Objectives: Understanding the experiences of overweight adolescents who have lost weight may be useful in the creation of effective weight loss programs. Our objective was to identify differences between the experiences of overweight, inner-city adolescents who lost weight compared to adolescents who gained weight over time.

Methods: A qualitative study of a convenience sample of overweight inner-city adolescents, comparing those whose body mass index (BMI)-for-age decreased to those whose BMI-for-age increased, was done over a period of 2 years. Focus groups and in-depth interviews were analyzed by the constant comparative method; frequencies of thematic responses were compared.

Results: Adolescents in both groups had poor diets, had similar rates of eating with parents, had complex effects of monetary constraints, had ambivalence about being overweight, and lived in unsafe neighborhoods. Weight-losing adolescents were more likely to describe a transformative experience, which changed their view of themselves in the world with regard to weight and activity; to engage in intense, daily exercise; and to have family members who supported healthy dietary behavior.

Conclusion: Transformative experiences, intense daily exercise, and family support appeared to be critical elements for weight reduction in inner-city adolescents. This information may guide the development of weight loss strategies.