Developing a Weight Management and Metabolic Health Program to support patient-centred, effective, and efficient treatment for veterans with overweight or obesity: protocol for a quality improvement programme

Making a U-turn at the stomach

Primary care providers (PCPs) are expected to help patients with obesity to lose weight through behavior change counseling and patient-centered use of available weight management resources. Yet, many PCPs face knowledge gaps and clinical time constraints that hinder their ability to successfully support patients' weight loss. Fortunately, a small and growing number of physicians are now certified in obesity medicine through the American Board of Obesity Medicine (ABOM) and can provide personalized and effective obesity treatment to individual patients. Little is known, however, about how to extend the expertise of ABOM-certified physicians to support PCPs and their many patients with obesity. To develop and pilot test an innovative care model - the Weight Navigation Program (WNP) - to integrate ABOM-certified physicians into primary care settings and to enhance the delivery of personalized, effective obesity care. Quality improvement program with an embedded, 12-month, single-arm pilot study. Patients with obesity and ≥1 weight-related co-morbidity may be referred to the WNP by PCPs. All patients seen within the WNP during the first 12 months of clinical operations will be compared to a matched cohort of patients from another primary care site. We will recruit a subset of WNP patients (n = 30) to participate in a remote weight monitoring pilot program, which will include surveys at 0, 6, and 12 months, qualitative interviews at 0 and 6 months, and use of an electronic health record (EHR)-based text messaging program for remote weight monitoring. Obesity is a complex chronic condition that requires evidence-based, personalized, and longitudinal care. To deliver such care in general practice, the WNP leverages the expertise of ABOM-certified physicians, health system and community weight management resources, and EHR-based population health management tools. The WNP is an innovative model with the potential to be implemented, scaled, and sustained in diverse primary care settings.

Personality influences lifestyle behaviors. Therefore, certain personality traits could contribute to obesity and the response to behaviorally based weight loss therapy. The aims of this study were to test the hypothesis that personality characteristics differ between lean and obese persons in the community, obese persons in the community and obese persons seeking weight loss therapy by enrolling in a comprehensive weight loss program, and in obese persons who were successful and unsuccessful in achieving behavioral therapy-induced weight loss. The Temperament and Character Inventory was administered to 264 lean (body mass index (BMI) <25 kg/m(2)) and 56 obese (BMI> or =35 kg/m(2)) subjects from the St Louis community and 183 obese patients (BMI=44+/-10 kg/m(2)) enrolled in the Washington University Weight Management Program (WUWMP), which involved weekly group behavioral therapy and diet education sessions for 22 weeks. Compared with lean subjects, obese subjects in the community scored higher in novelty seeking (19.7+/-5.9 vs 16.2+/-6.0, P<0.05), lower in Persistence (4.1+/-1.8 vs 4.8+/-1.7, P<0.05) and lower in self-directedness (32.1+/-7.6 vs 34.3+/-6.6, P<0.05.) Patients enrolled in the WUWMP scored higher than obese persons in the general population in both Reward Dependence (17.1+/-4.2 vs 15.7+/-4.3, P<0.05) and cooperativeness (36.9+/-5.4 vs 34.5+/-6.2, P<0.05). Patients who were successful in losing weight (>10% weight loss) after 22 weeks of behavioral therapy scored lower in novelty seeking than those who were unsuccessful in losing weight (<5% weight loss) (17.6+/-5.9 vs 20.2+/-5.9, P<0.05). These results suggest that personality traits differ between lean and obese persons, and between obese persons who enroll and who do not enroll in a comprehensive weight management program. Moreover, high scores in novelty seeking are associated with decreased success in achieving behavioral therapy-induced weight loss.

