Weight loss maintenance more successful with patient versus professional support
Patients who had lost weight were more likely to keep it off if they received weight loss maintenance advice and support from other patients rather than standard care from professionals, a randomized trial found.
Patients may be more likely to maintain weight loss if they receive treatment and support from other patients, a study found.
Researchers conducted a two-phase randomized clinical trial among patients at a single U.S. academic medical center who were 18 to 75 years of age and had a body mass index of 25 to 50 kg/m2. In phase 1, patients participated in an online weight loss program, and those who lost at least 5% of their body weight were eligible for phase 2, an 18-month trial of weight loss maintenance.
In the maintenance trial, patients were randomly assigned to a lifestyle intervention for weight loss management that was delivered entirely by other patients or to standard of care delivered by professionals. In the patient treatment group, mentors who had successfully lost weight delivered intervention sessions and peers who were fellow trial participants provided evidence-based social support remotely on an ongoing basis. Mentors were paid $25 per hour. Those in the standard-of-care group participated in group lifestyle intervention sessions led by professional interventionists trained in evidence-based behavioral strategies for weight loss maintenance.
Weight change during the 18-month trial was the primary outcome, while secondary outcomes included blood pressure, heart rate, physical activity, and sedentary behavior. The study results were published May 27 by JAMA Internal Medicine.
The trial randomized 287 participants (83.6% female; mean age, 53.6 years), and of these, 268 (93.4%) completed it, 144 in the patient-to-patient group and 124 in the standard-of-care group (P=0.59). Participants assigned to the patient-to-patient group regained significantly less weight than those in the standard-of-care group at all time points (−1.44 kg [95% CI, −2.35 kg to 0.54 kg] vs. −0.16 kg [95% CI, −1.13 kg to 0.82 kg] at month 6, 0.04 kg [95% CI, −0.86 kg to 0.95 kg] vs. 0.77 kg [95% CI, −0.21 kg to 1.47 kg] at month 12, and 0.77 kg [95% CI, −0.14 kg to 1.68 kg] vs. 2.37 kg [95% CI, 1.40 kg to 3.34 kg] at month 18; P=0.002). Those in the patient-to-patient group also had better results at each time point for diastolic blood pressure, heart rate, lifestyle activity, and sedentary behavior.
Generalizability of the findings may be limited, and the cost of the interventions was not considered, the authors noted. They concluded, “Results of this randomized clinical trial suggest that an entirely patient-delivered intervention (mentors and peers) is more effective than professional care for maintenance of lost weight and reduction of cardiovascular disease risk factors, providing a new intervention paradigm for the field of behavioral medicine.”
An accompanying editorial said the results suggest several key directions for future research, including determining the mechanisms of action of the patient-delivered intervention and whether it could be effective in helping patients maintain weight lost by other methods, such as bariatric surgery and antiobesity medications.
“These results are also exciting, as they offer new hope for researchers and clinicians aiming to identify effective methods of promoting long-term weight loss maintenance, underscoring the potential for future development of novel and sustainable treatment approaches that could improve the health of millions of US adults,” the editorialist wrote.