Table 1.
Descriptions of Sample Intervention Components and Findingsfrom Behavioral Weight Loss Intervention Trials
| Study | Setting | Sample size and Sample characteristics† |
Duration/Frequency | Mode of delivery/Training and race/ethnicity of interventionists |
Theoretical framework |
Intervention components |
Cultural adaptation |
Outcome Measures |
Mean baseline weight (kg) and/or BMI (kg/m2) |
Mean weight (±SD) (kg) |
Retention/ Adherence |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Multi-site Randomized Controlled Trial Design (n=5) | |||||||||||
| 1. Kumanyika (1991)* (39) Hypertension Prevention Trial (HPT) |
Setting Clinical/University |
n=246 (28 B women (42 W women) Age (y) 25–49 (all participants) SES NDR Education College graduate: 48% (all participants) Health status Healthy, Normotensive |
Duration 6 months (intensive WL period) Frequency Weekly |
Delivery Group (93) Training and race/ethnicity of interventionists Trained behaviorists (93) (race/ethnicity NDR) |
Behavioral self-management | Nutrition Behavioral components | NDR | Weight/BMI | B: 77.2 kg W: 78.0 kg 28.5 kg/m2 (B and W) |
B: − 2.6 (±3.9) W: −4.7 (±4.3) |
Retention 93% (B/W) Adherence 63.9% (93) |
| 2. Kumanyika (1991)* (39) Trials of Hypertension (TOHP) |
Setting Clinical/University |
n=303 (33 B women) (48 W women) Age (y) 30–54 (all participants) SES NDR Education College graduate: 50% (all participants) Health status Diastolic BP 80– 89 mmHg |
Duration 6 months (intensive WL period) Frequency Weekly |
Delivery Group (94) Training and race/ethnicity of interventionists Registered dietitian, psychologist and exercise physiologist (94) (race/ethnicity NDR) |
Behavioral self-management | Nutrition Behavioral components | NDR | Weight/BMI PA |
B: 79.9 kg W: 79.7 kg 29.6 kg/m2 (B and W) |
B: −1.9 (±3.5) W: −4.9 (±4.8) |
Retention B: 97% W:100% Adherence 55.6% for men and 56.6% for women (94) |
| 3. Svetkey (2005) (12) |
Setting Clinical/University |
n= 810 (211 B women) (292 W women) Mean Age (y) 48.6 (B women) 50.7 (W women) SES B women: 72% > $30,000 W women: 91% > $30,000 Education College graduate: 47% (B) 53% (W) Health status Healthy, pre-hypertensive and stage 1 hypertension |
Duration 6 months Frequency 14 group meetings 4 individual meetings |
Delivery Group and Individual Training and race/ethnicity of interventionists Certified interventionists (race/ethnicity NDR) |
Social cognitive theory Behavioral self-management TTM |
Nutrition (IL + DASH group only) PA (self) Behavioral components | Yes (95) | Weight/BMI BP VO2 max Diet Self-report PA 24 hour urine Health survey |
I (B): 95.5 kg I + DASH (B): 93.7 kg C (B): 92.0 kg I (W): 90.3 kg I + DASH (W): 94.4 kg C (W): 91.1 kg |
IL (B): −3.2 (±4.7) IL + DASH(B): −3.2 (±3.7) C (B): −0.8 (±2.8) IL (W): −5.7 (±5.6) IL + DASH (W): −6.7 (±5.7) C (W): −1.9 (±3.8) |
Retention 94–95% (B/W) Adherence B: mean 74% of 18 sessions W: mean 84% of 18 sessions |
| 4. Hollis (2008) (10)* Note: Results reported for Phase 1 NR SG only |
Setting Clinical/University |
n=1685 (540 B women) (594 W women) Mean Age (y) 52.3 (B women) 56.2 (W women) SES B: 84% > $30,000/year W:92% > $30,000/year Education Completed HS: 100% (B and W women) Health status Hypertensive and/or Dyslipidemic |