Health hazards of obesity have been recognized for centuries, appearing, for example, in writings attributed to Hippocrates. From the later decades of the 20th century through the present, there have been numerous epidemiological studies of the relationship between excess weight and the total, or all-cause, mortality rate,1 a critical cumulative measure of the public health impact of any health condition. Using body mass index (BMI), an indicator of relative weight for height (weight [kg]/height [m]2) and a frequently used surrogate for assessment of excess body fat, these studies have found linear, U-shaped, or J-shaped relationships between total mortality and BMI. That is, in some studies, both the thin and the obese were more likely to die than those in between. There is, however, always a point at which increasing BMI is associated with increasing mortality risk, but the BMI at which this occurs varies across studies and populations.2 Currently,3 overweight in adults is defined as a BMI of 25.0 to <30.0 kg/m2 and obesity as a BMI of ≥30.0 kg/m2 (Table 1). A number of studies have found no significant relationship between BMI in the overweight range and mortality rate4 and have shown the nadir of mortality risk to be in the overweight range. In particular, commentaries in both the lay press5–7 and scientific literature2,8,9 subsequent to recent reports from National Health and Nutrition Examination Surveys (NHANES)10,11 have highlighted the confusion and controversy regarding this issue. Some have interpreted the recent data to mean that overweight is not detrimental to health and is not in itself a public health concern and that drawing attention to the need for weight loss in this range will have negative effects on the health and well-being of the general population.8 Others have argued …

Reprint: 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults.

Employing peer coaches to provide weight management counseling in primary care could address patient- and clinician-level barriers to obesity care, improve outcomes, and boost engagement in weight management programs. To evaluate the efficacy of peer coaching to deliver a low- to moderate-intensity intervention for weight management compared with enhanced usual care (EUC). This 2-arm, cluster randomized clinical trial was conducted from November 2017 to August 2021 at a single US Department of Veteran Affairs (VA) site. Primary care physicians (PCPs) and their patients with a body mass index (calculated as weight in kilograms divided by height in meters squared) of at least 25 (overweight) or 30 or more (obesity) were invited to participate. Enrollment was stopped early due to the COVID-19 pandemic, when weight management services at the VA site transitioned to primarily virtual care. PCPs were randomized to either the peer coaching (ie, Peer-Assisted Lifestyle) intervention or EUC arm, and their patients received the corresponding treatment for those arms. Data were analyzed according to the intention-to-treat principle from February 2023 and July 2024. Patients in the peer coaching arm completed a tablet-based, goal-setting tool and received 1 in-person and up to 12 individual peer-coaching telephone sessions over 1 year. Peer coaches were veterans with a bachelor's degree and training for a minimum of 20 hours. Patients in the EUC control arm received health education materials. The primary outcome was mean (SE) change in weight (in kilograms) at 12 months. Secondary outcomes included mean (SE) weight change in percentage, proportion of patients achieving 5% or higher weight loss, and change in waist circumference in inches. A total of 20 PCPs (11 women [55.0%]) and 281 patients were enrolled. Patients had a mean (SD) age of 50.6 (11.5) years and included 221 men (78.6%). The mean (SD) body mass index at baseline was 33.4 (5.1). At 12 months, the adjusted mean (SE) weight change was -2.51 (0.73) kg in the peer coaching arm and -0.79 (0.48) kg in the EUC arm, but the difference was not statistically signficant (difference, -1.72 [0.88] kg; P = .05). At 6 months, the adjusted mean (SE) proportion of patients who lost at least 5% of body weight was 16.68% (0.47%) in the peer coaching arm vs 5.50% (0.32%) in the EUC arm (difference, 11.18 [5.22] percentage points; P = .03). At 6 months, the adjusted mean (SE) proportion of patients who attended a weight management program was 28.68% (5.37%) in the peer coaching arm and 13.32% (3.38%) in the EUC arm (difference, 15.37 [6.45] percentage points; P = .02). In this randomized clinical trial, a low- to moderate-intensity peer-coaching intervention did not result in greater weight loss at 12 months, but it improved attendance at weight management programs. ClinicalTrials.gov Identifier: NCT03163264.

