title: Comparison of strategies for sustaining weight loss: the weight loss maintenance randomized controlled trial.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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 -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 technology-based intervention provided early but transient benefit.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00054925.
authors.affiliation: Division of Nephrology, Department of Medicine, Duke Hypertension Center and Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina 27710, USA. Svetk001@mc.duke.edu
authors.forename: Laura P
authors.initials: LP
authors.lastname: Svetkey
authors.forename: Victor J
authors.initials: VJ
authors.lastname: Stevens
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Brantley
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Appel
authors.forename: Jack F
authors.initials: JF
authors.lastname: Hollis
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Loria
authors.forename: William M
authors.initials: WM
authors.lastname: Vollmer
authors.forename: Christina M
authors.initials: CM
authors.lastname: Gullion
authors.forename: Kristine
authors.initials: K
authors.lastname: Funk
authors.forename: Patti
authors.initials: P
authors.lastname: Smith
authors.forename: Carmen
authors.initials: C
authors.lastname: Samuel-Hodge
authors.forename: Valerie
authors.initials: V
authors.lastname: Myers
authors.forename: Lillian F
authors.initials: LF
authors.lastname: Lien
authors.forename: Daniel
authors.initials: D
authors.lastname: Laferriere
authors.forename: Betty
authors.initials: B
authors.lastname: Kennedy
authors.forename: Gerald J
authors.initials: GJ
authors.lastname: Jerome
authors.forename: Fran
authors.initials: F
authors.lastname: Heinith
authors.forename: David W
authors.initials: DW
authors.lastname: Harsha
authors.forename: Pamela
authors.initials: P
authors.lastname: Evans
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Erlinger
authors.forename: Arline T
authors.initials: AT
authors.lastname: Dalcin
authors.forename: Janelle
authors.initials: J
authors.lastname: Coughlin
authors.forename: Jeanne
authors.initials: J
authors.lastname: Charleston
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Champagne
authors.forename: Alan
authors.initials: A
authors.lastname: Bauck
authors.forename: Jamy D
authors.initials: JD
authors.lastname: Ard
authors.forename: Kathleen
authors.initials: K
authors.lastname: Aicher
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D003266:Continuity of Patient Care; D002149:Energy Intake; D004734:Energy Metabolism; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000517:prevention & control*; D040242:Risk Reduction Behavior; D015431:Weight Loss