Duration 6 months Frequency 20 sessions, approximately once per week (90–120 min) |
Delivery Group Training and race/ethnicity of interventionists Nutrition and behavior counselors (race/ethnicity NDR) |
Social cognitive theory Behavioral self-management TTM |
Nutrition PA (S and self) Behavioral components |
Yes | Weight/BMI Diet Self-report PA |
B: 95.1 kg/35.6 kg/m2 W: 89.2 kg/33.6 kg/m2 |
B: − −4.1 (±2.9) W: −5.8 (±6.1) |
Retention 92% (B/W) Adherence mean 68% of 20 sessions (B) mean 75% of 20 sessions(W) |
| 5. West (2008)* (11) |
Setting Clinical/University |
n=2921 IL: 120 B women/381 W women SL+ Metformin: 110 B women/377 W women SL+placebo:111 B women/402 W women Age (y) 77.4% B women: > 40 years 75.6% W women : > 40 years SES NDR Education NDR Health status Impaired glucose tolerance |
Duration 6 months (Active WL phase) Frequency IL: 16 sessions SL+(Metformin/SL+ placebo: 1 individual session and written materials |
Delivery Individual Training and race/ethnicity of interventionists Case managers (race/ethnicity NDR) |
Behavioral self-management | IL: Nutrition PA (S and self) Behavioral components SL+ Metformin 850 mg BID, Diet Rx Standard care SL+Placebo BID, Diet Rx. Standard care |
Yes (IL only) |
Weight/BMI | I (IL): 82 kg (B) I (Metformin): 86.4 kg (B) C (placebo): 85.2 kg (B) I (IL): 95.1 kg (W) I (Metformin): 92.1 kg (W) C (placebo): 93.7 kg (W) |
IL: −4.7 (±5.1) (B) SL +Metformin: −2.1 (±3.6) (B) SL + placebo: +0.02 (±3.7) (B) IL: −7.5 (±5.6) (W) SL+Metformin: −2.3 (±4.2) (W) SL+ placebo: −0.05 (±4.4) (W) |
Retention (6 months) I (IL):93.3% (B) I (Metformin): 93.6% (B) C (placebo): 90% (B) I (IL):98.9% (W) I (Metformin): 96.0% (W) C (placebo): 94% (W) Adherence lifestyle arm 93% (63) |
| Single-site Randomized Controlled Trial Design (n= 9) | |||||||||||
| 1. McNabb (1997) (21) |
Setting Community church |
n=39 (I:19 B women) (C: 20 B women) Mean Age (y) I:56.5/C:56.6 SES NDR Education I: Completed HS: 89% C: Completed HS :85% Health status Healthy (Disease prevalence: NDR) |
Duration 14 weeks Frequency Weekly (90 min) |
Delivery Group Training and race/ethnicity of interventionists B site coordinator and lay health educators |
NDR | Nutrition PA(self) Behavioral components |
Yes | Weight/BMI WC Diet Psychosocial survey |
I:90.5 kg/33.9 kg/m2 C:89.5 kg/33.1 kg/m2 |
I: −4.6 (±4.7) C:+0.9 (±1.9) |
Retention 85% (I/C) Adherence I:mean 71% of 14 sessions |
| 2. Fitzgibbon (2005a) (18) |
Setting University |
Cohort 1 n=27: (I:13 B women) (C:14 B women) Cohort 2 n=37: (I:18 B women) (C:19 B women) Mean Age (y) Cohort 1: 44.4 Cohort 2: 45.1 SES Median income: $42,500 Education Cohort 1: 14.7 y Cohort 2: 14.9 y Health status Healthy or medically cleared (Disease prevalence: NDR) |
Duration 20 weeks Frequency Twice weekly sessions Session 1: didactic/PA (S) (90 min) Session 2: PA (S) (45 min) |
Delivery Group Training and race/ethnicity of interventionists NDR |
Social cognitive theory | Nutrition PA (S) Behavioral components |
Yes | Weight/BMI Diet Self-report PA Breast health behavior Breast self-exam proficiency |
Cohort 1: I:101.1 kg/37.7 kg/m2 C:98.2 kg/35.9 kg/m2 Cohort 2: I:93.9 kg/35.7 kg/m2 C:95.8 kg/36.3 kg/m2 |
Cohort 1: I:+0.5 (±2.2) C:+0.7 (±2.6) Cohort 2: I: −3.4 (±3.8) C: +0.9 (±3.4) |
