Randomized controlled trial of a comprehensive home environment-focused weight-loss program for adults.
OBJECTIVE
Behavioral weight-loss programs (BWL) provide limited instruction on how to change the environmental context of weight-regulating behaviors, perhaps contributing to regain. Drawing on social ecological models, this trial evaluated a comprehensive weight-loss program that targeted both an individual's behavior and his or her physical and social home environment.


METHODS
Overweight and obese adults (N = 201; 48.9 ± 10.5 years; 78.1% women) were randomized to BWL or to BWL plus home-environment changes (BWL + H). Groups met weekly for 6 months and bimonthly for 12 months. BWL + H participants were given items to facilitate healthy choices in their homes (e.g., exercise equipment, portion plates) and attended treatment with a household partner. Weight loss at 6 and 18 months was the primary outcome.


RESULTS
BWL + H changed many aspects of the home environment and produced better 6-month weight losses than BWL (p = .017). At 18 months, no weight-loss differences were observed (p = .19) and rates of regain were equivalent (p = .30). Treatment response was moderated by gender (6 months, p = .011; 18 months, p = .006). Women lost more weight in BWL + H than BWL at 6 and 18 months, whereas men in BWL lost more weight than those in BWL + H at 18 months. Partners, regardless of gender, lost more weight in BWL + H than BWL at both time points (ps < .0001).


CONCLUSIONS
The home food and exercise environment is malleable and targeting this microenvironment appears to improve initial weight loss, and in women, 18-month outcomes. Research is needed to understand this gender difference and to develop home-focused strategies with more powerful and sustained weight-loss effects.
Department of Psychology, Center for Health, Intervention, and Prevention, University of Connecticut, Storrs, CT 06269-1248, USA. amy.gorin@uconn.edu
Amy A
AA
Gorin
Hollie A
HA
Raynor
Joseph
J
Fava
Kimberly
K
Maguire
Erica
E
Robichaud
Jennifer
J
Trautvetter
Melissa
M
Crane
Rena R
RR
Wing
D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D003191:Comprehensive Health Care; D005260:Female; D015438:Health Behavior; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000628:therapy; D050177:Overweight / Q000628:therapy*; D015397:Program Evaluation; D012931:Social Environment; D015431:Weight Loss; D061217:Weight Reduction Programs / Q000379:methods*