Disability assessment in an Italian cohort of patients with obesity using an International Classification of Functioning, Disability and Health (ICF)-derived questionnaire.

BACKGROUND: Obesity is a clinical condition that contributes to the development of related disability in different areas (physical, psychological and social). Multidisciplinary treatment calls for specific instruments able to evaluate all related functional problems. We have developed a tool (an ICF-based assessment instrument, the ICF-OB schedule) to evaluate obesity-related disability, composed of an inventory of 71-items from the WHO International Classification of Functioning, Disability and Health (ICF). AIM: The aim of the present study was to validate this new tool for the definition of obesity-related disability. We also sought to examine the relationship between obesity disability, an index of multimorbidity (Cumulative Illness Rating Scale [CIRS]) and a well-validated score of perceived obesity-related disability (Italian Obesity Society Test for Obesity-Related Disability [TSD-OC]). DESIGN: Process validation of the ICF-OB schedule. SETTING: Baseline conditions of out- and in-patients. POPULATION: A large cohort of obese patients recruited from 9 multidisciplinary centers belonging to the Italian Obesity Society (SIO) network, which provide specialized obesity care. METHODS: A total of 353 patients (F: 70%, age: 50.2±12.7yrs, BMI: 41.4±8.3kg/m2) were enrolled between January 2017 and June 2018. The ICF-OB was used to define patients' functioning and disability profiles in order to set and appraise rehabilitation goals. RESULTS: We described the distribution of body functions (BF), body structures (BS) and activities and participations (A&P) categories and the agreement rates were significant for the majority of these. The ICF-OB was more often significantly associated, and with stronger coefficients, with patients' comorbidities as described by the CIRS rather than with Body Mass Index (BMI). The TSD-OC also presented a strong association with A&P indexes. CONCLUSIONS: The complexity of clinical condition, that generates disability in obesity might be well identified with the use of this new instrument that appear significant related to the perceived disability for each patients and also with their multimorbidity. CLINICAL REHABILITATION IMPACT: The ICF-OB shows great promise as a tool for goal setting in the rehabilitation of obese patients.

Self-efficacy and Physical Activity in Overweight and Obese Adults Participating in a Worksite Weight Loss Intervention: Multistate Modeling of Wearable Device Data.

BACKGROUND: Physical activity is associated with a reduced risk of numerous types of cancer and plays an important role in maintaining a healthy weight. Wearable physical activity trackers may supplement behavioral intervention and enable researchers to study how determinants like self-efficacy predict physical activity patterns over time. METHODS: We used multistate models to evaluate how self-efficacy predicted physical activity states among overweight and obese individuals participating in a 26-week weight loss program (N = 96). We specified five states to capture physical activity patterns: (i) active (i.e., meeting recommendations for 2 weeks), (ii) insufficiently active, (iii) nonvalid wear, (iv) favorable transition (i.e., improvement in physical activity over 2 weeks), and (v) unfavorable transition. We calculated HRs of transition probabilities by self-efficacy, body mass index, age, and time. RESULTS: The average prevalence of individuals in the active, insufficiently active, and nonvalid wear states was 13%, 44%, and 16%, respectively. Low self-efficacy negatively predicted entering an active state [HR, 0.51; 95% confidence interval (CI), 0.29-0.88]. Obesity negatively predicted making a favorable transition out of an insufficiently active state (HR, 0.61; 95% CI, 0.40-0.91). Older participants were less likely to transition to the nonvalid wear state (HR, 0.53; 95% CI, 0.30-0.93). Device nonwear increased in the second half of the intervention (HR, 1.73; 95% CI, 1.07-2.81). CONCLUSIONS: Self-efficacy is an important predictor for clinically relevant physical activity change in overweight and obese individuals. Multistate modeling is useful for analyzing longitudinal physical activity data. IMPACT: Multistate modeling can be used for statistical inference of covariates and allow for explicit modeling of nonvalid wear.See all articles in this CEBP Focus section, "Modernizing Population Science."

Real-world impact of ongoing regular exercise in overweight and obese US adults with diabetes on health care utilization and expenses.

