Abstract
Objective. To examine whether baseline obesity severity modifies the effects of two different, primary care-based, technology-enhanced lifestyle interventions among overweight or obese adults with prediabetes and/or metabolic syndrome. Patients and Methods. We compared mean differences in changes from baseline to 15 months in clinical measures of general and central obesity among participants randomized to usual care alone (n = 81) or usual care plus a coach-led group (n = 79) or self-directed individual (n = 81) intervention, stratified by baseline body mass index (BMI) category. Results. Participants with baseline BMI 35+ had greater reductions in mean BMI, body weight (as percentage change), and waist circumference in the coach-led group intervention, compared to usual care and the self-directed individual intervention (P < 0.05 for all). In contrast, the self-directed intervention was more effective than usual care only among participants with baseline BMIs between 25 ≤ 35. Mean weight loss exceeded 5% in the coach-led intervention regardless of baseline BMI category, but this was achieved only among self-directed intervention participants with baseline BMIs <35. Conclusions. Baseline BMI may influence behavioral weight-loss treatment effectiveness. Researchers and clinicians should take an individual's baseline BMI into account when developing or recommending lifestyle focused treatment strategy. This trial is registered with ClinicalTrials.gov NCT00842426.
Highlights
Obesity remains a pressing public health problem with adverse medical, psychological, social, and economical consequences
Bariatric surgery is the recommended treatment for severely obese individuals and/or moderately obese individuals (BMI 35 ≤ 40) with comorbidities [3], its implementation is limited by access, cost, recidivism, and complications [4, 5]
The coachled group achieved a mean percentage weight loss exceeding 5%, a commonly accepted threshold of clinically significant weight loss, and the upper 95% confidence limit was at least 3% weight loss, across the baseline body mass index (BMI) categories
Summary
Obesity remains a pressing public health problem with adverse medical, psychological, social, and economical consequences. 70% of US adults are overweight (body mass index [BMI] in kg/m2 25 ≤ 30) or obese (BMI ≥ 30), with 36% obese [1]. The 6.3% prevalence of severely obesity (BMI ≥ 40) [1] is projected to increase by 130% over the 2 decades [2]. Bariatric surgery is the recommended treatment for severely obese individuals and/or moderately obese individuals (BMI 35 ≤ 40) with comorbidities [3], its implementation is limited by access, cost, recidivism, and complications [4, 5]. Weight loss medications have had limited effectiveness, some serious adverse effects, and limited uptake [7]
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