Weight loss during the intensive intervention phase of the weight-loss maintenance trial
Open accessAbstract
Background To improve methods for long-term weight management, the Weight Loss Maintenance (WLM) trial, a four-center randomized trial, was conducted to compare alternative strategies for maintaining weight loss over a 30-month period. This paper describes methods and results for the initial 6-month weight-loss program (Phase I). Methods Eligible adults were aged ≥25, overweight or obese (BMI=25–45 kg/m2), and on medications for hypertension and/or dyslipidemia. Anthropomorphic, demographic, and psychosocial measures were collected at baseline and 6 months. Participants (n=1685) attended 20 weekly group sessions to encourage calorie restriction, moderate-intensity physical activity, and the DASH (dietary approaches to stop hypertension) dietary pattern. Weight-loss predictors with missing data were replaced by multiple imputation. Results Participants were 44% African American and 67% women; 79% were obese (BMI≥30), 87% were taking anti-hypertensive medications, and 38% were taking antidyslipidemia medications. Participants attended an average of 72% of 20 group sessions. They self-reported 117 minutes of moderate-intensity physical activity per week, kept 3.7 daily food records per week, and consumed 2.9 servings of fruits and vegetables per day. The Phase-I follow-up rate was 92%. Mean (SD) weight change was −5.8 kg (4.4), and 69% lost at least 4 kg. All race–gender subgroups lost substantial weight: African-American men (−5.4 kg ± 7.7); African-American women (−4.1 kg ± 2.9); non–African-American men (−8.5 kg ± 12.9); and non–African-American women (−5.8 kg ± 6.1). Behavioral measures (e.g., diet records and physical activity) accounted for most of the weight-loss variation, although the association between behavioral measures and weight loss differed by race and gender groups. Conclusions The WLM behavioral intervention successfully achieved clinically significant short-term weight loss in a diverse population of high-risk patients.
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The number of food records completed had a stronger association with weight loss among African-Americans compared to non-African-Americans, regardless of gender.
“This same study found that the number of food records completed had a stronger association with weight loss among African-Americans when compared to non-African-Americans, regardless of gender (26).”
From Self-monitoring in weight loss: a systematic review of the literature (2011) · cites this paper as [26]
The Predictors of Phase-I Weight Loss section states the opposite: keeping more food records had a greater estimated association with weight loss for non-African Americans than for African Americans, regardless of gender. The Discussion repeats this direction of the difference. Page numbers are not supplied in our copy. (LLM, conf=0.95)
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Experimental — accuracy not yet measuredMen completed significantly more diaries than women.
“One study revealed that men completed significantly more diaries than women (26).”
From Self-monitoring in weight loss: a systematic review of the literature (2011) · cites this paper as [26]
Men were more adherent than women.
“Similar to the findings reported by Hollis and colleagues (26), men were more adherent than women.”
From Self-monitoring in weight loss: a systematic review of the literature (2011) · cites this paper as [26]
Both observational data and clinical trial evidence demonstrate the importance of self-monitoring in achieving behavior change.
“Both observational data60–64 and evidence from clinical trials26–28,30,36,38,50,52 demonstrate the importance of self-monitoring in achieving behavior change.”
At 3 years in the Women's Health Initiative, the only predictors of continued dietary maintenance were attending more sessions and submitting more self-monitoring records.
“Notably, at 3 years, the only predictors of continued dietary maintenance were attending more sessions and submitting more self-monitoring records.63,64”
Adherence to monitoring is what is important for weight loss, regardless of method.
“This demonstrates that adherence to monitoring is what is important for weight loss [40], regardless of method.”
From Tweets, Apps, and Pods: Results of the 6-Month Mobile Pounds Off Digitally (Mobile POD) Randomized Weight-Loss Intervention Among Adults (2011) · cites this paper as [40]
In a six-month intervention study, greater weight loss was associated with more frequent monitoring.
“For example, a six-month intervention study found that the average number of food records per week was 3.7 and greater weight loss was associated with more frequent monitoring [12].”
From Factors related to sustained use of a free mobile app for dietary self-monitoring with photography and peer feedback: retrospective cohort study (2014) · cites this paper as [12]
In a six-month intervention study, the average number of food records per week was 3.7.
“For example, a six-month intervention study found that the average number of food records per week was 3.7 and greater weight loss was associated with more frequent monitoring [12].”
