Weight maintenance 2 years after participation in a weight loss program promoting low-energy density foods

Objective: Observational study designed to determine weight outcomes and associated dietary intake patterns for a sample of participants ≥1 year after completing the University of Alabama at Birmingham EatRight Weight Management Program. Research Methods and Procedures: Seventy‐four former participants (64% women) completed follow‐up visits ≥1 year after participating in EatRight, which promotes low‐energy density, high‐complex carbohydrate foods. Weight maintenance was defined as gaining <5% of body weight since completion of the EatRight program and staying below their program entry weight. Those who gained ≥5% of their body weight since completion were classified as gainers. Results: During EatRight, participants of the follow‐up study lost an average of 4.0 kg. After a mean follow‐up time of 2.2 years, the average weight change was +0.59 kg (mean BMI, 32.5 kg/m²). Seventy‐eight percent of participants gained <5% of their body weight; 46% had no weight regain or continued weight loss. Unadjusted mean intake for maintainers was 1608 kcal, whereas calorie intake for gainers was 1989 kcal. Despite eating slightly fewer calories (adjusted difference, 244; p = 0.058), maintainers ate a similar amount of food, resulting in a lower energy‐density pattern (p = 0.016) compared with those who regained ≥5% of body weight. Gainers also reported consuming larger portions of several food groups. Discussion: Our results indicate that low‐energy‐density eating habits are associated with long‐term weight maintenance. Those who maintain weight after the EatRight program consume a low‐energy‐density dietary pattern and smaller portions of food groups potentially high in energy density than those who regain weight.     

Sociodemographic,behavioral, and biological variables related to weight loss in native hawaiians and other pacific islanders

Objective:

Native Hawaiians and other Pacific Islanders (NHs/PIs) have a high obesity prevalence compared to other ethnic groups. We examined socio‐demographic, behavioral, and biological factors related to ≥3% weight loss in 100 overweight/obese NHs/PIs who completed a lifestyle intervention.

Design and Methods:

Data were from 56 Native Hawaiians, 22 Chuukese, and 22 Other Pacific Islanders who participated in a randomized controlled trial of the Partnership for Improving Lifestyle Intervention (PILI) 'Ohana Project. All completed a 3‐month weight loss program (WLP) to initiate weight loss and were then randomized into either a 6‐month family/community focused WLP called the PILI Lifestyle Program (PLP; n = 49) or a standard behavior WLP (SBP; n = 51). We collected baseline, 3‐ and 9‐month follow‐up data on socio‐demographics, weight (kg), a 6‐min. walk test, dietary fat, exercise frequency, and blood pressure.

Results and Conclusion:

Based on ANCOVA or logistic fit, ethnicity, sex, initial weight loss, fat in diet at baseline, change in systolic blood pressure, and intervention type were significantly associated (P ≤ .05) with ≥3% weight loss at 9‐month follow‐up. A logistic regression model indicated that Chuukese (OR = 6.04; CI = 1.14–32.17) and participants who had more weight loss in the first 3‐months (OR = 1.47; CI = 1.22–1.86) and who were in the PLP (OR = 4.50; CI = 1.50–15.14) were more likely to achieve ≥3% weight loss [model; χ² (7, N = 100) = 45.50, P < .0001]. The same lifestyle intervention does not benefit all NHs/PIs equally, possibly due to differences in acculturation status and social support. The findings also point to the importance of initial weight loss to sustain motivation toward long‐term weight loss maintenance.     

