title: Trial of prevention and reduction of obesity through active living in clinical settings: a randomized controlled trial.
abstract: BACKGROUND
  The efficacy of physical activity with a healthful diet to reduce obesity is established; however, little is known about the translation of effective lifestyle strategies for obesity reduction in primary care settings.
  
  
  METHODS
  We assessed the effectiveness of a 2-year behaviorally based physical activity and diet program implemented entirely within clinical practices to reduce obesity. A total of 490 sedentary, obese adults were randomized to usual care (n = 241) or to the behavioral intervention (n = 249). The usual care group received advice from their physicians about lifestyle as a strategy for obesity reduction. The behavioral intervention included individual counseling from health educators to promote physical activity with a healthful diet. The primary outcome was change in waist circumference (WC).
  
  
  RESULTS
  A total of 396 participants completed the trial (80.8%). A significant main effect was observed for WC change within the intervention compared with usual care (P < .001) that was sustained at 24 months (mean [SE], -0.9 [0.4] vs 0.2 [0.4] cm; P = .05). Secondary analyses revealed significant main effects for change in WC in men (P = .009) and women (P = .02). In men, the mean (SE) reduction in WC at 24 months was greater with behavioral intervention compared with usual care (-1.6 [0.6] vs 0.1 [0.6] cm; P = .049). In women, the behavioral intervention was associated with differences in WC compared with usual care at 6 and 12 months (P ≤ .01) but not at 24 months (P = .10).
  
  
  CONCLUSIONS
  Behavioral intervention in clinical settings is associated with modest reductions in WC during a 2-year study in obese patients. However, the effectiveness of the intervention is restricted to men.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00665158.
authors.affiliation: School of Kinesiology and Health Studies, 28 Division St, Queen's University, Kingston, ON K7L 3N6, Canada. rossr@queensu.ca
authors.forename: Robert
authors.initials: R
authors.lastname: Ross
authors.forename: Miu
authors.initials: M
authors.lastname: Lam
authors.forename: Steven N
authors.initials: SN
authors.lastname: Blair
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Church
authors.forename: Marshall
authors.initials: M
authors.lastname: Godwin
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Hotz
authors.forename: Ana
authors.initials: A
authors.lastname: Johnson
authors.forename: Peter T
authors.initials: PT
authors.lastname: Katzmarzyk
authors.forename: Lucie
authors.initials: L
authors.lastname: Lévesque
authors.forename: Susan
authors.initials: S
authors.lastname: MacDonald
mesh_terms: D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D015992:Body Mass Index; D004032:Diet; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D009765:Obesity / Q000517:prevention & control*; D009864:Ontario; D010349:Patient Compliance / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000379:methods; D016896:Treatment Outcome; D055105:Waist Circumference; D015431:Weight Loss