PREVENTING FRAILTY IN OBESE OLDER ADULTS

The prevalence of obesity in the United States and the world has risen to epidemic/pandemic proportions. This increase has occurred despite efforts by healthcare providers and consumers alike to improve the health-related behaviors of the population and a tremendous push from the scientific community to better understand the pathophysiology of obesity. This epidemic is all the more concerning given the clear association between excess adiposity and adverse health consequences such as cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). These risks associated with overweight/obesity are primarily related to the deposition of excess adiposity or body fatness. Weight loss, specifically loss of body fat, is associated with benefits in all of the obesity-related comorbidities, but, unfortunately, most weight loss interventions are associated with weight regain and are therefore not successful in the long term. It is for these reasons that efforts to prevent weight gain and overweight/obesity are necessary. This is especially important when one considers younger individuals, who have even more to lose as a consequence of a longer duration of excess adiposity. After a brief review of the epidemiology of obesity, this statement will make the case for the importance of weight gain prevention. This argument will first include a review of the complications of overweight and obesity in both adults and children, including the future CVD risks of obesity in early life. Energy balance dysregulation and adaptations to the weight-reduced state, favoring weight regain, will then be reviewed as further argument for the need for obesity prevention. This will be followed by a discussion on the goals and strategies for accomplishing the difficult task of the prevention of weight gain and obesity. ### Classification of Overweight and Obesity The body mass index (BMI) is the most widely used and accepted method for the assessment and classification of excess adiposity or body fatness. Overweight …

Obesity and chronic kidney disease (CKD) are highly prevalent worldwide and result in substantial health care costs. Obesity is a predictor of incident CKD and progression to kidney failure. Whether weight loss interventions are safe and effective to impact on disease progression and clinical outcomes, such as death remains unclear. This review aimed to evaluate the safety and efficacy of intentional weight loss interventions in overweight and obese adults with CKD; including those with end-stage kidney disease (ESKD) being treated with dialysis, kidney transplantation, or supportive care. We searched the Cochrane Kidney and Transplant Register of Studies up to 14 December 2020 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. Randomised controlled trials (RCTs) and quasi-RCTs of more than four weeks duration, reporting on intentional weight loss interventions, in individuals with any stage of CKD, designed to promote weight loss as one of their primary stated goals, in any health care setting. Two authors independently assessed study eligibility and extracted data. We applied the Cochrane 'Risk of Bias' tool and used the GRADE process to assess the certainty of evidence. We estimated treatment effects using random-effects meta-analysis. Results were expressed as risk ratios (RR) for dichotomous outcomes together with 95% confidence intervals (CI) or mean differences (MD) or standardised mean difference (SMD) for continuous outcomes or