Comparative effectiveness of three doses of weight-loss counseling: Two-year findings from the rural LITE trial

Perri, Michael G.; Limacher, Marian C.; Castel-Roberts, Kristina von; Daniels, Michael J.; Durning, P; Janicke, David M.; Bobroff, Linda B.; Radcliff, Tiffany A.; Milsom, Vanessa A.; Kim, ChanMin; Martin, A. Daniel

doi:10.1002/oby.20832

Cited by 55 publications

(67 citation statements)

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“…32 Our findings that family support and healthy behaviors with peers mediate children’s treatment outcomes also extend laboratory and observational research findings. 33 Family and peers play a crucial role in establishing healthy home and social environments that encourage children to engage in ongoing weight-control behaviors, and their social support should be viewed as a key treatment component. 11,12,34 Given that social neglect or rejection of children with overweight and obesity starts in early childhood, 33 intervening in early to middle childhood through family-based treatment that incorporates social targets may be particularly important, as social (eg, more peer influence) and physiological (eg, puberty) issues could make later intervention more challenging.…”

Section: Discussionmentioning

confidence: 99%

Dose, Content, and Mediators of Family-Based Treatment for Childhood Obesity

et al. 2017

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IMPORTANCE Elucidation of optimal dosing and treatment content is critical for health care providers, payers, and policy makers, as well as mechanisms of change to inform intervention delivery and training initiatives for childhood obesity.OBJECTIVES To evaluate effects, following a 4-month family-based behavioral weight loss treatment (FBT), of 2 doses (HIGH or LOW) of a weight-control intervention (enhanced social facilitation maintenance [SFM+]) vs a weight-control education condition (CONTROL; matched for dose with LOW), on child anthropometrics, and to explore putative mediators of weight loss outcomes. DESIGN, SETTING, AND PARTICIPANTS For this parallel-group randomized clinical trial conducted at 2 US academic medical centers from December 2009 to March 2013, 172 parent-child dyads completed FBT and were then randomized to 8 months of SFM+ (HIGH, n = 59; LOW, n = 56) or CONTROL (n = 57). Children (aged 7-11 years) with overweight and obesity (body mass index [BMI; calculated as weight in kilograms divided by height in meters squared] Ն85th percentile) with at least 1 parent with overweight and obesity (BMI Ն25) were recruited. INTERVENTIONS HIGH SFM+ vs LOW SFM+ (CONTROL matched the dose of LOW).MAIN OUTCOMES AND MEASURES Intention-to-treat analysis using mixed-effects models estimated change in child percentage overweight (percentage above the median BMI for a child's age and sex) for the FBT period (0-4 months) and the SFM+ period (4-12 months), and proportion of children achieving a clinically significant change in percentage overweight (Ն9-unit decrease; months 0-12). Theory-based outcome mediators were also evaluated. RESULTSThis study recruited 172 parent-child dyads (mean [SD] age: parents 42.3 [6.4] years; children, 9.4 [1.3] years). The omnibus treatment × time interaction for child percentage overweight was significant (F 8, 618.9 = 2.89; P = .004). Planned pairwise comparisons revealed that from months 4 to 12, LOW had better outcomes than CONTROL (difference, −3.34; 95% CI, −6.21 to −0.47; d = −0.40; P = .02). HIGH had better outcomes than LOW (difference, −3.37; 95% CI, −6.15 to −0.59; d = −0.38; P = .02) and CONTROL (difference, −6.71; 95% CI, −9.57 to −3.84; d = −0.77; P < .001). A greater proportion of children in HIGH (45 [82%]) vs LOW (34 [64%]) (difference, 18.00; 95% CI, 1.00-34.00; P = .03; number needed to treat = 5.56) and CONTROL (25 [48%]) (difference, 34.00; 95% CI, 16.00-51.00; P < .001; number needed to treat = 2.94) had clinically significant percentage overweight reductions. Food and activity monitoring and goal setting mediated the effect of LOW vs CONTROL (50%). Monitoring and goal setting, family and home environment, and healthy behaviors with peers mediated the effect of HIGH vs CONTROL (25%-42%).CONCLUSIONS AND RELEVANCE Following FBT, specialized intervention content (SFM+) enhanced children's weight outcomes and outperformed a credible control condition, with high dose delivery yielding the best outcomes. Sustained monitoring and goal setting, support from the family a...

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Section: Discussionmentioning

confidence: 99%

Dose, Content, and Mediators of Family-Based Treatment for Childhood Obesity

et al. 2017

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“…Research shows that the more counselling is provided, the more weight is lost (Perri et al, 2014). However, intensive counselling results in higher costs.…”

Section: Discussionmentioning

confidence: 99%

Technology-based interventions in the treatment of overweight and obesity: A systematic review

et al. 2015

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“…The first corresponds to regaining an average 0.3 kg per month after leaving the study,(9, 33, 34) and the second corresponds to predicting missing values based on observed data using multiple imputation. Both approaches revealed the same pattern of findings.…”

Section: Methodsmentioning

confidence: 99%

Weight loss maintenance strategies among rural breast cancer survivors: The rural women connecting for better health trial

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Klemp

Sullivan

et al. 2016

Obesity

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Objective Obesity is a risk factor for breast cancer recurrence. Rural women have higher obesity rates compared to urban women and are in need of distance-based interventions that promote long-term weight loss. Methods In this two-phase trial, rural breast cancer survivors who lost > 5% of their starting weight during a 6-month lifestyle intervention (delivered through weekly group conference calls) were randomized to one of two 12-month interventions for weight loss maintenance: continued bi-weekly group phone-based counseling or mailed newsletters. The primary outcome was weight regain from 6 to 18 months. Secondary outcomes included dichotomous measures of weight change and costs. Results Mean weight loss at 6 months was 14.0 ± 5.1%. Participants in the group phone condition regained less weight (3.3±4.8 kg) compared to participants in the newsletter condition (4.9±4.8 kg; p=0.03). At 18 months, 75.3% of participants in the group phone condition remained ≥ 5% below baseline weight compared to 57.8% in the newsletter condition (p=0.02). Incremental cost effectiveness ratios were $882 to keep one more person ≥ 5% below baseline weight. Conclusions A lifestyle intervention incorporating group phone-based support improved the magnitude of weight loss maintained and increased the proportion of survivors who maintained clinically significant reductions.

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Comparative effectiveness of three doses of weight-loss counseling: Two-year findings from the rural LITE trial

Cited by 55 publications

References 29 publications

Dose, Content, and Mediators of Family-Based Treatment for Childhood Obesity

Dose, Content, and Mediators of Family-Based Treatment for Childhood Obesity

Technology-based interventions in the treatment of overweight and obesity: A systematic review

Weight loss maintenance strategies among rural breast cancer survivors: The rural women connecting for better health trial

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