Weight loss maintenance following an augmented intervention for early slow weight loss responders: An adaptive trial.

ABSTRACT

Early slow weight loss during treatment is associated with less weight loss overall. The impact of an augmented intervention designed for early slow weight loss responders compared with a standard diabetes prevention intervention was evaluated following 12 months of treatment and 6 months of no contact. The impact of standard vs. augmented intervention sequences on weight and glycemia also was determined. Adults were ≥21 years old with overweight or obesity and prediabetes (n = 174). Slow responders were stratified to augmented treatment if they failed to achieve >2.5% weight loss (%WL) at Week 5. Matched within-sex pairs of participants were created based on %WL at Month 5 following the intensive intervention phase, and each person within the pair was randomly assigned to treatment for Months 5-12 during the extended intervention phase. Both 12-month interventions included a ≥7%WL goal. Mean 12-month %WL was 5.29% (95% CI 4.27%-6.31%; P < .0001) and 18-month %WL was 3.34% (95% CI 2.01%-4.66%; P < .0001) overall. %WL was greater for the standard (9.55%) than the augmented (4.0%) intervention (P = .0001); no differences occurred in weight regain between early and slow responders (P = .9476). No differences occurred in mean %WL at 12 months between the standard and augmented groups after controlling for %WL at Week 5 and sex (P = .23) nor in the change in glycemia (all P > .05). WL following the first month of treatment predicted 12- and 18-month WL success regardless of intervention sequence; however, even early slow responders achieved significant WL during treatment. Further research is needed to support effective WL maintenance for people with prediabetes.

Weight loss is a primary strategy for risk reduction in adults with prediabetes, and early weight loss may indicate weight loss success long-term. Early slow weight loss responders during behavioral treatment may benefit from alternate treatment compared with remaining in a standard diabetes prevention program. An intervention augmented with training in goal setting and problem-solving was implemented among slow weight loss responders following the first month of treatment in the current study. The change in percent weight loss observed in the augmented intervention compared with the standard diabetes prevention intervention was determined at 12 and 18 months from baseline. Both the standard and augmented interventions facilitated significant weight loss at 12 months. Participants who lost more than 2.5% of their weight during the first month of treatment (early responders) lost more weight overall during the study compared with people who were slower to respond. Percent weight loss following the first month of lifestyle intervention and sex predicted percent weight loss at 12 months. Participants regained some weight at 18 months regardless of the treatment group but weighed less than their baseline weight. Both early and slow weight loss responders may benefit from ongoing support following 12 months of treatment to achieve weight loss maintenance.