title: Weight loss maintenance strategies among rural breast cancer survivors: The rural women connecting for better health trial.
abstract: OBJECTIVE
  Obesity is a risk factor for breast cancer recurrence. Rural women have higher obesity rates compared with urban women and are in need of distance-based interventions that promote long-term weight loss.
  
  
  METHODS
  In this two-phase trial, rural breast cancer survivors who lost >5% of their starting weight during a 6-month lifestyle intervention (delivered through weekly group conference calls) were randomized to one of two 12-month interventions for weight loss maintenance: continued biweekly phone-based group counseling or mailed newsletters. The primary outcome was weight regain from 6 to 18 months. Secondary outcomes included dichotomous measures of weight change and costs.
  
  
  RESULTS
  Mean weight loss at 6 months was 14.0 ± 5.1%. Participants in the group phone condition regained less weight (3.3 ± 4.8 kg) compared with participants in the newsletter condition (4.9 ± 4.8 kg; P = 0.03). At 18 months, 75.3% of participants in the group phone condition remained ≥5% below baseline weight compared with 57.8% in the newsletter condition (P = 0.02). Incremental cost-effectiveness ratios were $882 to keep one more person ≥5% below baseline weight.
  
  
  CONCLUSIONS
  A lifestyle intervention incorporating group phone-based support improved the magnitude of weight loss maintained and increased the proportion of survivors who maintained clinically significant reductions.
authors: Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, Kansas, USA. cbefort@kumc.edu.
authors: Christie A
authors: CA
authors: Befort
authors: Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA.
authors: Jennifer R
authors: JR
authors: Klemp
authors: Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, Kansas, USA.
authors: Debra K
authors: DK
authors: Sullivan
authors: Department of Health Services, Policy, and Practice, Brown University, Providence, Rhode Island, USA.
authors: Theresa
authors: T
authors: Shireman
authors: Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas, USA.
authors: Francisco J
authors: FJ
authors: Diaz
authors: Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors: Kathryn
authors: K
authors: Schmitz
authors: Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA.
authors: Michael G
authors: MG
authors: Perri
authors: Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA.
authors: Carol
authors: C
authors: Fabian
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000150:complications / Q000628:therapy*; D003376:Counseling / Q000379:methods*; D005260:Female; D006801:Humans; D008019:Life Style; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D009765:Obesity / Q000150:complications / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life; D012424:Rural Population / Q000706:statistics & numerical data*; D012657:Self-Help Groups; D017741:Survivors / Q000523:psychology / Q000706:statistics & numerical data*; D015431:Weight Loss