AIMS: To assess the effect of regular exercise on health care utilization patterns and expenses in a real-world national sample of overweight and obese US adults with diabetes. METHODS: Medical Expenditure Panel Survey data (2010-2015) identified adults with diabetes and a body mass index (kg/m2) ≥25. Two groups were created: exercise (moderate or vigorous physical activity >30min at least five times weekly) and non-exercise groups. OUTCOMES MEASURED: average total health care expenses (per-person per-annum) and the likelihood of hospitalization. RESULTS: Among 5140 overweight and obese adults with diabetes, 49.1% reported exercising at least five times weekly. The exercise group showed lower medical care and prescription drug utilization than the non-exercise group (p<0.001). Total unadjusted health expenses in the exercise group were $5651 lower than the non-exercise group (p<0.001). After controlling for socioeconomic and health-related variables, regular exercise reduced total health care expenses by 22.1% (p<0.001) and the likelihood of hospitalization by 28% (p=0.001). CONCLUSIONS: Reduced hospitalization and health care expenses were associated with regular exercise (≥30min at least five times weekly) in overweight and obese adults with diabetes.

Effects of different aerobic exercise programmes with nutritional intervention in sedentary adults with overweight/obesity and hypertension: EXERDIET-HTA study.

Background Both exercise training and diet are recommended to prevent and control hypertension and overweight/obesity. Purpose The purpose of this study was to determine the effectiveness of different 16-week aerobic exercise programmes with hypocaloric diet on blood pressure, body composition, cardiorespiratory fitness and pharmacological treatment. Methods Overweight/obese, sedentary participants ( n = 175, aged 54.0 ± 8.2 years) with hypertension were randomly assigned into an attention control group (physical activity recommendations) or one of three supervised exercise groups (2 days/week: high-volume with 45 minutes of moderate-intensity continuous training (MICT), high-volume and high-intensity interval training (HIIT), alternating high and moderate intensities, and low-volume HIIT (20 minutes)). All variables were assessed pre- and post-intervention. All participants received the same hypocaloric diet. Results Following the intervention, there was a significant reduction in blood pressure and body mass in all groups with no between-group differences for blood pressure. However, body mass was significantly less reduced in the attention control group compared with all exercise groups (attention control -6.6%, high-volume MICT -8.3%, high-volume HIIT -9.7%, low-volume HIIT -6.9%). HIIT groups had significantly higher cardiorespiratory fitness than high-volume MICT, but there were no significant between-HIIT differences (attention control 16.4%, high-volume MICT 23.6%, high-volume HIIT 36.7%, low-volume HIIT 30.5%). Medication was removed in 7.6% and reduced in 37.7% of the participants. Conclusions The combination of hypocaloric diet with supervised aerobic exercise 2 days/week offers an optimal non-pharmacological tool in the management of blood pressure, cardiorespiratory fitness and body composition in overweight/obese and sedentary individuals with hypertension. High-volume HIIT seems to be better for reducing body mass compared with low-volume HIIT. The exercise-induced improvement in cardiorespiratory fitness is intensity dependent with low-volume HIIT as a time-efficient method in this population. ClinicalTrials.gov Registration: NCT02283047.

Maintenance of Lost Weight and Long-Term Management of Obesity.

Weight loss can be achieved through a variety of modalities, but long-term maintenance of lost weight is much more challenging. Obesity interventions typically result in early weight loss followed by a weight plateau and progressive regain. This review describes current understanding of the biological, behavioral, and environmental factors driving this near-ubiquitous body weight trajectory and the implications for long-term weight management. Treatment of obesity requires ongoing clinical attention and weight maintenance-specific counseling to support sustainable healthful behaviors and positive weight regulation.

Utility of Social Cognitive Theory in Intervention Design for Promoting Physical Activity among African-American Women: A Qualitative Study.

OBJECTIVE: We examined the cultural relevance of Social Cognitive Theory (SCT) in the design of a physical activity intervention for African-American women. METHODS: A qualitative study design was used. Twenty-five African-American women (Mean age = 38.5 years, Mean BMI = 39.4 kg·m2) were enrolled in a series of focus groups (N = 9) to elucidate how 5 SCT constructs (ie, Behavioral Capability, Outcome Expectations, Self-efficacy, Self-regulation, Social Support) can be culturally tailored in the design of a physical activity program for African-American women. RESULTS: For the construct of Behavioral Capability, participants were generally unaware of the amount, intensity, and types of physical activity needed for health benefits. Outcome Expectations associated with physical activity included increased energy, improved health, weight loss, and positive role modeling behaviors. Constructs of Self-efficacy and Self-regulation were elicited through the women perceiving themselves as a primary barrier to physical activity. Participants endorsed the need of a strong social support component and identified a variety of acceptable sources to include in a physical activity program (ie, family, friends, other program participants). CONCLUSIONS: Findings explicate the utility of SCT as a behavioral change theoretical basis for tailoring physical activity programs to African-American women.

