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Self-selected weight-loss plans effective in underserved, rural areas
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Overweight adults in underserved, rural communities who were given the option to choose their own weight-loss program — compared with those who were assigned an intervention — lost more weight and maintained the reduction longer, according to recent findings.
“Participants who were empowered to choose their lifestyle intervention modality, were twice as likely to sustain improvements compared to other groups. Indeed, the importance of patient-centered decision-making in health care is paramount,” Gretchen A. Piatt, PhD, assistant professor of learning health sciences and assistant professor of health behavior and health education at the University of Michigan in Ann Arbor, told Endocrine Today.
Gretchen A. Piatt
Piatt and colleagues evaluated 434 adults (mean age, 51 years; 87.6% women) from eight rural communities near Pittsburgh. Eligible participants had overweight (BMI, 25 kg/m2) and abdominal obesity (waist circumference, > 40 inches in men and > 35 inches in women).
This study is part of the long-term follow-up component of the REACT study, a quasi-experimental prospective intervention study.
Participants were assigned to one of the following weight-loss/cardiovascular disease risk reduction interventions: face-to-face (n = 119), DVD (n = 113), Internet (n = 101) or self-selection (n = 101). Those in the self-selection group were able to choose their preference among the modalities offered (60% face-to-face; 40% Internet; 0% DVD).
Study participants were scheduled for in-person follow-up visits at 3, 6, 12 and 18 months after enrollment; at each visit, they were assessed for height, weight, blood pressure and waist circumference. The study’s primary outcome was change in weight from baseline through 18-month follow-up, and the secondary outcome was change in CVD risk factors.
The researchers found a pronounced decrease in weight within all groups at 3 months, with the self-selection group achieving the largest average weight loss. At 18 months, the mean weight loss from baseline was –10.9 lb in the face-to-face group (P < .0001), –9.9 lb in the DVD group (P < .0001), –11.5 lb in the Internet group (P < .0001) and –13.1 lb in the self-selection group (P < .0001). At 18 months, participants in the self-selection group maintained an average 2.4-lb greater weight reduction than participants in the other groups (P = .16). Moreover, of those who saw 5% weight loss at 3 months (face-to-face, 57.2%; DVD, 56.7%; Internet, 62%; self-selection, 66.7%), more than 65% of participants in each group sustained the weight loss at 18 months (face-to-face, 68.5%; DVD, 69.4%; Internet, 67.7%; self-selection, 89.5%; P = .09). After adjustment for the clustering of participants within communities, baseline weight, age and sex, participants in the self-selection group were 2.3 times more likely to maintain 5% weight loss at 18 months (P = .0007).
Nearly 75% of participants maintained a reduction of at least one CVD risk factor at 18 months.
“REACT demonstrated that when individuals are able to choose an intervention that suits their lifestyle, they are more successful at achieving improvements in outcomes and maintaining them in the long term,” they wrote. – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.
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