TABLE 1.

Detailed description of the combined lifestyle intervention (CLI).

Component	Frequency	Duration	Healthcare professional	Details
Combined nutritional advice and cognitive-behavioural therapy (CBT)	• 1x per week in week 1–10	1.5 h	A dietician and a psychologist	The nutrition education protocol focused on promoting a well-balanced healthy diet in accordance with the Dutch food dietary guideline (Voedingscentrum, 2015), whereby participants were instructed not to follow a low-calorie diet scheme (therefore, we refer to the diet as ‘normocaloric’). The aim is to help patients implement a healthy diet into their everyday-life which is sustainable on the long-term and will therefore support long-term weight management and health
	• 1x per 2 weeks in week 11–18
	• 1x per 4 weeks in week 19–26			The psychoeducational sessions were based on CBT and aimed to improve (stress-)coping, impulsivity, self-confidence and usage of the social support system. Techniques that were implemented in these sessions include cognitive restructuring, emotion regulation, increased self-control, problem solving strategies and relapse prevention
	• 1x in 12 weeks in week 26–78
Exercise session	• 1x per week in week 1–10	1.5 h	Physical therapist	The nutrition and psychoeducation sessions were followed by 1.5 h of exercise. The exercise sessions comprised both aerobic endurance training as well as anaerobic resistance training. The aim was to stimulate exercise in the home-setting and to improve cardiorespiratory fitness and muscle strength. Therefore, the content of exercise sessions varied: In some sessions, patients were subjected to strength and/or endurance training which they could repeat at home, other sessions focused on introducing new sports such as e.g. tennis or basketball in order to stimulate the patients’ exploration of their individual ways to create a more active lifestyle. Moreover, patients received advice on a healthy pattern of physical activity: including 30 min of mild physical activity per day (e.g. walking), as well as 1–2 times endurance training per week (e.g. running), and 1–2 times per week resistance training (e.g. muscle strengthening with weights)
	• 1x per 2 weeks in week 11–18
	• 1x per 4 weeks in week 19–26
	• 1x in 12 weeks in week 26–78
Homework			Dietician, psychologist and physical therapist	During group sessions, homework was given in order to promote the patients’ active participation in the program and to support their own exploration of ways to establish a healthier lifestyle in a personalized way
Medical evaluations	• Baseline		Medical doctors	Patients underwent medical consults in order to changes in relevant clinical parameters (e.g. weight, waist circumference, blood glucose, lipid levels … ), to consult regarding medication use and to take additional blood samples for research purposes
	• After 10 weeks
	• After 78 weeks (end of program)