A “stepped care” weight-loss program that escalates in intensity as needed may provide a way to help patients achieve clinically important weight loss while using fewer resources than standard costly intensive programs, according to new findings presented earlier this week at the Obesity Society’s annual meeting, in Orlando, Fla.
Intensive programs to treat obesity can result in sustained weight loss of 8% to 10% of body weight. These efforts typically require weekly contact with clinicians, interactions that are tapered off after the initial 6 months. Unfortunately, this tapering is usually associated with weight regain.
Thus intensive weight-loss programs, which are expensive, are not necessarily effective in the long run. Seeking an alternative and potentially more realistic approach to inducing weight loss, John M. Jakicic, PhD, and colleagues from the University of Pittsburgh and the University of North Carolina at Chapel Hill adopted and studied a stepped approach that starts with a low-intensity intervention and then progressively escalates treatment intensity only for those patients who do not respond to less aggressive measures.
In their study, the researchers compared 2 approaches, a stepped intervention and a standard intensive treatment. The stepped intervention involved providing patients each month with in-person weight-loss counseling about lifestyle changes aimed at shedding pounds, and then assessing weight loss at 3-month intervals. At each 3-month assessment, if the patients were not achieving their weight-loss goal, the intervention was intensified by additional counseling sessions. Patients who received the standard intensive treatment had weekly weight-loss counseling sessions for the first 3 months of the study, followed by biweekly visits that transitioned to monthly visits thereafter.
After 18 months, both groups achieved the same weight loss: 8% of total body weight. An impressive 40% of patients in these groups who completed the entire study experienced weight loss of more than 10% of total body weight.
This study shows that clinically important weight loss can be achieved using fewer resources compared with standard costly intensive interventions. “There is a need for more cost-effective and feasible weight-loss interventions that can be implemented within traditional health care settings,” said Jakicic. “A stepped care approach appears to be one of the promising and effective approaches that should be considered.”