Retention Cohort 1: I:100% C: 93% Cohort 2: I: 83% C: 95% Adherence Cohort 1: 41% of 37 sessions Cohort 2: 55% of 38 sessions |
| 3. Fitzgibbon (2005b) (19) |
Setting University |
n=59 [I:30 B women (faith-based WL)] [C:29 B women (WL only)] Mean Age (y) I:47.8/C:49.1 SES Median income: $20,500 Education I:13.6 y/C:12.9 y Health status Healthy or medically cleared (Disease prevalence: NDR) |
Duration 12 weeks Frequency Twice weekly: Session 1: didactic/PA (S) (90 min) Session 2: PA (S) (45 min) |
Delivery Group Training and race/ethnicity of interventionists NDR |
Social cognitive theory | Nutrition PA (S) Behavioral components |
Yes | Weight/BMI Diet Self-report PA Breast health Faith-based surveys |
I:103.7 kg/39.9 kg/m2 C:103.0 kg/38.4 kg/m2 |
I: −2.6 (±3.5) C: −1.6 (±3.2) |
Retention I:77% C:79% Adherence I:mean 53% of 12 sessions C:mean 54% of 12 sessions |
| 4. Brandon (2006) (42) |
Setting University |
n=52 (I:15 B women/13 W women) (C:12 B women/12 W women) Mean Age (y) I:34.0 B/40.5 W C:36.0 B/42.0 W SES NDR Education NDR Health status Medical clearance if 2 or more CVD risk factors (Disease prevalence: NDR) |
Duration 18 weeks Frequency 3 sessions per week. First 2 weeks used as walking conditioning and instruction sessions; last 16 weeks training sessions (50 min) |
Delivery Group Training and race/ethnicity of interventionists NDR |
NDR | PA (S) | NDR | Weight/BMI WC HC Body composition VO2 max Diet BP |
I (B): 90.9 kg/34.0 kg/m2 C(B): 83.1 kg/33.0 kg/m2 I(W): 80.2 kg/29.5 kg/m2 C(W):85.7 kg/32.8 kg/m2 |
I (B): −0.4 C (B): +2.4 I(W): −3.4 C(W): +2.7 |
Retention†† 45% (B) 74% (W) Adherence†† I: 88% of 54 sessions (B/W) |
| 5. Martin (2006) (16) |
Setting Community clinic |
n=144 (I:71 B women) (C:73 B women) Mean Age (y) I:40.7/C:42.9 SES Low income Education NDR Health status Healthy and medically cleared (Disease prevalence: NDR) |
Duration 6 months Frequency Monthly (15 min) |
Delivery Individual Training and race/ethnicity of interventionists Primary care physician (race/ethnicity NDR) |
Social cognitive theory Stages of change Other varied tenets from behavioral theories |
Nutrition PA (self) Behavioral components |
Yes | Weight/BMI WC Diet Food preference Self-report PA Psychosocial surveys |
I:100.9 kg/38.1 kg/m2 C:103.0 kg/39.6 kg/m2 |
I: −2.0 (±3.2) C:+0.20 (±2.9) |
Retention 73.6% (I/C) Adherence I:mean 50% of 6 sessions |
| 6. Befort (2008) (15) |
Setting Community clinic |
n=44 [I: 23 B women (WL + MI)] [C: 21 B women (WL + HE)] Mean Age (y) I: 41.6/C:47.2 SES Low income Education Completed HS: 74% Health status Approx 50% had at least one co-morbid condition Medically cleared |
Duration 16 weeks Frequency Weekly WL session (90 min) Four MI or HE sessions (30 min) |
Delivery Group and Individual Training and race/ethnicity of interventionists Psychologist; counselor, registered dietitian (race/ethnicity NDR) |
NDR | Nutrition MI or HE PA (self) Behavioral components |
Yes | Weight/BMI Diet Self-report PA Psychosocial surveys Adherence |
I:103.7 kg/39.4 kg/m2 C:109.6 kg/40.4 kg/m2 |
I: −2.6 (±4.2) C: −3.2 (±5.7) |
Retention 77.3% (I/C) Adherence mean 53% of 16 group sessions (I/C) mean 80% of 4 individual sessions (I/C) |
| 7. Djuric (2009) (43) Note: Results reported for NR SG Active WL phase only |