Stages of change in obesity and weight management: factorial structure of the Italian version of the University of Rhode Island Change Assessment Scale.

PURPOSE: To examine the factorial structure of the University of Rhode Island Change Assessment Scale (IT-URICA) for weight management in a sample of Italian overweight and obese patients enrolled in a nutritional rehabilitation program. METHODS: 334 inpatients completed the translated and adjusted version of the IT-URICA at admission to the hospital. Psychometric testing included confirmatory factor analysis and internal consistency (Cronbach's α). RESULTS: The IT-URICA for weight management was successfully translated into Italian, and the factorial analysis confirmed the four-factor solution of the commonly accepted version of the measure. CONCLUSION: High levels of RTC are considered critical to the long-term success of weight management, and the IT-URICA may be an appropriate measure of motivational readiness for use among Italian overweight and obese patients. Its use is, therefore, recommended for clinical and research purposes.

Design and validation of a low cost, high-capacity weighing device for wheelchair users and bariatrics.

Accessible high-capacity weighing scales are scarce in healthcare facilities, in part due to high device cost and weight. This shortage impairs weight monitoring and health maintenance for people with disabilities and/or morbid obesity. We conducted this study to design and validate a lighter, lower cost, high-capacity accessible weighing device. A prototype featuring 360 kg (800 lbs) of weight capacity, a wheelchair-accessible ramp, and wireless data transmission was fabricated. Forty-five participants (20 standing, 20 manual wheelchair users, and five power wheelchair users) were weighed using the prototype and a calibrated scale. Participants were surveyed to assess perception of each weighing device and the weighing procedure. Weight measurements between devices demonstrated a strong linear correlation (R2 = 0.997) with absolute differences of 1.4 ± 2.0% (mean±SD). Participant preference ratings showed no difference between devices. The prototype weighed 11 kg (38%) less than the next lightest high-capacity commercial device found by author survey. The prototype's estimated commercial price range, $500-$600, is approximately half the price of the least expensive commercial device found by author survey. Such low cost weighing devices may improve access to weighing instrumentation, which may in turn help eliminate current health disparities. Future work is needed to determine the feasibility of market transition.

Veterans Health Administration's MOVE! Weight Management Program: Primary Care Clinicians' Perceptions of Program Implementation.

The Veterans Health Administration's MOVE! Program is the largest health care-delivered weight loss intervention in the United States. As a referring clinician's perceptions and knowledge of health programs may impact implementation, examining perceptions of MOVE! may inform improvements to this and other programs. This study investigated primary care clinician perceptions of MOVE! (n = 754, 50% nurses). Perceived effectiveness ratings were highest for groups with 11 to 25 group members (p < 0.01) and for a combined lecture and support group format (p = 0.026), though session length and several other aspects of delivery were not associated with perceptions of effectiveness. MOVE! staff also rated the program as more effective than did other clinicians (p < 0.01). Many respondents lacked knowledge about program specifics, especially those not involved with MOVE! delivery (vs. those directly involved; p < 0.01). These findings indicate that variety in group size and format is related to perceptions of MOVE! effectiveness. Also, clinicians not involved with MOVE! may lack knowledge about the program and underestimate its effectiveness, which could negatively affect referral likelihood or enthusiasm expressed to referred patients. Findings highlight opportunities for clarifying perceptions of a weight control program among clinicians in a large health care system.

[Financial incentives on weight loss after rehabilitation]. / Finanzielle Anreize zur Gewichtsreduktion nach stationärer Rehabilitation.

INTRODUCTION: Increasing rates of obesity and associated diseases and their consequences make the implementation of preventive and counteracting measures necessary. The aim of this study was the examination of the long-term effects of financial incentives on weight loss in obese patients and the identification of influencing factors. METHODS: 700 obese patients were randomly assigned to one of three study conditions: For reaching a pre-defined target weight within 4 months they were rewarded with Euro 150, Euro 300 or not at all. The effect of the incentives on weight loss in different subgroups was compared. After 18 months, other possible influences on weight loss were analyzed by comparing responders and non-responders. RESULTS: Financial rewards led to significant weight loss in all subgroups, whereupon the height of the incentive only mattered in some. After 22 months, for several subgroups, the incentive's effect was still visible. Furthermore, responders showed more healthy behaviour, were better informed and reported more social support. CONCLUSION: Especially for patient groups who do not lose weight in orthodox treatments alone, financial incentives can be an effective supplement. In addition it became clear that this kind of reward programme can be implemented area-wide.

