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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 behaviors (e.g., 100‐kcal reduction or increases of 1000 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 randomized and quasi‐randomized 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 program‐end and −0.9 kg (95% CI −1.5 to −0.3, 95% PI −3.1 to 1.3) at last follow‐up, favoring 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.