Treatment of Morbid Obesity in Inner‐City Women

Objective: To explore the use of the very‐low‐calorie formula diet (VLCD) in the indigent population of Newark, NJ, with the goal of achieving 10% weight loss within a relatively short period of 10 weeks. Research Methods and Procedures: We accepted 131 morbidly obese indigent women into our study program. The study was limited to women only and the average starting weight was 292.3 ± 5.9 lbs (± SE; 50.3 ± 0.9 body mass index [kg/m²]). We used three treatment paradigms: total cost‐free program for 10 weeks; cost‐free, but compliance requirements; and a weekly charge of $25. The results obtained were compared with two control populations: women enrolled during the same recruitment period in a comparable suburban VLCD program and a historical control population of suburban women treated from 1985 through 1995. Results: In group A (total cost‐free), 79% of patients completed the 10‐week program, but only 18% of patients achieved the goal of 10% weight loss. In group B when attendance and weight loss requirements were imposed, the dropout rate accelerated such that only 37% of patients completed the 10‐week course, and 16% of the women were successful with their weight loss. In group C, imposing $25/wk financial outlay also accelerated dropouts but had little effect on weight loss success, which was 10% of the starting group. By comparison, the suburban patients and the historical control group exhibited 67% and 76% attendance rates after 10 weeks, and 33% and 55% success rates, respectively, in achieving the weight loss goal. Discussion: We conclude that inner‐city patients exhibit great interest in weight loss when financial barriers are removed. Successful weight loss was achieved in 10% to 18% of patients using the VLCD approach, approximately one‐half of that obtained in affluent suburban women. Imposing financial or compliance restrictions to the inner‐city patients served only to enhance dropouts.     

Physical activity patterns during weight maintenance following a low-energy density dietary intervention

Objective: The objective was to determine the role of physical activity (PA) and energy intake on weight maintenance among former University of Alabama at Birmingham EatRight Weight Management Program participants. Research Methods and Procedures: Eighty‐nine former participants completed follow‐up visits ≥1 year after completing EatRight. BMI was calculated using measured height and weight. Diet intake was estimated from 4‐day food records. PA was assessed using a module from the Behavioral Risk Factor Surveillance System Survey. Cut‐off points were chosen based on the distribution of minutes of activity. For moderate and total activity, cut‐off points were 0, 1 to 30, 31 to 60, and >60 minutes. For vigorous activity, the categories were 0, 1 to 20, 21 to 30, and >30 minutes. General linear models determined the association of PA with change in weight at follow‐up controlling for gender and total energy intake (kcal/d). Results: At follow‐up, 80% (n = 71) of participants maintained (regained <5% of program end weight) their body weight and 20% had gained weight. Mean weight change was 1.0 ± 6.5 kg. Maintainers consumed 384 fewer kcal/d on average. Maintainers had a lower energy density dietary pattern (1.58 vs. 2.01 kcal/g, p < 0.01). There was no significant difference in PA min/d reported by maintainers and gainers. Discussion: Our results suggest that, despite being minimally active, weight‐reduced individuals can successfully maintain their newly achieved body weight with appropriate caloric intake. Adopting a lower calorie, low energy density dietary pattern may reduce the amount of PA that is truly necessary for weight maintenance.     

Combining Weight‐Loss Counseling with the Weight Watchers Plan for Obese Breast Cancer Survivors

Objective: The objective was to develop effective weight‐loss methods for women who have had breast cancer, because obesity may result in an adverse prognosis. Research Methods and Procedures: This randomized pilot study tested an individualized approach toward weight loss in obese women who have had a diagnosis of breast cancer. An individualized approach was applied either alone or combined with the commercial Weight Watchers program. Forty‐eight women (body mass index of 30 to 44 kg/m²) were enrolled. Results: Weight change after 12 months of intervention was as follows (mean ± SD): 0.85 ± 6.0 kg in the control group, ?2.6 ± 5.9 kg in the Weight Watchers group, ?8.0 ± 5.5 kg in the individualized group, and ?9.4 ± 8.6 kg in the comprehensive group that used both individualized counseling and Weight Watchers. Weight loss relative to control was statistically significant in the comprehensive group 3, 6, and 12 months after randomization, whereas weight loss in the individualized group was significant only at 12 months. Weight loss of 10% or more of initial body weight was observed in 6 of 10 women in the comprehensive group at 12 months. In the comprehensive and Weight Watchers–only groups, weight loss was significantly related to frequency of attendance at Weight Watchers meetings, and attendance was more frequent in the comprehensive group. Discussion: These data indicate that the most weight loss was achieved when the counseling approach combined both Weight Watchers and individualized contacts. This was effective even though most of the individualized contacts were by telephone.     

