Maintenance Intervention Slows Weight Regain in Obese Patients

Diana Phillips

February 22, 2017

A primarily telephone-based behavioral intervention for maintaining weight loss slowed the rate of weight regain among obese individuals who lost a clinically significant amount of weight in a structured program, a randomized controlled trial has shown.

The researchers from Durham Veterans Affairs (VA) Medical Center and Duke University Medical Center, Durham, North Carolina, compared the efficacy of the post–weight loss intervention with usual care among patients who lost at least 4 kg during a 4-month program. At 56 weeks, the estimated mean weight regain among the intervention group was significantly less than that of the control group, lead author Corrine I. Voils, PhD, from the University of Wisconsin–Madison, and colleagues report in an article published online February 21 in the Annals of Internal Medicine.

Unlike resource-intensive, behavior-based maintenance programs, the current intervention was designed "to help participants adopt maintenance-specific skills while being delivered in a resource-conserving way," the authors write.

"Participants maintained their weight even though the intervention decreased in frequency, shifted from in-person to telephone delivery, and involved no intervention contact in the final 14 weeks."

The researchers randomly assigned 222 obese outpatients (body mass index, ≥30 kg/m2) who lost 4 kg or more of body weight during a 16-week, group-based weight loss program to receive the maintenance intervention or usual care. The patients were recruited from three primary care clinics at the VA Medical Center in Durham and Raleigh, North Carolina.

The intervention took place during a 42-week period and was followed by 14 weeks of no contact. It was based on a conceptual model developed previously by Dr Voils and colleagues that distinguishes behavior initiation from maintenance. The maintenance program included three group sessions and eight individual telephone calls. The group sessions focused on maintenance caloric intake, weight self-monitoring, physical activity, social support, and relapse prevention, and the calls focused on satisfaction with outcomes, relapse-prevention planning, self-monitoring, and social support, the authors write.

Those randomly assigned to usual care received no further intervention after the weight-loss program, which, the authors write, is "the typical patient experience."

The study population consisted largely of middle-aged male patients who had attempted weight loss previously.

At 42 weeks, the intervention group's weight regain was significantly lower than that of the control groups, with an estimated mean difference of 1.67 kg (95% confidence interval [CI], 0.18 - 3.17 kg; P = .029). Similarly, at 56 weeks, the estimated weight regain for the intervention group was 0.75 kg, significantly lower than the 2.36 kg observed in the usual care group (estimated mean difference, 1.60 kg; 95% CI, 0.07 - 3.13 kg; P = .040).

The investigators also compared self-reported caloric intake, walking, and moderate physical activity between the intervention and usual care groups and observed a significant between-group difference in self-reported calorie intake at week 26 only, with the intervention group reporting an estimated mean intake of 1176.06 kcal compared with 1399.50 kcal for the usual care group (estimated mean difference, −223.44 kcal; CI, −395.92 to −50.96 kcal; P = .011).

The between-group difference in calorie intake was no longer significant at 56 weeks, nor were there significant between-group differences at either point in the estimated rates of walking or moderate physical activity between the maintenance and usual care groups or in estimated waist circumference, the authors report.

"The lack of statistically significant differences in our secondary outcomes at week 56 may be the result of measurement error due to the limited reliability and validity of self-report measures of dietary intake and physical activity," the authors write. "In addition, participants' behavioral plans for maintaining weight loss varied in whether they focused on maintaining a constant dietary pattern or incorporating physical activity, which may have masked treatment differences in the 2 behaviors."

The intervention was designed to be low cost "so that more resources could be devoted to initial weight loss relative to maintenance" and with implementation in mind, according to the authors. "Its script is standardized so that it can be programmed into a custom software package and store participant responses for future reference." The program also allows participants who regain weight beyond a certain threshold to refocus on weight loss initiation processes, they note.

Future research should examine longer-term effects of the intervention and determine the extent to which continued intervention contact is necessary to help patients maintain weight loss, the authors suggest. In addition, studies designed to evaluate the efficacy of other behavior maintenance strategies, as well as those looking at ways in which such interventions can be integrated into clinical practice, "such as identifying an appropriate referral process, addressing barriers to initiation and retention in a comprehensive weight management program, and identifying optimal staff training and fidelity monitoring processes" are warranted, they write. "By incorporating a weight maintenance intervention into clinical or commercial weight loss programs, the effect of efficacious weight loss programs may be increased," the authors conclude.

This study was funded by a US Department of Veterans Affairs Health Services Research and Development grant. One coauthor reports nonfinancial support from Amgen. One coauthor reports personal fees from University of Pennsylvania/Weight Watchers International. Dr Voils and the remaining coauthors have disclosed no relevant financial relationships.

Ann Intern Med. Published online February 21, 2017. Abstract

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