Table 2.

Weight Loss Maintenance Intervention Trials: An Evaluation Using RE-AIM Dimensions

Diet Only Interventions
Study	Study Design	Reach (R)	Efficacy/Effectiveness (E)	Adoption (A)	Implementation (I)	Maintenance (M)
Lantz, et al. 2003 (18)	18 mo RCT 2 groups (both groups followed a hypocaloric diet minus 500 kcal/day) Intermittent (I): consume VLCD (450kcal/day) for 2 weeks every third month On-demand (OD): consume VLCD when wt increases > 3kg from baseline	n= 334* 18–60 years old* 247 Female* BMI >30 kg/m2 *	I lost 7.0kg; OD lost 9.1kg. No significant differences between groups. 65% Attrition*	Participants were monitored by a physician, registered dietitian, and a nurse at various time points in a clinical setting	Monthly meetings	No data
Ryttig, et al. 1995 (28)	12 mo RCT 2 Groups: Group 1 (G1): hypocaloric diet (1600 kcal/day), of which 220 kcal were provided by a supplement Group 2 (G2): hypocaloric diet (1600 kcal/day), no supplement.	n= 52 39.1±5.5 years old* 41 Female BMI 39.1±5.5 kg/m2 *	% wt gain in G1 was 9.3±9.4%: 8.0±8.2kg % wt gain in G2 was 12.3±10.0%: 12.3±9.7kg G1 regained 39± 35.7% of wt lost during weight loss trial compared to 54±38.5% in G2 22% Attrition Effect size: G1–G2: 0.49	Interventions and assessments were delivered by a nurse and dietitian in a university outpatient obesity clinic	Both groups were seen for assessments every month for 7 months, then every 7th week during the remainder of the intervention.	No data
Diet and Behavior Change Interventions
Study	Study Design	Reach	Efficacy/Effectiveness	Adoption	Implementation	Maintenance
Layman, et al. 2009 (19)	8 mo RCT 2 groups: Low carbohydrate to protein ratio (LOW): 40% energy from carbohydrate, 30% from protein, 30% from fat High carbohydrate to protein (HIGH): 55% of energy from carbohydrate, 15% from protein, 30% from fat	n= 103 45.4±(SE)1.2 years old* 72 Female* BMI 32.6±(SE)0.8 kg/m2	Mean wt change(kg) from baseline: Intent to Treat: LOW: −9.3 ±(SE)1.0 HIGH: −7.4 ±(SE)0.6 Completers: LOW −10.4 ±(SE)1.2 HIGH −8.4 ±(SE)0.9 No difference between groups in mean wt change 31% Attrition Effect size**: LOW-HIGH: 0.31	Group meetings were led by a research dietitian at a weight management research facility. Any unexcused absence was followed up by a phone call	Both groups were required to attend a 1 hour meeting each week. The LOW group had a significantly greater number of participants (64%) complete compared to the HIGH group (45%). Compliance with group meetings was >75%.	No data
Perri, et al. 1988 (24)	13 mo RCT: 5 groups: Behavior Therapy (B): Control, no maintenance intervention Treatment contact (BC): Therapist contacts with 80 min/wk of exercise recommended BC plus social influence program (BCS): Therapist contacts plus program of social influence strategies BC plus aerobic exercise maintenance program (BCA): Therapist contacts plus aerobic exercise program BC plus aerobic plus social influence (BCAS): Therapist contacts plus aerobic exercise program plus social influence	n= 94 22–59 years old* 97 Female*	Wt regain over 13 months for each intervention: B: 7.2kg BC: 1.76kg BCS: 2.91kg BCA: 3.91kg BCAS: 0.13kg 2% Attrition	Interventions were delivered by a clinical psychologist, physician, or a nurse practitioner	BC, BCS, BCA, and BCAS received 26 biweekly therapist contacts Participants attended 66.8% of the 26 scheduled sessions	No data
Ryttig, et al. 1997 (27)	26 mo RCT 3 Groups: Group 1(A): Hypocaloric diet (1600 kcal) with behavior control modification Group 2(B): Hypocaloric diet (1600 kcal) with behavior control modification with previous wt loss program of VLCD Group 3(C): Hypocaloric diet (1600 kcal) with 239 kcal of a supplement	n= 77 41.6±10 years old* BMI 37.7±4.8 kg/m2 *	Mean wt reduction after 26 months was 7%, 10%, and 9.5% in A, B, and C respectively. Mean wt regain for the 3 groups: (A):1.7kg (B): 13.3kg (C): 13.5kg No significant group differences 49% Attrition	Participants were seen by a nurse if problems arose; group sessions were led by a dietitian. Assessments and groups sessions were held at a hospital obesity unit.	Four assessment contacts for all groups at months 2, 6, 14, and 26.	No data
