Effect of planned pauses versus continuous energy restriction on weight loss and attrition: a systematic review

Objective: The objective of this study was to investigate whether pausing a weight loss program for a defined period of time could enhance weight loss and reduce attrition. Methods: Five databases and two trial registries were searched from inception to July 2023. Randomized-controlled trials of adults with overweight and/or obesity were included if they compared planned-pause interventions with continuous energy restriction (CER), usual care, or a minimal intervention. To be included, the weight loss intervention must have incorporated a pause of at least 1 week. Pooled mean differences for weight change and risk ratios for attrition were calculated using random-effects meta-analyses. Results: Nine intervention arms (N = 796 participants, 77% female) were included. Pooled results did not detect a significant difference in weight change between planned pauses and CER interventions at the end of the active intervention at a median 26 weeks (planned pauses vs. CER mean: −7.09 vs. −7.0 kg; mean difference: −0.09 kg; 95% CI: −1.10 to 0.93) or at final follow-up at a median 52 weeks (planned pauses vs. CER mean: −6.91 vs. −6.19 kg; mean difference: −0.72 kg; 95% CI: −2.92 to 1.48). There was no difference in attrition between planned pauses and CER interventions at the end of the active intervention (risk ratio: 1.20, 95% CI: 0.82 to 1.75) or at final follow-up (risk ratio: 1.04, 95% CI: 0.89 to 1.22). Conclusions: Planned pauses were consistently found to be no more or less effective than CER for weight loss or attrition.