Compliance With A Strategy For Weight Loss Maintenance
A Self-Regulation Program for Maintenance of Weight Loss, Wing R, Tate D, et al NEJM October 12, 2006, 355:1563-1571
Daily Weighing and Quick Action Keeps Pounds Off, Study Shows
Lifespan October 11, 2006
The STOP Regain Program & Clinical Trial
The STOP Regain Program is designed to maintain weight loss, regardless of how the weight was initially lost. Its strategies were the focus of this study, reported in the NEJM.
The description of the clinical trial methodology from the abstract follows:
In essence, participants in the STOP Regain Program are taught to weigh themselves daily and to make calculations based on the results to adjust or maintain their diet or exercise routine. The Program’s goal is to maintain a participant’s weight loss within five pounds of the weight on admission to the Program.
Study Results
Mean Weight Gain
- Control Group: 4.9±6.5 kg
- Face-To-Face Group: 2.5±6.7 kg
- Internet Group: 4.7±8.6 kg
The difference between the Control Group and the Face-To-Face Group is statistically significant.
Proportion of Subjects Regaining 2.3 kg (~5 pounds) Or More
- Control Group: 72.4%
- Face-To-Face Group: 45.7%
- Internet Group: 54.8%
The differences in the percentages of Control Group patients regaining weight compared to both the Face-To-Face Group and the Internet Group are significant.
Discussion By Project Leader
According to the project’s leader, Rena Wing, Ph.D., “If you want to keep lost pounds off, daily weighing is critical, but stepping on the scale isn’t enough. You have to use that information to change your behavior, whether that means eating healthier or walking more. Paying attention to weight – and taking quick action if it creeps up – seems to be the secret to success.”
While the emphasis in the Program is on the correlation between daily weighing and prevention of weight gain, the authors note that “daily weighing in the control group had little to no effect on the amount of weight regained.” Dr. Wing interprets this finding as suggesting that ” … participants in the two intervention groups were able to use the information from the scale to make constructive changes in their eating and exercise behaviors. It’s further evidence that getting on the scale each day is only part of the solution.”
Commentary
While none of the tactics explored in this study are unique or dramatic, it is heartening to see ideas tested rather than indiscriminately used because they qualify as “common sense.”
And, it’s refreshing that the researchers in this case took on one of the most challenging varieties of patient compliance. Weight loss maintenance requires a shift in eating, one of the most basic of human behaviors. Moreover, to be effective, this shift must be long-term.
The Program’s goal of maintaining the patient’s weight loss within five pounds (2.3 kg) brings up the problem of defining adequate treatment compliance in general. In this case, the NEJM article noted that 2.3 kg was “chosen because it is larger than the change expected with normal daily weight fluctuation and because of its public health implication,” referencing a 2006 article by Stevens et al1 that “recommend[s] that long-term weight maintenance in adults be defined as a weight change of <3% of body weight.” 2 Building in an allowance for some slippage to take place without labeling the patient’s effort a treatment failure is, clearly, a legitimate research stipulation. On the other hand, it would also be interesting to determine the effect varying standards of success and failure have on the patients in the Program.
The most important finding, by my lights, is the observation that “daily weighing in the control group had little to no effect on the amount of weight regained.” Given that, thus, daily weigh-ins appear to be a necessary but not sufficient element of the Program’s success, the pertinent, most useful research goal is factoring out the other essential components (e.g., informal interaction with clinicians, peer support, etc.)
Footnotes
- Stevens J, Truesdale KP, McClain JE, Cai J. The definition of weight maintenance. Int J Obes (Lond) 2006;30:391-9 [back]
- While it appears unlikely that the results would have been affected, following the recommendation to use a percentage of a specific patient’s body weight as the goal, at least for the purposes of this study, would reduce the chance that a few outliers could skew the results. It would also be consistent with the study’s admission criterion of a previous loss of 10% of body weight. [back]
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