Very-low-calorie diets (VLCDs) cause rapid weight loss. However, weight regain is rapid upon discontinuing the VLCD unless lifestyle is altered. The addition of a behavioral-modification (BMOD) program improves the long-term outcome. The major components of a BMOD program to alter lifestyle are education about nutrition and eating habits with alteration of amount and patterns of eating, institution of an aerobic activity program designed to increase energy expenditure, training in self-awareness and assertiveness, and training in coping techniques for long-term alteration of lifestyle. By retrospective chart review, we evaluated two VLCD programs at the same institution. One program gave 12 wk of BMOD before a 12-wk course of VLCD (Program 1), then scheduled individual visits regularly thereafter. The other program used simultaneous VLCD and BMOD in a 26-wk treatment course (Program 2), consisting of 2 wk of stabilization on 5020 kJ/d (1200 kcal/d), 12 wk of VLCD, and 12 wk of transition to a low-calorie solid food diet. Follow-up was obtained at 1 y in both groups. Maximum weight loss was similar, but subjects in Program 2 regained about one-third of the lost weight versus approximately 10% in Program 2. A third program of preceding BMOD followed by a low-calorie diet (Program 3) gave similar weight maintenance at 1 y as Program 1. Prospective studies are needed to determine if BMOD simultaneously with or preceding VLCD promotes better long-term weight maintenance. These data confirm the benefits of long-term follow-up for maintaining weight loss.