Realfit is a 13-week weight-reduction programme for adolescents. This study investigated the programme’s long-term effectiveness regarding the psychological outcomes of self-esteem and food craving. Methods: the study had a quasi-experimental design. Body mass index, self-esteem and food craving were assessed at baseline (t0), immediately after realfit (t1), and after five months (t2) and one year (t3) of follow-up. Control participants (n = 32) were overweight adolescents who received no treatment. Results: comparison between the intervention (n = 86) and control groups showed a significant difference for the self-esteem domain of global self-worth (1.63; 95% confidence interval: 0.28 to 2.99) in favour of the intervention group. The differences regarding overall self-esteem and the physical appearance domain showed a trend towards improvement. No significant difference was found for food craving. Conclusions: taking all results and limitations into account, it may cautiously be concluded that realfit has beneficial long-term effects on some domains of self-esteem, but no substantial effect on food craving. The appropriate duration and delivery of cue-exposure sessions in groups of overweight adolescents to decrease food craving should be investigated to further improve the realfit intervention.