Effective long-term treatment of obesity: a continuing care model

BACKGROUND: Despite the well-documented success of behavioral techniques in producing temporary weight loss, treatment is typically followed by weight regain. The maintenance of treatment effects may therefore be the greatest challenge in the long-term management of obesity, and continuous care may be necessary to achieve it. OBJECTIVE: To describe the design and evaluate the effectiveness of the Trevose Behavior Modification Program, a potentially widely replicable self-help weight loss program offering continuous care. DESIGN: A description of the course of all subjects (n = 171) who entered the Trevose program during 1992 and 1993. SUBJECTS: One hundred and forty-six women aged 44.1 +/- 11.7 y with a body mass index (BMI, kg/m(2)) of 33.2 +/- 4.4, and 25 men aged 49.0 +/- 19.6 with a BMI of 35.1 +/- 5.2 enrolled in the Trevose program during 1992-1993. RESULTS: Mean duration of treatment was 27.1 months, with 47.4% of members still in treatment at 2 y and 21.6% at 5 y. Mean intent-to-treat weight loss was 13.7 +/- 0.5% of initial weight, or 12.8 +/- 0.5 kg. As long as they remained in treatment, almost all participants lost at least 5% of their initial weight and at least 83% lost more than 10%. Members completing 2 y of treatment lost an average of 19.3% of their initial body weight (17.9 kg); at 5 y the loss was still 17.3% (15.7 kg). After leaving the program, subjects regained weight but remained 4.7% (4.5 kg) below their pretreatment weight. CONCLUSION: A low-cost program offering treatment of indefinite duration produced large long-term weight losses and may be suitable for widespread replication.