in descriptive format when meta-analysis was not possible. We included 17 RCTs enrolling 988 overweight or obese adults with CKD. The weight loss interventions and comparators across studies varied. We categorised comparisons into three groups: any weight loss intervention versus usual care or control; any weight loss intervention versus dietary intervention; and surgical intervention versus non-surgical intervention. Methodological quality was varied, with many studies providing insufficient information to accurately judge the risk of bias. Death (any cause), cardiovascular events, successful kidney transplantation, nutritional status, cost effectiveness and economic analysis were not measured in any of the included studies. Across all 17 studies many clinical parameters, patient-centred outcomes, and adverse events were not measured limiting comparisons for these outcomes. In studies comparing any weight loss intervention to usual care or control, weight loss interventions may lead to weight loss or reduction in body weight post intervention (6 studies, 180 participants: MD -3.69 kg, 95% CI -5.82 to -1.57; follow-up: 5 weeks to 12 months, very low-certainty evidence). In very low certainty evidence any weight loss intervention had uncertain effects on body mass index (BMI) (4 studies, 100 participants: MD -2.18 kg/m², 95% CI -4.90 to 0.54), waist circumference (2 studies, 53 participants: MD 0.68 cm, 95% CI -7.6 to 6.24), proteinuria (4 studies, 84 participants: 0.29 g/day, 95% CI -0.76 to 0.18), systolic (4 studies, 139 participants: -3.45 mmHg, 95% CI -9.99 to 3.09) and diastolic blood pressure (4 studies, 139 participants: -2.02 mmHg, 95% CI -3.79 to 0.24). Any weight loss intervention made little or no difference to total cholesterol, high density lipoprotein cholesterol, and inflammation, but may lower low density lipoprotein cholesterol. There was little or no difference between any weight loss interventions (lifestyle or pharmacological) compared to dietary-only weight loss interventions for weight loss, BMI, waist circumference, proteinuria, and systolic blood pressure, however diastolic blood pressure was probably reduced. Furthermore, studies comparing the efficacy of different types of dietary interventions failed to find a specific dietary intervention to be superior for weight loss or a reduction in BMI. Surgical interventions probably reduced body weight (1 study, 11 participants: MD -29.50 kg, 95% CI -36.4 to -23.35), BMI (2 studies, 17 participants: MD -10.43 kg/m², 95% CI -13.58 to -7.29), and waist circumference (MD -30.00 cm, 95% CI -39.93 to -20.07) when compared to non-surgical weight loss interventions after 12 months of follow-up. Proteinuria and blood pressure were not reported. All results across all comparators should be interpreted with caution due to the small number of studies, very low quality of evidence and heterogeneity across interventions and comparators. All types of weight loss interventions had uncertain effects on death and cardiovascular events among overweight and obese adults with CKD as no studies reported these outcome measures. Non-surgical weight loss interventions (predominately lifestyle) appear to be an effective treatment to reduce body weight, and LDL cholesterol. Surgical interventions probably reduce body weight, waist circumference, and fat mass. The current evidence is limited by the small number of included studies, as well as the significant heterogeneity and a high risk of bias in most studies.