From Factors related to sustained use of a free mobile app for dietary self-monitoring with photography and peer feedback: retrospective cohort study (2014) · cites this paper as [12]
The association between outcomes and adherence to dietary self-monitoring has been found to differ between race and gender groups in weight loss interventions.
“the association between outcomes and adherence to dietary self-monitoring has been found to differ between race and gender groups in weight loss interventions [12]”
From Factors related to sustained use of a free mobile app for dietary self-monitoring with photography and peer feedback: retrospective cohort study (2014) · cites this paper as [12]
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- [1]1. This work was supported by National Heart, Lung, Blood Institute grants 5-U01 HL68920, 5-U01 HL68734, 5-U01 HL68676, 5-U01 HL68790 and 5-HL68955. We also wish to thank the WLM Data and Safety Monitoring Board and special thanks go to the WLM participants that made this study possible. In addition, we would like to thank the following individ- uals at each of the participating sites: From Duke University Medical Center, Durham NC: Kath- leen Aicher, Joel Bronstein, Blondeaner Brown, William Fan, MD, Jeanne Gresko, Tovon Hamilton, Aidan Hysjulien, Keely Kelly, Martis King, Lillian Lien, MD, Velda Martin, Heather McGuire, MD, Tonya Milligan, LaVerne Pruden, LaChanda Reams, Patrice Reams, Fran Rukenbrod, RD, LDN, Sonia Steele, MPH, RD, LDN, Edward Van Williamson. From Johns Hopkins Pro Health, Baltimore MD: Andrea Booth, Cassie Brode, BA, Jeanne Charleston, RN, Janelle Coughlin, PhD, Berkley C. Curtis, Jr., MS, PA-S, Arlene T. Dalcin, RDI, Maura K. Deeley, Thomas Erlinger MD, MPH, Debra J. Gayles BS, Tara Harrison, Gerald J. Jerome, PhD, Gloria Lawrence, Adriana E. Matos, BA, Karen McCully, MSc, LDN, Denise Monnett, Dana Owens, BS, Theresa L. Panich- ello, Mark E. Poisall, MS, CSCS, Ryan Rinke, Joy Q. Saunders, Amber C. Summers, MHS, RD, Karen White MS, RD. From Kaiser Permanente Center for Health Research Clin- ical Site, Portland OR:
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- Authors
- Hollis, J. F., Gullion, C. M., Stevens, V. J., Brantley, P. J., Appel, L. J., Ard, J. D., Champagne, C. M., Dalcin, A., Erlinger, T. P., Funk, K., Laferriere, D., Lin, P.-H., Loria, C. M., Samuel-Hodge, C., Vollmer, W. M., & Svetkey, L. P.
- Affiliations
- Kaiser Permanente (US)
- Pennington Biomedical Research Center (US)
- Johns Hopkins University (US)
- University of Alabama at Birmingham (US)
- Duke Medical Center (US)
- National Institutes of Health (US)
- Corresponding author
- Hollis, Jack F.
- ORCID
- Venue
- American Journal of Preventive Medicine
- Publisher
- Elsevier BV
- Published
- 2008-08
- Volume
- 35
- Issue
- 2
- Pages
- 118-126
- ISSN
- 0749-3797 (ISSN-L)
- PMC
- PMC2515566
- OpenAlex
- W2098371352
- Semantic Scholar
- 7266e32110f00a3564777ac18afe0f14c01db2ca
- Cited by
- 321
- References
- 78
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 4 · 2023: 3 · 2022: 9 · 2021: 8 · 2020: 18 · 2019: 13 · 2018: 16 · 2017: 20 · 2016: 16 · 2015: 24 · 2014: 28 · 2013: 33 · 2012: 31
- FWCI
- 28.48
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- American Journal of Preventive Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Kaiser Permanente
- Johns Hopkins University
- National Heart, Lung, and Blood Institute (U01HL068790, 5U01 HL 68790, 5-U01 HL68920, 5-HL68955, U01HL068920, 5-U01 HL68676, U01HL068955, 5-U01 HL68734, U01HL068734, U01HL068676)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Pharmacology › Pharmacology and Obesity Treatment
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- weight loss maintenance, obesity, overweight, behavioral interventions, group intervention, DASH diet, caloric restriction, physical activity, dietary self-monitoring, race and gender differences, hypertension, dyslipidemia, predictors of weight loss
- MeSH terms
- Adult, Combined Modality Therapy, Diet, Female, Humans, Male, Middle Aged, Obesity, Patient Compliance, Weight Loss, Exercise, Diet Records, Overweight
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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