Randomized trial of a novel lifestyle intervention compared with the Diabetes Prevention Program for weight loss in adult dependents of military service members

Abstract

Background Lifestyle interventions are the first-line treatment for obesity, but participant weight loss is typically low. Objectives We evaluated the efficacy of an alternative lifestyle intervention [Healthy Weight for Living (HWL)] compared with a modified Diabetes Prevention Program (m-DPP). HWL was based on a revised health behavior change model emphasizing hunger management and the development of healthy food preferences. m-DPP was a standard Diabetes Prevention Program implemented with counselor time matched to HWL. Participants were adult dependents of military personnel and had overweight or obesity. Methods Participants were randomly assigned to HWL (n = 121) or m-DPP (n = 117), delivered primarily by group videoconference with additional midweek emails. The primary outcome was 12-mo weight change. Secondary outcomes included 6-mo changes in cardiometabolic risk factors and diet. Intention-to-treat (ITT) and complete case (CC) analyses were performed using linear mixed models. Results Retention did not differ between groups (72% and 66% for HWL and m-DPP at 12 mo, respectively; P = 0.30). Mean ± SE adjusted 12-mo weight loss in the ITT cohort was 7.46 ± 0.85 kg for HWL and 7.32 ± 0.87 kg for m-DPP (P = 0.91); in the CC cohort, it was 7.83 ± 0.82 kg for HWL and 6.86 ± 0.88 kg for m-DPP (P = 0.43). Thirty-eight percent of HWL and 30% of m-DPP completers achieved ≥10% weight loss (P = 0.32). Improvements in systolic blood pressure, LDL cholesterol, triglycerides, fasting glucose, general health, sleep, and mood were similar across groups; improvements in diastolic blood pressure were greater in m-DPP. Adjusted group mean reductions in energy intake were not significantly different between groups, but HWL participants were more adherent to their dietary prescription for lower glycemic index and high fiber and protein (P = 0.05 to <0.001 for ITT). Conclusions HWL and m-DPP showed equivalent and clinically impactful mean weight loss with cardiometabolic benefits. These results identify an alternative approach for behavioral treatment of overweight and obesity. This trial was registered at clinicaltrials.gov as NCT02348853.

Effect of a Weight Loss and Lifestyle Intervention on Dietary Behavior in Men with Obstructive Sleep Apnea: The INTERAPNEA Trial

“…These results are consistent with the limited existing evidence supporting the beneficial effects of behavioral weight loss interventions promoting nutritional education and behavior change on dietary behavior, diet quality, and/or adherence to the Mediterranean diet [29][30][31][32][33]. Patnode et al [29], in a systematic review for the U.S. Preventive Services Task Force, found that healthful diet interventions in adults without known cardiovascular disease risk factors were related to reduced total energy and saturated fat intake and increased fiber and fruits and vegetables consumption.…”

“…Instead, alternative approaches, such as Mediterranean diets and other dietary strategies focusing on nutritional education and behavior change, have been proposed as potential strategies of choice for OSA management [26][27][28]. Still, although effective at improving dietary behaviors in persons with and without cardiovascular risk factors and other conditions [29][30][31][32][33], there is no evidence to date on the effects of this approach on the unhealthy dietary behaviors and poor quality of the diet commonly found in patients with OSA [34][35][36]. Similarly, and consecutively, there is no study investigating the association of changes in dietary behaviors and changes in OSA severity and related outcomes, such as body weight and composition in adults with OSA and who are overweight/have obesity.…”

The Dynamic Interplay of Healthy Lifestyle Behaviors for Cardiovascular Health

“…Das et al conducted a 12-month parallel randomized controlled trial in free-living adults comparing two weight-loss interventions with the common goal of reducing calories (500–1000 kcal/day) and achieving physical activity goals (150 min/week), but one emphasized weight loss through tracking food and physical activity (modified Diabetes Prevention Program [m-DPP]) and the other emphasized behavior change (stress management, mindful eating, etc.) (Healthy Weight for Living [HWL]) [ 50 ]. Both interventions (m-DPP and HWL) significantly improved weight (− 7.32 and 7.46 kg) and cardiometabolic risk factors (LDL-C [− 10 and − 15 mg/dL], triglycerides [18 and − 21 mg/dL], and glucose [− 3 and − 6 mg/dL]) from baseline with similar non-significant improvements in sleep, emotional, and general health.…”

Factors associated with choice of behavioural weight loss program by adults with obesity

“…In the two randomized trials evaluating its weight loss effectiveness, HWL resulted in weight loss of 8.0 kg 9 and 8.5%. 8 However, neither of these trials was designed to provide a rigorous evaluation of HWL against a traditional program.…”

“…Members of our team developed the Healthy Weight for Living (HWL) program, 7,8 which is based on a revised health behaviour change model with emphasis on biological factors that influence energy regulation (i.e., reducing hunger and food craving) and reducing participant burden (i.e., minimal emphasis on logging activities), as well as the psychological, environmental, and practical factors that are recognized in traditional models. In the two randomized trials evaluating its weight loss effectiveness, HWL resulted in weight loss of 8.0 kg 9 and 8.5% 8 . However, neither of these trials was designed to provide a rigorous evaluation of HWL against a traditional program.…”