Background Obesity and chronic kidney disease (CKD) are highly prevalent worldwide and result in substantial health care costs. Obesity is a predictor of incident CKD and progression to kidney failure. Whether weight loss interventions are safe and effective to impact on disease progression and clinical outcomes, such as death remains unclear. Objectives This review aimed to evaluate the safety and efficacy of intentional weight loss interventions in overweight and obese adults with CKD; including those with end-stage kidney disease (ESKD) being treated with dialysis, kidney transplantation, or supportive care. Search methods We searched the Cochrane Kidney and Transplant Register of Studies up to 14 December 2020 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. Selection criteria Randomised controlled trials (RCTs) and quasi-RCTs of more than four weeks duration, reporting on intentional weight loss interventions, in individuals with any stage of CKD, designed to promote weight loss as one of their primary stated goals, in any health care setting. Data collection and analysis Two authors independently assessed study eligibility and extracted data. We applied the Cochrane 'Risk of Bias' tool and used the GRADE process to assess the certainty of evidence. We estimated treatment effects using random-effects meta-analysis. Results were expressed as risk ratios (RR) for dichotomous outcomes together with 95% confidence intervals (CI) or mean differences (MD) or standardised mean difference (SMD) for continuous outcomes or in descriptive format when meta-analysis was not possible. Main results We included 17 RCTs enrolling 988 overweight or obese adults with CKD. The weight loss interventions and comparators across studies varied. We categorised comparisons into three groups: any weight loss intervention versus usual care or control; any weight loss intervention versus dietary intervention; and surgical intervention versus non-surgical intervention. Methodological quality was varied, with many studies providing insufficient information to accurately judge the risk of bias. Death (any cause), cardiovascular events, successful kidney transplantation, nutritional status, cost effectiveness and economic analysis were not measured in any of the included studies. Across all 17 studies many clinical parameters, patient-centred outcomes, and adverse events were not measured limiting comparisons for these outcomes. In studies comparing any weight loss intervention to usual care or control, weight loss interventions may lead to weight loss or reduction in body weight post intervention (6 studies, 180 participants: MD -3.69 kg, 95% CI -5.82 to -1.57; follow-up: 5 weeks to 12 months, very low-certainty evidence). In very low certainty evidence any weight loss intervention had uncertain effects on body mass index (BMI) (4 studies, 100 participants: MD -2.18 kg/m², 95% CI -4.90 to 0.54), waist circumference (2 studies, 53 participants: MD 0.68 cm, 95% CI -7.6 to 6.24), proteinuria (4 studies, 84 participants: 0.29 g/day, 95% CI -0.76 to 0.18), systolic (4 studies, 139 participants: -3.45 mmHg, 95% CI -9.99 to 3.09) and diastolic blood pressure (4 studies, 139 participants: -2.02 mmHg, 95% CI -3.79 to 0.24). Any weight loss intervention made little or no difference to total cholesterol, high density lipoprotein cholesterol, and inflammation, but may lower low density lipoprotein cholesterol. There was little or no difference between any weight loss interventions (lifestyle or pharmacological) compared to dietary-only weight loss interventions for weight loss, BMI, waist circumference, proteinuria, and systolic blood pressure, however diastolic blood pressure was probably reduced. Furthermore, studies comparing the efficacy of different types of dietary interventions failed to find a specific dietary intervention to be superior for weight loss or a reduction in BMI. Surgical interventions probably reduced body weight (1 study, 11 participants: MD -29.50 kg, 95% CI -36.4 to -23.35), BMI (2 studies, 17 participants: MD -10.43 kg/m², 95% CI -13.58 to -7.29), and waist circumference (MD -30.00 cm, 95% CI -39.93 to -20.07) when compared to non-surgical weight loss interventions after 12 months of follow-up. Proteinuria and blood pressure were not reported. All results across all comparators should be interpreted with caution due to the small number of studies, very low quality of evidence and heterogeneity across interventions and comparators. Authors' conclusions All types of weight loss interventions had uncertain effects on death and cardiovascular events among overweight and obese adults with CKD as no studies reported these outcome measures. Non-surgical weight loss interventions (predominately lifestyle) appear to be an effective treatment to reduce body weight, and LDL cholesterol. Surgical interventions probably reduce body weight, waist circumference, and fat mass. The current evidence is limited by the small number of included studies, as well as the significant heterogeneity and a high risk of bias in most studies.

