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Low-cost Telephone Intervention Helps Obese Veterans Reduce Weight Regain after Weight Loss Program


BACKGROUND:
Interventions targeting dietary change, physical activity, and behavioral strategies yield clinically significant weight loss of at least 5%. After this initial loss, most people tend to regain 1 to 2 kg of weight per year, with faster rates of regain in the earlier years. To reduce weight regain, various strategies have been evaluated (i.e., meal replacements, medications, and behavioral approaches). One behavioral approach is teaching patients maintenance-specific skills. This study evaluated the efficacy of a maintenance intervention compared with usual care among obese Veterans – who had lost at least 4 kg in a weight loss program – from three VA primary care clinics. Investigators randomized 110 Veterans to the maintenance intervention and 112 Veterans to usual care. The maintenance intervention involved transitions from initiation to maintenance skills and from group visits to individual monthly telephone calls. The intervention period was 42 weeks, followed by 14 weeks of no contact. Usual care was chosen as the comparator to mimic the typical patient experience of no further intervention after participating in a weight loss program. The primary outcome was mean weight regain at week 56. Secondary outcomes included self-reported caloric intake, walking, and moderate physical activity.

FINDINGS:

  • Estimated mean weight regain was statistically significantly lower in the intervention (.75 kg) than the usual care group (2.36 kg). Moreover, Veterans in the intervention group maintained their weight even though the intervention decreased in frequency, shifted from in-person to telephone delivery, and involved no intervention contact in the final 14 weeks.
  • No statistically significant differences in secondary outcomes were seen at 56 weeks.
  • No adverse events attributable to the intervention were observed.
  • Cost of the maintenance intervention was $276 per patient.

IMPLICATIONS:

  • Focusing on maintenance-specific skills may help people maintain much of their initial weight loss 56 weeks after participating in a weight loss program.

LIMITATIONS:

  • Dietary intake and physical activity were self-reported.
  • AUTHOR/FUNDING INFORMATION:
    This study was funded by HSR&D (IIR 11-040), and Dr. Voils was supported by an HSR&D Research Career Scientist award. Drs. Olsen and Gierisch are part of HSR&D's Center for Health Services Research in Primary Care, Durham, NC. Dr. Voils conducted the study while she was at this center, and is now at the William S. Middleton Memorial Veterans Hospital, Madison, WI.


    PubMed Logo Voils C, Olsen M, Gierisch J, et al. Maintenance of Weight Loss after Initiation of Nutrition Training: A Randomized Trial. Annals of Internal Medicine. April 4, 2017;166(7):463-71.

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    What are HSR&D Publication Briefs?

    HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.