Comparison of Strategies for Sustaining Weight Loss
Context Behavioral weight loss interventions achieve short-term success, but re-gain is common.
Objective To compare 2 weight loss maintenance interventions with a self-directed control group.
Design, Setting, and Participants Two-phase trial in which 1032 overweight or obese adults (38% African American, 63% women) with hypertension, dyslipidemia, or both who had lost at least 4 kg during a 6-month weight loss program (phase 1) were randomized to a weight-loss maintenance intervention (phase 2). Enrollment at 4 academic centers occurred August 2003-July 2004 and randomization, February-December 2004. Data collection was completed in June 2007.
Interventions After the phase 1 weight-loss program, participants were randomized to one of the following groups for 30 months: monthly personal contact, unlimited access to an interactive technology–based intervention, or self-directed control. indian viagra buy
Main Outcome Changes in weight from randomization.
Results Mean entry weight was 96.7 kg. During the initial 6-month program, mean weight loss was 8.5 kg. After randomization, weight regain occurred. Participants in the personal-contact group regained less weight (4.0 kg) than those in the self-directed group (5.5 kg; mean difference at 30 months, −1.5 kg; 95% confidence interval [CI], −2.4 to −0.6 kg; P = .001). At 30 months, weight regain did not differ between the interactive technology–based (5.2 kg) and self-directed groups (5.5 kg; mean difference −0.3 kg; 95% CI, −1.2 to 0.6 kg; P = .51); however, weight regain was lower in the interactive technology–based than in the self-directed group at 18 months (mean difference, −1.1 kg; 95% CI, −1.9 to −0.4 kg; P = .003) and at 24 months (mean difference, −0.9 kg; 95% CI, −1.7 to −0.02 kg; P = .04). At 30 months, the difference between the personal-contact and interactive technology–based group was −1.2 kg (95% CI −2.1 to −0.3; P = .008). Effects did not differ significantly by sex, race, age, and body mass index subgroups. Overall, 71% of study participants remained below entry weight.
Conclusions The majority of individuals who successfully completed an initial behavioral weight loss program maintained a weight below their initial level. Monthly brief personal contact provided modest benefit in sustaining weight loss, whereas an interactive techonology–based intervention provided early but transient benefit.
Nearly two-thirds of US adults are overweight or obese. Together overweight and obesity are the second leading cause of preventable death, primarily through effects on cardiovascular disease (CVD) risk factors (hypertension, dyslipidemia, and type 2 diabetes). Weight loss improves these risk factors, and evidence suggests that benefits persist as long as weight loss is maintained. Relatively short-term (ie, 4-6 months) behavioral interventions for adults result in clinically significant weight loss, but regain is an intractable problem. Given the vast scope of the overweight and obesity epidemic, there is a critical need for practical, affordable, and scalable intervention strategies that effectively maintain weight loss. Such strategies may also play an important role in preventing weight gain among normal-weight individuals, thereby reducing the incidence of overweight and obesity.