Unhealthy Body Weight, Illness Absence, Presenteeism, Medical Payments, and Disability Leave: A Longitudinal View.

The objective of this study is to examine how much of the relationships between unhealthy body weight, and health and productivity outcomes are attributable to health status, and how much can be ameliorated by weight loss or improvements in health. Cross-sectional and first-difference regressions were conducted of employees' body mass index (BMI) category, illness absences, presenteeism, medical spending, and disability leaves. Employees in the obese BMI category have significantly worse outcomes than employees in the healthy and overweight BMI categories. Controlling for physical and emotional health status mediates much of the observed relationships. Improved health, stress, and psychological distress are associated with reduced illness absence and presenteeism among overweight and obese employees. Obese employees who lost weight experienced reduced presenteeism. The findings suggest that overweight and obese employees can realize improved productivity without weight loss.

Feasibility of popular m-health technologies for activity tracking among individuals with serious mental illness.

Obesity prevalence is nearly double among individuals with serious mental illness (SMI), including schizophrenia spectrum disorders, bipolar disorder, or major depressive disorder, compared with the general population. Emerging mobile health (m-health) technologies are increasingly available and offer the potential to support lifestyle interventions targeting weight loss, yet the practical feasibility of using these technologies in this high-risk group has not been established. We evaluated the feasibility and acceptability of popular m-health technologies for activity tracking among overweight and obese individuals with SMI. We provided wearable activity monitoring devices (FitBit [San Francisco, CA] Zip™ or Nike Inc. [Beaverton, OR] FuelBand) and smartphones (Apple [Cupertino, CA] iPhone(®) 4S) for accessing the smartphone application for each device to participants with SMI enrolled in a weight loss program. Feasibility of these devices was measured by the frequency of use over time. Acceptability was measured through qualitative follow-up interviews with participants. Ten participants with SMI wore the devices for a mean of 89% (standard deviation=13%) of the days in the study. Five participants wore the devices 100% of the time. Participants reported high satisfaction, stating the devices were easy to use, helpful for setting goals, motivational, and useful for self-monitoring. Several participants liked the social connectivity feature of the devices where they could see each other's progress on the smartphone application, noting that "friendly" competition increased motivation to be more physically active. This study supports using popular m-health technologies for activity tracking among individuals with SMI. These findings can inform the design of weight loss interventions targeting this vulnerable patient population.

Bridging the gap between goal intentions and actions: a systematic review in patient populations.

PURPOSE: To evaluate the evidence for the effectiveness of if-then implementation intentions (if-then plans) in adult patient populations. Outcomes of interest included adherence, goal pursuit and physical health outcomes. METHODS: Keywords were used to search electronic databases without date or language restrictions (up to 30 April 2014). Studies were included if they (1) concerned a patient population; (2) used if-then plans as a sole intervention or as part of treatment, therapy or rehabilitation; (3) if they were randomised controlled trials. The PEDro scale was used to evaluate study quality. Guidance as set out by the Cochrane Collaboration was used. Two reviewers independently extracted data, discrepancies were discussed and if required referred to a third reviewer. RESULTS: In total, 18 of the 2141 articles were identified as potentially relevant and four studies of people with epilepsy, chronic back pain, stroke and obesity met the inclusion criteria. People who form if-then plans achieved better outcomes on epilepsy and stroke medication adherence and physical capacity than controls. CONCLUSIONS: Of the four studies that used an if-then plan, only one (people with epilepsy) looked at the intervention as a stand-alone strategy. Further research needs to explore if this simple approach improves rehabilitation outcomes and is a helpful and feasible strategy for people experiencing disabilities. Implications for Rehabilitation Steps involved in achieving goals, such as doing exercises or completing other goal related tasks, can be compromised for people with chronic health conditions particularly resulting from difficulties in self-regulating behaviour. If-then plans are implementation intention tools aimed at supporting people to deal more effectively with self-regulatory problems that might undermine goal striving and goal attainment, and have been found to be effective in health promotion and health behaviour change. This systematic literature review identified four studies completed with patient populations, with three demonstrating effectiveness. If-then plans provide an opportunity for clinicians to develop better ways of implementing rehabilitation.

Comparison of Veteran experiences of low-cost, home-based diet and exercise interventions.

