Is a small change approach for weight management effective? A systematic review and meta‐analysis of randomized controlled trials

Traditional weight management interventions typically involve people making large changes to their energy intake and/or expenditure and can be effective in the short-term, but weight regain is common. An alternative strategy is a small change approach, which asks people to make small(er) changes to their diet and/or physical activity behaviours (e.g., 100 kilocalories reduction or increases of 1,000 steps/day). This approach may lead to sustained weight management because such energy deficit goals are easier for people to integrate into their lives and then maintain. This systematic review and meta-analysis of randomised and quasi-randomised controlled trials assessed the effectiveness of a small change approach for weight management; 21 trials were included. In weight gain prevention trials with adults, the mean difference in weight change between groups was -0.7 kg (95% CI -1.0 to -0.4, 95% PI -1.1 to -0.3) at programme-end and -0.9 kg (95% CI -1.5 to -0.3, 95% PI -3.1 to 1.3) at last follow-up, favouring small change interventions. A small change approach was not effective for weight loss. Only 2/21 trials had a low risk of bias. Initial evidence supports the effectiveness of a small change approach for weight gain prevention, but not weight loss. Further high-quality trials with longer follow-up are required