Most Who Lose Weight Stay With Low-cost Program, Keep It Off

Marlene Busko

May 23, 2016

In a US study of overweight and obese individuals who joined the Take Off Pounds Sensibly (TOPS) low-cost weight-loss program, most individuals who lost a significant amount of weight in the first year maintained this weight loss in the next few years if they stayed with the program.

Specifically, of more than 65,000 Americans who participated in this national nonprofit weight-loss program, half lost a significant amount of weight — defined by the Institute of Medicine (now called the National Academy of Medicine) as a weight loss of >5% of baseline weight — in the first year.

Importantly, 80% to 95% of these individuals who continued to attend weekly TOPS meetings throughout were able to maintain a significant weight loss for up to 7 years.

Nia S Mitchell, MD, at the University of Colorado Anschutz Medical Campus, in Aurora, presented the findings May 13 at the 2016 Society of General Internal Medicine Annual Meeting in Hollywood, Florida.

"TOPS is a program that is affordable to many patients compared with other programs that are out there, since it costs $92 a year" — $32 to join the national program and up to $5 a month to attend weekly chapter meetings,” Dr Mitchell told Medscape Medical News. In Canada, it costs $36 to join, plus similar monthly fees.

Other programs typically gradually phase out the time people attend community-support groups. However, with TOPS, "you go weekly when you are in the weight-loss phase, and when you are in maintenance you are still expected to come weekly as part of the 'Keep Off Pounds Sensibly (KOPS)' program," Dr Mitchell noted.

"I think that's unique in weight loss and probably why we may be able to see longer extended weight-loss maintenance," she emphasized.

Can TOPS Keep People Engaged, Ward Off Weight Regain?

Studies have shown that with lifestyle programs, about a third of lost weight is typically regained within a year and 80% is regained within 5 years, Dr Mitchell noted. However, even a 5% weight loss is clinically significant, since "people with diabetes, for instance, can actively show improvement in their diabetes if they lose 5% of their weight," she explained. Unfortunately, health benefits disappear after the weight is regained.

Dr Mitchell became interested in the TOPS program as a resident working in a clinic that treated an underserved population. TOPS consists of weekly meetings with private weigh-ins and information about nutrition, fitness, and exercise, as well as access to a website and opportunities to participate in weight-loss contests.

In a previous study, the researchers showed that on average, TOPS participants who consecutively renewed their membership lost 6% of their baseline weight at 1 year and 8% at 7 years.

The current study aimed to determine what percentage of individuals who achieved significant weight loss with TOPS at 1 year were able to maintain this weight loss longer term.

The researchers analyzed data from 65,559 participants who joined TOPS from 2005 to 2010 in the United States and had at least two consecutive annual membership renewals.

At year 1, 50% had significant weight loss (>5% of their baseline weight), 32% had stable weight (the same as or <5% greater than baseline weight), and 18% had gained weight.

At year 2, of the 68% of the individuals with significant weight loss at year 1 who stuck with the program (renewed their membership), 80% still had significant weight loss, 16% had stable weight, and 4% had gained weight, all compared with baseline weight.

Of the participants who had lost significant weight at year 1 and had 7-year follow-up data and continued to follow the program throughout, 95% still had significant weight loss at 7 years.

"Our study demonstrates that significant weight loss can be maintained for up to 7 years in a subset of individuals participating in the TOPS program," Dr Mitchell and colleagues summarize.

Maintaining Long-term Weight Loss Is Critical

Since it is difficult to stick to a lifestyle-modification program for an extended period of time to lose weight and since health benefits from weight loss disappear when weight is regained, "maintaining long-term weight loss is a critical challenge in treating obesity and weight-related comorbidities," they stress.

"Therefore, further studies of the TOPS program should examine which populations will succeed at weight loss and weight-loss maintenance and determine the factors that can improve these outcomes," they conclude.

The study was funded by the National Heart Lung and Blood Institute of the National Institutes of Health. Take Off Pounds Sensibly (TOPS) provided access to its data but was not involved with the study. Dr Mitchell has no relevant financial relationships.

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Society of General Internal Medicine Annual Meeting; May 13, 2016; Hollywood, FL.


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