Innovative Approaches to Weight Loss in a High Risk Population: The Small Changes and Lasting Effects (SCALE) Trial

OBJECTIVE: To evaluate the efficacy of a small change behavioral weight loss intervention with or without a positive affect/self-affirmation (PA/SA) component on weight loss at 12 months. METHODS: Black and Hispanic adults (N=405) with body mass index 25-50 kg/m(2) selected one of 10 small change eating strategies and a physical activity goal, randomly with/without positive affect/self-affirmation. Participants were followed by community health workers (CHW's) at set intervals (weekly months 1-3; biweekly months 4-9; once monthly months 10-12). RESULTS: There was no difference in weight loss at 12 months between participants in the small change approach alone (1.1%) vs. the small change PA/SA intervention (1.2%). During treatment, 9% of participants lost at least 7% of their initial body weight. Participants who reported more interval life events had a lower likelihood of losing weight (p <.0001). However, those randomized to the small change PA/SA intervention gained less weight (+0.3% vs. 2.3% gain; P value <.0001). CONCLUSION: The small change PA/SA intervention did not lead to a significant difference in weight loss in comparison to the small change approach alone. It did however decrease the negative impact of psychosocial stressors on weight gain among participants with more interval life events.