Abstract 18492: Effectiveness of Lifestyle Intervention by Obesity Status: Does One Size Fit All?

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Most U.S. adults are overweight or obese with severe obesity projected to increase 130% within 2 decades. Little is known about the effectiveness of efficacious lifestyle intervention by severity of obesity once adapted to real-world settings. This study compared by baseline body mass index (BMI) category (25-≤30, 30-≤35, or 35+) the effects of 2 primary care-based lifestyle interventions among overweight or obese adults with pre-diabetes and/or metabolic syndrome randomized to receive usual care alone (n = 81) or usual care plus a coach-led (n = 79) or self-directed (n = 81) behavioral weight-loss intervention. Each used a Diabetes Prevention Program-based 12-week core curriculum plus technology-mediated coach contact and self-monitoring for a total of 15 months. Between-group differences at 15 months were evaluated by intention-to-treat and tests of group by baseline BMI category interactions in repeated-measures (3, 6 and 15 months) mixed models (SAS, version 9.2). Compared to usual care, the coach-led intervention resulted in significantly greater reductions from baseline to 15 months in BMI (primary outcome) and weight for all categories, in waist circumference (WC) for BMI 25≤30 and 35+, and in fasting plasma glucose levels for BMI 30≤35 and 35+ (largest P = .02). In contrast, self-directed intervention led to greater improvements than did usual care in BMI ( P = .03) and weight ( P = .02) only for BMI 25≤30, in WC for BMI 30≤35 ( P = .03), and in glucose levels for BMI 35+ ( P = .02). Moreover, BMI and weight ( P = .01) and WC ( P = .04) reductions for BMI 35+ were significantly greater in the coach-led vs. self-directed intervention. Overweight participants (BMI 25 ≤ 30) responded comparably to interventions, both of which were more effective than usual care. In conclusion, baseline BMI may influence treatment effectiveness. Clinicians and researchers should take an individual’s baseline BMI into account when developing or recommending a weight-loss treatment strategy.