Physical Activity and Behavior Change Interventions
Study	Study Design	Reach	Efficacy/Effectiveness	Adoption	Implementation	Maintenance
Pasman, et al. 1999 (22)	12 mo non RCT 2 groups: Endurance training (ET): swim, cycle, and run 3–4 per wk Control (C): not involved in a training program	n= 15 37.3 ±5.2 years old 0 Female BMI 30.9±2.8 kg/m2	Wt regain at 12 mo was 65% for the whole group (52% for ET and 74% for the C); no correlation between the training hours per week and the regain of body wt at 12 mo. 3 participants were unwilling to continue the training program, therefore they were moved to a control.	Weekly endurance training sessions (ET) were monitored by a professional coach at a triathlon club.	ET: 3–4 weekly endurance exercise sessions for 1 hour.	No data
Diet, Physical Activity, and Behavior Change Interventions
Study	Study Design	Reach	Efficacy/Effectiveness	Adoption	Implementation	Maintenance
Fogelholm, et al. 1999 (12)	6 mo RCT 3 groups: Control(C): no increase in habitual walking Walk 1 (W1): targeted for 1000 kcal weekly expenditure Walk 2 (W2): targeted for 2000 kcal weekly expenditure	n= 80 29–46 years old * 80 Female* BMI 34 kg/m2 * Participation rate: 100%	(C) gained 1.7kg (W1): lost 0.7kg (W2): gained 0.2kg 6% Attrition Effect size: C-W1: 0.52 C-W2: 0.35 W1–W2: 0.19	Weekly walking sessions were supervised by an exercise instructor at a clinical institute	All groups included 6 mo of weekly group meetings; W1 and W2 groups had weekly walking sessions	No data
Harvey-Berino, et al. 2002 (13)	12 mo RCT 3 groups: Internet support (IS): biweekly chat sessions, phone calls and emails sent on alternate weeks In-person support (F-IPS): met in-person biweekly for 52 weeks; phone calls or emails sent on alternate weeks Minimal in-person support (M-IPS): met in-person monthly for the first 6 mo, then no contact	n= 122* 48.4±9.6 years old* 104 Female* BMI 32.2±4.5 kg/m2 *	IS gained significantly more wt that the F-IPS. No difference between groups at 2-yrs The F-IPS and M-IPS maintained a weight loss ≥ 5% (M-IPS: 81.3%, F-IPS: 81%, IS: 44.4%) 12% Attrition Effect size: IS-MIPS: 0.62 IS-FIPS: 0.78 FIPS-MIPS: 0.00	Interventions were delivered by group therapist and peers	IS had biweekly internet sessions, F-IPS had in-person biweekly sessions, and M-IPS met monthly for 1 hour during the first 6 months Attendance to treatment sessions were 59% for F-IPS and 39% for IS Adherence to self-monitoring was 22% for F-IPS and 19% for IS	No data
Harvey-Berino, et al. 2004 (14)	12 mo RCT 3 groups Internet support (IS): biweekly chat sessions, phone or emails sent on alternate weeks Frequent in-person support (F-IPS): met in-person at an interactive television (ITV) studio biweekly for 52 weeks; phone calls or emails on alternate weeks Minimal in-person support (M-IPS): met in-person over ITV monthly for the first 6 mo, then no contact. IS and F-IPS also participated in a social-influence program	n= 232 46.0±8.8 years old 194 Female BMI 29.0±4.4 kg/m2	No differences in wt loss maintained (8.2% IS, 5.6% F-IPS, 6.0% M-IPS) 24% Attrition Effect size**: IS-MIPS: 0.37 IS-FIPS: 0.26 FIPS-MIPS: 0.05	Interventions were delivered by MS-level dietitians over ITV; assessments completed in a clinical university setting	IS had biweekly internet sessions and alternate week phone or email contact, F-IPS had in-person biweekly sessions and alternate week phone or email contact, and M-IPS met monthly for 1 hour during the first 6 months Participants in the F-IPS attended significantly more group meetings compared to those in the IS group (10±5.1 vs. 7.7±5.3 meetings attended) 69% of participants provided data at all assessment points	No data