Using telehealth to increase participation in weight maintenance programs

Objective: To compare weight regain, satisfaction, and convenience among three weight maintenance programs: telehealth, traditional classes, and no program. Research Methods and Procedures: This quasi‐experimental study compared weight change, satisfaction, and convenience among three program types. The telehealth participants interacted with a registered dietitian (RD) through the web and e‐mail, traditional program participants attended a traditional classroom program, and no program participants received no interaction. Eighty‐seven subjects (14 men and 73 women) were enrolled in the study: 31 traditional, 31 telehealth, and 25 no program participants. Eligibility included participation in a community‐based weight loss program (Colorado Weigh) and minimum 7% weight loss before enrollment. Results: Subject characteristics at baseline were as follows: age, 50 ± 9.3 (standard deviation) years; height, 1.68 ± 0.09 m; weight, 80.5 ± 18.4 kg, with no significant differences between groups. Over 6 months, the traditional group lost 0.5 ± 4.3 kg, the telehealth group lost 0.6 ± 2.5 kg, and the no program group gained 1.7 ± 3.0 kg. Weight change among all three groups was significant (p = 0.02); no program participants gained significantly more weight than the telehealth and traditional groups. There were no differences in overall satisfaction between the telehealth and traditional groups (p = 0.43), but individuals in the telehealth group rated their program as more convenient compared with the traditional group (p = 0.0001). Discussion: These results show the usefulness of telehealth programs in long‐term weight loss maintenance. They may be a useful alternative for those who successfully lose weight in a structured behavioral program but do not choose to participate in a formal behavioral weight loss maintenance program.     

A pilot randomized controlled trial of a commercial diet and exercise weight loss program in minority breast cancer survivors

Objective:

Obesity is associated with poorer breast cancer outcomes and losing weight postdiagnosis may improve survival. As Hispanic and black women have poorer breast cancer prognosis than non‐Hispanic whites diagnosed at similar age and stage, and have higher rates of obesity, effective weight loss strategies are needed. We piloted a randomized, waitlist‐controlled, crossover study to examine the effects and feasibility of the commercial Curves weight loss program among Hispanic, African American and Afro‐Caribbean breast cancer survivors.

Design and Methods:

Women with stage 0–IIIa breast cancer ≥6 months posttreatment, sedentary, and BMI ≥25 kg/m² were randomized to the immediate arm (IA): 6 months of the Curves program followed by 6 months of observation; or the waitlist control arm (WCA): 6 months of observation followed by 6 months of the Curves program. The Curves program uses a 30‐min exercise circuit and a high‐vegetable/low‐fat/calorie‐restricted diet.

Results:

A total of 42 women enrolled (79% Hispanic, 21% black), mean age 51 (range 32–69) and mean BMI 33.2(±5.9) kg/m²; 91% were retained at month 12. At month 6, women in the IA lost an average 3.3% (±3.5%) of body weight (range: 1.7% gain to 10.6% loss), as compared with 1.8% (±2.9%) weight loss in the WCA (P = 0.04). At month 12, on average women in the IA regained some but not all of the weight lost during the first 6 months (P = 0.02).

Conclusions:

Minority breast cancer survivors were recruited and retained in a weight loss study. Six months of the Curves program resulted in moderate weight loss, but weight loss was not maintained postintervention. Future interventions should identify methods to increase uptake and maintenance of weight loss behaviors.     

