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Many approaches to weight loss have been proposed. In this study, 363 adults (mostly women; mean age, 42; mean body-mass index, 33 kg/m2) received up to 42 group-based counseling sessions over 18 months that included typical knowledge-based approaches to physical activity promotion and eating behaviors. Participants were randomized to either a standard behavioral weight loss intervention group (SBWI; participants received the full fixed set of counseling sessions) or to a stepped care group (STEP; the frequency and type of sessions were modified depending on the achievement of specific goals every 3 months). STEP participants moved to the next set of counseling sessions only if the prior goal was not achieved.
About 72% of each group completed the full 18-month program. At 18 months, mean weight loss was 7.6 kg in the SBWI group and 6.2 kg in the STEP group (8.1% vs. 6.9%, a nonsignificant difference). The total cost was estimated to be about US$1350 for the SBWI and $780 for the STEP program.
Jakicic JM et al. Effect of a stepped-care intervention approach on weight loss in adults: A randomized clinical trial. JAMA 2012 Jun 27; 307:2617. (http://dx.doi.org/10.1001/jama.2012.6866)
Comment
These approaches suffer from all the same problems as other behavioral approaches: a fairly modest weight loss for so much effort, a partial rebound in weight loss from the initial response (weight loss in both groups peaked at 6 months), and a significant drop-out rate. The wide variation in costs argues for an approach that focuses more energy on patients who are making less progress, rather than a one-size-fits-all approach.