title: Baseline obesity status modifies effectiveness of adapted diabetes prevention program lifestyle interventions for weight management in primary care.
abstract: OBJECTIVE
  To examine whether baseline obesity severity modifies the effects of two different, primary care-based, technology-enhanced lifestyle interventions among overweight or obese adults with prediabetes and/or metabolic syndrome.
  
  
  METHODS
  We compared mean differences in changes from baseline to 15 months in clinical measures of general and central obesity among participants randomized to usual care alone (n = 81) or usual care plus a coach-led group (n = 79) or self-directed individual (n = 81) intervention, stratified by baseline body mass index (BMI) category.
  
  
  RESULTS
  Participants with baseline BMI 35+ had greater reductions in mean BMI, body weight (as percentage change), and waist circumference in the coach-led group intervention, compared to usual care and the self-directed individual intervention (P < 0.05 for all). In contrast, the self-directed intervention was more effective than usual care only among participants with baseline BMIs between 25 ≤ 35. Mean weight loss exceeded 5% in the coach-led intervention regardless of baseline BMI category, but this was achieved only among self-directed intervention participants with baseline BMIs <35.
  
  
  CONCLUSIONS
  Baseline BMI may influence behavioral weight-loss treatment effectiveness. Researchers and clinicians should take an individual's baseline BMI into account when developing or recommending lifestyle focused treatment strategy. This trial is registered with ClinicalTrials.gov NCT00842426.
authors.affiliation: Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Ames Building, Palo Alto, CA 94301, USA.
authors.forename: Kristen M J
authors.initials: KM
authors.lastname: Azar
authors.affiliation: Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Ames Building, Palo Alto, CA 94301, USA.
authors.forename: Lan
authors.initials: L
authors.lastname: Xiao
authors.affiliation: Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Ames Building, Palo Alto, CA 94301, USA ; Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Jun
authors.initials: J
authors.lastname: Ma
mesh_terms: D000328:Adult; D001823:Body Composition; D015992:Body Mass Index; D003920:Diabetes Mellitus / Q000503:physiopathology* / Q000628:therapy; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D050177:Overweight / Q000503:physiopathology*; D015431:Weight Loss