Cited by 158Obesity, Physical Activity, DietObesity and Health PracticesPharmacology and Obesity Treatment

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Effect of a Stepped-Care Intervention Approach on Weight Loss in Adults: A Randomized Clinical Trial

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Jakicic, John M., Tate, Deborah F., Lang, Wei, Davis, Kelli K., Polzien, Kristen, Rickman, Amy D., Erickson, Karen, Neiberg, Rebecca H., Finkelstein, Eric A.·2012·JAMA

DOI 10.1001/jama.2012.6866PMC PMC4132634

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Abstract

CONTEXT: Given the obesity epidemic, effective but resource-efficient weight loss treatments are needed. Stepped-treatment approaches customize interventions based on milestone completion and can be more effective while costing less to administer than conventional treatment approaches. OBJECTIVE: To determine whether a stepped-care weight loss intervention (STEP) compared with a standard behavioral weight loss intervention (SBWI) would result in greater weight loss. DESIGN, SETTING, AND PARTICIPANTS: A randomized clinical trial of 363 overweight and obese adults (body mass index: 25-<40; age: 18-55 years, 33% nonwhite, and 83% female) who were randomized to SBWI (n = 165) or STEP (n = 198) at 2 universities affiliated with academic medical centers in the United States (Step-Up Study). Participants were enrolled between May 2008 and February 2010 and data collection was completed by September 2011. INTERVENTIONS: All participants were placed on a low-calorie diet, prescribed increases in physical activity, and attended group counseling sessions ranging from weekly to monthly during an 18-month period. The SBWI group was assigned to a fixed program. Counseling frequency, type, and weight loss strategies could be modified every 3 months for the STEP group in response to observed weight loss as it related to weight loss goals. MAIN OUTCOME MEASURE: Mean change in weight over 18 months. Additional outcomes included resting heart rate and blood pressure, waist circumference, body composition, fitness, physical activity, dietary intake, and cost of the program. RESULTS: Of the 363 participants randomized, 260 (71.6%) provided a measure of mean change in weight over 18 months. The 18-month intervention resulted in weight decreasing from 93.1 kg (95% CI, 91.0 to 95.2 kg) to 85.6 kg (95% CI, 83.4 to 87.7 kg) (P < .001) in the SBWI group and from 92.7 kg (95% CI, 90.8 to 94.6 kg) to 86.4 kg (95% CI, 84.5 to 88.4 kg) in the STEP group (P < .001). The percentage change in weight from baseline to 18 months was -8.1% (95% CI, -9.4% to -6.9%) in the SBWI group (P < .001) compared with -6.9% (95% CI, -8.0% to -5.8%) in the STEP group (P < .001). Although the between-group difference in 18-month weight loss was not statistically different (-1.3 kg [95% CI, -2.8 to 0.2 kg]; P = .09), there was a significant group × time interaction effect (P = .03). The cost per participant was $1357 (95% CI, $1272 to $1442) for the SBWI group vs $785 (95% CI, $739 to $830) for the STEP group (P < .001). Both groups had significant and comparable improvements in resting heart rate, blood pressure level, and fitness. CONCLUSIONS: Among overweight and obese adults, the use of SBWI resulted in a greater mean weight loss than STEP over 18 months. Compared with SBWI, STEP resulted in clinically meaningful weight loss that cost less to implement. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00714168.

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Authors: Jakicic, J. M., Tate, D. F., Lang, W., Davis, K. K., Polzien, K., Rickman, A. D., Erickson, K., Neiberg, R. H., & Finkelstein, E. A.
Affiliations: University of Pittsburgh (US)
University of North Carolina at Chapel Hill (US)
Wake Forest University Health Sciences (US)
National University of Singapore (SG)
ORCID: Jakicic, John M.
Tate, Deborah F.
Lang, Wei
Neiberg, Rebecca H.
Finkelstein, Eric A.
Venue: JAMA
Publisher: American Medical Association (AMA)
Published: 2012-06-27
Volume: 307
Issue: 24
Pages: 2617-26
ISSN: 0002-9955 (ISSN-L)
0098-7484
DOI: 10.1001/jama.2012.6866
PMC: PMC4132634
OpenAlex: W2049460685
Cited by: 158
References: 28
Citations by year: 2026: 4 · 2025: 3 · 2024: 7 · 2023: 1 · 2022: 8 · 2021: 7 · 2020: 10 · 2019: 23 · 2018: 12 · 2017: 18 · 2016: 12 · 2015: 16 · 2014: 22 · 2013: 12 · 2012: 3
FWCI: 16.35
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: JAMA (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
National University of Singapore (submittedVersion)
Funders: National Heart, Lung, and Blood Institute (R01HL084400, HL084400)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity and Health Practices
Health Sciences › Medicine › Pharmacology (medical) › Pharmacology and Obesity Treatment
Keywords: stepped-care intervention, weight loss, obesity, behavioral weight loss, hypocaloric diet, physical activity, group counseling, personalized treatment, cost-effectiveness, resting heart rate, blood pressure, waist circumference, body composition, adults with obesity, overweight adults, program costs, physical activity adherence, dietary intake, fitness, step-up
MeSH terms: Adolescent, Adult, Blood Pressure, Body Composition, Counseling, Diet, Reducing, Female, Heart Rate, Humans, Male, Middle Aged, Obesity, Physical Fitness, Weight Loss, Exercise, Body Mass Index, Treatment Outcome, Cost Savings, Overweight, Young Adult

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Effect of a Stepped-Care Intervention Approach on Weight Loss in Adults: A Randomized Clinical Trial

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