Personal counselling and web-based strategies show modest success for sustaining weight loss

Adults who lost weight in a six-month program were able to keep at least some of the weight off for 2.5 years with the help of brief monthly personal counselling, according to a new study from the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health. A Web-based intervention also helped participants keep the weight off for two years, but the benefit waned during the last six months of the trial.

The results of the Weight Loss Maintenance Trial, the largest and longest duration trial to test different weight-loss maintenance strategies, were published in the March 12, 2008, issue of the Journal of the American Medical Association. Results were also presented at the American Heart Association’s Nutrition, Physical Activity, and Metabolism Council Meeting on March 12 in Colorado Springs, Colo.

“Maintaining a healthy weight is a key tenet of every heart disease prevention plan. We have well-tested techniques for successful weight loss, but preventing weight re-gain is especially challenging. This study provides insight into best practices for practical interventions that can help adults keep the weight off and therefore lower their risks for heart disease and other conditions,” said Elizabeth G. Nabel, M.D., director, NHLBI.

The study initially enrolled 1,685 overweight or obese adults with high blood pressure or high cholesterol or both. Of those, 1,032 lost an average of 18.7 pounds during an initial six-month weight loss intervention involving 20 weekly group-counselling sessions which emphasized a heart-healthy dietary pattern and three hours per week of physical activity. They were then randomly assigned to one of three strategies for weight loss maintenance: monthly personal counselling on diet and physical activity, a Web-based intervention with the same advice, and self-direction, where participants received minimal further intervention from study staff.

At the end of the study, participants receiving personal counselling retained an average weight loss of 9.2 pounds, compared to an average of 7.3 pounds for those using the Web-based intervention and 6.4 pounds for those in the self-directed group.

Personal counselling sessions were brief and mainly by telephone. The Web site was developed to provide the same advice as personal counselling. Both interventions were designed to be practical to implement in a variety of settings.

“Most people in the study regained at least some of the weight they initially lost. However, both the personal counselling and the Web-based program modestly alleviated weight re-gain for up to two years, with the personal counselling ultimately proving to be the most beneficial by the end of the 2.5 year study,” said Laura Svetkey, M.D, a professor of medicine at Duke University Medical Center, and the study’s lead author.  

Maintaining a healthy weight is an important part of heart disease prevention. Weight loss is shown to lower blood pressure, lower LDL “bad” cholesterol, and help prevent type 2 diabetes. Each 2.2 pounds of weight loss can lower blood pressure by one point and can lower the risk of developing diabetes by 16 percent in high-risk adults.

“The relatively long-term, 24-month success of the Web-based intervention shows promise particularly because of the potential to reach a large number of adults at a relatively low cost per person,” said Catherine Loria, Ph.D., program officer at NHLBI, and a study co-author. “We need to continue working to improve both interventions so that they are more effective and can be implemented widely.”

Approximately 38 percent of participants were African-American and 37 percent of participants were men.

(Source: Journal of the American Medical Association: Duke University Medical Center: March 2008)