Randomized trial of a multifaceted commercial weight loss program

Objective: To test whether a commercial weight loss program promotes greater weight loss in overweight or obese women compared with control conditions and to describe the effect on plasma lipids, carotenoids, hormones, and fitness. Research Methods and Procedures: Overweight or obese women were randomized to commercial weight loss program or control conditions (n = 35 each). Results: At randomization, participants were 41.1 (11.4) (mean [standard deviation]) years, BMI 34.0 (3.5) kg/m², and weight 92.0 (11.1) kg. At 6 months, change in weight by intent‐to‐treat (ITT) analysis was ?7.2 (6.7) kg and ?7.8% (7.2%) in the intervention group vs. ?0.3 (3.9) kg and ?0.3% (4.5%) in the control group (n = 35 for each; p < 0.01). One‐year ITT analysis revealed significantly greater change in weight, percent weight, BMI, and waist and hip circumferences in the intervention vs. control group. Completers at 1 year exhibited change in weight of ?7.3 (10.4) kg for the intervention group (n = 32) vs. ?0.7 (5.6) kg for controls (n = 33) (p < 0.01), and ?7.8% (11.1%) weight change for the intervention group vs. ?0.7% (6.2%) for controls (p < 0.01). High‐density lipoprotein (HDL) cholesterol concentration increased significantly in the intervention group. Fasting serum insulin decreased in the intervention but increased in the control group at 6 months (p < 0.01), remaining different at 1 year (p = 0.05). Discussion: The commercial program successfully facilitated weight loss, which was notably maintained at 1 year, and promoted favorable changes in plasma lipid and hormone concentrations.     

Predictors of attrition and weight loss in an adolescent weight control program

Objective: To evaluate demographic and psychosocial predictors of attrition and weight loss in a behaviorally based adolescent weight control trial. Methods and Procedures: Adolescents (N = 76) aged 13–16 years and 20–80% overweight (M = 60.56%, s.d. = 15.17%) received standard group‐based behavioral treatment as part of a randomized trial comparing different activity interventions for overweight adolescents. Anthropometric and psychosocial measures were obtained at baseline and after the 16‐week intervention. Results: Higher parent (P < 0.01) and adolescent BMI (P < 0.05) at baseline, as well as ethnic minority status (P < 0.05) were significantly associated with attrition in univariate analyses. Parent BMI remained the only significant predictor of attrition in multivariate analyses. BMI change for completers (N = 62) was highly variable, ranging from ?6.09 to +1.62 BMI units. Male gender (P < 0.01) was a significant predictor of reduction in BMI, whereas not being from an ethnic minority group (P < 0.05) and attendance at group sessions (P = 0.05) were associated with ≥5% absolute weight loss in multivariate analyses. Absolute weight loss during the first 4 weeks of the program was strongly associated with weight loss (pr = 0.44, P < 0.001) during the remainder of the intervention. Psychosocial variables were unrelated to attrition or treatment outcome. Discussion: These findings highlight the potential importance of attending to parental BMI in efforts to retain adolescent participants in treatment, as well as the need to develop weight control interventions that are more effective for ethnic minority youth.     

Young Adults' Performance in a Low‐Intensity Weight Loss Campaign

Young adults (YA) are underrepresented in behavioral weight loss programs and achieve poorer outcomes than older adults (OA). There has been a call to develop programs specifically targeting this age group. This study examined the performance of YA enrolled in a low‐intensity, team‐based weight loss campaign and compared their outcomes to OA to determine the utility of such an approach for weight loss in this population. Shape Up Rhode Island (SURI) 2009 was a 12‐week online team‐based weight loss and exercise competition (N = 6,795, 81% female, 94% white, age = 44.7 ± 11.2, BMI = 29.4 ± 5.9). YA was defined as 18–35 years and OA as >35 years; YA and OA were compared on enrollment, retention, weight loss, and change in steps. A total of 1,562 YA enrolled and 715 completed the program. Fewer YA completed compared with OA (46 vs. 62%, P < 0.001). However, among completers, YA achieved greater percent weight loss (‐4.5 ± 4.0 vs. ?3.8 ± 3.2%) and greater daily step change (+1,578.2 ± 3,877.2 vs. +1,342.2 ± 3,645.7) than OA (P's < 0.001). Further, more YA completers achieved a ≥5% weight loss (40 vs. 29%, P < 0.001). Findings were consistent in the overweight/obese (OW/OB) subsample, and using ≤25 years of age as the cut off for YA. Weight losses among YA in this low‐intensity weight loss campaign were quite promising, with over 700 YA completing the program and on average achieving a 4.5% weight loss. Indeed, the potential public health impact of such an approach is substantial; future efforts to develop programs for this age group may benefit from using a low‐intensity, team‐based approach.     

