Summarizing The Weight Management Wisdom: What Works in Weight Management

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Summarizing The Weight Management Wisdom What
Works in Weight Management?

• Phillip J. Brantley, PhD
• Pennington Biomedical Research Center

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A Typical Pattern of Weight Loss Regain in
Behavioral Interventions
Long-term outcomes for behavioral weight loss
treatment (Kramer et al., 1989)
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Review of Behavioral Weight Loss Treatment
(Perri Corsica, 2002)

• Reviewed nine studies with follow-ups of two
  years or more (2-12 years)
• Initial weight loss across studies ranged from
  4.5 to 14.3 kg (M8.3 kg)
• Every study met the IOM criterion for maintenance
  at one year (5 reduction)
• Net loss across studies at final follow-up
  averaged 3 kg with only 2 of 9 meeting IOM
  Criterion at final follow-up

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Weight Loss Maintenance Trial

• A multicenter, randomized clinical trial to
  determine the effectiveness of two innovative
  behavioral interventions, compared to an advice
  only control group in maintaining weight loss

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WLM Sites

• Clinical Sites
• Pennington Biomedical Research Center
• Duke University Medical Center
• Johns Hopkins School of Medicine
• Kaiser Center for Health Research
• Coordinating Center
• Kaiser Center for Health Research
• Project Office
• NHLBI Prevention Scientific Research Group

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Reasons for Weight Regain

• Loss of motivation
• Life stressors
• Hunger/cravings
• Obesogenic environment
• Obesity is a chronic, possibly lifelong problem

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Factors Associated with Weight Maintenance

• Extended Treatment
• Treatment Intensity
• Continued Contact
• Level of Physical Activity
• Motivational Enhancement
• Maintenance Specific Skills
• Other

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Extended Treatment
Perri et al (1989) compared a standard 20 week
program with an extended 40 week program.
Clients in the extended treatment increased their
weight losses by 35 during weeks 20-40.
Follow-up data showed that after the extended
treatment was concluded, clients reduced their
adherence and began to regain weight. (Perri,
Nezu, Patti, McCann, 1989)
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Review of Extended Behavioral Treatment (Perri
Corsica, 2002)

• Reviewed 13 studies that extended group treatment
  more than 6 months using weekly or biweekly
  sessions (35-65 sessions over 40-78 weeks
• Extended Treatment groups averaged maintaining 96
  of weight loss compared to 66 in controls

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Major Problem with with Extended Treatment Low
Adherence

• Attendance for 1st six months was 65, for next
  12 months it averaged 25
• Jeffery et al (1993)
• PREMIER similar rates

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Factors Associated with Weight Maintenance

• Extended Treatment
• Treatment Intensity
• Continued Contact
• Level of Physical Activity
• Motivational Enhancement
• Maintenance Specific Skills
• Other

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Treatment Intensity
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Kicking it up a notch

• Structured meal plans and portion controlled
  diets early on
• Home based or supervised exercise
• Motivational strategies,e.g., recruit with
  friends, group competition

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Factors Associated with Weight Maintenance

• Extended Treatment
• Treatment Intensity
• Continued Contact
• Level of Physical Activity
• Motivational Enhancement
• Maintenance Specific Skills
• Other

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Telephone Prompts (Wing et al, 1996)

• Weekly telephone prompts used to promote
  self-monitoring of body weight and food intake
  over a 12 month post-treatment period.
• Contacts were made by non-interventionists who
  did not offer counseling or guidance.
• Although telephone prompts were associated with
  less weight regain (r-.52), they did not enhance
  maintenance of weight loss compared to no-contact
  control condition.

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Telephone and Mail Contacts by Interventionists
(Perri et al, 1984)

• Most telephone and mail contacts were made by the
  interventionist who conducted the initial weight
  loss intervention
• Group who received post treatment contacts
  maintained greater weight loss

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Internet Technology to Promote Weight Maintenance

• Internet programs using email and Internet Web
  sites have been shown to improve diabetes
  management, promote physical activity and improve
  quality of life in patients with HIV/AIDS
• Studies look promising for weight maintenance
  (e.g., Harvey-Berino et al, 20022004 Tate 2006
  WLM Protocol)
• Only people who already use internet will
  participantwill it maintain weight for extended
  time period ?

