Nutrition, Joint Editor of the International Journal of Obesity, a member of the Mars Scientific Advisory Council, of Scientific Advisory boards for Nestle Research, Novozymes, a Scientific Adviser to the Waltham Centre for Pet Nutrition. None of the other authors declares that they have no conflict of interest.

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Madjd, A., Taylor, M.A., Delavari, A. et al. Effects of cognitive behavioral therapy on weight maintenance after successful weight loss in women; a randomized clinical trial. Eur J Clin Nutr 74, 436–444 (2020).

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