Comparative Effectiveness of Weight-Loss Interventions in Clinical Practice

Abstract

Background Obesity and its cardiovascular complications are extremely common medical problems, but evidence on how to accomplish weight loss in clinical practice is sparse. Methods We conducted a randomized, controlled trial to examine the effects of two behavioral weight-loss interventions in 415 obese patients with at least one cardiovascular risk factor. Participants were recruited from six primary care practices; 63.6% were women, 41.0% were black, and the mean age was 54.0 years. One intervention provided patients with weight-loss support remotely — through the telephone, a study-specific Web site, and e-mail. The other intervention provided in-person support during group and individual sessions, along with the three remote means of support. There was also a control group in which weight loss was self-directed. Outcomes were compared between each intervention group and the control group and between the two intervention groups. For both interventions, primary care providers reinforced participation at routinely scheduled visits. The trial duration was 24 months. Results At baseline, the mean body-mass index (the weight in kilograms divided by the square of the height in meters) for all participants was 36.6, and the mean weight was 103.8 kg. At 24 months, the mean change in weight from baseline was −0.8 kg in the control group, −4.6 kg in the group receiving remote support only (P<0.001 for the comparison with the control group), and −5.1 kg in the group receiving in-person support (P<0.001 for the comparison with the control group). The percentage of participants who lost 5% or more of their initial weight was 18.8% in the control group, 38.2% in the group receiving remote support only, and 41.4% in the group receiving in-person support. The change in weight from baseline did not differ significantly between the two intervention groups. Conclusions In two behavioral interventions, one delivered with in-person support and the other delivered remotely, without face-to-face contact between participants and weight-loss coaches, obese patients achieved and sustained clinically significant weight loss over a period of 24 months. (Funded by the National Heart, Lung, and Blood Institute and others; ClinicalTrials.gov number, NCT00783315.)

Systematic review and meta‐analysis of internet‐delivered interventions providing personalized feedback for weight loss in overweight and obese adults

“…In nine studies, the control groups not receiving personalized feedback took the form of wait list or minimal face‐to‐face interventions 30, 31, 32, 35, 36, 37, 38, 39, 40. Minimal interventions included one‐off usual care appointments where participants received standardized weight loss‐printed information.…”

Program compliance, weight loss and health profile changes in WHO obesity classes after very low energy dietary intervention

“…The behaviour management components covered the core areas of assertion, stress management, goal setting, self monitoring, portion control, problem solving, cognitive restructuring, relapse prevention, optimistic thinking and self care. These groups were led by physical and health educators (week 1-8, 23-26), a registered psychologist (week 9-12), dietician (week [13][14][15][16][17][18][19][20] or exercise physiologist (week 4-5, 21-22). All groups followed the program manual that was supplied to each participant [17,18].…”

Virtual small groups for weight management: an innovative delivery mechanism for evidence-based lifestyle interventions among obese men

“…In the landmark Diabetes Prevention Program trial, only 50 % of people in the lifestyle arm achieved the weight loss goal of 7 % of their body weight [3]. In general, low adherence and attendance are formidable challenges to the effectiveness of many existing clinicbased interventions, with group session attendance dropping markedly over time [15][16][17].…”

“…Frequent and sustained in-person contact presents cost and feasibility challenges, with group session attendance dropping markedly over time [15][16][17]. Further, men are a difficult population to engage in weight loss studies [18,19].…”