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Summarizing The Weight Management Wisdom: What Works in Weight Management? Phillip J. Brantley, PhD Pennington Biomedical Research Center 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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Summarizing the weight management wisdom what works in weight management l.jpg

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 Interventions(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 (M=8.3 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 Interventions

  • 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 Interventions

  • 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 Interventions

  • 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 Interventions

  • Extended Treatment

  • Treatment Intensity

  • Continued Contact

  • Level of Physical Activity

  • Motivational Enhancement

  • Maintenance Specific Skills

  • Other


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Extended Treatment Interventions

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 theiradherence and began to regain weight. (Perri, Nezu, Patti, & McCann, 1989)


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Review of Extended Behavioral Treatment Interventions(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: InterventionsLow 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 Interventions

  • Extended Treatment

  • Treatment Intensity

  • Continued Contact

  • Level of Physical Activity

  • Motivational Enhancement

  • Maintenance Specific Skills

  • Other


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Treatment Intensity Interventions


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“Kicking it up a notch” Interventions

  • 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 Interventions

  • Extended Treatment

  • Treatment Intensity

  • Continued Contact

  • Level of Physical Activity

  • Motivational Enhancement

  • Maintenance Specific Skills

  • Other


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Telephone Prompts Interventions(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 Interventions(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 Interventions

  • 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, 2002;2004; Tate 2006; WLM Protocol)

  • Only people who already use internet will participant…will it maintain weight for extended time period ?


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Factors Associated with Weight Maintenance Interventions

  • Extended Treatment

  • Treatment Intensity

  • Continued Contact

  • Level of Physical Activity

  • Motivational Enhancement

  • Maintenance Specific Skills

  • Other


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Physical Activity & Weight Loss Interventions

  • 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 Interventions

  • Extended Treatment

  • Treatment Intensity

  • Continued Contact

  • Level of Physical Activity

  • Motivational Enhancement

  • Maintenance Specific Skills

  • Other


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Motivational Enhancement Methods Interventions

  • Financial Incentives

  • Social Support

  • Motivational Interviewing


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Financial Incentives Interventions

  • Jeffery et al, 1993 Paid participants $25 per week over an 18 month period to loss and maintain weight…did not improve

  • Kramer et al, 1986 Collected $100 from participants at start of weight loss…at 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 Interventions

  • 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 Interventions

  • Interaction style: interact with participants based on their level of motivation (“stage of change”)

  • Elicit change statements and realistic plans…Build confidence…avoid 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 Interventions

  • Extended Treatment

  • Treatment Intensity

  • Continued Contact

  • Level of Physical Activity

  • Motivational Enhancement

  • Maintenance Specific Skills

  • Other


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Maintenance Specific Skills Interventions

  • “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 Interventions

  • 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 isn’t very effective for maintenance

  • Appears more effective during maintenance phase of Tx


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Factors Associated with Weight Maintenance Interventions

  • Extended Treatment

  • Treatment Intensity

  • Continued Contact

  • Level of Physical Activity

  • Motivational Enhancement

  • Maintenance Specific Skills

  • Other Maintenance Tools


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Problem Solving Interventions

  • 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 Interventions

  • 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 Registry…weigh at least weekly…attempt to eat reduced fat and calories


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What does not work by alone? Interventions

  • 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? Interventions

  • 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 Interventions

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