In comparison with weight-loss education alone, follow up sessions (both face-to-face and by telephone) appears to be a more effective method of weight-loss maintenance, according to an article released on November 24, 2008 in Archives of Internal Medicine, one of the JAMA/Archives journals.

There is a well recognized epidemic of obesity in the United States, especially in certain areas and demographic groups. "Rural counties in the United States have higher rates of obesity, sedentary lifestyle and associated chronic diseases than non-rural areas, yet treatment of obesity in the rural population has received little research attention," write the authors.

It has been shown previously that diet, exercise, and behavior change can result in significant weight loss, and that this loss can be improved through extended care programs such as clinic-based follow-up sessions. The authors point out that significant barriers prevent some individuals from accessing these programs:  "However, in rural communities, distance to health care centers represents a significant barrier to ongoing care."

To investigate effective weight-loss interventions, Michael G. Perri, Ph.D., of the University of Florida, Gainesville, and colleagues performed a randomized controlled trial on 234 obese women between the ages of 50 and 75. Each participant completed a six-month weight loss program in one of six medically underserved rural communities. Following this, subjects were randomly assigned to one of three different extended care programs made up of 26 biweekly sessions for one year: telephone counseling, face-to-face counseling, or biweekly newsletters. The researchers also estimated the costs of each program.

At the start of the study, the average weight of the population was 212.5 pounds (96.4 kilograms), and during the initial six-month intervention, the average weight lost was 22 pounds (10 kilograms). After the randomization, significant differences were found between the follow-up groups. The authors write: "participants in the telephone and face-to-face extended-care programs regained less weight [an average of 1.2 kilograms (2.6 pounds) for each group] than those in the education control group [an average 3.7 kilograms (8.2 pounds)]."

The authors point out several benefits of telephone counseling. "The beneficial effects of extended-care counseling were mediated by greater adherence to behavioral weight management strategies, and cost analyses indicated that telephone counseling was less expensive than face-to-face intervention," they write.

They conclude, recommending this intervention. "Our findings highlight the benefits of extended-care interventions and indicate that telephone counseling represents an effective and cost-efficient approach to the management of obesity in underserved rural settings," they write. 

Extended-Care Programs for Weight Management in Rural Communities: The Treatment of Obesity in Underserved Rural Settings (TOURS) Randomized Trial
Michael G. Perri, PhD; Marian C. Limacher, MD; Patricia E. Durning, PhD; David M. Janicke, PhD; Lesley D. Lutes, PhD; Linda B. Bobroff, PhD; Martha Sue Dale, MAg; Michael J. Daniels, ScD; Tiffany A. Radcliff, PhD; A. Daniel Martin, PhD
Arch Intern Med. 2008;168(21):2347-2354.
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Anna Sophia McKenney

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