Trial reportJAMA2012
Effect of a stepped-care intervention approach on weight loss in adults: a randomized clinical trial.
Trial report in JAMA, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to 2 registered trials, which are not on this map. Cited by 100 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
The Effect of a Stepped-care Approach to Long-term Weight Loss
Feasibility of a Campaign Intervention Compared to a Standard Behavioral Weight Loss Intervention in Overweight and Obese Adults
Who cites it
100 citing papers in PubMed, 3 syntheses or guidelines pooled it, 154 citations in OpenAlex.
- Long-Term Weight Management Using Wearable Technology in Overweight and Obese Adults: Systematic Review.JMIR mHealth and uHealth · 2020Pooled it
- Statistical design and analysis in trials of proportionate interventions: a systematic review.Trials · 2019Pooled it
- Transtheoretical model stages of change for dietary and physical exercise modification in weight loss management for overweight and obese adults.The Cochrane database of systematic reviews · 2014Pooled it
- Adaptive Mobile Health Intervention to Reduce Excess Gestational Weight Gain: A Cluster-Randomized Clinical Trial.JAMA network open · 2026Trial
- Anti-obesity medication for weight loss in early nonresponders to behavioral treatment: a randomized controlled trial.Nature medicine · 2025Trial
- An Adaptive Telephone Coaching Intervention for Patients in an Online Weight Loss Program: A Randomized Clinical Trial.JAMA network open · 2024Trial
- A cluster-randomized controlled trial of automated internet weight-loss programs in primary care: Role of automated provider feedback.Obesity (Silver Spring, Md.) · 2022Trial
- Impact of weight loss with diet or diet plus physical activity on cardiac magnetic resonance imaging and cardiovascular disease risk factors: Heart Health Study randomized trial.Obesity (Silver Spring, Md.) · 2022Trial
- BestFIT Sequential Multiple Assignment Randomized Trial Results: A SMART Approach to Developing Individualized Weight Loss Treatment Sequences.Annals of behavioral medicine : a publication of the Society of Behavioral Medicine · 2022Trial
- A pilot randomized trial of simplified versus standard calorie dietary self-monitoring in a mobile weight loss intervention.Obesity (Silver Spring, Md.) · 2022Trial
- The role of parents in adolescent obesity treatment: Results of the TEENS+ randomized clinical pilot trial.Pediatric obesity · 2022Trial
- Effect of tailoring on weight loss among young adults receiving digital interventions: an 18 month randomized controlled trial.Translational behavioral medicine · 2021Trial
- Stepped Exercise Program for Patients With Knee Osteoarthritis : A Randomized Controlled Trial.Annals of internal medicine · 2021Trial
- Feasibility of Integration of Yoga in a Behavioral Weight-Loss Intervention: A Randomized Trial.Obesity (Silver Spring, Md.) · 2021Trial
- Early Engagement is Associated with Better Weight Loss in Emerging Adults.American journal of health behavior · 2019Trial
- Adapting evidence-based behavioral weight loss programs for emerging adults: A pilot randomized controlled trial.Journal of health psychology · 2019Trial
- Early Weight Loss in Behavioral Treatment Predicts Later Rate of Weight Loss and Response to Pharmacotherapy.Annals of behavioral medicine : a publication of the Society of Behavioral Medicine · 2019Trial
- Planned care for obesity and cardiovascular risk reduction using a stepped-down approach: A randomized-controlled trial.Preventive medicine · 2018Trial
- Pattern of Daily Steps is Associated with Weight Loss: Secondary Analysis from the Step-Up Randomized Trial.Obesity (Silver Spring, Md.) · 2018Trial
- Design and development of a stepped-care behavioral intervention to support parents of young children newly diagnosed with type 1 diabetes.Contemporary clinical trials · 2017Trial
40 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
- Erratum issued
Authors and funding
9 authors at 4 institutions in 3 countries.
Funding
Abstract
contextGiven the obesity epidemic, effective but resource-efficient weight loss treatments are needed. Stepped-treatment approaches customize interventions based on milestone completion and can be more effective while costing less to administer than conventional treatment approaches.
objectiveTo determine whether a stepped-care weight loss intervention (STEP) compared with a standard behavioral weight loss intervention (SBWI) would result in greater weight loss. DESIGN, SETTING, AND
participantsA randomized clinical trial of 363 overweight and obese adults (body mass index: 25-<40; age: 18-55 years, 33% nonwhite, and 83% female) who were randomized to SBWI (n = 165) or STEP (n = 198) at 2 universities affiliated with academic medical centers in the United States (Step-Up Study). Participants were enrolled between May 2008 and February 2010 and data collection was completed by September 2011.
interventionsAll participants were placed on a low-calorie diet, prescribed increases in physical activity, and attended group counseling sessions ranging from weekly to monthly during an 18-month period. The SBWI group was assigned to a fixed program. Counseling frequency, type, and weight loss strategies could be modified every 3 months for the STEP group in response to observed weight loss as it related to weight loss goals.
main outcome measureMean change in weight over 18 months. Additional outcomes included resting heart rate and blood pressure, waist circumference, body composition, fitness, physical activity, dietary intake, and cost of the program.
resultsOf the 363 participants randomized, 260 (71.6%) provided a measure of mean change in weight over 18 months. The 18-month intervention resulted in weight decreasing from 93.1 kg (95% CI, 91.0 to 95.2 kg) to 85.6 kg (95% CI, 83.4 to 87.7 kg) (P < .001) in the SBWI group and from 92.7 kg (95% CI, 90.8 to 94.6 kg) to 86.4 kg (95% CI, 84.5 to 88.4 kg) in the STEP group (P < .001). The percentage change in weight from baseline to 18 months was -8.1% (95% CI, -9.4% to -6.9%) in the SBWI group (P < .001) compared with -6.9% (95% CI, -8.0% to -5.8%) in the STEP group (P < .001). Although the between-group difference in 18-month weight loss was not statistically different (-1.3 kg [95% CI, -2.8 to 0.2 kg]; P = .09), there was a significant group × time interaction effect (P = .03). The cost per participant was $1357 (95% CI, $1272 to $1442) for the SBWI group vs $785 (95% CI, $739 to $830) for the STEP group (P < .001). Both groups had significant and comparable improvements in resting heart rate, blood pressure level, and fitness.
conclusionsAmong overweight and obese adults, the use of SBWI resulted in a greater mean weight loss than STEP over 18 months. Compared with SBWI, STEP resulted in clinically meaningful weight loss that cost less to implement.
trial registrationclinicaltrials.gov Identifier: NCT00714168.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.