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The Weight Loss Maintenance Randomized Controlled Trial

Laura P. Svetkey, MD; Victor J. Stevens, PhD; Phillip J. Brantley, PhD; Lawrence J. Appel, MD; Jack F. Hollis, PhD; Catherine M. Loria, PhD; William M. Vollmer, PhD; Christina M. Gullion, PhD; Kristine Funk; Patti Smith; Carmen Samuel-Hodge, PhD; Valerie Myers, PhD; Lillian F. Lien, MD; Daniel Laferriere; Betty Kennedy, PhD; Gerald J. Jerome, PhD; Fran Heinith; David W. Harsha, PhD; Pamela Evans; Thomas P. Erlinger, MD; Arline T. Dalcin; Janelle Coughlin, PhD; Jeanne Charleston; Catherine M. Champagne, PhD; Alan Bauck; Jamy D. Ard, MD; Kathleen Aicher; for the Weight Loss Maintenance Collaborative Research Group

JAMA. 2008;299(10):1139-1148.

Context  Behavioral weight loss interventions achieve short-term success, but re-gain 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

Author Affiliations: Divisions of Nephrology (Dr Svetkey and Ms Aicher) and Endocrinology (Dr Lien), Department of Medicine, Duke Hypertension Center and Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina; Health Sciences Programs, the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Drs Stevens, Hollis, Vollmer, and Guillion, Mss Funk, Heinith, and Evans, and Messrs Laferriere and Bauck); Behavioral Medicine Laboratory (Drs Brantley and Myers and Ms Smith), Dietary Assessment and Food Analysis Core (Dr Kennedy), Chronic Disease Epidemiology and Health Delivery (Dr Harsha), and Nutritional Epidemiology and Dietary Assessment and Counseling (Dr Champagne), Pennington Biomedical Research Center, Baton Rouge, Louisiana; the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University School of Medicine, Johns Hopkins University, ProHealth, Baltimore, Maryland (Drs Appel, Jerome, and Coughlin and Mss Dalcin and Charleston); Division of Prevention and Population Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland (Dr Loria); Department of Nutrition, School of Public Health and School of Medicine, University of North Carolina at Chapel Hill (Dr Samuel-Hodge); Department of Medicine, University of Texas Medical Branch, Austin (Dr Erlinger); and Department of Nutrition Sciences, University of Alabama at Birmingham (Dr Ard).

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