The challenges of supporting activities and behaviors to address obesity by people in their daily lives are explored in 2 studies and an editorial.
An 18-month program of weight loss and exercise in 823 patients with overweight or obesity and knee osteoarthritis “led to a small difference in knee pain of uncertain clinical importance,” a study shows. An attention control group that received social interaction and evidence-based nutrition and health education during in-person meetings produced a weight loss of 1.7 kg at 18 months, significantly less than the loss of 7.7 kg observed with a diet and exercise intervention. Knee pain was improved, with a difference of 0.5 on the 0 to 20 Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) knee pain instrument. Participants in the diet and exercise group had more bodily injuries, muscle strains, and trips/falls than those in the attention-control group.
In the D-ELITE randomized clinical trial of 511 adult participants with obesity, “a remotely delivered, self-directed behavioral lifestyle intervention, compared with usual care, resulted in a statistically significant difference in weight loss that was not clinically important and no significant difference in general physical health status at 12 months,” researchers report. All participants received usual care; those “randomized to the intervention received Diabetes Prevention Program–based self-directed videos, handouts, and coaching messages via an online platform or US mail for 12 months,” the authors write. “The unadjusted mean weight at 12 months declined from 102.7 kg to 99.8 kg in the intervention group compared with 101.9 kg to 101.0 kg in the control group (adjusted between-group mean difference, −1.93 [97.5% CI, −3.24 to −0.61]; P = .001).… Cardiovascular events represented the highest percentage of serious adverse events, accounting for 25% of events in the intervention group and 35% in the control group.”
Editorial: “These studies raise the question of whether it is possible to design an intervention that is just right: not too weak or too strong to be applicable in future pragmatic studies,” writes an editorialist. “To answer this question, it will be necessary to determine what components are needed to make a lifestyle intervention highly effective without raising the cost of delivering the program. The use of the Multiphase Optimization Strategy (MOST) design, which allows investigators to study several different strategies simultaneously, might be a good way to determine which components of the intervention are required to increase weight losses and hopefully thereby improve clinical outcomes.”