Weight loss success in metabolic syndrome by telephone interventions: results from the SHINE Study

Abstract

Background: The Diabetes Prevention Program (DPP) intensive lifestyle intervention resulted in significant weight loss, reducing the development of diabetes, but needs to be adapted to primary care provider (PCP) practices.

Objectives: To compare a DPP-translation using individual (IC) vs. conference (CC) calls delivered by PCP staff for the outcome of percent weight loss over 2 years.

Design: Randomized clinical trial.

Setting: Five PCP sites.

Participants: Obese patients with metabolic syndrome, without diabetes (IC, n = 129; CC, n = 128).

Intervention: Telephone delivery of the DPP Lifestyle Balance intervention [16-session core curriculum in year 1, 12-session continued telephone contact in year 2 plus telephone coaching sessions (dietitians).

Main measures: Weight (kg), body mass index (BMI), and waist circumference.

Baseline data: age = 52 years, BMI = 39 kg/m(2), 75 % female, 85 % non-Hispanic White, 13 % non-Hispanic Black, and 48 % annual incomes <$40,000/year. In the intention-to-treat analyses at year 2, mean percent weight loss was -5.6 % (CC, p < 0.001) and -1.8 % (IC, p = 0.046) and was greater for CC than for IC (p = 0.016). At year 2, mean weight loss was 6.2 kg (CC) and 2.2 kg (IC) (p < 0.001). There was similar weight loss at year 1, but between year 1 and year 2 CC participants continued to lose while IC participants regained. At year 2, 52 % and 43 % (CC) and 29 % and 22 % (IC) of participants lost at least 5 % and 7 % of initial weight. BMI also decreased more for CC than IC (-2.1 kg/m(2) vs. -0.8 kg/m(2) p < 0.001). Waist circumference decreased by 3.1 cm (CC) and 2.4 cm (IC) at year 2. Completers (≥9 of 16 sessions; mean 13.3 sessions) lost significantly more weight than non-completers (mean 4.3 sessions).

Conclusions: PCP staff delivery of the DPP lifestyle intervention by telephone can be effective in achieving weight loss in obese people with metabolic syndrome. Greater weight loss may be attained with a group telephone intervention.

Figures

Figure 1.

CONSORT flow diagram.

Figure 2.

Mean percent weight change (a), weight (b), body mass index (c) and waist circumference (d) at baseline, 6, 12 and 24 months for participants in the Individual Call (IC) and Conference Call (CC) interventions. Vertical lines indicate 95 % confidence intervals.

Figure 3.

Mean weight (a), body mass index (b) and waist circumference (c) at baseline, 6, 12 and 24 months for Completers and Non-completers. Vertical lines indicate 95 % confidence intervals.