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Factors Associated with Weight Maintenance

• Extended Treatment
• Treatment Intensity
• Continued Contact
• Level of Physical Activity
• Motivational Enhancement
• Maintenance Specific Skills
• Other

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Physical Activity Weight Loss

• Even though physical activity is NOT the most
  efficient method of LOSING weight, it appears to
  be CRUCIAL to maintaining weight loss.
• It may be more than calories burned exercise
  may enhance mood or motivation for caloric
  control ?

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Factors Associated with Weight Maintenance

• Extended Treatment
• Treatment Intensity
• Continued Contact
• Level of Physical Activity
• Motivational Enhancement
• Maintenance Specific Skills
• Other

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Motivational Enhancement Methods

• Financial Incentives
• Social Support
• Motivational Interviewing

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Financial Incentives

• Jeffery et al, 1993 Paid participants 25 per
  week over an 18 month period to loss and maintain
  weightdid not improve
• Kramer et al, 1986 Collected 100 from
  participants at start of weight lossat beginning
  of maintenance either gave it back, paid it
  contingent on attendance or paid it contingent on
  weight maintenance no difference

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Social Support

• Modest support for including spouses or
  significant others
• Support triggered by financial incentives for
  group weight loss is promising (Kramer et al,
  1986 Perri et al, 1988)
• Also promising is allowing groups of friends to
  participate together in weight loss (Wing and
  Jeffery, 1999)

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Motivational Interviewing

• Interaction style interact with participants
  based on their level of motivation (stage of
  change)
• Elicit change statements and realistic
  plansBuild confidenceavoid lecturing
• Impacts treatment outcome by promoting better
  adherence (better attendance, more participation)
• Zweben Zuckoff in Miller and Rollnick,
  2002

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Factors Associated with Weight Maintenance

• Extended Treatment
• Treatment Intensity
• Continued Contact
• Level of Physical Activity
• Motivational Enhancement
• Maintenance Specific Skills
• Other

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Maintenance Specific Skills

• Strategies that are effective for maintaining an
  energy deficit in a period of weight loss may be
  different than those involved in maintaining a
  stable energy balance around a lower weight
• Jeffery et al, 2000

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Relapse Prevention Training

• Teaches people to avoid or cope with slips and
  relapses
• Slips lead to negative psychological reactions
  that precipitate a return to pretreatment
  patterns
• RPT in initial treatment phase isnt very
  effective for maintenance
• Appears more effective during maintenance phase
  of Tx

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Factors Associated with Weight Maintenance

• Extended Treatment
• Treatment Intensity
• Continued Contact
• Level of Physical Activity
• Motivational Enhancement
• Maintenance Specific Skills
• Other Maintenance Tools

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Problem Solving

• Systematic method for coping with barriers or
  problems
• Uses Problem Identification, Generation of
  Alternatives, Selection of Best Solution,
  Implementation, Evaluation
• Leader can do it or facilitate it
• Successful use in weight maintenance by Perri et
  al

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Self-Monitoring

• Food and activity monitoring is one of best
  predictors of success in weight loss.unclear of
  its role in maintenance
• Nearly all extended treatment studies promote
  recording of food intake and weight
• National Weight Control Registryweigh at least
  weeklyattempt to eat reduced fat and calories

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What does not work by alone?

• Individual monetary incentives
• RPT without contact
• Telephone prompts by non-interventionists
• Personal trainers
• Frequent group meetings
• Supervised group exercise
• Reliance on meal replacements

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What works?

• Multi-component Program
• Continued contact providing accountability and
  motivation
• Physical activity promotion
• RPT by interventionist
• Problem solving
• Weekly weighing
• Reduced calorie and fat diet

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Intervention Components
PC
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