Changes in the Perceptions of Self‐weighing Across Time in a Behavioral Weight Loss Intervention

Objective

Changes in beliefs about self‐weighing were examined across time in a behavioral weight loss intervention.

Methods

Active duty military personnel (n = 248) enrolled in a 12‐month counselor‐initiated or self‐paced intervention based on the Look AHEAD (Action for Health in Diabetes) Intensive Lifestyle Intervention. Using an electronic scale, participants were asked to self‐weigh daily. Self‐weighing perceptions were compared from baseline to 4 months (weight loss phase), from 4 months to 12 months (weight maintenance phase), and from baseline to 12 months (full intervention), as well as across time by behavioral and demographic characteristics.

Results

Overall, participants perceived self‐weighing as more helpful and positive, less frustrating, and making them less self‐conscious after the weight loss phase. After weight maintenance, individuals believed self‐weighing was less helpful and positive, more frustrating and anxiety provoking, and making them more self‐conscious. However, after the intervention, participants still viewed self‐weighing as more helpful and positive and less frustrating than at baseline. Weight change, self‐weighing behavior prior to the intervention, and intervention condition were associated with perception change. Controlling for these influencing factors, differences in gender, BMI, age, ethnicity, and race were observed in how beliefs changed across time.

Conclusions

Results suggest engaging in a weight loss intervention promoting daily self‐weighing increases positive and decreases negative beliefs about self‐weighing.     

Sex Hormones and Sexual Function in Obese Men Losing Weight

Objective: To study the impact of a weight‐loss program on sex hormones and sexual function among 38 middle‐aged obese men (BMI ≥35 kg/m²). Research Methods and Procedures: A randomized controlled clinical trial was conducted. The treatment group (n = 19) participated in a 4‐month weight‐loss program including 10 weeks on a very‐low‐energy diet (VLED) and 17 behavior modification visits. There was no intervention in the control group (n = 19). Both groups were followed for 8 months, i.e., 22 weeks after the active weight loss in the treatment group. The outcome measures (weight, sex hormones, sexual function, leptin, and metabolic variables) were obtained at baseline and at three time‐points during follow‐up. Results: The mean weight loss in the treatment group was 21 kg at the end of the 10‐week VLED. At the end of follow‐up, the maintained weight loss was 17 kg of baseline weight. The control group was weight stable throughout the study. In the treatment group, increases in sex hormone‐binding globulin, testosterone, and high‐density lipoprotein‐cholesterol, as well as decreases in insulin and leptin, were maintained until the end of follow‐up, although with VLED, the level of several hormones and metabolic variables improved transiently during the rapid weight loss. There were no significant changes in the questionnaire scores on sexual function in either group. Discussion: We conclude that obese men lose weight and increase their serum testosterone level on a weight‐loss program with VLED and behavior modification. However, they do not change their sexual function scores.     

