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Weight Control
Telephone- Based Diet and Exercise Coaching and
a Weight-L •ss Supplement Result in Weight and
Fat Loss in 120 Men and Women
Larry A. Tucker, PhD Amy J. Cook, MS; Neil R. Nokes, MPH; Troy B. Adams, PhD
Abstract PURPOSE
Purpose. Determine the effet ts of telephone-based coaching and a xueight-loss supplement on Attaining and maintaining a healthy
the lüäght and body fat (BF) o/overwäght adults. weight has become a significant prob-
Design. Randomized, placet o-controlled experiment with assessments at baseline, 2 months, lem for most adults. This problem is
and 4 months. especially prevalent in the United
Setting. Community. States, where it is esdmated that 66% of
Subjects. Sixty ovenueight o obese men and 60 overweight or obese women, 25 to 60 years adults are overweight or obese.'
old. Overweight and obesity have dra-
Intervention. Eleven 30-mii .ute telephone coaching sessions were spaced throughout the madc health consequences. Adults
study; the initial conversation lasted 60 to 90 minutes. Supplement or placebo capsules were with a body mass index (BMI) of 25 or
taken daily over the 17 tveeks. greater are considered at risk for
Measures. Weight xuas measured using an electronic scale, and BF tvas assessed using dual developing diseases and morbidides
energy x-ray absorptiometry. such as hypertension, dyslipidemia,
Results. Subjects taking the placebo lost 1.8 ± 3.3 kg of lueight and 0.7 ± 2.2 kg of BF, type 2 diabetes, coronary heart disease,
whereas supplement users lost i tore: 3.1 ± 3.7 kg of wäght (F = 4.1, P= . 045) and 1.7 ± stroke, gall bladder disease, osteoar-
2.6 kg ofBF (F = 4.4, p = . 139). Partidpants receiving no coaching lost 1.8 ± 3.3 kg of thrids, sleep apnea, and respiratory
weight and 0.7 ± 2.2 kg of BF, ivhereas adults receiving coaching lost more: 3.2 ± 3.6 kg of problems.^"'' There is also a higher
)eight(F= 4.8, p= .032) a- id 1.6 ± 2.5 kg ofBF (F = 4.2, p = .044). Adults receiving prevalence of endometrial, breast,
both the supplement and coach ing had the greatest losses of weight and BF, suggesting an prostate, and colon cancers among this
additive effect (F = 3.2, p — 026; F = 2.9, p = .039, respectively), segment of the populadon. Further-
Conclusions. Both treatmen s, coaching and the supplement, viexued separately and in more, higher body weight is associated
combination, luorked to help subjects lose weight and BF. Adults can be educated and motivated with increased all-cause mortality.'^"'''''
via telef)hone to change behavU rrs leading to weight loss, and a lueight-loss supplement can be Clearly, obesity represents a major
included to increase success. (/ m J Health Promot 2008;23[2]:121-129.) challenge because it is both a highly
Key Words: Obesity, We ght Loss, Coaching, Education, Supplement, prevalent and a highly preventable
Overweight, Prevendon Re; earch. Manuscript format: research; Research purpose: contributor to morbidity and mortality.
intervendon tesdng/progra n evaluadon; Study design: randomized trial; Outcome At the workplace, obesity restilts in
measure: biométrie; Setdnjj: local community; Healtb focus: nutridon, weight substantially bigher health care costs
control; Strategy: educadoi , skill building/bebavior change; Target populadon and absenteeism. According to Finkel-
age: adults; Target population circumstances: geographic locadon stein et al.,' the cost of obesity (ex-
cluding overweight) in a company with
1000 workers is approximately
$285,000 annually. Gorsky et al.^ in-
Larry A. Tucker, PliD; Amy J. Cook, MS; and Nal R. Nokes, MPH, are idth the College of dicate that over the next 25 years
Health and Human Performance, Brigham Young University, Provo, Utah. Troy B. Adams, $16 billion will be spent treadng bealth
PhD, is with the Department of Health Promotion and Wellness, Rocky Mountain University of problems stemming from overweight
Health Professions, Provo, Uta I. women in the United States. Eurther,
Send reprint reqttests to Larry i . Tttcker, PhD, 237 SFH, Brigham Young University, Provo, UT in a review by Scbmier et al.,'' it is
84602; tucker@byu.edu. pointed out that health care costs in
77ii.v ynanuscñpt xtias submitted May 16,2007; rexri.sions xuere requested July 17, September 12, and September 27, 2007; the,
the workplace are consistently higher
manuscript xuas accepted for pubtication ictoberB, 2007. among heavy employees compared
with their normal weight counterparts.
Copyright © 2008 by American Joumal i Health Promotion, Inc.
