Effect of a Free Prepared Meal and Incentivized Weight Loss Program on Weight Loss and Weight Loss Maintenance in Obese and Overweight Women: A Randomized Controlled Trial

School of Medicine, University of California, San Diego, and Moores UCSD Cancer Center, La Jolla, California 92093, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 10/2010; 304(16):1803-10. DOI: 10.1001/jama.2010.1503
Source: PubMed


The prevalence of overweight and obesity in the United States remains high. Commercial weight loss programs may contribute to efforts to reduce the prevalence of overweight and obesity, although few studies have examined their efficacy in controlled trials.
To test whether a free prepared meal and incentivized structured weight loss program promotes greater weight loss and weight loss maintenance at 2 years compared with usual care.
A randomized controlled trial of weight loss and weight loss maintenance in 442 overweight or obese women (body mass index, 25-40) aged 18 to 69 years (mean age, 44 years) conducted at US institutions over 2 years with follow-up between November 2007 and April 2010.
The program, which involves in-person center-based or telephone-based one-to-one weight loss counseling, was available over a 2-year period. Behavioral goals were an energy-reduced, nutritionally adequate diet, facilitated by the inclusion of prepackaged food items in a planned menu during the initial weight loss phase, and increased physical activity. Participants assigned to usual care received 2 individualized weight loss counseling sessions with a dietetics professional and monthly contacts.
Weight loss and weight loss maintenance.
Weight data were available at 24 months for 407 women (92.1% of the study sample). In an intent-to-treat analysis with baseline value substitution, mean weight loss was 7.4 kg (95% confidence interval [CI], 6.1-8.7 kg) or 7.9% (95% CI, 6.5%-9.3%) of initial weight at 24 months for the center-based group, 6.2 kg (95% CI, 4.9-7.6 kg) or 6.8% (95% CI, 5.2%-8.4%) for the telephone-based group, and 2.0 kg (95% CI, 0.6-3.3 kg) or 2.1% (95% CI, 0.7%-3.5%) for the usual care control group after 24 months (P < .001 for intervention effect).
Compared with usual care, this structured weight loss program resulted in greater weight loss over 2 years. Identifier: NCT00640900.