Obesity‐related Comorbidities in Obese African Americans in an Outpatient Weight Loss Program

Objective: To identify, among obese African‐American enrollees in an outpatient weight loss program, differences between those with and without obesity‐related comorbidities (ORCMs). Research Methods and Procedures: Data were from 237 obese African Americans (BMI, 30 to 50 kg/m²; 90% women) who enrolled in a 10‐week lifestyle weight loss program. Analyses compared subgroups defined by ORCM status (from medical history) on baseline characteristics, program attendance, and postprogram weight change. Results: Most participants (76%) had one or more ORCMs. Those with versus without ORCMs, respectively, were older (mean age, 45.6 vs. 37.1 years; p < 0.001), were less educated (59.2% vs. 76.6% with >12 years; p = 0.031), were more likely to perceive a physical limitation affecting activity (22.2% vs. 1.8%; p < 0.001), and had higher waist circumference (mean, 113.7 vs. 106.9 cm; p < 0.001) but not BMI (38.3 vs. 37.0 kg/m²; p = 0.095). Logistic regression analyses confirmed the independence of these associations. Having ORCMs was not associated with class attendance or return for data collection after the 10‐week program. Postprogram weight change (n = 134) was unrelated to ORCMs, but better weight loss was seen among those without perceived physical limitations (1.9 vs. 0.4 kg in those without versus with limitations; p = 0.069). Conclusion: Data from this clinical sample of obese African Americans suggest that waist circumference is relevant to ORCM status at BMI levels up to 50 kg/m². Clear indications for tailoring of treatment based on ORCM status were not identified, although the possible influence of ORCM‐related activity limitations warrants further study.     

Mediators of Weight Loss in a Family‐Based Intervention Presented over the Internet

Objective: To assess the process variables involved in a weight loss program for African‐American adolescent girls. Several process variables have been identified as affecting success in in vivo weight loss programs for adults and children, including program adherence, self‐efficacy, and social support. The current study sought to broaden the understanding of these process variables as they pertain to an intervention program that is presented using the Internet. It was hypothesized that variables such as program adherence, dietary self‐efficacy, psychological factors, and family environment factors would mediate the effect of the experimental condition on weight loss. Research Methods and Procedures: Participants were 57 adolescent African‐American girls who joined the program with one obese parent; family pairs were randomized to either a behavioral or control condition in an Internet‐based weight loss program. Outcome data (weight loss) are reported for the first 6 months of the intervention. Results: Results partially supported the hypotheses. For weight loss among adolescents, parent variables pertaining to life and family satisfaction were the strongest mediating variables. For parental weight loss, changes in dietary practices over the course of 6 months were the strongest mediators. Discussion: The identification of factors that enhance or impede weight loss for adolescents is an important step in improving weight loss programs for this group. The current findings suggest that family/parental variables exert a strong influence on weight loss efforts for adolescents and should be considered in developing future programs.     

Obesity Reduction Black Intervention Trial (ORBIT): 18‐Month Results

Obesity is a chronic condition that is prevalent in black women. The Obesity Reduction Black Intervention Trial (ORBIT) was a randomized controlled weight loss and weight‐loss maintenance (WLM) trial. Participants (N = 213) were randomized to the intervention or control groups in August 2005 and September 2006. Follow‐up data were collected 6 and 18 months after randomization. The main outcome was change in weight and BMI from baseline to 18 months. The mean weight at baseline was 104.9 kg, and the mean weight loss in the intervention group at 6 months was 3.0 kg and a gain of 0.2 kg in the control group (mean difference between groups in weight change at 6 months, adjusting for baseline weight and cohort, ?3.27 kg; 95% confidence interval (CI), ?4.50 to ?2.05 kg; P < 0.001). Both groups gained weight between 6 and 18 months (mean 1.0 kg in the intervention group and 0.1 kg in the control group). However, intervention participants lost significantly more weight than control participants during the 18‐month intervention (adjusted mean difference between groups at 18 months, ?2.83 kg; 95% CI, ?4.71 to ?0.95; P = 0.003). At 18 months, intervention participants were more likely than control participants to have lost at least 5% of baseline weight (24% vs. 12%, P < 0.04). Our results indicate that the ORBIT program did promote weight loss and weight‐loss maintenance. However, the results also clearly illustrate there is more to learn about what will contribute to meaningful weight loss and maintenance in this population.     

