Community-based Weight Management Program Research Articles

Effectiveness of a behavioral incentive scheme linked to goal achievement: study protocol for a randomized controlled trial.

BackgroundChildhood obesity is a concern in Australia and across the world. Community-based weight management programs are an important response to address childhood obesity. However, the scientific literature suggests that their effectiveness could potentially be enhanced by providing a structured incentive scheme. This proposal aims to determine the effectiveness of enhanced goal setting linked to a structured incentive scheme designed to improve the sustained health and wellbeing of overweight/obese children within the context of an existing community-based program.Methods/DesignThis study is a cluster randomized controlled trial delivered within the context of the existing NSW “Go4Fun” program with a 10-week and 6- and 12-month follow-up (n = 40 sites, 570 participants) that compares the effectiveness of small changes to the program in which children were asked to set goals (supported by text messages) and were given rewards for achieving them (intervention). This will be compared to the standard/existing program (control), which did not have the same structured incentive program. Data will be collected for all participants at baseline, end of program, and at 6 and 12 months. The primary outcome is a mean change in body mass index (BMI) z score at the 12-month follow-up. Secondary outcomes include anthropometric measures (body weight, height, and waist circumference) and behavioral measures collected via validated questionnaires. A process evaluation (comprising surveys and focus groups) to determine acceptability and sustainability and to inform downstream translation will also be conducted.DiscussionThis study will inform policy and program delivery as well as the broader evidence base regarding goal achievement and incentive schemes directed at children’s health-related behaviors and will provide evidence that is likely to be transferrable across a range of health conditions.Trial RegistrationACTRN12615000558527 registered on 29 May 2015.

Changes in Weight Loss, Health Behaviors, and Intentions among 400 Participants Who Dropped out from an Insurance-Sponsored, Community-Based Weight Management Program.

The majority of weight management research is based on data from randomized controlled studies conducted in clinical settings. As these findings are translated into community-based settings, additional research is needed to understand patterns of lifestyle change and dropout. The purpose of this study was to examine reasons for and consequences associated with dropout (or removal) from an insurance-funded weight management program. Using a mixed methods approach with objectively measured changes in body weight and attendance along with quantitative and qualitative survey data, patterns of intention and behavior change were explored. The results from a sample of 400 respondents support the idea that there are both positive and negative consequences of program participation. Overall, 1 in 5 respondents lost a clinically significant amount of weight during the program (>5% of baseline body weight) and 1 in 3 experienced a positive consequence, while only 6% expressed a negative outcome of participation. Additionally, nearly 90% of all of the consequences that emerged from the data were positive. Attitude change was a major theme, including positive health intentions, perceived success, learning skills, and new appreciation of exercise.

Effect on Diet Quality of a Community-Based Weight Management Program for Hispanic Families

Effect on Diet Quality of a Community-Based Weight Management Program for Hispanic Families

Probability of an Obese Person Attaining Normal Body Weight: Cohort Study Using Electronic Health Records.

We examined the probability of an obese person attaining normal body weight. We drew a sample of individuals aged 20 years and older from the United Kingdom's Clinical Practice Research Datalink from 2004 to 2014. We analyzed data for 76,704 obese men and 99,791 obese women. We excluded participants who received bariatric surgery. We estimated the probability of attaining normal weight or 5% reduction in body weight. During a maximum of 9 years' follow-up, 1283 men and 2245 women attained normal body weight. In simple obesity (body mass index = 30.0-34.9 kg/m(2)), the annual probability of attaining normal weight was 1 in 210 for men and 1 in 124 for women, increasing to 1 in 1290 for men and 1 in 677 for women with morbid obesity (body mass index = 40.0-44.9 kg/m(2)). The annual probability of achieving a 5% weight reduction was 1 in 8 for men and 1 in 7 for women with morbid obesity. The probability of attaining normal weight or maintaining weight loss is low. Obesity treatment frameworks grounded in community-based weight management programs may be ineffective.

Choose to change maternity weight management pilot.