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    • "While existing evidence indicates that weight loss at any age is difficult to achieve and sustain, successful programs for women in their reproductive years reaffirm that women can overcome environmental pressures like easy access to low-cost, high-calorie foods and develop healthy eating habits. These programs promote dietary modification and increased physical activity through sustained daily changes, with the help of a support system and regular monitoring [28-36]. Women should be encouraged to include moderate physical activity in their daily routine to improve weight and cardiovascular status before pregnancy and reduce the likelihood of developing weight-related complications during gestation [37]. "
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    ABSTRACT: Providing care to adolescent girls and women before and between pregnancies improves their own health and wellbeing, as well as pregnancy and newborn outcomes, and can also reduce the rates of preterm birth. This paper has reviewed the evidence-based interventions and services for preventing preterm births, reported the findings from research priority exercise, and prescribed actions for taking this call further. Certain factors in the preconception period have been shown to increase the risk for prematurity and, therefore, preconception care services for all women of reproductive age should address these risk factors through preventing adolescent pregnancy, preventing unintended pregnancies, promoting optimal birth spacing, optimizing pre-pregnancy weight and nutritional status (including a folic acid-containing multivitamin supplement) and ensuring that all adolescent girls have received complete vaccination. Preconception care must also address risk factors that may be applicable to only some women. These include screening for and management of chronic diseases, especially diabetes; sexually-transmitted infections; tobacco and smoke exposure; mental health disorders, notably depression; and intimate partner violence. The approach to research in preconception care to prevent preterm births should include a cycle of development and delivery research that evaluates how best to scale up coverage of existing evidence-based interventions, epidemiologic research that assesses the impact of implementing these interventions and discovery science that better elucidates the complex causal pathway of preterm birth and helps to develop new screening and intervention tools. In addition to research, policy and financial investment is crucial to increasing opportunities to implement preconception care, and rates of prematurity should be included as a tracking indicator in global and national maternal child health assessments.
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    • "The majority of studies to date have used specially prepared meals (McCarron et al., 1998; Metz et al., 2000). Only one study looked at a commercial all meal replacement service in combination with dietary and physical activity counselling, reporting a greater weight loss compared to usual care (Rock et al., 2010). To date, the effectiveness of a commercial all meal replacement service alone has not been evaluated and compared with that of self-directed dieting within the UK. "
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    ABSTRACT: Effective approaches are needed to address the increasing prevalence of overweight and obesity. The present study investigated whether all meal provision was a more effective and acceptable method for weight loss than a self-directed diet. This randomised controlled trial recruited 112 men and women with a body mass index in the range 27-35 kg m(-2) , who had no comorbidities, from the local area of Hull. Participants were randomised to receive either meal provision or follow a self-directed diet for a 12-week period that resulted in an estimated 2928 kJ day(-1) (700 kcal day(-1) ) deficit. A dietitian supervised both dietary interventions. At 12 weeks [mean (SEM)], percentage weight loss in the meal provision group was 6.6% (0.5%) compared to 4.3% (0.6%) for those on the self-directed diet. In terms of clinically relevant weight loss, 61% of participants lost 5% or more of their body weight with meal provision compared to 22% on the self-directed diet (P < 0.001). Weight loss was associated with wellbeing in both groups. Attrition was less apparent with 7% of those participants receiving meal provision withdrawing from the study compared to 41% of those following the self-directed diet (P < 0.001). Meal provision was a more effective and accepted method for weight loss over a 12-week period compared to a self-directed diet. This may in part represent the difference between being given the meal provision food free of charge. However, longer-term maintenance studies need to be undertaken to ascertain their effects on the maintenance of weight loss.
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    • "Moreover, considering the phenomenon of universal weight regain, clients were able to keep off an average of 97.5% of lost body weight by the end of the maintenance phase, which lasted 16 weeks. This is significantly better than maintenance results noted in the literature for other commercial diet plans [34] [35]. One of the distinguishing features of the MD plan, perhaps more important than the weight loss itself, is the targeted loss of body fat. "
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    ABSTRACT: Objective: A chart review was performed to evaluate the effectiveness of the Medifast (MD) meal replacement (MR) plan in a Medifast Weight Control Center (MWCC) on body weight, body composition, and other health measures at 4, 12, 24 weeks, and final weight loss visit. Methods: Charts included adults aged 18 -70 (n = 446) with a BMI ≥ 25 kg/m 2 who attended one of three MWCCs and were following the MD MR program. Data were collected electronically and included weight, systolic and diastolic blood pressure, pulse, lean muscle mass (LMM), body fat mass, % body fat, and abdominal circumference. Compliance measures included attendance at weekly visits, intake of MRs and supple-ments, food journals, and ketone testing. Results: Significant weight loss and % weight loss were achieved at all time points with clinically significant weight loss (>5%) occurring in just 4 weeks. Additionally, significant improvements in body composition were seen at all time points coupled with increases in % total body weight as LMM (% LMM im-proved by 3.5, 9.8, 16.0, and 13.9%, respectively). Blood pressure and pulse were significantly improved, demonstrat-ing the clinical benefit for clients. Multivariate regression revealed a strong inverse relationship between weight change, % compliance with attendance, and the number of weeks that MRs were taken as recommended as well as a positive association with number of ketone tests. Conclusion: The MD MR plan, combined with the support and accountability available in the MWCC, is an efficacious program that promotes significant weight loss and improvements in body composition. These results reveal significant associations between components of compliance and weight loss, but par-ticularly highlight the importance of attendance, a focus of the MWCC model compared to non-clinic models.
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