In asking that weight loss be maintained for periods greater than a few months, physicians are asking a great deal of their patients. In Western society, this means substantial behavioral change in an environment and culture that promotes weight gain. It is extremely common for people to regain the weight they have lost. To illustrate how we may in the future be able to achieve longer-term weight maintenance, a brief outline of 1 study--the 2-year, randomized, double-blind, placebo-controlled study: Sibutramine Trial of Obesity Reduction and Maintenance--will be described. This study showed that with an individualized weight-management program, most obese patients can achieve metabolically significant weight loss, and this loss can be sustained in most patients who continue therapy for 2 years. New analyses reveal that those patients who maintain a higher level of physical activity do better, and the prediction that blood pressure responses might be hazardous is counteracted by predictive analyses of multiple sibutramine trials, which suggest a likely absolute reduction in cardiovascular risk in sibutramine-treated patients. Additional evidence suggests a reduced cardiovascular load as a result of this new management system, which should be seen as the beginning of a new era in our approach to tackling the hazards of overweight and obesity long term.