Obesity during pregnancy is associated with increased risk of adverse health outcomes during pregnancy. There is limited research available regarding effective interventions during pregnancy for obese women and this is combined with local inadequate service provision to support obese mothers in Greater Manchester (GM). Choose to Change (CTC) aims to develop, deliver and evaluate a community based weight management programme to limit excessive gestational weight gain. Participants (n=73) referred from January to December 2013 by Community Midwifery Teams (>18years) with a BMI >30 attended a healthy lifestyle intervention (1:1 or group) covering nutrition, physical activity and behaviour change over 12weeks. Baseline measures were weight, Body Mass Index (BMI), Blood Pressure, physical activity, dietary habits and psychological questionnaires measuring anxiety, self-esteem and dis-ordered eating. 28 clients were assigned to intervention (group (n=15), 1:1 (n=13). Mean age 29 (SD=5.78), mean BMI at referral was 38.96 (SD=4.87). Descriptive statistics suggest an average weight gain for clients (excluding drop outs n=12) is 0.94kg (SD=6.65). For those who have completed the programme (n=8) average weight gain was 1.03kg (SD=7.71). Results vary according to intervention type 1:1, 0.04kg (SD=8.82kg), group, 1.52kg (SD=3.17kg). Drop-out rate from referral to assessment was 62%, from assessment to intervention 32% and during intervention 26%. Overall the results of the present pilot study indicate that the CTC healthy lifestyle intervention can limit excessive gestational weight gain. CTC is looking at future directions for development including changing the assessment procedure to improve DORs, further analysis of various mediating factors including BMI and intervention type and exploration of post-measurements to show further improved health outcomes as the programme is rolled out across GM.

Effects of a Pediatric Weight Management Program With and Without Active Video Games

Active video games may offer an effective strategy to increase physical activity in overweight and obese children. However, the specific effects of active gaming when delivered within the context of a pediatric weight management program are unknown. To evaluate the effects of active video gaming on physical activity and weight loss in children participating in an evidence-based weight management program delivered in the community. Group-randomized clinical trial conducted during a 16-week period in YMCAs and schools located in Massachusetts, Rhode Island, and Texas. Seventy-five overweight or obese children (41 girls [55%], 34 whites [45%], 20 Hispanics [27%], and 17 blacks [23%]) enrolled in a community-based pediatric weight management program. Mean (SD) age of the participants was 10.0 (1.7) years; body mass index (BMI) z score, 2.15 (0.40); and percentage overweight from the median BMI for age and sex, 64.3% (19.9%). All participants received a comprehensive family-based pediatric weight management program (JOIN for ME). Participants in the program and active gaming group received hardware consisting of a game console and motion capture device and 1 active game at their second treatment session and a second game in week 9 of the program. Participants in the program-only group were given the hardware and 2 games at the completion of the 16-week program. Objectively measured daily moderate-to-vigorous and vigorous physical activity, percentage overweight, and BMI z score. Participants in the program and active gaming group exhibited significant increases in moderate-to-vigorous (mean [SD], 7.4 [2.7] min/d) and vigorous (2.8 [0.9] min/d) physical activity at week 16 (P < .05). In the program-only group, a decline or no change was observed in the moderate-to-vigorous (mean [SD] net difference, 8.0 [3.8] min/d; P = .04) and vigorous (3.1 [1.3] min/d; P = .02) physical activity. Participants in both groups exhibited significant reductions in percentage overweight and BMI z scores at week 16. However, the program and active gaming group exhibited significantly greater reductions in percentage overweight (mean [SD], -10.9%[1.6%] vs -5.5%[1.5%]; P = .02) and BMI z score (-0.25 [0.03] vs -0.11 [0.03]; P < .001). CONCLUSIONS AND RELEVANCE Incorporating active video gaming into an evidence-based pediatric weight management program has positive effects on physical activity and relative weight. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01757925.

The dieting experience: A Jewish perspective

Considered to be a chronic recidivist condition, obesity places significant burdens on the society. The search for appropriate interventions remains challenging. Research suggests individuals' environments should be considered when addressing eating behaviours. Nomothetic accounts of the dieting experiences of eight self-selected British Jews within a commercially run, community-based weight-management programme adapted to Jewish participants' cultural needs were explored using interpretative phenomenological analysis. Four themes were identified: 'Me, myself and I', 'behaviour change', 'structural framework' and 'social interaction'. Emergent aspects were social support and structural flexibility to motivate participants to initiate and sustain behaviour change. Implications for future weight-loss interventions are discussed.

A comparison of the provision of the My Choice Weight Management Programme via general practitioner practices and community pharmacies in the United Kingdom.

