Behavioral Strategies for Weight Loss May Have Lasting, Accumulating Benefits

NEW ORLEANS — Behavioral strategies for success in weight management need to provide accountability and enhance motivation in order to be successful, according to nutrition expert Catherine Champagne, PhD, RDN, LDN. 

She has been studying what interventions work and do not work in terms of weight loss in patients with diabetes and found that patients may benefit once they are taught new problem solving skills.

Successful strategies should include an orderly method for coping with barriers or problems and encouraging self-monitoring, according to Champagne, who spoke on this topic at AADE 2015, the annual meeting of the American Association of Diabetes Educators. With new apps, she said, weekly weighing and food monitoring is just a click away, which can be highly beneficial.

She also noted that using motivational techniques and cultivating social support are vital. In addition, utilizing motivational interviewing when relapse signals seem to be emerging, teaching maintenance skills and providing relapse prevention training have all been shown to be successful strategies.

“The most important message is that the dietitian is an essential member of the diabetes management team, and while the endocrinologist is likely on board with us, not all dietitians are well versed in the behavioral skills necessary to enable changes that patients need to achieve weight loss and weight management,” said Champagne, who is professor and chief of dietary assessment and nutrition counseling at Pennington Biomedical Research Center in Baton Rouge, Louisiana.

“To be more effective, dietitians may need extra training in behavioral skills and techniques. A number of trainings in motivational interviewing and other behavioral techniques are available, and endocrinologists should consider sending their dietitians to these in order to enhance skills needed for effective counseling.”

Champagne said obesity and type 2 diabetes are common and incidence rates are increasing rapidly. Both are associated with increased morbidity and mortality, she noted, yet limited data exist on long-term effects of intentional weight loss achieved through lifestyle changes.

The goal of the Look AHEAD study was to determine the long-term (up to 13.5 years) effects of an intensive lifestyle intervention program designed to produce weight loss and increase physical activity on cardiovascular (CV) morbidity and mortality in overweight or obese patients with type 2 diabetes.

The randomized, controlled, multicenter trial compared an intensive lifestyle intervention with diabetes support and education at 16 clinical sites in the United States. Study endpoints included CV death, fatal myocardial infarction (MI) and stroke, nonfatal MI, nonfatal stroke and hospitalization for angina.

“Look AHEAD produced a mean weight loss of 7.9% at 1 year and 2.5% at 10 years. It also produced substantial differences in physical fitness,” said Champagne.

She noted that the study also showed a reduction in medical care use and costs across a spectrum of disease areas thanks to intensive lifestyle intervention. The cost-savings appeared to accumulate gradually throughout 10 years and appeared to persist and expand over time as the participants aged. 

Although the cost savings were reasonably similar across broad subgroups of participants, the study did not meet the CVD endpoints, Champagne said. Look AHEAD found that intensive lifestyle intervention did not reduce the risk for CV morbidity and mortality compared with a control program of diabetes education and support in overweight and obese participants with type 2 diabetes.¹

“While we may not necessarily see, as in the Look AHEAD trial, that the endpoint of cardiac mortality was different between the groups, we certainly saw improvements in lifestyle and a better quality of life. However, in most research studies that I have been involved in, there were indeed changes related to improved care and outcomes, such as was seen in terms of weight loss and reduction of blood pressure in the DASH trials,” Champagne told Endocrinology Advisor.

Other studies, including the multicenter PREMIER and Weight loss Maintenance trials, both implemented the DASH diet to determine if it yielded any weight loss and CV benefits. 

The DASH diet (Dietary Approaches to Stop Hypertension) includes seven to eight servings of grain and grain products a day, four to five servings of vegetables daily, four to five servings of fruits a day and controlled sodium intake. It also includes two to three servings daily of low-fat or nonfat dairy foods, two or less servings daily of meats, poultry and fish and four to five servings daily of nuts, seeds and legumes.

The researchers found that an intensive lifestyle intervention to reduce weight produced many short-term and long-term benefits.² She said currently, there is extensive evidence suggesting that weight loss can be achieved over the short term. However, weight regain is extremely common. 

Champagne said there is an urgent need for research into the optimal ways to sustaining weight loss, including a team of dietitians trained in behavior change techniques.

References

1. The Look AHEAD Research group. N Engl J Med. 2013;369:145-154.
2. Elmer PJ et al. Ann Intern Med. 2006;144(7):485-495.
3. Champagne C. F22 – Weight Loss and Lifestyle Modification: Predictors of Success in the Look AHEAD and DASH Intervention Studies. Presented at: AADE 2015; Aug. 5-8, 2015; New Orleans.