Comparison of strategies for sustaining weight loss: the weight loss maintenance randomized controlled trial.
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.
Svetkey
Laura P
LP
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
Stevens
Victor J
VJ
Brantley
Phillip J
PJ
Appel
Lawrence J
LJ
Hollis
Jack F
JF
Loria
Catherine M
CM
Vollmer
William M
WM
Gullion
Christina M
CM
Funk
Kristine
K
Smith
Patti
P
Samuel-Hodge
Carmen
C
Myers
Valerie
V
Lien
Lillian F
LF
Laferriere
Daniel
D
Kennedy
Betty
B
Jerome
Gerald J
GJ
Heinith
Fran
F
Harsha
David W
DW
Evans
Pamela
P
Erlinger
Thomas P
TP
Dalcin
Arline T
AT
Coughlin
Janelle
J
Charleston
Jeanne
J
Champagne
Catherine M
CM
Bauck
Alan
A
Ard
Jamy D
JD
Aicher
Kathleen
K
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