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Objective: This investigation was designed to examine whether: (i) individuals could successfully lose 5% of their body weight with minimal assistance, (ii) weight loss would be improved by the addition of therapist assistance, and (iii) individuals unsuccessful at losing 5% total body weight during the minimal assistance phase (with or without therapist assistance) would benefit from a weekly weight loss group.
Methods and Procedures: Fifty-four overweight or obese adults (BMI > 27 kg/m2) initially participated in a 14-week self-help (SH) or therapist-assisted SH (TASH) weight loss program. Participants who were unsuccessful at losing 5% total body weight were stepped-up to a 3-month, group-based behavioral weight loss program (BWLP) with weekly weigh-ins.
Results: Although ∼60% of the participants were successful at losing 5% of their total body weight (lb) during the minimal assistance phase (M = 10.6; s.d. = 11.5; P < 0.01), treatment outcome was not improved by the addition of therapist assistance. For individuals who were unsuccessful at losing 5% of total body weight during a minimal assistance phase, the addition of a group-based BWLP did not improve their weight loss.
Discussion: While many individuals were quite successful at losing weight with minimal assistance, other individuals evidenced difficulties losing weight, even when participating in a greater intensity intervention (i.e., BWLP group).
In a stepped-care approach to weight loss, when a minimally intensive treatment (e.g., self-help (SH)) does not result in clinically meaningful weight loss, then a more intensive treatment (e.g., behavioral weight loss program (BWLP)) is implemented (1,2). Although minimally intensive weight loss programs have shown promise (3), weight loss outcomes are often modest (4). In addition, evidence for improved treatment outcomes with increased professional contact has been equivocal (3). In contrast, moderately intensive approaches (e.g., BWLPs) have been quite successful in promoting short-term weight loss (5).
In this investigation, participants were initially randomized to a minimally intensive SH or therapist-assisted SH (TASH) weight loss program (minimal assistance phase). Participants unable to achieve a 5% weight loss during the minimal assistance phase were stepped-up to a group-based BWLP (BWLP group phase). This investigation examined whether: (i) individuals could successfully lose 5% of their body weight with minimal assistance, (ii) weight loss was improved with therapist assistance, and (iii) individuals unsuccessful at losing 5% total body weight during the minimal assistance phase would lose significantly more weight during the BWLP group phase.
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During the minimal assistance phase, participants lost, on average, 5.2% of their total body weight, and nearly 60% reached their 5% weight loss goal. However, weight loss was not improved with therapist assistance. In addition, individuals stepped-up to a BWLP group due to their inability to lose 5% body weight during the minimal assistance phase were remarkably unsuccessful at losing weight. During the 12-week BWLP group, participants lost, on average, 0.15 lb.
Concepts articulated in the Transtheoretical Model's stages of change may shed light on the findings from this investigation (9). It is plausible that individuals who are ready and motivated to lose weight, such as those individuals in the late preparation (i.e., ready to take action) or early action (i.e., beginning to make changes) stages of change, may necessitate only minimal assistance to successfully lose weight. Because they are sufficiently motivated, regular contact with a therapist or participation in a BWLP group might not be essential for successful weight loss. However, some individuals in an early stages of change might be aware that a weight problem exists and may even be seriously thinking about losing weight (e.g., contemplation stage), but these individuals have not yet committed themselves to taking action. For individuals without a clear commitment to action, even greater intensity treatment may still prove insufficient to produce weight loss. Alternatively, because treatment content (i.e., LEARN program) in the minimal assistance and BWLP group phases was similar, the BWLP groups may have been viewed as offering little new material to struggling weight loss participants. Also, other medical or behavioral complications, such as binge eating, may have adversely influenced treatment outcomes despite adequate participant motivation (1). Finally, the small sample in this investigation had limited power to detect group differences that did not evidence a large effect size. For example, a small effect size was evident when examining the weight loss difference between the TASH and SH condition (TASH: M = 11.5, s.d. = 10.9; SH: M = 9.6, s.d. = 12.4) during the minimal assistance phase.
Consistent with a stepped-care perspective, it is clear that some individuals can be quite successful at losing weight with a minimally intensive intervention. However, other individuals, who are not adequately engaged by program content, have not yet made a firm commitment to take action, or are experiencing psychological complications that are interfering with treatment, are unlikely to benefit from a greater intensity intervention. Designing specialized interventions that increase readiness for committed action as well as target behavioral complications and individual treatment preferences will be necessary for improving weight loss treatment outcomes and combating the obesity epidemic.