Comparison of strategies for sustaining weight loss - The weight loss maintenance randomized controlled trial

Context Behavioral weight loss interventions achieve short- term success, but regain is common. Objective To compare 2 weight loss maintenance interventions with a self- directed control group. Design, Setting, and Participants Two- phase trial in which 1032 overweight or obese adults ( 38% African American, 63% women) with hypertension, dyslipidemia, or both who had lost at least 4 kg during a 6- month weight loss program ( phase 1) were randomized to a weight- loss maintenance intervention ( phase 2). Enrollment at 4 academic centers occurred August 2003- July 2004 and randomization, February-December 2004. Data collection was completed in June 2007. Interventions After the phase 1 weight- loss program, participants were randomized to one of the following groups for 30 months: monthly personal contact, unlimited access to an interactive technology - based intervention, or self- directed control. Main Outcome Changes in weight from randomization. Results Mean entry weight was 96.7 kg. During the initial 6- month program, mean weight loss was 8.5 kg. After randomization, weight regain occurred. Participants in the personal- contact group regained less weight ( 4.0 kg) than those in the self- directed group ( 5.5 kg; mean difference at 30 months, - 1.5 kg; 95% confidence interval [ CI], - 2.4 to - 0.6 kg; P=. 001). At 30 months, weight regain did not differ between the interactive technology - based ( 5.2 kg) and self- directed groups ( 5.5 kg; mean difference - 0.3 kg; 95% CI, - 1.2 to 0.6 kg; P=. 51); however, weight regain was lower in the interactive technology - based than in the self- directed group at 18 months ( mean difference, - 1.1 kg; 95% CI, - 1.9 to - 0.4 kg; P=. 003) and at 24 months ( mean difference, - 0.9 kg; 95% CI, - 1.7 to - 0.02 kg; P=. 04). At 30 months, the difference between the personal-contact and interactive technology - based group was - 1.2 kg ( 95% CI - 2.1 to - 0.3; P=. 008). Effects did not differ significantly by sex, race, age, and body mass index subgroups. Overall, 71% of study participants remained below entry weight. Conclusions The majority of individuals who successfully completed an initial behavioral weight loss program maintained a weight below their initial level. Monthly brief personal contact provided modest benefit in sustaining weight loss, whereas an interactive techonology - based intervention provided early but transient benefit. Trial Registration clinicaltrials. gov Identifier: NCT00054925.