This study aimed to assess the effectiveness of a novel, community-based weight management programme delivered through general practitioner (GP) practices and community pharmacies in one city in the United Kingdom. This study used a non-randomized, retrospective, observational comparison of clinical data collected by participating GP practices and community pharmacies. Subjects were 451 overweight or obese men and women resident in areas of high socioeconomic deprivation (82% from black and minority ethnic groups, 86% women, mean age: 41.1 years, mean body mass index [BMI]: 34.5 kg m(-2)). Weight, waist circumference and BMI at baseline, after 12 weeks and after 9 months were measured. Costs of delivery were also analysed. Sixty-four per cent of participants lost weight after the first 12 weeks of the My Choice Weight Management Programme. There was considerable dropout. Mean percentage weight loss (last observation carried forward) was 1.9% at 12 weeks and 1.9% at final follow-up (9 months). There was no significant difference in weight loss between participants attending GP practices and those attending pharmacies at both 12 weeks and at final follow-up. Costs per participant were higher via community pharmacy which was attributable to better attendance at sessions among community pharmacy participants than among GP participants. The My Choice Weight Management Programme produced modest reductions in weight at 12 weeks and 9 months. Such programmes may not be sufficient to tackle the obesity epidemic.

Text Messaging as Adjunct to Community-Based Weight Management Program

Increasing obesity rates are still a public health priority. The primary aim of this study was to evaluate the effect of tailored text messages on body weight change in overweight and obese adults in a community-based weight management program. A secondary aim was to detect behavioral changes in the same population. The study design was quasi-experimental with pretest and posttest analysis, conducted over 12 weeks. A total of 28 participants were included in the analysis. Body weight, eating behaviors, exercise and nutrition self-efficacy, attitude toward mobile technology, social support, and physical activity were assessed at baseline and at 12 weeks. Text messages were sent biweekly to the intervention but not to the control group. At 12 weeks, the intervention group had lost significant weight as compared with the control group. There was a trend toward an improvement in eating behaviors, exercise, and nutrition self-efficacy in the intervention group, with no significant difference between groups. A total of 79% of participants stated that text messages helped in adopting healthy behaviors. Tailored text messages appear to enhance weight loss in a weight management program at a community setting. Large-scale and long-term intervention studies are needed to confirm these findings.

Childhood obesity in America

To provide an overview of the current advances in childhood obesity physiology, intervention, and prevention. Structural and functional brain impairments are present in obese adolescents with metabolic syndrome (MetS). Aerobic training for 20 or 40 min per day produced similar affects on metabolic risk factors. Vitamin D supplementation has been shown to improve the metabolic risk factors in obese children; however, obese children require greater doses to treat vitamin D deficiency. A 10-week community-based exergaming weight management program significantly decreased the BMI in obese children. There is surmounting research on MetS and its associated risk factors in obese children. Gaining a comprehensive overview of the factors associated with obesity in children is crucial in developing the most effective intervention strategies. Community-based and family-centered interventions have generated positive results in reducing children's BMI and improving MetS risk factors. In addition to obesity intervention efforts, ongoing prevention initiatives are imperative to reduce the prevalence of childhood obesity.

Evaluation of a community-based weight management program for predominantly severely obese, difficult-to-reach, inner-city minority adolescents.

Few interventions targeting severely obese minority youth have been implemented in community-based settings. We evaluate a 9-month multicomponent, community-based program for obese, inner-city adolescents. Of 5250 estimated eligible adolescents, 349 were recruited; they had a mean age of 15 ± 2 years, mean BMI %ile 98.9 ± 1.5, and comprised 52% African American and 44% Hispanic. Longitudinal trends of anthropometric measures were compared 1 year before enrollment (T-12), at baseline (T0) and after program completion (T9). Dietary and physical activity behaviors were compared at T0 and T9. Anthropometric changes were compared at T9 and 18 months (T18) in completers and noncompleters. A majority of participants were severely obese (67%) and expressed low readiness to change behaviors (82%). For intervals T-12 to T0 versus T0 to T9, there were significant decreases in rates of gain in BMI (0.13 vs. 0.04, p < 0.01), BMI percentile (0.0002 vs. -0.0001, p < 0.01), percent overweight (0.001 vs. -0.001, p < 0.01), and BMI z-score (0.003 vs. -0.003, p < 0.01). Significant increases in vegetable and fruit consumption and in vigorous physical activity participation were observed. From T9 to T18, except for a significant increase in BMI (38.3 ± 7.4 vs. 39.0 ± 7.5, p < 0.01) in completers, all other anthropometric measures remained unchanged in completers and noncompleters. We demonstrate modest clinical improvements and increased healthy lifestyle behaviors in predominantly severely obese, difficult-to-reach, ethnic minority adolescents attending a community-based weight management program. The loss of clinical improvements 9 months after program completion implies that extending the duration of such a program may prevent long-term weight regain in severely obese adolescents.

