Study Shows Long-Term Weight Control Is Achievable With Monthly Counseling
most of the past decade, there was much hubbub about the Atkins and
Zone diets. Both focus on quick, effective ways to lose weight through
high-protein and low-carbohydrate foods. Today, many still swear by
who shed weight and want to keep it off might benefit from monthly
personal contact interventions, researchers reported at the American
Heart Association’s recent Conference on Nutrition, Physical
Activity and Metabolism.
test of three ways that might help people maintain weight loss, those
who received monthly personal counseling were best at keeping off
unwanted pounds. Overall, 42 percent of the study members maintained at
least a 4-kilogram (9-pound) weight loss for 30 months.
know how to help people lose weight in a healthy way, but we know very
little about how to help them to keep the weight off," said Dr. Laura
P. Svetkey, lead author of the study and professor of medicine at Duke
University Medical Center, Durham, N.C. "This study is the longest and
largest to test strategies for long-term weight loss maintenance, and
it suggests that long-term weight control is an achievable goal.
United States is in the midst of an obesity epidemic, one that portends
serious future health consequences. Overweight and obesity are the
leading cause of high blood pressure, diabetes and abnormal
cholesterol, which are leading causes of cardiovascular disease, which
is, in turn, the leading cause of death in this country," Svetkey said.
"So if we really want to get to the root causes of these disorders, we
need to address the obesity epidemic."
Despite the importance of obesity control, few studies have tested strategies to maintain weight loss over long periods.
and her colleagues enrolled 1,685 participants in the two-phase weight
loss maintenance trial, which was conducted at four clinical centers in
the U. S.
I consisted of 20 weekly group sessions of 18-25 participants held over
six months, during which trained counselors emphasized three key
elements to weight loss — consuming fewer calories, increasing
moderate physical activity, and eating a healthy diet. Researchers
recommended DASH (Dietary Approaches to Stop Hypertension), a diet rich
in fruits, vegetables, whole-grain and high fiber foods, that uses
low-fat and fat-free dairy products and is low in total and saturated
fat and sodium. DASH lowers blood pressure and cholesterol even without
helped participants use tools like self-monitoring and goal-setting,
and helped them remember why they wanted to lose weight in the first
place. The group sessions also provided study members with social
support from other participants.
end of Phase I, 61 percent of the participants in the trial were
eligible for Phase II, which lasted for 30 months, because they had
lost at least nine pounds and as much as 66 pounds.
percent of people in Phase II were African-American and 37 percent were
male. "This is important because men are often underrepresented in
weight loss studies, and obesitydisproportionately affects African
Americans," Svetkey said.
Researchers randomly assigned the volunteers to one of three groups:
- Personal contact
(PC) — Participants talked with an interventionist (monthly, nine
times by telephone and three times face-to-face each year) who provided
personal counseling and encouragement.
- Interactive technology
(IT) — Study members had access to an interactive Web site on
which they could record and track their exercise and calorie intake;
set goals and monitor their progress toward them; and communicate with
others in the IT group.
- Self-directed (SD) — Participants were urged to maintain their weight loss and then sent off without further intervention.
Results from the trial after 30 months included:
71 percent weighed less than when they began Phase I. The difference in
the percentage of each group that weighed less was statistically
significant — PC group (77 percent); IT group (69 percent) and SD
group (67 percent).
percent of enrollees weighed at least 5 percent below their beginning
weight. Again, the PC participants (42 percent) significantly
out-performed those in the SD (34 percent) and IT (29 percent) groups.
all study members, 32 percent weighed no more than 3 percent above
their weight at randomization. However, differences between the three
groups — SD (29 percent), IT (29 percent) and PC (36 percent)
— were not significantly different statistically.
at 24 months the average weight regained by the IT group was less than
that of the SD arm, researchers found no difference between the two at
effects we observed were modest," Svetkey said. "The personal contact
group regained about 3.3 pounds less than the self-directed group."
Even a small weight loss can have potential health benefits, she noted.
pound of weight loss can lower blood pressure by as much as a
millimeter of mercury, and the more weight you lose, the bigger the
blood pressure effect," Svetkey said. "Each pound of weight loss is
estimated to lower the risk of developing diabetes by 8 percent, which
is quite impressive.
more research is needed to refine these maintenance interventions to
make them more effective, but this study is an important step in the
study was conducted at four clinical sites: Duke, Pennington Biomedical
Research Center, Johns Hopkins University and the Kaiser Permanente
Center for Health (CHR) Research, which also served as the coordinating
are: Victor J. Stevens, Ph.D. (CHR Coordinating Center); Phillip J.
Brantley, Ph.D. (Pennington); Lawrence J. Appel, M.D. (Hopkins); Jack
F. Hollis, Ph.D. (CHR); Catherine M. Loria, Ph.D. (NHLBI); and William
M. Vollmer, Ph.D.; Cristina M. Gullion, Ph.D.; and KristineFunk, M.S.
(all at the CHR coordinating center.)
of the study were published in the Journal of the American Medical
Association. The National Heart, Lung and Blood Institute, National
Institutes of Health funded the study.
For more information on Duke University Medical Center, visit www.dukehealth.org.