Low-cost, maintenance-specific strategies slow weight regain

Emphasizing maintenance strategies in weight loss interventions after successful weight loss in obese adults modestly reduced the rate of weight regain, with minimal additional use of resources, according to recent study findings.

Perspective from Scott Kahan, MD, MPH, FTOS

“Some trials evaluating maintenance skills did not have a specific weight loss requirement, so maintenance-specific skills could not be fully tested,” Corrine I. Voils, PhD, from the William S. Middleton Veterans Memorial Hospital and the University of Wisconsin-Madison, and colleagues wrote in Annals of Internal Medicine. “Efficacious maintenance interventions are needed to help participants adopt maintenance-specific skills while being delivered in a resource-conserving way.”

To assess the efficacy of a weight loss maintenance program compared with usual care among obese adults, researchers designed a 2-group, parallel randomized trial stratified by initial weight loss (less than 10 kg vs. 10 kg or more) from Aug. 20, 2012 to Dec. 18, 2015.

The participants included obese outpatients at three primary care clinics at the Veterans Affairs Medical Center in Durham and Raleigh, North Carolina who lost 4 kg or more of body weight during a 16-week, group-based program. Voils and colleagues delivered intervention via telephone, addressed satisfaction with outcomes, relapse-prevention planning, self-monitoring and social support. They measured mean weight regain at week 56, self-reported caloric intake, walking and moderate physical activity.

Out of 504 total patients who participated in the initial program, 222 lost at least 4 kg. researchers assigned the patients randomly into either maintenance (n = 110) or usual care (n = 112); retention was 85%. They found that mean weight at randomization was 103.6 kg and mean weight loss during initiation was 7.2 kg. In the intervention group, estimated weight regain was significantly lower (0.75 kg) compared with the usual care (2.36 kg) group (estimated mean difference, 1.6 kg; 95% CI, 0.07- 3.13 kg; P = .04). At 56 weeks, there was no difference in self-reported caloric intake, walking and moderate physical activity.

Despite the efficacy of behavioral weight loss initiation programs, maintenance has remained the holy grail of weight loss research,” Voils and colleagues wrote. “By incorporating a weight maintenance intervention into clinical or commercial weight loss programs, the effect of efficacious weight loss programs may be increased.” – by Savannah Demko

Disclosure: Voils reports receiving grants from Veterans Affairs Health Services Research & Development. Please see the full study for a list of all other authors’ relevant financial disclosures.

Perspective

Scott Kahan, MD, MPH, FTOS

This is an important addition to the scientific literature. While the vast majority of clinical trials on weight management focus on weight loss, this trial showed that a weight maintenance treatment plan — one geared specifically to the behaviors, skills, and insights needed to continue weight management and keep weight off, as opposed to those needed to lose weight — can be effective, albeit modestly so. Participants who received the weight maintenance treatment kept off about 3.5 lb more than a comparison group, which is a meaningful difference. Importantly, this was designed to be a low-intensive — and cheap — intervention. Prior interventions have shown more weight loss maintenance, but at a substantially greater price. Finding the optimal "dose" of treatment will be important.

This is not the first study to show that weight maintenance-specific intervention is important and valuable. Clinicians are already starting to learn about weight loss counseling to support their patients; it will be important for them to also learn how to support weight maintenance for their patients. Some of this should occur in the clinical setting, and requires clinicians to beef up their skills. Other parts can occur in community settings, so it's important for clinicians to have a robust set of referral options available, such as community weight management support groups, Diabetes Prevention Program groups, and some commercial programs that incorporate some of these skills, such as Weight Watchers.

Scott Kahan, MD, MPH, FTOS

Director, National Center for Weight and Wellness

Faculty, Johns Hopkins Bloomberg School of Public Health

Disclosures: Kahan reports no relevant financial disclosures.

Sources/Disclosures

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Source: Voils CI, et al. Ann Intern Med. 2017;doi:10.7326/M16-2160.