Service Learning in a Pediatric Weight Management Program to Address Childhood Obesity

ABSTRACTThis paper describes an inter-professional service learning collaboration and reflects benefits and considerations when incorporating a family-oriented approach in the community-based pediatric weight management program. Because obesity has tremendous consequences on a nation's health and economy, a pediatrician in a community health network has utilized an inter-professional team to implement a pediatric weight management program targeting children between the ages of 8 and 15 years. The team incorporates a culturally sensitive curriculum using a family-oriented approach for obesity prevention and intervention. Physicians, registered dietitians, occupational therapists, nurse practitioners, and mental health professionals assist participants in adopting a healthier lifestyle by addressing physical and psychosocial issues related to obesity, developing a nutrition plan, making healthier food choices, and finding fun ways to be more physically active. Graduate occupational therapy students work closely with the team members to assist delivery of interactive activities and behavior intervention.

Predictors of Clinically Significant Weight Loss and Participant Retention in an Insurance-Sponsored Community-Based Weight Management Program

Health insurance providers are a logical partner in providing third-party payment for behavioral weight loss programming, but little evidence of predictors of improved outcomes or retention in large, insurance-sponsored lifestyle programming is available. The purpose was to determine predictors of weight loss and retention in an insurance-sponsored, community-based weight management program. Current and former participants (N = 2,106) were recruited to complete a program evaluation survey. Respondents' survey and objective outcome data (n = 766) were analyzed using logistic regression procedures to understand the factors predictive of clinically-significant (5%) weight loss and program retention (>6 months). Clinically significant weight loss was predicted by completing more than 6 months of the program, positive ratings of staff interaction, and social support from friends on success. Ratings of positive impact of site hours of operation, nurse calls, and availability of safe places to be active and feeling comfortable at the site were predictive of program retention. Modifiable intervention, social factors, and site-level factors were predictive of clinically significant weight loss and program retention, providing fodder for further study and dissemination to current providers and to a broader network of health promotion professionals.

Two-year outcomes of an adjunctive telephone coaching and electronic contact intervention for adolescent weight-loss maintenance: the Loozit randomized controlled trial

This paper reports the final 24-month outcomes of a randomized controlled trial evaluating the effect of additional therapeutic contact (ATC) as an adjunct to a community-based weight-management program for overweight and obese 13-16-year-olds. ATC involved telephone coaching or short-message-service and/or email communication once per fortnight. Adolescents were randomized to receive the Loozit group program-a two-phase behavioral lifestyle intervention with (n=73), or without (n=78), ATC in Phase 2. Adolescents/parents separately attended seven weekly group sessions (Phase 1), followed by quarterly adolescent sessions (Phase 2). Assessor-blinded, 24-month changes in anthropometry and metabolic health included primary outcomes body mass index (BMI) z-score and waist:height ratio (WHtR). Secondary outcomes were self-reported psychosocial and lifestyle changes. By 24 months, 17 adolescents had formally withdrawn. Relative to the Loozit program alone, ATC largely had no impact on outcomes. Secondary pre-post assessment of the Loozit group program showed mean (95% CI) reductions in BMI z-score (-0.13 (-0.20, -0.06)) and WHtR (-0.02 (-0.03, -0.01)) in both arms, with several metabolic and psychosocial improvements. Adjunctive ATC did not provide further benefits to the Loozit group program. We recommend that further work is needed to optimize technological support for adolescents in weight-loss maintenance. Australian New Zealand Clinical Trials Registry Number ACTRNO12606000175572.