The efficacy of a technology-based system in a short-term behavioral weight loss intervention

Objective: The objective was to examine the efficacy of adding a technology‐based program to an in‐person, behavioral weight loss intervention. Research Methods and Procedures: Fifty‐seven subjects (BMI = 33.1 ± 2.8 kg/m²; age = 41.3 ± 8.7 years) participated in a 12‐week intervention with random assignment to Standard In‐Person Behavioral Weight Control Program (SBWP) or Intermittent or Continuous Technology‐Based Program (INT‐TECH, CON‐TECH). SBWP subjects received seven individualized weight loss sessions encouraging dietary and exercise modifications. INT‐TECH and CON‐TECH subjects received all SBWP components; additionally, these groups used a SenseWear Pro Armband (BodyMedia, Inc.) to monitor energy expenditure and an Internet‐based program to monitor eating behaviors. These features were used by INT‐TECH subjects during weeks 1, 5, and 9 and CON‐TECH subjects weekly throughout the intervention. Results: Intent‐to‐treat analysis revealed weight loss of 4.1 ± 2.8 kg, 3.4 ± 3.4 kg, and 6.2 ± 4.0 kg, for SBWP, INT‐TECH, and CON‐TECH groups, respectively (CON‐TECH > INT‐TECH, p ≤ 0.05). Discussion: These results indicate that the technology‐based program needs to be used continuously throughout the intervention period to significantly impact weight loss. Future studies should examine the long‐term and independent effect of this technology on weight loss, and for whom this intervention format is most effective.     

Predictors of Attrition in a Large Clinic‐Based Weight‐Loss Program

Objective: Identifying client factors that predict dropout is critical for the development of effective weight‐loss programs. Although demographic predictors are studied, there are few consistent findings. The purpose of this study was to identify predictors of dropout in a large clinic‐based weight‐loss program using readily attainable demographic variables. Research Methods and Procedures: All 866 weight‐loss patients in a clinic‐based weight‐loss program enrolled during 1998 to 1999 were followed. Attrition and retention rates were measured at 8 and 16 weeks. Six variables (sex, race, marital status, age, BMI, and treatment protocol) were evaluated using bivariate and multivariable statistics for relative association with dropout. Results: The overall attrition rate for the 16‐week program was 31%. The retention rate was 69%. Significant risk for dropout, measured as bivariate relative risk (95% confidence interval), was found among patients who were: females, 1.32 (1.01 to 1.73); divorced, 1.54 (1.13 to 2.09); African Americans, 1.68 (1.26 to 2.23); age < 40, 1.66 (1.27 to 2.18); and ages 40 to 50, 1.33 (1.01 to 1.76). There were no significant differences in retention rates by BMI group or program protocol. After logistic regression analysis to control for all variables, young age < 50 years had the only significant association with dropout [odds ratio = 1.39 (1.02 to 1.90)]. Discussion: Multivariable modeling was helpful for prioritizing risk factors for program dropout. These findings have important implications for improving weight‐loss program effectiveness and reducing attrition. By knowing the groups at risk for dropout, we can improve or target program treatments to these populations.     

Weight Loss Intervention for Obese Older Women: Improvements in Performance and Function

