During ICAN, maximal weight loss (4.7%) occurred in the period of more frequent contact with RD case managers. From 8 to 12 months, the period of modest weight regain in the intervention group, participants received only 30 min of individual lime with case managers (12.5% of total individual therapeutic time) and 2 h of group classes. Although this decrease in intensity and support was intentional as a way to transition participants from intervention to maintenance, increased intensity has been positively related to amount of weight lost (33,34). Weight regain within the last 4 months of the intervention suggests the need for greater intensity during this time period and the need for ongoing lifestyle coaching to support maintenance. The weight regain may have been physiologically based. Maximal weight loss is typically observed at 6 months in obesity trials, regardless of intervention mode (behavioral, very-low-calorie diet, pharmacology) (5,6,27,35). After weight has been reduced, it takes a greater caloric deficit to maintain the lower weight. In addition, physical activity has been shown to improve weight maintenance (22). Although RD case managers supported increases in physical activity, other support for physical activity (e.g., fitness trainers) was not provided. Despite the weight regain from 8 to 12 months, almost twice as many participants in the case management group lost >5% of initial weight compared with participants in the usual care group. The National Heart, Lung, and Blood Institute guideline on obesity treatment stresses the importance of a 5-10% weight loss (22).