A Randomized Controlled Trial of a Weight Loss Maintenance Program in Adults with Obesity: the WLM3P Study

Overview

Journal Eur J Clin Nutr

Specialty Nutritional Sciences

Date 2024 Jun 6

PMID 38844671

Authors

Vanessa Pereira

Ines Barreiros-Mota

Filipa Cortez

Ines Castela

Diana Teixeira

Conceicao Calhau

Claudia Camila Dias

Andre Moreira-Rosario

Marta P Silvestre

Affiliations

Soon will be listed here.

Abstract

Background/objectives: The escalating obesity epidemic necessitates effective, sustainable weight loss (WL) and maintenance strategies. This study aimed to evaluate the effectiveness of the Weight Loss Maintenance 3 Phases Program (WLM3P) in achieving a clinically significant long-term weight loss (WL) (≥5% initial WL at 18 months) in adults with obesity compared to a standard low-carbohydrate diet (LCD).

Subjects/methods: In this two-phase trial, 112 participants targeting initial WL (0-6 months) and subsequent maintenance (7-18 months) were randomly assigned to either WLM3P or LCD groups. Outcomes assessed included change in body weight (kg, %), improvements in body composition, and metabolic profile.

Results: Of 112 randomized participants, 69% (n = 77) completed the study. At 18 months, WL in the WLM3P group (n = 40) was 15.5 ± 8.3% compared to 9.6 ± 8.5% in the LCD group (n = 37) (p < 0.001). The odds ratio of achieving WL ≥ 10% and ≥15% were significantly higher in the WLM3P group. Complete-case analysis revealed significantly greater improvements in BMI, body fat mass, visceral fat area, waist circumference, waist-to-hip ratio, HDL, and triglyceride/HDL ratio in WLM3P than in LCD. No serious adverse events were reported.

Conclusion: Both programs effectively promoted clinically relevant WL and its maintenance. However, the WLM3P program was more successful in helping participants achieve greater WL targets of ≥10% and ≥15%, along with other clinical benefits, after an 18-month intervention.

Trial Registration Number: NCT04192357.

References

Fruhbeck G, Busetto L, Dicker D, Yumuk V, Goossens G, Hebebrand J . The ABCD of Obesity: An EASO Position Statement on a Diagnostic Term with Clinical and Scientific Implications. Obes Facts. 2019; 12(2):131-136. PMC: 6547280. DOI: 10.1159/000497124. View

Durrer Schutz D, Busetto L, Dicker D, Farpour-Lambert N, Pryke R, Toplak H . European Practical and Patient-Centred Guidelines for Adult Obesity Management in Primary Care. Obes Facts. 2019; 12(1):40-66. PMC: 6465693. DOI: 10.1159/000496183. View

Lv N, Azar K, Goldman Rosas L, Wulfovich S, Xiao L, Ma J . Behavioral lifestyle interventions for moderate and severe obesity: A systematic review. Prev Med. 2017; 100:180-193. PMC: 5503454. DOI: 10.1016/j.ypmed.2017.04.022. View

Sun J, Tan Z, He C, Hu H, Zhai C, Qian G . Time-restricted eating with calorie restriction on weight loss and cardiometabolic risk: a systematic review and meta-analysis. Eur J Clin Nutr. 2023; 77(11):1014-1025. PMC: 10630127. DOI: 10.1038/s41430-023-01311-w. View

Konstantinidi M, Koutelidakis A . Functional Foods and Bioactive Compounds: A Review of Its Possible Role on Weight Management and Obesity's Metabolic Consequences. Medicines (Basel). 2019; 6(3). PMC: 6789755. DOI: 10.3390/medicines6030094. View

Kupila S, Joki A, Suojanen L, Pietilainen K . The Effectiveness of eHealth Interventions for Weight Loss and Weight Loss Maintenance in Adults with Overweight or Obesity: A Systematic Review of Systematic Reviews. Curr Obes Rep. 2023; 12(3):371-394. PMC: 10482795. DOI: 10.1007/s13679-023-00515-2. View

