OBJECTIVES: To describe patterns of weight change in subjects with obesity after an initial period of weight loss or maintenance. METHODS: A retrospective longitudinal study was conducted using electronic medical records data from the General Electric Centricity database. Subjects age ≥18 years old, with BMI ≥30 kg/m (the first defining the index BMI), without comorbidities related to unintentional weight loss, and with ≥4 BMI measurements/year for ≥5 years were included. Subjects who had stable weight (within <5% of index BMI) or weight loss (modest: ≥5 to <10% of index BMI; moderate: ≥10 to <15% of index BMI; high: ≥15% of index BMI) in the 6-months after the index date were evaluated for weight change over the next 2 years (observation period). RESULTS: Of the 177,743 subjects included in the analysis, 85.1% of subjects had stable weight at the start of the observation period, 9.3% had modest weight loss, 2.3% had moderate weight loss, and 3.3% had high weight loss. The proportion of subjects who maintained their weight during the first 3 months of the observation period significantly decreased by the end of the 2-year observation period in all weight change groups: from 93.6% to 39.7% in the stable weight, 84.6% to 23.1% in modest weight loss, 72.8% to 14.1% in moderate weight loss, and 65.3% to 19.4% in high weight loss groups (all p<0.05). Most subjects experienced weight cycling (did not continue to lose, gain, or maintain weight throughout the observation period relative to its start), with significantly more weight cycling in the modest and moderate weight loss groups (71.5% and 74.1%, respectively; p<0.001) compared to the stable weight group (58.3%) but not the high weight loss group (58.3%; p=0.917). CONCLUSIONS: Few subjects with obesity maintained their initial weight loss, with most subjects experiencing weight cycling over a 2-year period.