The Women on the Move Through Activity and Nutrition (WOMAN) Study: Final 48‐Month Results

Abstract

The Women on the Move through Activity and Nutrition (WOMAN) study was designed to test whether a nonpharmacological intervention including qualitative and quantitative dietary changes to induce weight loss and increased physical activity levels would reduce blood triglyceride levels and number of low-density lipoprotein particles (LDL-P). Such decreases in lipoproteins and other risk factors could reduce or slow progression of subclinical cardiovascular disease (CVD). Study participants were randomized to either the intervention (Lifestyle Change) or assessment (Health Education) group. Most of the intervention ended at the 30-month visit. The last 48-month examination was completed in 9/2008. There was very substantial weight loss and increased exercise during the first 30 months of the trial resulting in significant decreases in CV risk factors. Most of the intervention effect was lost through 48 months. Weight loss was 3.4 kg in Lifestyle Intervention and 0.2 kg in the Health Education at 48 months (P = 0.000). There were no significant changes at 48 months in lipid levels, blood pressure (BP), glucose, insulin, or in the subclinical measures of coronary calcium, carotid intima media thickness, or plaque. There was a significant decrease in long-distance corridor walk time in the Lifestyle vs. Health Education groups. Significant lifestyle changes can be achieved that result in decreases in CV risk factors. Whether such changes reduce CV outcomes is still untested in clinical trials of weight loss or exercise. Long-term maintenance of successful lifestyle changes, weight loss and reduced risk factors is the hurdle for lifestyle interventions attempting to prevent CV and other chronic diseases.

Long-term weight status in regainers after weight loss by lifestyle intervention: status and challenges

“…In Lindstroem's study (42) significant improvements were seen at year 1 in fasting plasma glucose (0·2 v. 0·0 mmol/l), 2-h plasma glucose (0·9 v. 0·3 mmol/l), HbA1c (0·1 v. 0·1 %), serum total cholesterol to HDL-cholesterol ratio (0·4 v. 0·1), and serum TAG (0·2 v. 0·0 mmol/l) in the intervention group compared with the control group. Additionally, Kuller et al (40) found that systolic blood pressure (P = 0·048), LDL-cholesterol (P = 0·026), TAG (P = 0·92), insulin (P = 0·0001), glucose (P = 0·002) and HDL-cholesterol (P = 0·0001) developed significantly differently between the Health Education and the Lifestyle Change group. In the reviewed studies, the weight changes from baseline to weight loss ranged from −4·0 to −0·2 kg; in two studies they were not reported (38,41) .…”

“…Champagne et al (39) , Kuller et al (40) and Svetkey et al (43) included also overweight participants. In the weight loss period, all authors (36)(37)(38)(39)(40)(41)(42)(43) applied the reduction of energy intake to at least 5020·8-7531·2 kJ/d (37)(38)(39)(40)42,43) even to very low energy diet (41) and with ready-to-use formula (Optifast) (36) . The content of fat in the diet was taken into account especially by Wadden et al (37) , Milson et al (38) , Kuller et al (40) and Svetkey et al (43).…”

“…In these studies, consumption under 30 % of energy from fat intake was generally taken as goal for the participants. In all studies included in this review article, increase in PA (goal about 180 min/week) was one of the intervention measures, with the exception of the studies performed by Kuller et al (40) and Lantz et al (41) . Each study conducted the education and dietary counselling for participants as individual as well as group sessions and provided this counselling in different forms, mostly faceto-face but also via email or telephone.…”

“…Other studies (40,42) also included the changes in biomarker concentrations (e.g. LDL-cholesterol, HDL-cholesterol, glucose and insulin).…”

“…In the first phase (weight reduction period), the effectiveness of different strategies for weight reduction in obese subjects has been investigated (36)(37)(38)(39)(40)(41)(42)(43) . It has been shown that similar responses regarding satiety, hunger and satisfaction exist for diets with different proportion of nutrients (44) .…”