Setting University |
n= 24 [I: 12 B women (WL + spirituality maintenance)] [C:12 B women (WL only maintenance)] Mean Age (y) I:55.0/C: 56.0 SES I: <$30,000/year= 25% C: <$30,000/year= 25% Education I: College graduate: 67% C:College graduate: 50% Health status Diagnosed with breast cancer in last 10 years, at least 3 months post-treatment |
Duration 6 month (Active WL) Frequency 0–3 months: weekly 4–6 months: biweekly |
Delivery Individual (in person and phone-based) Training and race/ethnicity of interventionists Registered dietitian (race/ethnicity NDR) |
Social cognitive theory | Nutrition PA (self) Behavioral components |
NDR | Weight/BMI Diet Self-report PA WC HC Health status Spirituality |
I: 93.8 kg/36.0 kg/m2 C: 94.9 kg/36.0 kg/m2 |
I: −1.5 (±6.5) C: −2.5 (±5.1) |
Retention 92% Adherence NDR |
| 8. Kennedy (2009) (20) |
Setting Community |
n=40 (I:20 B women) (C:20 B women) Mean Age (y) I:45.5/C:36.4 SES NDR Education NDR Health status Healthy (Disease prevalence NDR) |
Duration 6 months Frequency Once monthly session and once weekly fresh fruit and vegetable distribution |
Delivery Group Training and race/ethnicity of interventionists Peer educator (race/ethnicity NDR) |
NDR | Nutrition PA (self) Behavioral components |
NDR | Weight/BMI Diet BP WC Self-report PA Quality of life Health survey |
I:89.8 kg/33.2 kg/m2 C:89.1 kg/34.3 kg/m2 |
I: −2.0 (±3.2) C:+1.1 (±2.0) |
Retention 93% (I/C) Adherence NDR |
| 9. Stolley (2009a) (23) |
Setting University |
n=213 (I:107 B women) (C:106 B women) Mean Age (y) I:46.4/C:45.5 SES Median income: $42,500 Education I:14.6 y/C:15.1 y Health status Healthy or medically cleared (Disease prevalence: NDR) |
Duration 6 months Frequency Twice weekly sessions Session 1: didactic/PA (S) (90 min) Session 2: PA (S) (45 min) Once monthly MI session |
Delivery Group and Individual (MI) Training and race/ethnicity of interventionists Training NDR Race/ethnicity included white, Black and Asian interventionists (96) |
Social cognitive theory | Nutrition PA (S and self) Behavioral components |
Yes | Weight/BMI Diet Self-report PA |
I: 104.3 kg/38.8 kg/m2 C: 105.8 kg/39.6 kg/m2 |
I: − 3.0 (±4.9) C: + 0.20 (±3.7) |
Retention I: 93.5% C: 92.5% Adherence I:53% of all sessions I:53% of MI sessions |
| Quasi-experimental Design (n= 3) | |||||||||||
| 1. Domel (1992)†† (17) |
Setting Community center |
n=57 (I:43 B women) (C:14 B women) Mean Age (y) 37.0 SES Low income Education Low literacy Health status NDR |
Duration 11 weeks Frequency Weekly |
Delivery Group Training and race/ethnicity of interventionists Registered dietitian (race/ethnicity NDR) |
NDR | Nutrition Behavioral components | Yes | Weight/BMI Nutrition knowledge |
I: 35.3 kg/m2 C: 37.8 kg/m2 |
I: −1.41 C: −0.14 |
Retention 72% Adherence mean 83% of 11 sessions |
| 2. McNabb (1993) (22) |
Setting Community clinic |
n=24 (I: 13 B women) (C: 10 B women) Mean Age (y) I:57/C:62 SES NDR Education I: Completed HS: 89% C: Completed HS :85% Health status Healthy (Disease prevalence: NDR) |
Duration 18 weeks Frequency Weekly |
Delivery Group Training and race/ethnicity of interventionists NDR |
NDR | Nutrition PA (SD) Behavioral components | Yes | Weight/BMI HbA1c |
I/C: 93.5 kg/35.6 kg/m2 | I: −4.4 C: +1.4 |