Objectives: To determine the feasibility of a 3‐month weight loss program for obese older women with short‐term laboratory, performance, functional, and life quality outcomes. Research Methods and Procedures: This was a pre‐ and postintervention design. Community‐dwelling women (n = 26) ≥60 years old with BMI ≥30 were enrolled in a 3‐month weight loss program promoting prudent diet, behavior modification, and physical activity. The primary emphasis of the program was on health, function, and quality of life. The approach was specifically tailored to older subjects through use of large‐font instructional materials, supplementation of calcium and vitamin D, and moderate weight loss and physical activity goals. An initial assessment by a bariatric physician was followed by eight visits with a dietitian and a follow‐up physician visit. Measurements included anthropometrics, body composition, laboratories, pedometer, physical performance, Short‐Form 36 Health Status Survey (SF‐36), Life Space Assessment, and dietary assessment. Results: Eighteen participants completed the program. There was a significant decrease in mean body weight (100 ± 15 vs. 96 ± 18 kg, p = 0.006), with a mean weight loss of 4.3 ± 5.5 kg (range ?15.5 to +7.20 kg). Significant improvements were observed for diastolic blood pressure, total cholesterol, triglycerides, physical performance, pedometer‐measured step counts, and step climb and descent. Self‐rated physical functioning (SF‐36 subscore) and vitality (SF‐36 subscore) were also significantly improved. Discussion: It is feasible for self‐selected obese older women to achieve a moderate weight loss and increase in physical activity resulting in short‐term improvements in laboratory, physical performance, self‐reported function, vitality, and life quality outcomes.     

Web-based weight management programs in an integrated health care setting: a randomized, controlled trial

Objective: To assess the efficacy of a Web‐based tailored behavioral weight management program compared with Web‐based information‐only weight management materials. Research Methods and Procedures: Participants, 2862 eligible overweight and obese (BMI = 27 to 40 kg/m²) members from four regions of Kaiser Permanente's integrated health care delivery system, were randomized to receive either a tailored expert system or information‐only Web‐based weight management materials. Weight change and program satisfaction were assessed by self‐report through an Internet‐based survey at 3‐ and 6‐month follow‐up periods. Results: Significantly greater weight loss at follow‐up was found among participants assigned to the tailored expert system than among those assigned to the information‐only condition. Subjects in the tailored expert system lost a mean of 3 ± 0.3% of their baseline weight, whereas subjects in the information‐only condition lost a mean of 1.2 ± 0.4% (p < 0.0004). Participants were also more likely to report that the tailored expert system was personally relevant, helpful, and easy to understand. Notably, 36% of enrollees were African‐American, with enrollment rates higher than the general proportion of African Americans in any of the study regions. Discussion: The results of this large, randomized control trial show the potential benefit of the Web‐based tailored expert system for weight management compared with a Web‐based information‐only weight management program.     

Two-year internet-based randomized controlled trial for weight loss in African-American girls

Objective: A randomized controlled trial tested the efficacy of an internet‐based lifestyle behavior modification program for African‐American girls over a 2‐year period of intervention. Research Methods and Procedures: Fifty‐seven overweight (mean BMI percentile, 98.3) African‐American girls (mean age, 13.2 years) were randomly assigned to an interactive behavioral internet program or an internet health education program, the control condition. Overweight parents were also participants in the study. Forty adolescent‐parent dyads (70%) completed the 2‐year trial. Outcome data including BMI, body weight, body composition, and weight loss behaviors were collected at baseline and at 6‐month intervals. A computer server tracked use of the web sites. Results: An intention‐to‐treat statistical approach was used, with the last observation carried forward. In comparison with the control condition, adolescents in the behavioral program lost more mean body fat (BF) (?1.12 ± 0.47% vs. 0.43 ± 0.47% BF, p < 0.05), and parents in the behavioral program lost significantly more mean body weight (?2.43 ± 0.66 vs. ?0.35 ± 0.64 kg, p < 0.05) during the first 6 months. This weight loss was regained over the next 18 months. After 2 years, differences in fat for adolescents (?0.08 ± 0.71% vs. 0.84 ± 0.72% BF) and weight for parents (?1.1 ± 0.91 vs. ?0.60 ± 0.89 kg) did not differ between the behavioral and control programs. Discussion: An internet‐based weight management program for African‐American adolescent girls and their parents resulted in weight loss during the first 6 months but did not yield long‐term loss due to reduced use of the web site over time.