Comparison of strategies for sustaining weight loss: The weight loss maintenance randomized controlled trial

Laura P. Svetkey, Victor J. Stevens, Phillip J. Brantley, Lawrence Appel, Jack F. Hollis, Catherine M. Loria, William M. Vollmer, Christina M. Gullion, Kristine Funk, Patti Smith, Carmen Samuel-Hodge, Valerie Myers, Lillian F. Lien, Daniel Laferriere, Betty Kennedy, Gerald J. Jerome, Fran Heinith, David W. Harsha, Pamela Evans, Thomas P. ErlingerArlene Dalcin, Janelle Coughlin, Jeanne B Charleston, Catherine M. Champagne, Alan Bauck, Jamy D. Ard, Kathleen Aicher

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Abstract

Context: Behavioral weight loss interventions achieve short-term success, but regain 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. 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 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. Trial Registration: clinicaltrials.gov Identifier: NCT00054925.

Original languageEnglish (US)
Pages (from-to)1139-1148
Number of pages10
JournalJournal of the American Medical Association
Volume299
Issue number10
DOIs
StatePublished - Mar 12 2008

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ASJC Scopus subject areas

  • Medicine(all)

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Svetkey, L. P., Stevens, V. J., Brantley, P. J., Appel, L., Hollis, J. F., Loria, C. M., Vollmer, W. M., Gullion, C. M., Funk, K., Smith, P., Samuel-Hodge, C., Myers, V., Lien, L. F., Laferriere, D., Kennedy, B., Jerome, G. J., Heinith, F., Harsha, D. W., Evans, P., ... Aicher, K. (2008). Comparison of strategies for sustaining weight loss: The weight loss maintenance randomized controlled trial. Journal of the American Medical Association, 299(10), 1139-1148. https://doi.org/10.1001/jama.299.10.1139