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Evidence summaries

Strategies for Sustaining Weight Loss

Case management approach with personal contacts appears to be an effective way of supporting maintenance of weight loss in overweight or obese adults with additional cardiovascular risk factors. Level of evidence: "B"

A randomized controlled trial 1 comparing different weight loss maintenance interventions involved 1032 overweight or obese adults with hypertension, dyslipidemia, or both. The participants had lost at least 4 kg during a 6-month weight loss program (phase 1) and were then randomized to one of three groups for 30 months (phase 2): monthly personal contact (supportive telephone contacts and a 1-h meeting with an interventionist quarterly), unlimited access to an interactive website providing a technology-based intervention, or self-directed control (printed lifestyle guidelines and a brief visit with an interventionist at 12 months). Mean entry weight was 96.7 kg. During phase 1, mean weight loss was 8.5 kg. At 30 months, participants in the personal-contact group had regained less weight than those in the self-directed group (4.0 kg vs. 5.5 kg; mean difference -1.5 kg; 95% confidence interval [CI], -2.4 to -0.6 kg; P = 0.001). Weight regain was lower in the interactive technology-based than in the self-directed group at 18 and 24 months, but at 30 months there was no difference left (5.2 vs. 5.5 kg; mean difference -0.3 kg; 95% CI, -1.2 to 0.6 kg; P = 0.51). At 30 months, the difference between the personal-contact and interactive technology-based group was -1.2 kg (95% CI -2.1 to -0.3; P = 0.008). Effects did not differ significantly by sex, race, age, and body mass index subgroups. Overall, 71% of study participants remained below entry weight.

Comment: The quality of evidence is downgraded by limitations in study quality (possible patient selection bias, possible contamination between the groups).

    References

    • Svetkey LP, Stevens VJ, Brantley PJ, et al; Weight Loss Maintenance Collaborative Research Group. Comparison of strategies for sustaining weight loss: the weight loss maintenance randomized controlled trial. JAMA 2008;299(10):1139-48 [Abstract and commentary in Evidence-Based Medicine 2008 Aug;13(4):109].

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