King, et al. 1989 (16)	12 mo RCT: 4 groups: Group 1 (1A): telephone and mail contact, previous wt loss through diet only Group 1 (1B): telephone and mail contact, previous wt loss through exercise only Group2 (2A): no contact, previous wt loss through diet only Group 2 (2B): no contact, previous wt loss through exercise only	n= 90 44.7±7.3 years old 0 Female	Mean wt changes: 1A: 3.2±2.9 kg 1B: 0.8±3.1 kg 2A: 2.6±2.8 kg 2B:3.9±2.8 kg Greater weight maintenance in 1B compared to 1A, 2A, and 2B. 20% Attrition Effect size: 1A–2A: 0.22 1A–1B: 0.82 1A–2B: 0.25 2A–1B: 0.62 2A–2B: 0.48 1B–2B: 1.07	No data	Group 1 received monthly mailings and phone calls lasting 5–10 minutes at months1, 2,3,6,9, and 12.	No data
Kumanyika, et al. 2005(17)	8–18 mo RCT 3 Groups: Group counseling (GC): 6-meetings biweekly then monthly Staff-assisted, self—help (SH): given a self-directed resource kit, monthly calls, facilitator support Clinic visits only (C): no intervention only semiannual clinic visit	n= 128 45.4±10.2 years old 116 Female BMI 37.0±5.5 kg/m2	Weight regain from baseline to final visit: GC: 0.02 (95% CI −1.7, 1.8) SH: 1.1 (95% CI −0.3, 2.5) C: −0.04 (95% CI −1.9,1.8) 32% Attrition	Counseling and intervention was delivered at a family practice department of a university health system by a nutrition, exercise, or behavior change specialist, of whom 45% were African American. Cost of the program was <$146 per person per year.	GC had 6 biweekly meetings, then met monthly thereafter. Average group session attendance for GC was 40% for the 6 biweekly sessions and 31% for the monthly sessions. In SH, the facilitator completed 35–55% of monthly telephone calls.	No data
Leermakers, et al. 1999 (20)	6 mo RCT 2 groups: Exercise-focused maintenance (EFM) program: designed to sustain the maintenance of physical activity Wt-focused maintenance (WFM) program: sessions focused on maintenance of wt loss	n= 67 50.8±11.1 years old 54 Female BMI 30.8±4.5 kg/m2	No differences between the 2 conditions in exercise participation and energy expenditure. 15% Attrition Effect size: EFM-WFM: 0.50	Groups were led by clinical psychology graduate students	Both groups included 6 months of biweekly group counseling sessions. Participant attendance rates were 73.1% for EFM and 70.8% for WFM	During the 18 month follow-up visit, participants in the WFM group had greater reductions in fat intake and better maintenance of wt loss. 28% Attrition Effect size12–18 months: EFM-WFM: 0.69 Effect size 6–18 month: EFM-WFM: 0.86
Liebbrand and Fichter, 2002 (21)	18 mo RCT 2 groups: Maintenance (M): supportive weight maintenance program by phone consultation Control (C): no support	n= 109 37.1±10.8 years old 91 Female BMI 44.8±8.7 kg/m2	From baseline-18 mo, BMI increased from 42.54±6.74 to 43±7.81 kg/m2 in the M group and decreased from 40.62±5.67 to 40.58±6.3 kg/m2 in the C group 21% attrition Effect size: M-C: 0.02	Interventions were delivered by a psychotherapist; assessments took place at a medical clinic	M received eight 45-minute phone consultations for 9 mo and 4 consultations for the last 9 mo, then invited to a 2-day therapist guided booster session	No data
Perri, et al. 2001 (58)	12 mo RCT: 3 groups: Control (BT): no contact Relapse Prevention therapy (RPT) (7): group sessions for relapse prevention Problem Solving therapy(25): group sessions for problem solving	n= 80 46.6±8.9 years old* 80 Female* BMI 35.8±4.5 kg/m2 *	Weight regain from baseline-12 mo: BT: +5.39 kg RPT: +2.56 kg PST: −1.51 kg 28% Attrition Effect size 5–11 month: BT-RPT: 0.94 BT-PST: 1.22 RPT-PST: 0.29 Effect size 11–17 month: BT-RPT: 0.32 BT-PST: 0.57 RPT-PST: 1.0	No data	RPT and PST were scheduled for 6 biweekly sessions Audiotape recordings were used to examine protocol delivery. In RPT, 100% of relapse prevention skills were observed and 0% of problem solving skills were observed. In PST, 100% of the problems solving skills were observed and 33% of the relapse prevention skills were observed. Adherence to program goals decreased over time; this differed between BT and PST.	No data