Clifton P, Condo D, Keogh J . Long term weight maintenance after advice to consume low carbohydrate, higher protein diets--a systematic review and meta analysis. Nutr Metab Cardiovasc Dis. 2014; 24(3):224-35. DOI: 10.1016/j.numecd.2013.11.006. View

Magkos F . Protein-Rich Diets for Weight Loss Maintenance. Curr Obes Rep. 2020; 9(3):213-218. DOI: 10.1007/s13679-020-00391-0. View

Moon J, Koh G . Clinical Evidence and Mechanisms of High-Protein Diet-Induced Weight Loss. J Obes Metab Syndr. 2020; 29(3):166-173. PMC: 7539343. DOI: 10.7570/jomes20028. View

10.

Craig C, Marshall A, Sjostrom M, Bauman A, Booth M, Ainsworth B . International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003; 35(8):1381-95. DOI: 10.1249/01.MSS.0000078924.61453.FB. View

11.

Acharya S, Elci O, Sereika S, Music E, Styn M, Turk M . Adherence to a behavioral weight loss treatment program enhances weight loss and improvements in biomarkers. Patient Prefer Adherence. 2009; 3:151-60. PMC: 2778406. DOI: 10.2147/ppa.s5802. View

12.

Nelson M, Atkinson M, Darbyshire S . Food photography II: use of food photographs for estimating portion size and the nutrient content of meals. Br J Nutr. 1996; 76(1):31-49. DOI: 10.1079/bjn19960007. View

13.

Horn D, Almandoz J, Look M . What is clinically relevant weight loss for your patients and how can it be achieved? A narrative review. Postgrad Med. 2022; 134(4):359-375. DOI: 10.1080/00325481.2022.2051366. View

14.

Li G, Rios R, Wang X, Yu Y, Zheng K, Huang O . Sex influences the association between appendicular skeletal muscle mass to visceral fat area ratio and non-alcoholic steatohepatitis in patients with biopsy-proven non-alcoholic fatty liver disease. Br J Nutr. 2021; 127(11):1613-1620. DOI: 10.1017/S0007114521002415. View

15.

Liu D, Zhong J, Wen W, Ruan Y, Zhang Z, Sun J . Relationship Between Skeletal Muscle Mass to Visceral Fat Area Ratio and Cardiovascular Risk in Type 2 Diabetes. Diabetes Metab Syndr Obes. 2021; 14:3733-3742. PMC: 8403572. DOI: 10.2147/DMSO.S326195. View

16.

Raynor H, Looney S, Anderson Steeves E, Spence M, Gorin A . The effects of an energy density prescription on diet quality and weight loss: a pilot randomized controlled trial. J Acad Nutr Diet. 2012; 112(9):1397-1402. DOI: 10.1016/j.jand.2012.02.020. View

17.

Lemstra M, Bird Y, Nwankwo C, Rogers M, Moraros J . Weight loss intervention adherence and factors promoting adherence: a meta-analysis. Patient Prefer Adherence. 2016; 10:1547-59. PMC: 4990387. DOI: 10.2147/PPA.S103649. View

18.

Hirshkowitz M, Whiton K, Albert S, Alessi C, Bruni O, DonCarlos L . National Sleep Foundation's updated sleep duration recommendations: final report. Sleep Health. 2017; 1(4):233-243. DOI: 10.1016/j.sleh.2015.10.004. View

19.

Gudzune K, Doshi R, Mehta A, Chaudhry Z, Jacobs D, Vakil R . Efficacy of commercial weight-loss programs: an updated systematic review. Ann Intern Med. 2015; 162(7):501-12. PMC: 4446719. DOI: 10.7326/M14-2238. View

20.

Carneiro D, Freire R, Honorio T, Zoghaib I, Cardoso F, Tresvenzol L . Randomized, Double-Blind Clinical Trial to Assess the Acute Diuretic Effect of Equisetum arvense (Field Horsetail) in Healthy Volunteers. Evid Based Complement Alternat Med. 2014; 2014:760683. PMC: 3960516. DOI: 10.1155/2014/760683. View