ObjectiveTo evaluate the effects and costs of three doses of behavioral weight-loss treatment delivered via Cooperative Extension Offices in rural communities.Design and MethodsObese adults (N=612) were randomly assigned to low, moderate or high doses of behavioral treatment (i.e., 16, 32 or 48 sessions over two years) or to a control condition that received nutrition education without instruction in behavior modification strategies.ResultsTwo-year mean reductions in initial body weight were 2.9% (95% Credible Interval=1.7–4.3), 3.5% (2.0–4.8), 6.7% (5.3–7.9), and 6.8% (5.5–8.1) for the control, low, moderate, and high-dose conditions, respectively. The moderate-dose treatment produced weight losses similar to the high-dose condition and significantly larger than the low-dose and control conditions (posterior probability > .996). The percentages of participants who achieved weight reductions ≥ 5% at two years were significantly higher in the moderate-dose (58%) and high-dose (58%) conditions compared with low-dose (43%) and control (40%) conditions (posterior probability > .996). Cost-effectiveness analyses favored the moderate-dose treatment over all other conditions.ConclusionA moderate dose of behavioral treatment produced two-year weight reductions comparable to high-dose treatment but at a lower cost. These findings have important policy implications for the dissemination of weight-loss interventions into communities with limited resources.Trial RegistrationClinicalTrials.gov number, NCT00912652.

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The study aim was to assess folate/folic acid intake and folate status of non‐supplement consuming young men and women (18–49 y), and to examine the relative contribution of food sources to folate/folic acid intake. Folate intake and status were determined for men (n = 140) and women (n = 162). Daily folate/folic acid intake was estimated by a DHQ. Mean serum and RBC folate for males (39.9 nmol/L; 810 nmol/L, respectively) did not differ (P>0.2) from that of females (41.7 nmol/L; 767 nmol/L). Plasma homocysteine was higher (P<0.0001) for males (8.0 μmol) than females (6.6 μmol/L). Total folate intake for males and females (652 and 512 μg/d DFE, respectively) exceeded the RDA (400 μg/d DFE). Average folic acid intake for females was 128 μg/d; only 3% consumed ≥400 μg/d. The largest contributors of folic acid for males and females were enriched cereal‐grain products (41.1%; 41.9%, respectively), fortified RTE cereals and bars (29.3%; 36.0%), and combination foods that included “enriched” ingredients (16.0%; 13.2%). Food categories that provided the most naturally occurring food folate for males and females were vegetables (31.6%; 38.4%, respectively) and legumes and nuts (16.2%; 14.4%). Dietary folic acid from enriched grain products and RTE cereals positively affected total folate intake and status of males and females; however, folic acid intake for females was less than that recommended for NTD risk reduction.