0S90-1111/08/15.00 + 0 Further, according to Tucker and
November/December 2008, Vol. 23, No. 2 121
Friedman,'" who re\'iewed 10,825 em- Although it is difficult to argue with be evaltiated, as well as the effects over
ployed adults from numerous work- the weight-loss success that typically the full 17 weeks. A 2 (supplement:
places in the United States, obese accompanies significant changes in yes/no) X 2 (coaching: yes/no) X 2
employees are more than twice as likely diet and exercise habits, many adults (gender: male/female) X 3 (dme:
to suffer from high-level absenteeism feel that they need extra help.'"'^" As baseline/midtest/posttest) factorial
tban lean workers. In a 2-year pro- a consequence, many weight-loss sup- design was employed. Randomization
spective sttidy incltiding mostly young plements have been developed.''•'•^" was stradfied or blocked to afford
employees, Tticker and Clegg" showed Unfortunately, the effectiveness of equal numbers of men and women in
that obese workers were 1.7 dmes more weight-loss supplements is rarely eval- each experimental condidon. In short,
likely to have high health care costs uated using sound methods. Although the 128 pardcipants were split into two
(>$5000) than nonobese employees. prescription drugs are regulated and groups based on gender, 64 men and
Because the majority of Americans mtist be shown to be effective employ- 64 women, and then the men and
are overweight or obese and the nega- ing the strictest sciendfic invesdga- women were randomly assigned sepa-
tive conseqtiences of carrying excess dons, supplements are not regulated rately to the two different treatments,
body weight are many and diverse, and do not require scientific investiga- active stipplement or placebo, and
effective health promotion programs don. Hence, consumer beliefs regard- coaching or no coaching, using a ran-
designed to help adults lose weight are ing the effectiveness of most weight- dom ntimbers table. Of tbe 128 sub-
needed. Numerous invesdgations have loss supplements are probably based jects in tbe invesdgadon, 64 were
shown that alteradons of diet and/or more on advertising and anecdotal assigned to the supplement group (32
exercise through sundry behavior ddbits than on science and research. men and 32 women) and 64 were
modificadon interventions can lead to assigned to the placebo grotip (32 men
Logic suggests that a sotind ap-
significant weight loss.'^"'* Simply stat- and 32 women). One-half of those in
proach to promoting weight loss
ed, eadng and exercise behaviors in- the supplement group also received
among adults would be to combine two
fltience body weight, and because these personal weight-loss coaching, and
weight-loss strategies that approach the
bebaviors are learned, they can be one-half received no coaching. Like-
challenge from different angles, one
modified. In short, adults who eat less wise, one-half of those in the placebo
based on traditional behavior change
and exercise more typically lose weight. group received coaching, and one-half
methods (only using the telephone to
did not. At the outset, there were 32
Unfortunately, teaching and moti- edticate and motivate conveniendy)
randomly assigned stibjects (16 men
vating adults to change diet and and the other using a weight-loss
and 16 women) in each of the four
exercise behaviors leading to signifi- supplement to help with the process.
experimental condidons: active stip-
cant weight loss is a daundng task. Based on this model, the ptirpose of
plement with coaching, active supple-
Moreover, in a worksite environment, the present study was to evaluate the
ment with no coaching, placebo with
the resources necessary to accomplish effectiveness of two interventions on
coaching, and placebo with no coach-
such a goal are significant. However, weight and fat loss: personal weight-
ing.
there may be a reasonable solution. loss coaching via telephone and
Few, if any, studies have evaluated the a weight-loss supplement. Specifically, Subjects were blinded to the sup-
extent to which periodic coaching over the objective was to determine the plement/placebo condition. For tbe
the telephone can be used as an extent to which personal weight-loss telephone coaching condidon, those
effective weight-loss strategy. Given the coaching and a weight-loss supple- who received weekly coaching obvi-
wide tise of cell phones, allowing ment, considered individually and in ously knew they were being coached;
individuals to be connected to a weight- combination, influence changes in however, stibjects not receiving coach-
loss coach while in almost any envi- body weigbt and body fat over ing were not aware that a coaching
ronment, and given the fast pace of 2 months and 4 months, compared condition existed. The no-coaching
our society, which limits the amount of with placebo use and no weigbt-loss subjects believed that the study was
free time adults perceive that they coaching, employing a randomized, only evaluating a weight-loss stipple-
have, weight-loss coaching via tele- experimental design. A secondary ob- ment. In this way, subjects not re-
phone may be helpful in reducing this jective was to determine the extent to ceiving coaching did not feel cheated
big problem. Overweight adtilts who which gender played a role in the or resentful because tbey were not
need help losing weight but cannot effecdveness of the telephone coach- receiving one-on-one help to lose
find dme to attend educational semi- ing and the supplement. weight.
