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Efficacy of a Weight Loss Program in Obese Adults
Ann Intern Med; ePub 2017 Feb 21; Voils, Olsen, et al
The rate of weight regain in obese adults was modestly slowed with a weight loss maintenance program focused on maintenance-specific strategies, a recent study found. This randomized trial included 2 patient groups stratified by initial weight loss from August 20, to December 18, 2015, at 3 primary care clinics. Patients who were obese (BMI ≥30 kg/m2) and who lost 4 kg or more of body weight during a 16-week, group-based weight loss program were enrolled. Primary outcome was mean weight regain at week 56; secondary outcomes included self-reported caloric intake, walking, and moderate physical activity. Researchers found:
- Of 504 patients (most middle-aged, white males), 222 lost at least 4 kg body weight and were randomly assigned to maintenance (n=110) or usual care (n=112); retention was 85%.
- Mean weight loss during initiation was 7.2 kg; mean weight at randomization was 103.6 kg.
- Estimated mean weight regain was statistically significantly lower in the intervention vs usual care group (0.75 kg vs 1.60 kg).
- No statistically significant differences in secondary outcomes were seen at 56 weeks.
Voils CI, Olsen MK, Gierisch JM, et al. Maintenance of weight loss after initiation of nutrition training: A randomized trial. [Published online ahead of print February 21, 2017]. Ann Intern Med. doi:10.7326/M16-2160.
There are many challenges to lifestyle modification and weight loss. The first challenge, of course, is losing weight. The second, and equally important challenge, is keeping the weight off that was lost. It is very common for people to lose weight for 6 to 12 months while they are enthusiastic and motivated to lose weight, only to regain the weight they have lost over the subsequent 12 months. This study points to the importance of actively addressing strategies for maintenance of weight loss—a concept nicely described as “active maintenance.” It is likely that maintenance-specific skills are different from the skills needed to lose weight initially. One of the novel approaches in this trial was using phone-based contact with decreasing frequency over time to help people acquire the skills necessary to keep weight off. Whatever method is used, it is clear that the maintenance of lifestyle changes over time is as important, if not more important, than even the initial decision to embark upon lifestyle change. —Neil Skolnik, MD