Monthly Contact With Counselor Provides Benefit for Weight Loss

Weight-loss program participants who had a brief, monthly personal contact intervention – most often a 10-15 minute phone conversation – regained less weight than participants who were in a Web-based intervention or self-directed program, according to a study in the March 12 issue of JAMA.

“Nearly two-thirds of U.S. adults are overweight or obese. Together overweight and obesity are the second leading cause of preventable death, primarily through effects on cardiovascular disease (CVD) risk factors (hypertension, dyslipidemia [abnormal amounts of lipids and lipoproteins in the blood], and type 2 diabetes). Weight loss improves these risk factors, and evidence suggests that benefits persist as long as weight loss is maintained,” the authors write.

Relatively short-term (4-6 months) behavioral interventions for adults can result in clinically significant weight loss, but regaining weight is common. “Given the vast scope of the overweight and obesity epidemic, there is a critical need for practical, affordable, and scalable intervention strategies that effectively maintain weight loss,” they write. “Despite the potential for health benefits of weight loss maintenance, there is little evidence, particularly from clinical trials, on how to accomplish this objective.”

Laura P. Svetkey, M.D., of Duke University Medical Center, Durham, N.C., and colleagues conducted the Weight Loss Maintenance (WLM) trial, a comparison of strategies for maintaining weight loss for 30 months following initial weight loss in a large, diverse, adult population at high risk for CVD. The two-phase trial included 1,032 overweight or obese adults (38 percent African American, 63 percent women) with hypertension, dyslipidemia, or both who had lost at least 8.8 lbs. during a 6-month weight loss program (phase 1) and were randomized to a weight-loss maintenance intervention (phase 2).

The interventions included monthly personal contact, unlimited access to an interactive technology–based intervention, or a self-directed control, in which participants received minimal intervention. Monthly personal contact consisted of a case management approach with monthly person-to-person guidance and support. Participants had telephone contact with an interventionist for 5 to 15 minutes each month, except for every 4th month when they had a 45- to 60-minute individual face-to-face contact. The interactive technology–based intervention included unlimited access to a Web site designed to support weight loss maintenance, with interactive features allowing participants to set personal goals and action plans for the next week and to graph personal data over time.

Average weight at entry in the study was 213 lbs. During the initial 6-month program, average weight loss was 18.7 lbs. All groups regained weight after randomization by an average of 12.1 lbs. in the self-directed, 11.5 lbs. in the interactive technology–based, and 8.8 lbs. in the personal-contact group. The average weight at 30 months remained lower in each group than average weight at entry into the study.