Economic evaluation of lifestyle interventions to treat overweight or obesity in children

To estimate lifetime cost effectiveness of lifestyle interventions to treat overweight and obese children, from the UK National Health Service perspective. An adaptation of the National Heart Forum economic model to predict lifetime health service costs and outcomes of lifestyle interventions on obesity-related diseases. Hospital or community-based weight-management programmes. Hypothetical cohorts of overweight or obese children based on body mass data from the National Child Measurement Programme. Lifestyle interventions that have been compared with no or minimal intervention in randomized controlled trials (RCTs). Reduction in body mass index (BMI) standard deviation score (SDS), intervention resources/costs, lifetime treatment costs, obesity-related diseases and cost per life year gained. Ten RCTs were identified by our search strategy. The median effect of interventions versus control from these 10 RCTs was a difference in BMI SDS of -0.13 at 12 months, but the range in effects among interventions was broad (0.04 to -0.60). Indicative costs per child of these interventions ranged from £108 to £662. For obese children aged 10-11 years, an intervention that resulted in a median reduction in BMI SDS at 12 months at a moderate cost of £400 increased life expectancy by 0.19 years and intervention costs were offset by subsequent undiscounted savings in treatment costs (net saving of £110 per child), though this saving did not emerge until the sixth or seventh decade of life. The discounted cost per life year gained was £13 589. Results were broadly similar for interventions aimed at children aged 4-5 years and which targeted both obese and overweight children. For more costly interventions, savings were less likely. Interventions to treat childhood obesity are potentially cost effective although cost savings and health benefits may not appear until the sixth or seventh decade of life.

HOPE Works: A Community-Based Obesity Intervention Addressing Social Determinants as Underlying Factors

Objectives: HOPE Works was an innovative, community-based participatory research (CBPR) intervention aimed at addressing health promotion and obesity in the context of social determinants for obese, low-income and minority rural North Carolina women. This study incorporated multiple social health determinants, including hope, which assesses participants’ abilities to set and achieve goals to reach desired health and life changes. Methods: Community Coordinators identified women to serve as HOPE Circle Leaders who received training and recruited women from their social networks. Thirty-four Circles met bi-weekly for 6 months following a manual-based curriculum and received tailored newsletters addressing health and economic literacy. Comparison women were drawn from the same communities. The primary outcome was weight loss. Secondary outcomes were moderate and vigorous physical activity (MVPA), fruit and vegetable (FV 277 comparison). Non-completers (117 intervention; 119 comparison) differed by race, employment status, household income, and contribution to household income in the past two years (all p < 0.05). Intervention women lost 4.5 (±1.2) pounds compared to 0.4 (±0.4) pounds for comparison women (p = 0.054 cohort, p = 0.154 ITT); 22.5% and 13.1% of the intervention and comparison groups respectively lost ≥5% of their body weight. Mean (SE) difference in total MVPA between groups was +51.8 (±19.2) minutes/week (p = 0.007), with non-significant improvement in FV however, intervention women marginally improved on Agency (goal directed energy) (p = 0.060). Conclusion: Women receiving a community-based weight management program based on addressing social determinants can successfully lose weight. Future, streamlined efforts addressing the needs of women including those unable to participate are important to enhance program reach and public health impact.

Effectiveness Of An 8-week Community Based Weight Management Program On Blood Lipids, 2000-2009

INTRODUCTION: It has been estimated that 67% of Americans are overweight or obese and the management of obesity-linked comorbidities costs about $60 billion. Several studies have found that a 10% weight loss results in significant reduction in the risk of obesity-related comorbidities. Recently, community based weight management programs have emerged as a practical alternative to inpatient weight loss therapy. PURPOSE: To determine the effects of an 8-week community based weight management program on body mass and blood lipids in overweight and obese individuals. METHODS: Over the last nine years (2000-2009), 238 subjects, 179 males and 59 females (mean ± SEM, age: 50.3 ± 0.7y; height: 1.7 ± 0.01m; body mass: 94.6 ± 1.2kg; BMI: 33.8 ± 0.4 kg/m2) participated in an 8-week community based weight management program consisting of a low-calorie diet (1200 kcal/day) and moderate physical activity. Subjects maintained daily dietary and exercise logs throughout the 8-week program. Subjects participated in weekly group meetings where they received education on the food exchange system and were counseled on behavior modification strategies related to diet and exercise adherence. Two test periods (pre- and post-) were analyzed using paired sample T-tests to determine changes in body total cholesterol (TC), low density lipoprotein-cholesterol (LDL-C), high density lipoprotein-cholesterol (HDL-C), triglycerides (TG), serum glucose, body mass, and BMI. RESULTS: Significant differences (p<0.001) were found in pre-test to post-test in TC, LDL-C, HDL-C and TG. Relative reductions in blood lipids were 9.5% for TC, 12.4% for TG, 10.7% for LDL-C, and 5.5% for HDL-C. Additionally, there were significant decreases (p<0.001) in body mass, BMI, and serum glucose (p<0.05). CONCLUSION: On average, a 6% relative decrease in body mass led to clinically relevant decreases in TC, TG, and LDL-C. Our data show that a community based weight management program that combines a low-calorie diet with daily moderate exercise produced significant positive changes in serum lipid profiles of overweight and obese participants.

