It's almost a given that you can achieve initial weight loss with a variety of methods, but what happens afterwards doesn't get as much attention, says Lawrence Appel, M.D., professor of medicine at the Johns Hopkins School of Medicine. Few studies have focused on how to prevent weight regain, which carries frustration and health risks, he says.

In a study published March 12 in the Journal of the American Medical Association, Appel and other researchers from Johns Hopkins and seven other institutions compared different interventions aimed at preventing weight regain among 1,032 volunteers who had recently lost, on average, about 19 pounds each.

The researchers tracked the volunteers, separated into three groups, over two and a half years. One group received regular, personal contact from trained weight-loss counselors. Once a month, counselors called these volunteers and chatted for five to 15 minutes about calorie intake, exercise habits and weight loss strategies. Every four months, these dieters had in-person meetings with their counselors that lasted about an hour.

A second group was given access to a custom-built weight-loss Web site loaded with information and tools to track weight, record food diaries and monitor physical activity levels. Bulletin boards on the site allowed these volunteers to get online support from other dieters, and automatic e-mails encouraged the volunteers to log onto the site at least weekly. If they missed more than two weeks, the volunteers received automatic phone calls to steer them back on track.

A third set of volunteers received some printed information with diet and lifestyle recommendations at the beginning of the study. This self-directed group also met briefly with a trained counselor once in the middle of the study, but worked to maintain weight loss largely on their own.

Weights were recorded every six months, and by the end of the study, most of the volunteers had gained some weight back. However, the average amount differed among the groups. Volunteers in the group who received personal contact regained the least amount of weight, averaging about 9 pounds each. Those in the Web site and self-directed groups regained slightly more, about 12 pounds apiece.

Although these differences were modest, Appel points out that even small changes in weight can have big effects on health. Keeping just a few pounds off can significantly affect your risk of getting high blood pressure or diabetes, he says.

Appel speculates that being personally accountable to a caring counselor could be an important motivator for people to maintain healthy eating habits. Some dimensions of person-to-person contact are hard to duplicate with technology, he adds.

Even given these findings, doctors aren't likely to recommend personal counselors for everyone trying to keep weight off. There aren't enough dietitians and weight-loss counselors in the world to maintain this kind of personal contact, Appel says. For their next study, he and his colleagues plan to test a combination of counseling and the Internet to provide weight-loss support.

hopkinsmedicine/