Retention I: 77% Adherence NDR |
| 3. Parker (2010) (44) |
Setting Community church |
n=35 [I: 24 B women (spiritual WL)] [C: 11 B women (non-spiritual WL)] Mean Age (y) I: 49.8/C:52.4 SES I: <$10.000/year= 11% C: < $10,000/year= 25% Education I: College graduate: 21% C: College graduate: 56% Health status Self-reported health status |
Duration 10 weeks Frequency Weekly |
Delivery Group Training and race/ethnicity of interventionists NDR |
NDR | Nutrition PA (self) | Yes | Weight/BMI BP Self-report PA Diet |
I: 98.5 kg/37.71 kg/m2 C: 73.5 kg/28.16 kg/m2 |
I: −0.61 C: −1.3 |
Retention 80% Adherence NDR |
| Non-randomized Single Group Design (n= 8) | |||||||||||
| 1. Kanders (1994)† (45) |
Setting University |
n=67 B women Mean Age (y) 49.0 SES $1000–5000 monthly Education Completed HS: 95% Health status Healthy and medically cleared (Disease prevalence: NDR) |
Duration 10 weeks Frequency Weekly (60 min) |
Delivery Group Training and race/ethnicity of interventionists B nutritionist |
NDR | Nutrition PA (self) Behavioral components |
Yes | Weight WC HC Insulin Glucose Self-repot PA Diet |
92.3 kg | −2.9 |
Retention 91% Adherence 85% attendance first 5 weeks 70% attendance last 5 weeks |
| 2. Glass (2002) (48) |
Setting University |
n=55 (27 B women) (28 W women) Mean Age (y) 33 (B women) 38 (W women) SES NDR Education NDR Health status Healthy (Disease prevalence: NDR) |
Duration 10–15 weeks Frequency Four sessions per week : 3 PA (S) (20–40 minutes) 1 PA (self) (20–40 minutes) |
Delivery Group Training and race/ethnicity of interventionists Exercise physiologist (race/ethnicity NDR) |
NDR | Nutrition PA (S and self) Behavioral components |
NDR | Weight/BMI RMR Blood lipids Girth measurements Body composition VO2 max BP |
B: 91.8 kg/34.3 kg/m2 W: 98.5 kg/35.0 kg/m2 |
B: −2.8 (± 1.0) W: −4.0 (±0.7) |
Retention B: 37% W: 68% Adherence†† mean 75% of 4 sessions per week (B/W) |
| 3. Karanja (2002) (46) |
Setting Community center |
n=66 B women Mean Age (y) 44.0 SES NDR Education NDR Health status Healthy and medically cleared (Disease prevalence: NDR) |
Duration 6 months Frequency Weekly (120 min) Not required but encouraged to attend once weekly PA session (S) (60 min) |
Delivery Group Training and race/ethnicity of interventionists B instructors (training NDR) |
NDR | Nutrition PA (S and self) Behavioral components |
Yes | Weight/BMI Self report PA Diet |
107.0 kg/39.0 kg/m2 | −3.7 (±5.1) |
Retention 95% Adherence 75% of participants attended at least 13 sessions |
| 4. Walcott-McQuigg (2002) (25) |
Setting University |
n=23 B women Mean Age (y) 38 SES Mean income: $29,000 Education College graduate: 32% Health status Healthy, medically cleared (Disease prevalence: NDR) |
Duration 16 weeks (Active WL phase) Frequency Weekly (60 min) One visit with a registered dietitian |
Delivery Group and Individual Training and race/ethnicity of interventionists B registered dietitian and nurse |
Social cognitive theory | Nutrition PA (self) Behavioral components |
Yes | Weight/BMI Body composition WC HC BP Blood lipids Self report PA Psychosocial surveys |
36.4 kg/m2 | −2.02 (±1.2) |
Retention 69.6% Adherence NDR |
| 5. Nicklas (2003) (47) |
Setting University |
n=124 (35 B women) (89 W women) Mean Age (y) 60 (B and W women) SES NDR Education NDR Health status Healthy (Disease prevalence: NDR) |