Changes in Abdominal Adiposity in Overweight and Obese Subjects Following an 8-Week Community Weight Management Program

INTRODUCTION: Centers for Disease Control and Prevention estimated that 68% of the Americans are either overweight or obese. Adiposity has been linked with increased risk of heart disease, diabetes mellitus, hypertension, high cholesterol, respiratory disease, and stroke. Specifically, visceral adiposity has been reported to increase the risk of these comorbidities. PURPOSE: To examine changes in visceral and subcutaneous abdominal fat stores, body mass, and body mass index (BMI) following an 8-week community weight management program. METHODS: Over the last nine years (2000-2009), 231 subjects, 175 females and 56 males (mean ± SEM, age: 50.5 ± 0.7y; height: 1.6 ± 0.005m; body mass: 95.6 ± 1.4kg; BMI: 34.2 ± 0.45 kg/m2) participated in an 8-week community based weight management program consisting of a low-calorie diet (1200 kcal/day) and moderate physical activity. Subjects participated in weekly group meetings where they received education on the food exchange system and were counseled on behavior modification strategies related to diet and exercise adherence. Fat distribution was estimated using anthropometric sagittal diameter and predictive equations. Percent body fat was measured using bioelectric impedance, Tanita BF-350 (Arlington Heights, IL). Self-reported data was used to monitor adherence to diet and exercise. Two test periods (pre-post) were analyzed using paired sample T-test to determine changes in body mass, BMI, percent fat, visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT) and total adipose tissue (TAT). RESULTS: Significant decreases (p<0.001) in body mass, BMI, VAT, SAT, TAT, and percent body fat (p<0.01) were found from pre-to-post test. Relative reductions were 6% for percent body fat, 18% for VAT, 9% for SAT, and 10% for TAT at the end of the 8-week intervention. CONCLUSION: The significant decrease in body mass as well as percent body fat contributed to significant losses in VAT, SAT, and TAT. In addition, there was greater relative loss of VAT than SAT. Our results show that an 8-week community based weight management program consisting of a low-calorie diet and moderate physical activity led to significant positive changes in body composition.

Eat Smart, Move More, Weigh Less: A Community-Based Weight Management Program for Adults

Describes development of a comprehensive low cost weight management program to be delivered by local public health educators or cooperative extension agents. The program was developed by a unique partnerships of the NC Cooperative Extension Serive the NC Division of Public Health and the Brody School of Medicine at East Carolina University.

Community-based weight management in long-term heart transplant recipients: a pilot study

Heart transplant recipients often suffer from obesity, dyslipidemia, and hypertension thought to be related to triple-drug immunosuppression and poor adherence to diet and exercise. A lifestyle intervention that allows recipients to attend a community-based weight management program may improve health outcomes. To determine (1) the effects of attending a community-based weight management program on weight, systolic and diastolic blood pressure, and the lipid profile; and (2) the feasibility of a community-based program for weight management. Twenty-one patients (81% male; age 57 years, 99.7 months since transplantation) participated in a randomized clinical trial and received either weight management counseling (control) or a 6-month scholarship to a structured commercial program (treatment). Using simple analysis of covariance models, group differences were assessed and reported as marginal means. At baseline, there were no demographic differences between groups. There were no differences in outcome variables except weight (control, 102.1 kg vs treatment, 98.3 kg; P= .05). After 6 months, significant differences were found in weight (control, 100.5 kg vs treatment, 95.6 kg; P= .047) and high-density lipoprotein cholesterol (control, 40.6 mg/dL vs treatment, 49.1 mg/dL; P= .044). A marginally significant difference was found in systolic blood pressure (control, 138 mm Hg vs treatment, 121 mm Hg; P= .07). A decrease in diastolic blood pressure (6 mm Hg) was attributed to treatment effect (P = .16). No differences were noted in total cholesterol, triglycerides, or low-density lipoprotein cholesterol. The structured commercial program appears to be an effective, feasible alternative to usual care. Findings need to be confirmed in future research with a larger sample.