Stepped-care in obesity treatment: Matching treatment intensity to participant performance

This investigation examined the effectiveness of a self-help (SH), stepped-care (SC) weight loss program. Based on a failure to achieve pre-assigned weight loss goals, participants were eligible to be stepped-up from a SH program to two levels of treatment intensity (weight loss group [WLG]; individual counseling [IC]) beyond SH. The primary outcome was change in body weight. Fifty-three overweight/obese adults (BMI ≥ 27 kg/m2; mean BMI of 37.3, SD = 6.6, 89% Caucasian, and 77% female) participated in an 18-week weight loss intervention. During several phases of the investigation, those stepped-up to more intensive treatment lost comparable weight to those who were not stepped-up. Nevertheless, by the end of treatment, individuals who remained in SH (M = 8.6%) lost a significantly greater percentage of weight than individuals who received SH + IC (M = 4.7%; p < .05) and individuals in SH + IC lost a significantly greater percentage of weight than individuals who received SH + WLG + IC (M = 1.6%; p < .05). While some individuals benefited from being stepped-up to greater intensity treatment, other individuals experienced little benefit. The application of SC principles to the treatment of obesity needs further study.

► We examined the effectiveness of a self-help, stepped-care weight loss program.
► Participants were eligible to be stepped-up to treatment beyond self-help.
► Some individuals benefited from being stepped-up to greater intensity treatment.