Perri, et al. 2008 (23)	12 mo RCT 3 groups: Group 1(A): extended care, phone counseling sessions Group1(B): extended care, face to face counseling sessions Group 2 (C): education control group which received newsletters	n= 234 59.4±6.1 years old 234 Female BMI 36.8±4.9 kg/m2	A and B regained less wt than Group C (1.2±(SE)0.7 kg and 1.2±(SE)0.6 kg vs. 3.7±(SE)0.7 kg, and had greater adherence to behavioral weight maintenance strategies. 6% Attrition Effect size: A-B: 0.00 A–C: 0.42 B–C: 0.43	Participant contacts were led by Cooperative Extension Services (CES) agents with a BS or MS in nutrition, exercise physiology, or psychology; in rural CES offices. Costs to program (per participant): A: $192±21 B: $391±73 C: $116±19 Costs to participant: A: $1933±1436 B: $2157±1449 C: $1708±1692	A and B received 26 biweekly counseling sessions, A received 15-20 min sessions and B received 60 min sessions. C received 26 biweekly mail newsletters. Sessions were based on Perri’s 5-stage problem solving model(25). A and B’s mean number of sessions attended were 13.8±8.6 and 21.1±5.7, respectively.	No data
Riebe, et al. 2004 (26)	18 mo RCT 2 Groups: Extended care group (EC): received additional personalized Transtheoretical. Model reports Control (C): received generic materials about diet/exercise. Both groups received reports on anthropometrics, biochemical, and dietary intake	n= 144 50.2 ±9.2 years old BMI 32.5±3.8 kg/m2	Mean wt change from baseline-24 mo: EC: 87.6±15.9 kg to 90.5±16.9 kg C: 84.1±14.1 kg to 86.9±15.4 kg No significant differences in wt change between groups.	A registered dietitian reviewed food records.*	Both groups received mailed reports at 6 and 18 mo, EC received mailed reports based on the Transtheoretical Model of Health Behavior Change at mo 3 and 9.	Both groups were received a follow up assessment at 18 months. 32% Attrition
Svetkey et al. 2008 (11)	30 mo RCT 3 groups: Personal contact (PC): monthly telephone and every 4th month face-to-face counseling Interactive technology-based intervention: participants were encouraged to regularly log on to an interactive Web site Self-directed (control)(25): minimal intervention	n= 1032 55.6±8.7 years old 654 Female BMI 34.1±4.8 kg/m2	PC regained 4.0kg ITI regained 5.2kg SD regained 5.5kg 71% of study participants remained below entry weight PC regained less wt as compared to SD. No difference between PC and ITI 6.6% Attrition Effect size: SD-ITI: 0.05 SD-PC: 0.27 PC-ITI: 0.27	Clinical university setting	30 monthly contacts for PC group, duration of 5–15 min each, and every 4th month duration was 45–60 min.	No data
Wing, et al. 1996 (29)	Study 1:12 mo RCT 2 Groups: Group 1 (G1): telephone-assisted weight maintenance and access to a nutritionist for further counseling Group 2 (G2): no-contact	n= 53 43.6± (SE)1.5 years old 53 Female BMI 32.2±(SE)0.4 kg/m2	G1 had a wt gain of 3.9± (SE)1.1kg vs a wt gain of 5.6±(SE)1.0kg in G2 15% Attrition Effect size: G1–G2: 0.33	Phone calls were completed by a trained interviewer in a university clinic	Participants were called every week for 15 min for the duration of the study; 80% of the calls were completed. 92% of participants were able to self report weight, 58% self reported food logs, and 62% self reported exercise logs.	No data
Wing, et al. 1996 (29)	Study 2:12 mo RCT Group 1 (G1): could purchase food boxes during any 4 months of program Group 2 (G12): no food provisions	n= 48 40.7± (SE)1.5 years old 48 Female BMI 32.4±(SE)0.4 kg/m2	G1 had a wt gain of 4.2± (SE)1.0kg vs a wt gain of 4.3±(SE)1.1kg in G2 Only 12 participants ordered food provisions. 0% Attrition Effect size: G1–G2: 0.02	Participants were weighed and discussed problems with a therapist.	Both groups were seen monthly for group sessions for the duration of the study.	No data

^*Represents data from the weight loss phase. No data were provided for only the weight maintenance phase of the intervention.

^**Effect size calculated from the mean (± SD) of the change in weight (kg) from baseline of weight loss phase to post intervention of weight maintenance phase. No data was reported for weight change from baseline of weight maintenance phase to post intervention of weight maintenance phase.

Abbreviations: BMI, Body Mass Index; min, minute; mo, month; RCT, Randomized Control Trial; VLCD; very low calorie diet; wt, Weight.

Data are reported as mean ± SD unless otherwise indicated.