Comparative Effectiveness of Lifestyle Intervention Efforts in the Community: Results of the Rethinking Eating and ACTivity (REACT) study

OBJECTIVE: To determine the comparative effectiveness of three lifestyle intervention modalities in decreasing risk for diabetes. RESEARCH DESIGN AND METHODS: Five hundred and fifty-five individuals (86.1% female, 95.1% white, and 55.8% obese) from eight rural communities were screened for BMI ≥25 kg/m(2) and waist circumference >40 inches in men and >35 inches in women. Communities with their eligible participants (n = 493; mean age 51 years, 87.6% female, 94.1% Caucasian) were assigned to four Group Lifestyle Balance (GLB) intervention groups: face to face (FF) (n = 119), DVD (n = 113), internet (INT) (n = 101), and self-selection (SS) (n = 101). SS participants chose the GLB modality. GLB is a comprehensive lifestyle behavior–change program. RESULTS: A marked decline was observed in weight after the intervention in all groups (FF −12.5 lbs, P = 0.01; DVD −12.2 lbs, P < 0.0001; INT −13.7 lbs, P < 0.0001; and SS −14 lbs, P < 0.0001). Participants in SS experienced the largest average weight loss. Weight loss was sustained in >90% of participants in each group at 6 months (FF 90.7%, DVD 90.9%, INT 92.1%, and SS 100%). All groups experienced improvements in the proportion of participants with CVD risk factors. The proportion of individuals with CVD risk factors remained steady between 3 and 6 months in all groups and never returned back to baseline. All associations remained after multivariate adjustment. CONCLUSIONS: Despite the modality, the GLB intervention was effective at decreasing weight and improving CVD risk factor control. SS and FF participants experienced greater improvements in outcomes compared with other groups, establishing the importance of patient-centered decision making and a support network for successful behavior change.