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. 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. 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. 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. 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. 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. 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. clinicaltrials.gov Identifier: NCT00714168.

ObjectivesThere is limited evidence on the effectiveness of weight management programmes provided within routine healthcare and inconsistent use of outcome measures. Our aim was to evaluate a large National Health...

Psoriasis affects 60 million people worldwide; 80% of them are either overweight or obese and at risk of developing weight-related comorbidities. Obesity increases susceptibility to psoriasis and is associated with more severe disease. In England, clinical guidelines recommend offering weight-management support for patients with psoriasis and obesity. Patients who attended our formative focus groups were unaware of the link between weight and psoriasis and desired evidence-based guidance on how weight management might improve their condition, but clinicians report a lack of evidence as a significant barrier to offering care. The aim of this study was to evaluate the impact of weight-loss interventions (lifestyle/behavioural and pharmacological) on psoriasis severity and quality of life. Psoriasis severity was measured using ≥ 50% and ≥ 75% reduction from baseline Psoriasis Area and Severity Index (PASI 50 and PASI 70, respectively), and quality of life was measured using Dermatology Life Quality Index. We conducted a systematic review of five databases and two trial registries from inception to 9 September 2024. Outcomes were informed by conversations with patient focus groups. Randomized controlled trials that compared any weight-loss intervention to usual care or a lower-intensity intervention for adults with psoriasis were included. Studies had to report weight change and at least one measure of psoriasis severity at baseline and follow-up. Data were analysed using a random effects meta-analysis. Risk of bias was assessed using the Cochrane tool (RoB2). Eleven randomized controlled trials (994 participants) with 12 comparisons were included. Ten interventions advised dietary changes (including low- and very-low-calorie diets, low-carbohydrate or low-fat diets, and total dietary replacement) with or without physical activity. Two offered pharmacological weight-loss agents (glucagon-like peptide-1 receptor agonists). Based on 11 comparisons (n = 732, mean weight change −6.3 kg), weight-loss interventions were associated with a greater reduction in psoriasis severity, compared with control, with a mean difference in PASI of −1.9 [95% confidence interval (CI) −3.1 to −0.8, P &amp;lt; 0.001, I2 = 72.1%]. Sensitivity analyses excluding studies at high risk of bias, where minimal weight loss was achieved or where baseline PASI was low, did not meaningfully modify the effect estimate. Based on five comparisons (n = 213, mean weight change −8.7 kg), there was no evidence that weight-loss interventions were associated with significant improvements in quality of life, with a pooled mean DLQI difference of −5.7 (95% CI −12.4 to 1.1, I2 = 95.9%). There was evidence of significant effects of weight-loss interventions on the likelihood of achieving PASI 75 (relative risk 1.6, 95% CI 1.1–2.2, I2 = 22.6%; based on six comparisons, n = 681, mean weight change −7.3 kg) and PASI 50 (relative risk 1.6, 95% CI 1.0–2.6, I2 = 0.0%; based on three comparisons, n = 389, mean weight change −4.9 kg). Various weight-loss interventions were associated with improvements in psoriasis severity and quality of life. This evidence should encourage clinicians to incorporate support for weight loss as part of routine care for people with psoriasis and obesity.

The evidence base for weight management programmes incorporating a weight loss and a weight maintenance phase for adults with intellectual disabilities (ID) is limited. This study describes the weight maintenance phase of a multicomponent weight management programme for adults with intellectual disability and obesity (TAKE 5). Thirty-one participants who had completed the 16week TAKE five weight loss intervention (Phase I) were invited to participate in a 12month weight maintenance intervention (Phase II). Content included recommendations of the National Weight Control Registry. Twenty-eight participants completed Phase II with 50.4% maintaining their weight (mean weight change -0.5kg, SD 2.2), 28.7% gaining weight (mean weight gain 5.4kg, SD 2.2) and 21.6% losing weight (mean weight loss -8.0kg, SD 3.0) at 12months. Further research is justified to investigate the efficacy of weight loss maintenance interventions in adults with intellectual disability and obesity, using controlled study designs.

Men are underrepresented in obesity services, suggesting current weight loss service provision is suboptimal. This systematic review evaluated evidence-based strategies for treating obesity in men. Eight bibliographic databases and four clinical trials' registers were searched to identify randomized controlled trials (RCTs) of weight loss interventions in men only, with mean/median body mass index of ≥30 kg/m2 (or ≥28 kg/m2 with cardiac risk factors), with a minimum mean/median duration of ≥52 weeks. Interventions included diet, physical activity, behavior change techniques, orlistat, or combinations of these; compared against each other, placebo, or a no intervention control group; in any setting. Twenty-one reports from 14 RCTs were identified. Reducing diets produced more favorable weight loss than physical activity alone (mean weight change after 1 year from a reducing diet compared with an exercise program -3.2 kg, 95% confidence interval -4.8 to -1.6 kg, reported p < .01). The most effective interventions combined reducing diets, exercise, and behavior change techniques (mean difference in weight at 1 year compared with no intervention was -4.9 kg, 95% confidence interval -5.9 to -4.0, reported p < .0001). Group interventions produced favorable weight loss results. The average reported participant retention rate was 78.2%, ranging from 44% to 100% retention, indicating that, once engaged, men remained committed to a weight loss intervention. Weight loss for men is best achieved and maintained with the combination of a reducing diet, increased physical activity, and behavior change techniques. Strategies to increase engagement of men with weight loss services to improve the reach of interventions are needed.