title: 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.).
authors.affiliation: Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA. lappel@jhmi.edu
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Appel
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Clark
authors.forename: Hsin-Chieh
authors.initials: HC
authors.lastname: Yeh
authors.forename: Nae-Yuh
authors.initials: NY
authors.lastname: Wang
authors.forename: Janelle W
authors.initials: JW
authors.lastname: Coughlin
authors.forename: Gail
authors.initials: G
authors.lastname: Daumit
authors.forename: Edgar R
authors.initials: ER
authors.lastname: Miller
authors.forename: Arlene
authors.initials: A
authors.lastname: Dalcin
authors.forename: Gerald J
authors.initials: GJ
authors.lastname: Jerome
authors.forename: Steven
authors.initials: S
authors.lastname: Geller
authors.forename: Gary
authors.initials: G
authors.lastname: Noronha
authors.forename: Thomas
authors.initials: T
authors.lastname: Pozefsky
authors.forename: Jeanne
authors.initials: J
authors.lastname: Charleston
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Reynolds
authors.forename: Nowella
authors.initials: N
authors.lastname: Durkin
authors.forename: Richard R
authors.initials: RR
authors.lastname: Rubin
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Louis
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Brancati
mesh_terms: D001521:Behavior Therapy / Q000379:methods*; D002318:Cardiovascular Diseases; D003376:Counseling; D004038:Diet, Reducing; D015444:Exercise; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000503:physiopathology / Q000628:therapy*; D058007:Physicians, Primary Care; D012307:Risk Factors; D017216:Telemedicine; D015431:Weight Loss
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