Introduction/Purpose This project evaluated the impact of accountability counseling on weight loss success in overweight or obese adults who were seeking to lose weight. The purpose of this quality improvement project was to evaluate if structured accountability counseling aided in individuals’ increased weight and fat loss compared to those who did not receive structured accountability counseling. Methods A group of 10 participants voluntarily engaged in a quality improvement project comparing the differences between structured accountability counseling and conventional standards of care in an outpatient weight loss clinic setting. The participants engaged in the project for six weeks, following up on a weekly basis. The weekly follow-up sessions were based on the behavior change model of the 5A’s (Assess, Advise, Agree, Assist, and Arrange). During the sessions, the participants received a body composition analysis using the Tanita scale that showed the participant’s Body Mass Index (BMI), weight, and body fat percentage. Two goals of body fat loss of 4% or greater and BMI drop of 2 points or greater were established for the participants to determine the effectiveness of structured accountability counseling on weight loss in overweight and obese adults. Results The study included patients aged 53 on average in the control group (n=10) and 43 on average in the implementation group (n=10). Patients in the implementation group showed a greater increase in fat loss and BMI reduction while receiving structured accountability counseling. Participants achieving both goals were only observed in the implementation group with 50% of individuals achieving both goals compared to the control group with 0% of individuals achieving both goals. In both groups, patients that maintained compliance with the program for the longest time were associated with higher weight loss, fat percentage loss, and reduction in BMI. Discussion The evaluation of data deemed the intervention successful. Fifty percent of participants achieved both project goals within the six-week quality improvement project. The project also demonstrated that increased compliance over time with a weight loss program improves weight loss goal achievement. Accountability counseling with weekly follow up increases weight loss in overweight and obese adults with the potential to improve compliance over time with the program.