OBESITY: Stepped Approach to Weight Loss Works
By Todd Neale, Senior Staff Writer, October 02, 2011
Action Points
Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
Explain that stepping up the intensity of a weight-loss intervention only for those patients who fail to reach their goal may be a viable alternative to standard lifestyle approaches.
Point out that this study used a stepped-care approach in which the intensity is increased only if the participant fails to reach a pre-specified goal.
Review
ORLANDO -- Stepping up the intensity of a weight-loss intervention only for those patients who fail to reach their goal may be a viable alternative to standard lifestyle approaches, a randomized trial showed.
There was no significant difference in the percentage of patients who achieved a 10% reduction in weight after 18 months between the stepped-care group and the standard group (26% versus 32%, P>0.05), according to John Jakicic, PhD, of the University of Pittsburgh.
The average percent weight loss was also similar in the two groups (5.8% versus 6.8%, P>0.05), Jakicic reported at the Obesity Society meeting here.
"So the stepped-care approach may present an effective alternative to standard behavioral weight loss interventions," he said.
He added that 30% to 40% of the patients in the stepped-care group remained at one of the first two steps, which involved monthly group meetings, weekly mailed lessons, and mailed feedback on a self-monitoring diary (for both steps), and one phone call per month (for the second step only).
Although behavioral interventions involving lifestyle changes have been shown to be effective at getting patients to lose weight, the intensity of such approaches generally remains the same regardless of whether the participants are responding.
A stepped approach, in which the intensity is increased only if the participant fails to reach a pre-specified goal, has been proposed as an alternative, but the strategy had not been compared with a standard behavioral weight loss intervention in a randomized trial, according to Jakicic.
He and his colleagues designed the Step Up study, which randomized 364 overweight and obese individuals to a stepped-care or standard intervention. The mean age of the participants was 42.2 and the mean body mass index was 33 kg/m2 (ranging from 25 to 39.9 kg/m2). Most of the participants were female (82.7%).
Those in both groups were prescribed dietary goals, with the aim of reducing calories and fat intake, and physical activity targets progressing to 300 minutes of moderate-to-vigorous intensity exercise per week.
The standard behavioral weight loss program involved group sessions weekly for the first six months, twice a month for the next six months, and monthly sessions for the final six months. The program remained consistent for all participants regardless of weight loss achieved.
In the stepped-care group, however, participants were scheduled to attend one group session per month throughout the study and to receive weekly mailed lessons, as well as mailed feedback on their diaries. Those who failed to achieve various weight loss goals -- 5% at three months, 7% at six months, and 10% at nine months and every three months thereafter -- received more frequent contact.
The intensified steps included up to two phone calls per month, up to two individual sessions to discuss weight loss per month, and the provision of meal replacements.
Although participants in both groups lost weight, the absolute loss was significantly greater in the standard group for the first six months (22 pounds versus 17.6 pounds, P<0.05), as was the percent weight loss (9.2% versus 7.6%, P<0.01). At each time point beyond six months, however, there was no significant difference between the two groups for either measure.
Jakicic said that there was more work to be done to evaluate a stepped-care intervention for weight loss, including looking at:
Whether any of the steps were more effective than others
Who responded to the approach
Different approaches for stepping up care
The effect of diet and physical activity behaviors
In addition, he and his colleagues will conduct a cost-effectiveness analysis and examine whether the weight loss thresholds for stepping up care need to be adjusted.
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