Objective: Compare weight loss and maintenance between a face-to-face (FTF) weight management clinic and a clinic delivered via virtual reality (VR). Methods: Participants were randomized to 3 months of weight loss with a weekly clinic delivered via FTF or VR and then 6 months' weight maintenance delivered with VR. Data were collected at baseline and 3 and 6 months for weight and process variables. Twenty overweight and obese individuals (31.1 plus or minus 3.6 years of age; body mass index, 32.8 plus or minus 5.1; 85% females; 20% minorities) responded to advertisement and met inclusion criteria. Diets (1,200-1,800 kcal/d) used prepackaged meals, fruits and vegetables, and physical activity (300 min/wk). Results: Weight loss was significantly greater for FTF at 10.8% compared with 7.6% for VR (P less than 0.05). However, weight maintenance was significantly greater for VR at 14.0% compared with 9.5% for FTF (P less than 0.05). Conclusions and Implications: Virtual reality compares favorably with FTF for weight loss and may facilitate greater weight maintenance. (Contains 1 figure and 1 table.)