title: Innovative approaches to weight loss in a high-risk population: The small changes and lasting effects (SCALE) trial.
abstract: To evaluate the efficacy of a small change behavioral weight loss intervention with or without a positive affect/self-affirmation (PA/SA) component on weight loss at 12 months.
  
  
  
  Black and Hispanic adults (N = 405) with body mass index 25-50 kg/m2selected one of ten small change eating strategies and a physical activity goal, randomly with/without PA/SA. Participants were followed by community health workers at set intervals (weekly in months 1-3; biweekly in months 4-9; once monthly in months 10-12).
  
  
  
  There was no difference in weight loss at 12 months between participants in the small change approach alone (1.1%) versus the small change PA/SA intervention (1.2%). During treatment, 9% of participants lost at least 7% of their initial body weight. Participants who reported more interval life events had a lower likelihood of losing weight (P < 0.0001). However, those randomized to the small change PA/SA intervention gained less weight (+0.3% vs. 2.3% gain; P < 0.0001).
  
  
  
  The small change PA/SA intervention did not lead to a significant difference in weight loss in comparison to the small change approach alone. It did, however, decrease the negative impact of psychosocial stressors on weight gain among participants with more interval life events.
authors.affiliation: Division of General Internal Medicine, Weill Cornell Medicine, New York, New York, USA.|Division of Clinical Epidemiology and Evaluative Science Research, Weill Cornell Medicine, New York, New York, USA.
authors.forename: Erica G
authors.initials: EG
authors.lastname: Phillips
authors.affiliation: Department of Statistical Science, Cornell University, Ithaca, New York, USA.
authors.forename: Martin T
authors.initials: MT
authors.lastname: Wells
authors.affiliation: Department of Medicine, George Washington University, Washington, DC, USA.
authors.forename: Ginger
authors.initials: G
authors.lastname: Winston
authors.affiliation: Division of Clinical Epidemiology and Evaluative Science Research, Weill Cornell Medicine, New York, New York, USA.
authors.forename: Rosio
authors.initials: R
authors.lastname: Ramos
authors.affiliation: Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA.
authors.forename: Carol M
authors.initials: CM
authors.lastname: Devine
authors.affiliation: Departments of Human Development and Sociology, Cornell University, Ithaca, New York, USA.
authors.forename: Elaine
authors.initials: E
authors.lastname: Wethington
authors.affiliation: Division of General Internal Medicine, Weill Cornell Medicine, New York, New York, USA.
authors.forename: Janey C
authors.initials: JC
authors.lastname: Peterson
authors.affiliation: School of Applied Economics and Management, Cornell University, Ithaca, New York, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Wansink
authors.affiliation: Division of Clinical Epidemiology and Evaluative Science Research, Weill Cornell Medicine, New York, New York, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Charlson
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity / Q000473:pathology / Q000628:therapy*; D015431:Weight Loss / Q000502:physiology*; D055815:Young Adult