Obesity is a significant health problem among Veterans who receive care from the Department of Veterans Affairs, as it is for so many other Americans. Veterans from Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) experience a myriad of chronic conditions, which can make it difficult to maintain a physically active lifestyle. This pilot study tested the feasibility and user satisfaction with three low-cost, home-based diet and exercise programs, as well as point-of-decision prompts among these Veterans. The three programs target mechanisms that have been shown to improve healthy behavior change, including (1) online mediated social support, (2) objective monitoring of physical activity, and (3) structured high-intensity workouts. This was a randomized crossover trial; each participant used two of the three programs, and all used the point-of-decision prompts. Our qualitative results identified five overall themes related to social support, objective monitoring, structured activity, awareness and understanding, and the point-of-decision prompts. In general, participants were satisfied with and lost weight with each of the interventions. This study demonstrated that these low-cost interventions could be successful with the OIF/OEF Veteran population. A larger and longer study is planned to further investigate the effectiveness of these interventions.

Metabolic rate monitoring and weight reduction/management.

Engineering research may provide tools to the individual as well as to the public in general, to effectively monitor wellness and health patterns, such as metabolic rate and weight control. Ketone bodies and acetone gas emissions in exhaled breath and skin, in particular, may be used as biomarkers of fatty acid metabolism and may be used in diet control. Two types of technologies, resistive chemosensors and chemomechanical actuators are outlined here as examples of such tools currently under development and of great promise.

Reganho de peso após o segundo ano do Bypass gástrico em Y de Roux / Regained weight after the second year of the gastric Bypass and Y ofRoux

Introdução: a obesidade é uma doença grave e inúmeros são os tratamentosrealizados para a perda e manutenção de peso. Tendo emvista a magnitude dessa doença, a cirurgia bariátrica é consideradaa ferramentamais eficaz no controle e no tratamento da obesidadesevera.Estudos mostram que a cura da obesidade não se resumeapenas ao ato cirúrgico, pelo contrário, é o início de um período deum a dois anos de mudanças que devem estar associadas às terapiasauxiliares como a reeducação alimentar, atividade física programadae mudança nos hábitos de vida.Objetivo: analisar na literatura os fatores interferentes no reganhode peso dos pacientes que se submeteram ao Bypass gástrico em Yde Roux após dois anos de cirurgia.Metodologia: trata-se de uma revisão da literatura de artigos científicosoriginais e de revisão, publicados em revistas indexadas nasbases de dados Lilacs, Medline (National Library of Medicine), Scieloe Pubmed, nos idiomas inglês e português, com ênfase nos últimosdez anos.Resultados: o bypass gástrico em Y de Roux é considerado uma cirurgiametabólica, pois além do efeito restritivo e disabsortivo ocorremtambém alterações neurais e hormonais, como a diminuiçãoda grelina e aumento do peptídeo-YY (PYY) e peptídeo glucagon--símile 1 (GLP-1) que contribuem para a diminuição do apetite conferindomaior eficiência a esse tipo de procedimento. A recuperaçãodo peso pode ocorrer devido a processos de adaptações fisiológicasno trato gastrointestinal. Os possíveis mecanismos envolvidos noreganho de peso são: aumento do consumo energético,... (AU)

Introduction: the obesity is a serious disease and there are manytreatments that offer loss weight as well as its maintenance. Owingto magnitude of this disease, the bariatric surgery is considered themost appropriate and effective treatment in the control of severeobesity. However, research show that cure obesity is not only a surgicalprocedure, but the beginning of a period between one and twoyears of changes, which must be associated with ancillary therapiessuch as nutritional education; starting a physical activity programand changes in daily habits.Objective: bibliographic analysis about the factors interfering inthe regain weight of patients that underwent to the gastric Bypassand Y of Roux, two years after surgery.Methodology: this paper brings a bibliographic review from readingof original scientific papers published in magazines indexedin databases - Lilacs, Medline (National Library of Medicine), Scieloe Pubmed in English and Portuguese languages, with emphasis inthe last ten years.Results: the gastric bypass in Y of Roux is considered a metabolicsurgery because beyond the restrictive and disabsorptive effect,also occur hormonal and neural changes such as decreased ghrelinand increased peptide-YY (PYY) and peptide glucagon-símile1 (GLP-1) - that contribute to decreased appetite, and resulting ina more efficient process in this type of procedure ...(AU)

In their own words: learning from families attending a multidisciplinary pediatric weight management program at the YMCA.

