Determining optimal approaches for weight maintenance: A randomized controlled trial

Department of Human Nutrition, University of Otago, Dunedin, New Zealand.
Canadian Medical Association Journal (Impact Factor: 5.96). 05/2009; 180(10):E39-46. DOI: 10.1503/cmaj.080974
Source: PubMed


Weight regain often occurs after weight loss in overweight individuals. We aimed to compare the effectiveness of 2 support programs and 2 diets of different macronutrient compositions intended to facilitate long-term weight maintenance.
Using a 2 x 2 factorial design, we randomly assigned 200 women who had lost 5% or more of their initial body weight to an intensive support program (implemented by nutrition and activity specialists) or to an inexpensive nurse-led program (involving "weigh-ins" and encouragement) that included advice about high-carbohydrate diets or relatively high-monounsaturated-fat diets.
In total, 174 (87%) participants were followed-up for 2 years. The average weight loss (about 2 kg) did not differ between those in the support programs (0.1 kg, 95% confidence interval [CI] -1.8 to 1.9, p = 0.95) or diets (0.7 kg, 95% CI -1.1 to 2.4, p = 0.46). Total and low-density lipoprotein (LDL) cholesterol levels were significantly higher among those on the high-monounsaturated-fat diet (total cholesterol: 0.17 mmol/L, 95% CI 0.01 to 0.33; p = 0.040; LDL cholesterol: 0.16 mmol/L, 95% CI 0.01 to 0.31; p = 0.039) than among those on the high-carbohydrate diet. Those on the high-monounsaturated-fat diet also had significantly higher intakes of total fat (5% total energy, 95% CI 3% to 6%, p < 0.001) and saturated fat (2% total energy, 95% CI 1% to 2%, p < 0.001). All of the other clinical and laboratory measures were similar among those in the support programs and diets.
A relatively inexpensive program involving nurse support is as effective as a more resource-intensive program for weight maintenance over a 2-year period. Diets of different macronutrient composition produced comparable beneficial effects in terms of weight loss maintenance.

Download full-text


Available from: Kelly S Dale, Oct 10, 2015
34 Reads
  • Source
    • "Body weight and body composition no difference between HP and HC groups in weight or BMI alterations during weight maintenance period Dale, 2009, New Zealand [20] Randomized controlled trial 200 women aged 25-70 years "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Weight regain after weight loss is a common problem for all those obese or overweight who have had a recent weight loss. Different cures such as diet therapy, behavioral therapy, exercise or a mixture of them have been advised as solutions. The purpose of this review is to find the best diet or eating pattern to maintain a recent weight loss. Materials and Methods: We searched in PubMed and SCOPUS by using the following key words: Overweight, obesity, weight maintenance, weight regain, and diet therapy. Finally, we assessed 26 articles in the present article. Results: Meal replacement, low carbohydrate-low glycemic index (GI) diet, high protein intake, and moderate fat consumption have shown some positive effects on weight maintenance. However, the results are controversial. A Dietary Approach to Stop Hypertension (DASH)-type diet seems helpful for weight maintenance although the need for more study has remained. Some special behaviors were associated with less weight regain, such as, not being awake late at night, drinking lower amount of sugar-sweetened beverages, and following a healthy pattern. Some special foods have been suggested for weight maintenance. However, the roles of specific foods are not confirmed. Conclusion: Healthy diets recommend low carbohydrate, low GI, and moderate fat foods, but it is not clear whether they are useful in preventing weight gain. It seems that consuming fewer calories helps people to keep weight loss. Further research to find strategies in obesity management focusing on successful maintenance of weight loss is needed.
    Journal of research in medical sciences 03/2014; 19(3):268-275. · 0.65 Impact Factor
  • Source
    • "The Tailored package is modelled in part on our successful HEAT study [43] and from the literature [2,39,66,69] and is designed to be suitable for incorporation into primary care. Three main areas of interest will be assessed and targeted; dietary intake, physical activity/inactivity, and parenting/behaviour (Table 1). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Because parental recognition of overweight in young children is poor, we need to determine how best to inform parents that their child is overweight in a way that enhances their acceptance and supports motivation for positive change. This study will assess 1) whether weight feedback delivered using motivational interviewing increases parental acceptance of their child's weight status and enhances motivation for behaviour change, and 2) whether a family-based individualised lifestyle intervention, delivered primarily by a MInT mentor with limited support from "expert" consultants in psychology, nutrition and physical activity, can improve weight outcomes after 12 and 24 months in young overweight children, compared with usual care. 1500 children aged 4-8 years will be screened for overweight (height, weight, waist, blood pressure, body composition). Parents will complete questionnaires on feeding practices, physical activity, diet, parenting, motivation for healthy lifestyles, and demographics. Parents of children classified as overweight (BMI > or = CDC 85th) will receive feedback about the results using Motivational interviewing or Usual care. Parental responses to feedback will be assessed two weeks later and participants will be invited into the intervention. Additional baseline measurements (accelerometry, diet, quality of life, child behaviour) will be collected and families will be randomised to Tailored package or Usual care. Parents in the Usual care condition will meet once with an advisor who will offer general advice regarding healthy eating and activity. Parents in the Tailored package condition will attend a single session with an "expert team" (MInT mentor, dietitian, physical activity advisor, clinical psychologist) to identify current challenges for the family, develop tailored goals for change, and plan behavioural strategies that best suit each family. The mentor will continue to provide support to the family via telephone and in-person consultations, decreasing in frequency over the two-year intervention. Outcome measures will be obtained at baseline, 12 and 24 months. This trial offers a unique opportunity to identify effective ways of providing feedback to parents about their child's weight status and to assess the efficacy of a supportive, individualised early intervention to improve weight outcomes in young children. Australian New Zealand Clinical Trials Registry ACTRN12609000749202.
    BMC Public Health 05/2010; 10(1):271. DOI:10.1186/1471-2458-10-271 · 2.26 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: For some years, there has been interest in exploring the effects of high-fat and high-protein diets on the control of body weight. More recently, less extreme dieting paradigms have been studied, with a focus on the use of increased plant food components. This article reviews these diets from the standpoint of potential therapeutic use in cardiovascular risk reduction. We conducted a search of the literature published in 2008 and 2009 for studies assessing the effect of diet on body weight control, especially where there was an emphasis on differences in macronutrient profiles and food sources used (e.g., plant vs. animal). No clear picture emerged on the ideal macronutrient profile for weight loss and cardiovascular disease risk factor reduction. However, in general, the use of more plant food-based approaches had the greatest effect in reducing cardiovascular disease risk factors, including blood lipids and blood pressure. Alterations in the proportion of protein and fat intakes gave inconsistent effects on body weight reduction. KeywordsCardiovascular health-Diet-Weight control-Macronutrients
    Current Cardiovascular Risk Reports 03/2010; 4(2):89-100. DOI:10.1007/s12170-010-0082-z
Show more