JMIR Publications

ABSTRACT

Background:

Extended intervention contact after an initial, intensive intervention is becoming accepted as best practice in behavioral weight control interventions. What is not clear is whether extended contact mitigates weight regain in the longer-term, or whether it simply delays weight regain until after the extended intervention contact ceases.

Objective:

To evaluate maintenance following the Get Healthy, Stay Healthy (GHSH) extended contact intervention, by comparing: the intervention and control group averages at 12 months (the traditional comparison of maintained intervention effects); the intervention and control group averages over the first six months of non-contact (a novel approach which directly compares the relapse effects between groups over the same duration of time); and, the individual participant changes over the first six months of non-contact (to explore the extent to which the group average is reflective of directions of changes for individuals).

Methods:

Clients completing the Get Healthy Service (GHS) lifestyle telephone coaching program were randomised to receive extended contact via tailored text messages (GHSH, n=114) or standard care (no additional contact, n=114) and were assessed at baseline (following completion of GHS), six months (following completion of GHSH) and 12 months (no-contact maintenance follow-up). At all three assessments participants self-reported their body weight, waist circumference, physical activity (walking, moderate and vigorous sessions/week) and dietary behaviors (fruit and vegetable serves/day, cups of sweetened drinks per day, takeaway meals per week; Fat, Fiber and Total indices from the Fat and Fiber Behavior Questionnaire). Moderate-vigorous physical activity (MVPA) was also assessed via accelerometry.

Results:

Retention over the 12-month trial was high (93%, 211/228). Participants had a mean (±standard deviation) age of 53.4±12.3 years and baseline BMI of 29.2±5.9 kg/m2. The between-group differences detected at 6 months were still present and statistically significant at 12 months for body weight (-1.33kg (-2.61, -0.05)) and accelerometer-assessed MVPA (24.9 minutes/week (5.8, 44.0)). None of the other outcomes were significantly favoured compared to the control group at 12 months. Changes over their first six months of non-contact for the GHSH group were significantly better than the control group in terms of accelerometer-measured MVPA and self-reported moderate activity (other differences between the groups were all non-significant). In addition to the maintenance seen in the group averages, most intervention participants had maintained their behavioral outcomes during the first six months of non-contact.

Conclusions:

The GHSH participants were better off relative to where they were initially, and relative to their counterparts not receiving extended contact in terms of MVPA. However, based on the between group difference in bodyweight over the first six months of non-contact, GHSH does appear to simply delay the ‘inevitable’ weight regain. However, this delay in weight regain, coupled with sustained improvements in MVPA, has public health benefit.