A randomized controlled trial testing an Internet delivered cost–benefit approach to weight loss maintenance

Abstract

Weight loss maintenance is a significant challenge in obesity treatment. During maintenance the “costs” of adhering to weight management behaviors may outweigh the “benefits.” This study examined the efficacy of a novel approach to weight loss maintenance based on modifying the cost-benefit ratio. Individuals who achieved a 5% weight loss (N=75) were randomized to one of three, 10-month maintenance interventions. All interventions were delivered primarily via the Internet. The Standard arm received traditional weight maintenance strategies. To increase benefits, or rewards, for maintenance behaviors, the two cost-benefit intervention conditions received weekly monetary rewards for self-monitoring and social reinforcement via e-coaching. To decrease behavioral costs (boredom) and increase novelty, participants in the cost-benefit conditions also monitored different evidence-based behaviors every two weeks (e.g., Weeks 1 & 2: steps; Week 3 & 4: red foods). The primary difference between the cost-benefit interventions was type of e-coach providing social reinforcement: Professional (CB Pro) or Peer (CB Peer). Study procedures took place in Providence, RI from 2013–2014. Retention was 99%. There were significant group differences in weight regain (p=.01). The Standard arm gained 3.5±5.7kg. In contrast, participants in CB Pro and CB Peer lost an additional 1.8±7.0kg and 0.5±6.4kg, respectively. These results suggest that an Internet delivered cost-benefit approach to weight loss maintenance may be effective for long-term weight control. In addition, using peer coaches to provide reinforcement may be a particularly economic alternative to professionals. These data are promising and provide support for a larger, longer trial. Clinicaltrials.gov Identifier NCT01760486

Self-management of dietary intake using mindful eating to improve dietary intake for individuals with early stage chronic kidney disease

“…The long term impact of this intervention is important to determine since maintenance of weight loss remains a challenge (Leahey et al, 2016). Extended treatment has been shown to consistently improve weight maintenance (Perri & Corsica, 2002) and innovative strategies to reduce behavioral costs (e.g., boredom) that affect long term maintenance need to be considered in interventions addressing dietary changes (Leahey et al, 2016). Long-term follow up has also been identified as a gap in the literature on the efficacy of interventions designed to improve diets for management of chronic disease (Desroches et al, 2013).…”

Average number of days of absence, by age group and BMI category, United States, 2001‑08

“…Discovery Health, a private health insurer, has developed and has been running one of the most wellknown examples of a privately-managed health prevention programme. The Vitality programme was first rolled out in South Africa to be subsequently extended to other markets, including the United Kingdom, the United States and China (Lambert and Kolbe-Alexander, 2013 [126]…”

Categorisation of countries

“…Discovery Health, a private health insurer, has developed and has been running one of the most wellknown examples of a privately-managed health prevention programme. The Vitality programme was first rolled out in South Africa to be subsequently extended to other markets, including the United Kingdom, the United States and China (Lambert and Kolbe-Alexander, 2013 [126] [127]). The Vitality programme was also found to reduce medical care costs, which created an additional incentive for private insurers to invest in prevention.…”