BACKGROUND: A family-based multidisciplinary weight management program for obese children 7-11 years old was implemented by a pediatric weight management center and local YMCA. The purpose of this study was to explore parents' and children's perceptions of the program to gain insight about factors that may enhance engagement and retention of families in weight management treatment. METHODS: Families were invited to participate in a telephone interview after their participation in the program. The interviews assessed satisfaction with program components, acceptability of the intervention, barriers to treatment participation, and suggestions for improvement. RESULTS: A total of 34 semistructured telephone interviews were performed, including 19 parents and 15 children. The majority of children (mean age=9.2±1.5 years) interviewed were female (74%) and recipients of Medicaid (79%). The population was racially diverse (63% black, 26% white, 11% other). Results suggest families were generally very positive about the program and viewed the major components of the program as helpful (i.e., nutrition, exercise, behavior). Families particularly enjoyed exercise and cooking demonstrations, whereas self-monitoring activities and learning about behavior change strategies were less enjoyable. Parents noted that increasing the length of individual sessions would likely be beneficial. Families who did not complete the program cited factors such as transportation barriers (e.g., gas money, distance), scheduling conflicts, and unmet expectations as contributing to their decision to discontinue participation. CONCLUSIONS: This study may have implications for how to enhance family-based pediatric weight management programs for children ages 7-11 years.

A community-based diabetes prevention program: evaluation of the group lifestyle balance program delivered by diabetes educators.

PURPOSE: With growing numbers of people at risk for diabetes and cardiovascular disease, diabetes educators report increasing referrals for intervention in prevention of these conditions. Diabetes educators have expertise in diabetes self-management education; however, they are generally not prepared for delivery of chronic disease primary prevention. The purpose of this project was to determine if individuals at risk for diabetes who participate in an intervention delivered by trained diabetes educators in existing diabetes self-management education community-based programs can reduce risk factors for diabetes and cardiovascular disease. METHODS: Diabetes educators in 3 outpatient-hospital programs (urban, suburban, and rural) received training and support for implementation of the Group Lifestyle Balance program, an adaptation of the Diabetes Prevention Program lifestyle intervention, from the Diabetes Prevention Support Center of the University of Pittsburgh. Adults with prediabetes and/or the metabolic syndrome were eligible to enroll in the program with physician referral. With use of existing diabetes educator networks, recruitment was completed via on-site physician in-services, informative letters, and e-mail contact as well as participant-directed newspaper advertisement. RESULTS: Eighty-one participants enrolled in the study (71 women, 10 men). Mean overall weight loss was 11.3 lb (5.1%, P < .001); in addition, significant decreases were noted in fasting plasma glucose, low-density lipoprotein cholesterol, triglycerides, and blood pressure. CONCLUSIONS: These results suggest that the Group Lifestyle Balance program delivered by diabetes educators was successful in reducing risk for diabetes and cardiovascular disease in high-risk individuals. Furthermore, diabetes educators, already integrated within the existing health care system, provide yet another resource for delivery of primary prevention programs in the community.

A randomized trial of a diet and exercise intervention for overweight and obese women from economically disadvantaged neighborhoods: Sisters Taking Action for Real Success (STARS).

BACKGROUND: Lower socioeconomic status at both the individual and neighborhood level is associated with increased health risks. Weight loss can reduce this risk, but few high quality weight-loss studies target this population. OBJECTIVES: STARS tests a culturally appropriate, group-based behavioral and social support intervention on body weight and waist circumference in women from financially disadvantaged neighborhoods. DESIGN: A stratified (by BMI) randomized trial. Randomization to group was generated by a random numbers table with allocation concealment by opaque envelopes. METHODS: Participants 25-50 years who had a BMI ≥ 25 kg/m(2) and a waist circumference ≥ 88 cm were recruited from 18 census tracts in Columbia, SC with high rates of poverty between November 2008 and November 2010. All participants received a dietary and exercise counseling session. Intervention participants then receive 16 theoretically-based and tailored weekly group sessions followed by 8 weeks of telephone maintenance counseling. Control participants receive 16 weekly health education mailings. Measurements correspond to baseline, post-group intervention, and post-telephone counseling, and for intervention participants, after a 12-week no-contact period. Measurement staff was blinded to group assignment. RESULTS: Participants (N=155; n=80 intervention, n=75 minimal intervention control) were primarily African American (86.5%) and averaged 38.9 years with a mean BMI of 40.1 kg/m(2) and waist circumference of 115.4 cm. Food insecurity was reported by 43% of participants. SUMMARY: STARS targets an underserved population with an innovative, tailored, and theoretically-grounded, group-based intervention followed by telephone maintenance. If effective, the approach has the potential to be feasible and cost-effective for community delivery.