Corrine I. Voils, PhD; Maren K. Olsen, PhD; Jennifer M. Gierisch, PhD; Megan A. McVay, PhD; Janet M. Grubber, MSPH; Leslie Gaillard, MPH, RD; Jamiyla Bolton, MS; Matthew L. Maciejewski, PhD; Elizabeth Strawbridge, MPH, RD; William S. Yancy Jr., MD, MHS
Note: Dr. Voils is now at the William S. Middleton Veterans Memorial Hospital and the University of Wisconsin–Madison, Madison, Wisconsin.
Disclaimer: The views represented in this article represent those of the authors and not those of the U.S. Department of Veterans Affairs or U.S. government.
Acknowledgment: The authors thank Jahdai Dawes, Marsha Turner, and Terry Ervin for assisting with recruitment and conducting measurements. They also thank Lesa Powell and Aviel Alkon for programming and database development and Lynn Van Scoyoc for creating data sets and variables necessary for health utilization analyses.
Grant Support: This study was funded by a grant awarded to Drs. Voils and Yancy by the Department of Veterans Affairs Health Services Research and Development (VA HSR&D) Service (IIR 11-040). Efforts on this study or manuscript also were made possible by a VA Research Career Scientist award to Dr. Voils (RCS 14-443), a career development award to Dr. McVay (K23 HL127334), and a VA Research Career Scientist award to Dr. Maciejewski (RCS 10-391).
Disclosures: Dr. Voils, Ms. Bolton, and Ms. Strawbridge report grants from VA HSR&D during the conduct of the study. Dr. Maciejewski reports grants from VA HSR&D during the conduct of the study, and nonfinancial support from Amgen and grants from the Agency for Healthcare Research and Quality and National Committee for Quality Assurance outside the submitted work. Dr. Yancy reports grants from the Department of Veterans Affairs during the conduct of the study, and personal fees from University of Pennsylvania/Weight Watchers International and grants from the National Institutes of Health outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-2160.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol: See Supplement 1. Statistical code: Available from the Supplement 2 or from Dr. Olsen (e-mail, firstname.lastname@example.org). Data set: Available through a data use agreement from Dr. Olsen (e-mail, email@example.com).
Requests for Single Reprints: Corrine I. Voils, PhD, K6/100 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Voils: K6/100 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792.
Drs. Olsen, Gierisch, and Maciejewski and Ms. Grubber, Ms. Gaillard, Ms. Bolton, and Ms. Strawbridge: Durham Veterans Affairs Medical Center, 508 Fulton Street (152), Durham, NC 27705.
Dr. McVay: Duke University Medical Center, Box 3862, Durham NC 27710.
Dr. Yancy: Duke University Diet and Fitness Center, 501 Douglas Street, Durham, NC 27705.
Author Contributions: Conception and design: C.I. Voils, M.K. Olsen, J.M. Gierisch, L. Gaillard, W.S. Yancy.
Analysis and interpretation of the data: C.I. Voils, M.K. Olsen, J.M. Gierisch, M.A. McVay, J.M. Grubber, M.L. Maciejewski, W.S. Yancy.
Drafting of the article: C.I. Voils, M.K. Olsen, J.M. Grubber.
Critical revision for important intellectual content: C.I. Voils, M.K. Olsen, J.M. Gierisch, M.A. McVay, J.M. Grubber, W.S. Yancy.
Final approval of the article: C.I. Voils, M.K. Olsen, J.M. Gierisch, M.A. McVay, J.M. Grubber, L. Gaillard, J. Bolton, M.L. Maciejewski, E. Strawbridge, W.S. Yancy.
Provision of study materials or patients: C.I. Voils, J.M. Gierisch, L. Gaillard, J. Bolton, E. Strawbridge.
Statistical expertise: M.K. Olsen, J.M. Grubber, M.L. Maciejewski.
Obtaining of funding: C.I. Voils, M.K. Olsen, J.M. Gierisch, W.S. Yancy.
Administrative, technical, or logistic support: C.I. Voils, J.M. Grubber, L. Gaillard, J. Bolton, M.L. Maciejewski, E. Strawbridge, W.S. Yancy.
Collection and assembly of data: J.M. Grubber, L. Gaillard, J. Bolton, E. Strawbridge.
Weight regain after successful weight loss interventions is common.
To establish the efficacy of a weight loss maintenance program compared with usual care in obese adults.
2-group, parallel, randomized trial stratified by initial weight loss (<10 kg vs. ≥10 kg), conducted from 20 August 2012 to 18 December 2015. Outcome assessors were blinded to treatment assignment. (ClinicalTrials.gov: NCT01357551)
3 primary care clinics at the Veterans Affairs Medical Center in Durham and Raleigh, North Carolina.
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.
The maintenance intervention, delivered primarily by telephone, addressed satisfaction with outcomes, relapse-prevention planning, self-monitoring, and social support. Usual care involved no contact except for study measurements.
Primary outcome was mean weight regain at week 56. Secondary outcomes included self-reported caloric intake, walking, and moderate physical activity.
Of 504 patients in the initial program, 222 lost at least 4 kg of body weight and were randomly assigned to maintenance (n = 110) or usual care (n = 112). Retention was 85%. Most patients were middle-aged white men. Mean weight loss during initiation was 7.2 kg (SD, 3.1); mean weight at randomization was 103.6 kg (SD, 20.4). Estimated mean weight regain was statistically significantly lower in the intervention (0.75 kg) than the usual care (2.36 kg) group (estimated mean difference, 1.60 kg [95% CI, 0.07 to 3.13 kg]; P = 0.040). No statistically significant differences in secondary outcomes were seen at 56 weeks. No adverse events directly attributable to the intervention were observed.
Results may not generalize to other settings or populations. Dietary intake and physical activity were self-reported. Duration was limited to 56 weeks.
An intervention focused on maintenance-specific strategies and delivered in a resource-conserving way modestly slowed the rate of weight regain in obese adults.
Veterans Affairs Health Services Research and Development Service.
Voils CI, Olsen MK, Gierisch JM, et al. Maintenance of Weight Loss After Initiation of Nutrition Training: A Randomized Trial. Ann Intern Med. 2017;166:463–471. [Epub ahead of print 21 February 2017]. doi: https://doi.org/10.7326/M16-2160
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Published: Ann Intern Med. 2017;166(7):463-471.
Published at www.annals.org on 21 February 2017
Cardiology, Healthcare Delivery and Policy, Hematology/Oncology, Obesity, Prevention/Screening.
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