Can Behavioral Obesity Treatment Outcomes be Enhanced with a “Booster” Model?

1. Jennifer Pells, Ph.D. Clinical Director, Structure House Durham, NC Can Behavioral Obesity Treatment Outcomes be Enhanced with a “Booster” Model?

2. Objectives • Brief review of lifestyle-based (behavioral) weight maintenance • Describe intervention evaluated in this study (Structure House program) • Present preliminary results related to maintenance visits • Discussion and future directions • Consider new ways of thinking about weight loss maintenance and ongoing treatment

3. Challenges of Weight Maintenance • Sustaining necessary behavioral changes (eating and physical activity), including self-monitoring • Metabolic adaptations to weight reduction that promote regain • Managing ‘obesogenic’ environment

4. Typical Outcomes • Most adults completing a standard behavioral weight management program will lose 5-10% of initial body weight • Most will regain ~1/3 of their lost weight within the first year after treatment and return to baseline weight within 3-5 years • Those who are successful at maintaining initial weight loss utilize a variety of strategies to limit dietary intake and increase physical activity • Those who maintain for 2-5 years have greatly increased likelihood of ongoing, long-term maintenance

5. Example of Treatment Trial with Maintenance Program

6. Aims of Current Study • Conduct preliminary analysis of self-initiated maintenance treatment (“return visits”) following initial residentially-based weight loss treatment • Describe pattern of return visits and associations between return visits and weight loss • Compare weight loss for individuals who completed return visits vs. no return visits

7. Intervention • Residentially-based • Multidisciplinary • Behavioral/Cognitive-Behavioral • Chronic disease/Lifelong • Empirically-supported nutritional, fitness, & behavioral components • Self-referred & self-pay • 28-day average initial LOS

8. Typical 4-week Results: Initial Treatment • Weight/BMI Males: 5.9% body wt reduction (average 19 lbs) Females: 5.1% body wt reduction (average 13 lbs) • Medical Triglycerides: 153 to 123 Total Cholesterol: 184 to 152 (LDL: 105 to 83) Blood Pressure: 117/75 to 111/72 • Psychosocial Improved Mood (Beck Depression Inventory; 0-63) : 17 to 5 Quality of Life (0-100) : 54 to 70

9. Treatment Sample • 981 cases analyzed from 2008-2013 • 70% female, 30% male; 95% Caucasian • Average age = 50 yrs • Average BMI = 42 (27-80) • 274 had >1 return visit; 707 had 0 return visits • Outcomes evaluated at time of return visit or standardized 12- and 24-month follow-up

10. Maintenance Intervention: Return Visits • Re-attend classes and groups • Participate in return-oriented clinical activities • Individualize treatment based on specific needs

11. Return Visit Patterns

12. No correlation between # of return visits and last-collected weight (r = .11) Greater weight reduction when first return visit occurred within 12 months of initial treatment Return Visits & Weight Loss

13. Return Visits & Weight Loss

14. Results: Comparison of Return vs. No Return

15. Results: Comparison of Return vs. No Return

16. Summary • Additional treatment, in the form of “booster” sessions (return visits), can enhance weight loss following a residential obesity program • The majority of initial participants, however, did not return to treatment; thus, alternative effective maintenance interventions are likely needed • Longer-term outcomes in this study are consistent with previous studies: maintenance treatment can delay regain but we do not yet have adequate interventions to sustain weight loss/prevent regain • However, intensive initial treatment and critically-timed additional treatment offers promise

17. jpells@structurehouse.com www.structurehouse.com Questions?