Duration 6 months Frequency Twice weekly: Session 1: didactic Session 2:PA (S) (30–45 min) |
Delivery Group Training and race/ethnicity of interventionists Registered dietitian (race/ethnicity NDR) |
NDR | Nutrition PA (S and self) Behavioral components |
NDR | Weight/BMI Diet WC HC Body composition VO2 max OGTT Blood lipids Leptin BP Sex hormones |
B: 94 kg/35.0 kg/m2†† W: 84 kg/32.0 kg/m2†† |
B: −3.9 (±3.6) W: −5.4 (±3.6) |
Retention
†† 61% (B/W) Adherence†† B: 72% attendance at all sessions W: 74% attendance at all sessions |
| 6. Annesi (2007) (49) |
Setting Community center |
n=64 (30 B women) (34 W women) Mean Age (y) 43.8 (B and W women) SES NDR Education NDR Health status Medically cleared (Disease prevalence: NDR) |
Duration 20 weeks Frequency Once monthly instruction on exercise equipment and cognitive behavior therapy related to PA 3, 30 minute PA sessions per week (self) 6 nutrition sessions |
Delivery Individual and Group Training and race/ethnicity of interventionists Wellness expert and registered dietitian (race/ethnicity NDR) |
NDR | Nutrition PA (S and self) Behavioral components |
NDR | Weight Psychosocial surveys |
B: 97.6 kg W:96.3 kg 36.2 kg/m2 (B and W) |
B: −4.1 (±6.2) W: −7.0 (±6.5) |
Retention NDR Adherence mean 76% of PA sessions per week(B/W) mean 80% of 6 nutrition sessions(B/W) |
| 7. Banks-Wallace (2007) (14) |
Setting NDR |
n=21 B women Mean Age (y) 50.3 SES 62% < $24,000 Education Completed HS: 100% Health status Hypertensive |
Duration 12 months Frequency Monthly (3 hours) |
Delivery Group Training and race/ethnicity of interventionists Nurses (race/ethnicity NDR) |
NDR | PA (S and self) |
NDR | Weight BP Steps/day Self-report PA |
93.7kg | −8.4 |
Retention 62% Adherence NDR |
| 8. Stolley (2009b) (24) |
Setting University |
n=23 B women Mean Age (y) 51.4 SES 87% > $20,000/year Education Beyond HS: 87% Health status Breast cancer survivor, at least 6 months post-treatment |
Duration 6 months Frequency Twice weekly sessions Session 1: didactic/PA (S) (120 min) Session 2: 60 min PA (S) |
Delivery Group Training and race/ethnicity of interventionists Certified exercise instructor (race/ethnicity NDR) |
Social cognitive theory Health belief model |
Nutrition PA (S and self) Behavioral components |
Yes | Weight/BMI Diet Self-report PA Psychosocial surveys |
88.0 kg/34.1 kg/m2 | −2.5 |
Retention 87% Adherence mean 67% of 46 classes |
*
Secondary analysis
†
Data reported for African American women or African American and White women only unless indicated otherwise
††
Data reported for completers only
Abbreviations: B, Black; BID, twice daily; BMI, body mass index; BP, blood pressure; C, control; CRC, clinical research center; HbA1c, hemoglobin A1c; HC, hip circumference; HE, health education; HS, High school; I, intervention; IL, intensive lifestyle; MI, motivational interviewing; NDR, No data reported; NR, non-randomized; OGTT, oral glucose tolerance test; PA, physical activity; RCT, randomized controlled trial; RMR, resting metabolic rate; S, supervised; SD, standard deviation; self, self-directed; SG, single group; SL, standard lifestyle; TTM, transtheoretical model; W, White; WC, waist circumference; WL, weight loss