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Changes in eating, physical activity and related behaviors in a primary care-based weight loss intervention

International Journal of Obesity volume 37, pages S12–S18 (2013)Cite this article

Subjects

Abstract

OBJECTIVE:

To examine changes in eating behaviors and physical activity, as well as predictors of weight loss success, in obese adults who participated in a 2-year behavioral weight loss intervention conducted in a primary care setting.

DESIGN:

A longitudinal, randomized controlled, multisite trial.

SUBJECTS:

Three hundred ninety obese (body mass index, 30–50 kg m–2) adults, ⩾21 years, in the Philadelphia region.

METHODS:

Participants were assigned to one of three interventions: (1) Usual Care (quarterly primary care provider (PCP) visits that included education on diet and exercise); (2) Brief Lifestyle Counseling (quarterly PCP visits plus monthly lifestyle counseling (LC) sessions about behavioral weight control); or (3) Enhanced Brief LC (the previous intervention with a choice of meal replacements or weight loss medication).

RESULTS:

At month 24, participants in both Brief LC and Enhanced Brief LC reported significantly greater improvements in mean (±s.e.) dietary restraint than those in Usual Care (4.4±0.5, 4.8±0.5 and 2.8±0.5, respectively; both P-values⩽0.016). The percentage of calories from fat, along with fruit and vegetable consumption, did not differ significantly among the three groups. At month 24, both the Brief LC and Enhanced Brief LC groups reported significantly greater increases than usual care in energy expenditure (kcal per week) from moderately vigorous activity (+593.4±175.9, +415.4±179.6 and −70.4±185.5 kcal per week, respectively; both P-values⩽0.037). The strongest predictor of weight loss at month 6 (partial R2=33.4%, P<0.0001) and at month 24 (partial R2=19.3%, P<0.001) was food records completed during the first 6 months. Participants who achieved a 5% weight loss at month 6 had 4.7 times greater odds of maintaining a ⩾5% weight loss at month 24.

CONCLUSIONS:

A behavioral weight loss intervention delivered in a primary care setting can result in significant weight loss, with corresponding improvements in eating restraint and energy expenditure. Moreover, completion of food records, along with weight loss at month 6, is a strong predictor of long-term weight loss.

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Acknowledgements

We thank Christopher Petro, PhD, for his assistance with data management, and Jeffrey Derbas, BS, Megan Dougherty, BS, Zahra Khan, BA, Joanna Perez, BA, Ilana Schriftman, BA and Dana Tioxon for their assistance with the execution of the research study. This research was supported by grants from the National Heart, Lung, and Blood Institute (U01-HL087072) and National Institute of Diabetes and Digestive and Kidney Diseases (K24-DK065018).

This article is published as part of a supplement, sponsored by the Center for Weight and Eating Disorders—University of Pennsylvania.

Author information

Author notes

  1. S Volger, T A Wadden, D B Sarwer, R H Moore, J Chittams, L K Diewald, E Panigrahi, R I Berkowitz, K Schmitz and M L Vetter: Members are listed in the Appendix.

Authors and Affiliations

  1. Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    S Volger, T A Wadden, D B Sarwer, R H Moore, L K Diewald, E Panigrahi, R I Berkowitz & M L Vetter

  2. Department of Psychology, Haverford College, Haverford, PA, USA

    T A Wadden

  3. Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    D B Sarwer

  4. Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    R H Moore & K Schmitz

  5. Department of Statistics, North Carolina State University, Raleigh, NC, USA

    R H Moore

  6. Biostatistics Division, University of Pennsylvania School of Nursing, Philadelphia, PA, USA

    J Chittams

  7. Division of Endocrinology, Department of Medicine, Diabetes, and Metabolism, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    M L Vetter

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Consortia

for the POWER-UP Research Group

Corresponding author

Correspondence to T A Wadden.

Ethics declarations

Competing interests

TAW serves on the advisory boards of Novo Nordisk and Orexigen Therapeutics, which are developing weight loss medications, as well as the advisory boards of Alere and the Cardiometabolic Support Network, which provide behavioral weight loss programs. TAW has also served as a consultant for Boehringer Ingelheim, and has received grant support from the National Institutes of Health (NIH/NIDDK and NIH/NHLBI). DBS discloses relationships with the following companies: Allergan, BariMD, BaroNova, Enteromedics and Galderma. DBS has also received grant support from the National Institutes of Health (NIH). The remaining authors declare no conflict of interest.

Appendix

Appendix

POWER-UP Research Group: Investigators and Research Coordinators

Academic investigators at the Perelman School of Medicine at the University of Pennsylvania were Thomas A Wadden, PhD (principal investigator), David B Sarwer, PhD (co-principal investigator), Robert I Berkowitz, MD, Jesse Chittams, MS, Lisa Diewald, MS, RD, Shiriki Kumanyika, PhD, Renee Moore, PhD, Kathryn Schmitz, PhD, Adam G Tsai, MD, MSCE, Marion Vetter, MD and Sheri Volger, MS, RD.

Research coordinators at the University of Pennsylvania were Caroline H Moran, BA, Jeffrey Derbas, BS, Megan Dougherty, BS, Zahra Khan, BA, Jeffrey Lavenberg, MA, Eva Panigrahi, MA, Joanna Evans, BA, Ilana Schriftman, BA, Dana Tioxon, Victoria Webb, BA and Catherine Williams-Smith, BS.

POWER-UP Research Group: Participating Sites and Clinical Investigators

PennCare—Bala Cynwyd Medical Associates: Ronald Barg, MD, Nelima Kute, MD, David Lush, MD, Celeste Mruk, MD, Charles Orellana, MD and Gail Rudnitsky, MD (primary care providers); Angela Monroe (lifestyle coach); Lisa Anderson (practice administrator).

PennCare—Internal Medicine Associates of Delaware County: David E Eberly, MD, Albert H. Fink Jr MD, Kathleen Malone, CRNP, Peter B Nonack, MD, Daniel Soffer, MD, John N Thurman, MD and Marc J Wertheimer, MD (primary care providers); Barbara Jean Shovlin, Lanisha Johnson (lifestyle coaches); Jill Esrey (practice administrator).

PennCare—Internal Medicine Mayfair: Jeffrey Heit, MD, Barbara C Joebstl, MD and Oana Vlad, MD (primary care providers); Rose Schneider, Tammi Brandley (lifestyle coaches); Linda Jelinski (practice administrator).

Penn Presbyterian Medical Associates: Joel Griska, MD, Karen J Nichols, MD, Edward G Reis, MD, James W Shepard, MD and Doris Davis-Whitely, PA (primary care providers); Dana Tioxon (lifestyle coach); Charin Sturgis (practice administrator).

PennCare—University City Family Medicine: Katherine Fleming, CRNP, Dana B Greenblatt, MD, Lisa Schaffer, DO, Tamara Welch, MD and Melissa Rosato, MD (primary care providers); Eugonda Butts, Marta Ortiz, Marysa Nieves and Alethea White (lifestyle coach); Cassandra Bullard (practice administrator).

PennCare—West Chester Family Practice: Jennifer DiMedio, CRNP, Melanie Ice, DO, Brandt Loev, DO, John S Potts, DO and Christine Tressel, DO (primary care providers); Iris Perez, Penny Rancy and Dianne Rittenhouse (lifestyle coaches); Joanne Colligan (practice administrator).

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Volger, S., Wadden, T., Sarwer, D. et al. Changes in eating, physical activity and related behaviors in a primary care-based weight loss intervention. Int J Obes 37 (Suppl 1), S12–S18 (2013). https://doi.org/10.1038/ijo.2013.91

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