The Tracking Study: description of a randomized controlled trial of variations on weight tracking frequency in a behavioral weight loss program.

BACKGROUND: Observational evidence from behavioral weight control trials and community studies suggests that greater frequency of weighing oneself, or tracking weight, is associated with better weight outcomes. Conversely, it has also been suggested that frequent weight tracking may have a negative impact on mental health and outcomes during weight loss, but there are minimal experimental data that address this concern in the context of an active weight loss program. To achieve the long-term goal of strengthening behavioral weight loss programs, the purpose of this randomized controlled trial (the Tracking Study) is to test variations on frequency of self-weighing during a behavioral weight loss program, and to examine psychosocial and mental health correlates of weight tracking and weight loss outcomes. This paper describes the study design, intervention features, recruitment, and baseline characteristics of participants enrolled in the Tracking Study. METHODS/DESIGN: Three hundred thirty-nine overweight and obese adults were recruited and randomized to one of three variations on weight tracking frequency during a 12-month weight loss program with a 12-month follow-up: daily weight tracking, weekly weight tracking, or no weight tracking. The primary outcome is weight in kilograms at 24 months. The weight loss program integrates each weight tracking instruction with standard behavioral weight loss techniques (goal setting, self-monitoring, stimulus control, dietary and physical activity enhancements, lifestyle modifications); participants in weight tracking conditions were provided with wireless Internet technology (wi-fi-enabled digital scales and touchscreen personal devices) to facilitate weight tracking during the study. CONCLUSION: This study was successful in recruiting adult male and female participants and is positioned to enhance the standard of care with regard to weight tracking recommendations.

Weight loss, glycemic control, and cardiovascular disease risk factors in response to differential diet composition in a weight loss program in type 2 diabetes: a randomized controlled trial.

OBJECTIVE: To test whether a weight loss program promotes greater weight loss, glycemic control, and improved cardiovascular disease risk factors compared with control conditions and whether there is a differential response to higher versus lower carbohydrate intake. RESEARCH DESIGN AND METHODS: This randomized controlled trial at two university medical centers enrolled 227 overweight or obese adults with type 2 diabetes and assigned them to parallel in-person diet and exercise counseling, with prepackaged foods in a planned menu during the initial phase, or to usual care (UC; two weight loss counseling sessions and monthly contacts). RESULTS: Relative weight loss was 7.4% (95% CI 5.7-9.2%), 9.0% (7.1-10.9%), and 2.5% (1.3-3.8%) for the lower fat, lower carbohydrate, and UC groups (P < 0.001 intervention effect). Glycemic control markers and triglyceride levels were lower in the intervention groups compared with UC group at 1 year (fasting glucose 141 [95% CI 133-149] vs. 159 [144-174] mg/dL, P = 0.023; hemoglobin A1c 6.9% [6.6-7.1%] vs. 7.5% [7.1-7.9%] or 52 [49-54] vs. 58 [54-63] mmol/mol, P = 0.001; triglycerides 148 [134-163] vs. 204 [173-234] mg/dL, P < 0.001). The lower versus higher carbohydrate groups maintained lower hemoglobin A1c (6.6% [95% CI 6.3-6.8%] vs. 7.2% [6.8-7.5%] or 49 [45-51] vs. 55 [51-58] mmol/mol) at 1 year (P = 0.008). CONCLUSIONS: The weight loss program resulted in greater weight loss and improved glycemic control in type 2 diabetes.

Recruitment to mail and telephone interventions for obesity in a managed care environment: the Weigh-To-Be project.

OBJECTIVE: To evaluate the success of mail- and telephone-based weight loss programs in recruiting a representative sample of overweight members of a managed care organization (MCO). STUDY DESIGN: Cross-sectional. PATIENTS AND METHODS: A total of 1801 members of an MCO were recruited by direct mail, clinic flier, and physician referral for a research study evaluating mail- and telephone-based weight loss programs; 412 additional overweight members of the same MCO were identified in a general member survey for comparison purposes. Body mass index, demographics, diet, and exercise habits were measured. RESULTS: Study volunteers were heavier, more likely to be women, more likely to be minorities, more educated, and younger than the general sample of overweight members. They also had a more extensive history of dieting, ate a diet higher in fat and lower in fruit and vegetables, and were more likely to report binge eating than the general sample. However, study volunteers reported a higher level of physical activity. CONCLUSIONS: Invitations to participate in weight loss programs can attract large numbers of people in a managed care setting. However, the participation bias in recruitment to such programs is similar to that seen in traditional face-to-face interventions. Women of higher socioeconomic status who are severely obese and who have an extensive history of weight control efforts are more likely to participate. Additional research is needed to find ways to reach more men and older adults.

The SUCCESS project: the effect of program format and incentives on participation and cessation in worksite smoking cessation programs.

OBJECTIVES: This study examined the effect of program format and incentives on participation and cessation in worksite smoking cessation programs. METHODS: Twenty-four worksites were randomized to 6 conditions that differed in cessation program format and the use of incentives. Programs were offered for 18 months in each worksite. A total of 2402 cigarette smokers identified at baseline were surveyed 12 and 24 months later to assess participation in programs and cessation. RESULTS: A total of 407 (16.9%) of the smoker cohort registered for programs; on the 12- and 24-month surveys, 15.4% and 19.4% of the cohort, respectively, reported that they had not smoked in the previous 7 days. Registration for programs in incentive sites was almost double that of no-incentive sites (22.4% vs 11.9%), but increased registration did not translate into significantly greater cessation rates. Program type did not affect registration or cessation rates. CONCLUSIONS: Although incentives increase rates of registration in worksite smoking cessation programs, they do not appear to increase cessation rates. Phone counseling seems to be at least as effective as group programs for promoting smoking cessation in worksites.