Behavioral Factors Associated With ≥ 15% Versus < 5% Weight Loss in Adults With Severe Obesity: A Retrospective Clinical Study

ABSTRACT Background Sustained weight loss requires a persistent reduction in energy intake combined with increased energy expenditure. Assessment of such strategies can improve treatment outcomes. The National Weight Control Registry (NWCR) has identified behavioral approaches associated with successful long‐term weight loss maintenance. Objectives To assess the prevalence of self‐reported NWCR strategies and examine their association with achieving ≥ 15% versus < 5% weight loss (WL) within a structured obesity treatment program. Methods Adults with a BMI ≥ 35 kg/m 2 at program initiation were included. Electronic medical records were retrospectively reviewed at baseline and at 6 and 12 months. Assessed NWCR strategies included reduced energy intake, reduced fat and sugar consumption, regular breakfast consumption, consistent meal frequency, self‐weighing, food intake monitoring, and regular physical activity. Results Participants achieving ≥ 15% WL more frequently reported reduced energy intake, reduced fat and sugar consumption, and regular physical activity at both 6 and 12 months compared with those achieving < 5% WL (all p < 0.03). Individuals in the ≥ 15% WL group reported a greater number of successful strategies at both time points ( p < 0.001). Conclusions These findings from a clinical setting largely corroborate previous registry‐based evidence, demonstrating that clinically significant weight loss achieved during structured obesity treatment is associated with more frequent reporting of behaviors identified by the National Weight Control Registry.