title: Stepped-care in obesity treatment: matching treatment intensity to participant performance.
abstract: This investigation examined the effectiveness of a self-help (SH), stepped-care (SC) weight loss program. Based on a failure to achieve pre-assigned weight loss goals, participants were eligible to be stepped-up from a SH program to two levels of treatment intensity (weight loss group [WLG]; individual counseling [IC]) beyond SH. The primary outcome was change in body weight. Fifty-three overweight/obese adults (BMI≥27 kg/m(2); mean BMI of 37.3, SD=6.6, 89% Caucasian, and 77% female) participated in an 18-week weight loss intervention. During several phases of the investigation, those stepped-up to more intensive treatment lost comparable weight to those who were not stepped-up. Nevertheless, by the end of treatment, individuals who remained in SH (M=8.6%) lost a significantly greater percentage of weight than individuals who received SH+IC (M=4.7%; p<.05) and individuals in SH+IC lost a significantly greater percentage of weight than individuals who received SH+WLG+IC (M=1.6%; p<.05). While some individuals benefited from being stepped-up to greater intensity treatment, other individuals experienced little benefit. The application of SC principles to the treatment of obesity needs further study.
authors.affiliation: Bowling Green State University, Department of Psychology, Bowling Green, OH 43403, USA. rcarels@bgsu.edu
authors.forename: Robert A
authors.initials: RA
authors.lastname: Carels
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Young
authors.forename: Nova
authors.initials: N
authors.lastname: Hinman
authors.forename: Amanda
authors.initials: A
authors.lastname: Gumble
authors.forename: Afton
authors.initials: A
authors.lastname: Koball
authors.forename: Marissa Wagner
authors.initials: MW
authors.lastname: Oehlhof
authors.forename: Lynn
authors.initials: L
authors.lastname: Darby
mesh_terms: D002149:Energy Intake; D004734:Energy Metabolism; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000523:psychology / Q000628:therapy*; D013997:Time Factors; D015431:Weight Loss; D061217:Weight Reduction Programs / Q000379:methods*