Getting personal helps modify behavior
Three RCTs compared clinic-based, Web-based, and self-directed advice and counseling to prevent weight gain (2 studies) and maintain weight loss (1 study). In the first study, 67 patients were assigned to 4 months of clinic-based or home-based counseling to increase exercise and reduce fat intake, or to a control group.8 Weight change was–1.9 kg in the clinic-based group,–1.3 kg in the home-based group, and +0.22 kg in the control group (P=.007).
In the second study, 1032 overweight or obese adults with hypertension and/or dyslipidemia who completed a weight-loss program were randomly assigned to receive monthly personal contact, unlimited access to a Web-based intervention, or a self-directed control group.9 At 30 months, participants in the personal contact group had regained less weight than the Web-based or control groups (4.0, 5.1, and 5.5 kg, respectively; P<.01).
A third RCT randomized 284 healthy 25- to 44-year-old women with BMI <30 kg/m2 to group meetings, lessons by mail, or a control group that received an information booklet. The study found no significant difference among the 3 groups in weight maintenance at a 3-year follow-up; 40% maintained weight, and 60% gained more than 2 pounds.10
Recommendations
Wide consensus supports screening by either BMI or height and weight. The US Preventive Services Task Force (USPSTF) recommends intensive counseling for everyone with a BMI ≥30 kg/m2 coupled with behavioral modification to promote sustained weight loss.11 The USPSTF found insufficient evidence to support less intensive counseling for obese patients or counseling of any intensity for overweight patients.
The Canadian Task Force on Preventive Health Care found insufficient evidence to recommend for or against BMI measurement during routine health evaluations of the general population.12
The American Diabetes Association13 and the American College of Preventive Medicine14 recommend counseling and behavior modification for all adults to prevent obesity.