nars or self-belp workshops or to visit
with a coach in person can probably METHODS Sample
find time to work with a weight-loss Subjects were recruited using news-
counselor over the telephone. This Design paper advertisements covering ap-
strategy requires less time and travel The study was a placebo-controlled, proximately 25 cities surrounding
than personal visits, making it attrac- randomized experiment lasdng a university in the Mountain West. All
dve to many overweight adults and also 17 weeks. Participants were assessed at subjects completed a questionnaire
to worksite health promotion pro- baseline, after 2 months, and after that requested information on their
grams, which are often understaffed 4 months to allow the first-half and medical histories and lifestyle beha-
and low in resources. second-half effects of the treatments to viors. Inclusion criteria included: age
122 American Journal of Health Promotion
of 25 to 60 years, BMI betwe en 25 and 0.999 {p 0.05).
success in weight-loss progrims."' lowered health care costs.''' Although the supplement and coaching may be
Early weight loss builds conf idence and rare, telephone coaching has also been pardy a funcdon of the dme-course
engenders hope concerning future used in one case to improve diabetes benefits of each treatment. The sup-
weight loss. Given the rapid weight loss care.™ However, to date, few, if any, plement had its greatest impact early in
resulting from use of the st pplement. invesdgations have studied the extent the study, likely ctirbing appedte while
it follows that the supplement would to which coaching over the telephone new behaviors were being adopted.
be valtiable in jtimp-starting weight-loss is a worthwhile weight-loss strategy. Later, as the effect of the supplement
efforts, thereby increasing s access in Because cell phone use has become diminished, behavior changes restilt-
weight-loss programs. commonplace, allowing the ovei"weight ing from coaching condnued to help
There were no significan! differ- to communicate with weight-loss coa- with additional weight and fat los.ses.
ences in weight or fat loss hetween ches in almost any setdng, and because Using the intent-to-treat approach
supplement and placebo usîrs during we live in a fast-paced society, limidng for the data analyses weakened the
tbe second half of the sttid). Appar- time to meet with health professionals, effects of the treatments, especially lor
endy, the supplement pronioted sig- telephone coaching designed to help telephone coaching. Using the intent-
nificant weight loss during ihe first with weight loss seems to be a com- to-treat strategy, eveiy stibject who
8 weeks, after which its influence di- monsense soludon. Obese individuals began the study was included in the
minished. Although the actual cause is who need assistance losing weight btit analyses, even those who dropped out
unknown, it is possible that subjects feel too busy or too shy to meet one on and those who did not comply with the
adapted physiologically to tlie supple- one may be able to find dme to work assigned protocol. Although this ap-
ment, becoming less sensiti"e to its with a weight-loss coach over the proach is commonly tised to protect
ingredients, making it less effective telephone. Less time and less travel are against biases tbat may lestilt from
over time. required compared with attending dropouts and noncompliance, the in-
According to the findings, one-on- meetings and personal visits, making tent-to-tieat method may not be a good
one coaching over the telep hone also telephone coaching valuable to many analysis strategy given the purpose of
resulted in significant weight and body adults. the present study. Combining subjects
fat losses in men and women. However, In tbe present study, tbe stipplement who should have taken the stipplement
unlike the effects of the supplement, and coaching were effective in pro- but did not with those who took the
weight loss due to coaching was less ducing significant weight loss in men stipplement and combining stibjects
front-loaded and more bala iced over and women. However, the two strate- wbo should have received telephone
the endre investigadon. In ihort, gies worked better in combination coaching but did not with those who
coaching helped subjects lo ;e weigbt than individually, displaying an addi- pardcipated in the coaching inteiA'en-
and fat over tbe 4-month study, but it tive effect. Specifically, adults who took don may introduce more bias into tbe
did not have a significant eflect during the supplement and received coaching study than it prevents.
the first 8 weeks like the supplement lost almost twice the weight and body In this study, the goal was to de-
did. fat compared with those who took the termine the direct effect of the sup-
Numerotis investigations f ave shown supplement btit received no coaching plement and telephone coaching on
that health coaching works.'""''^ Re- or those who received coaching but weight loss. It is doubtful tbat tbe effect
search has indicated that the coaching took tbe placebo. In short, the two of tbese treatments can be determined
strategy has helped type 2 d abedcs," weight-loss strategies, supplement use if subjects who did not receive the
increased fitness pardcipadc n,'''' sup- and telephone coaching, best promote treatment, whether because of qtiitdng
ported lifestyle changes,'^•'^ improved weigbt loss when used together. the sttidy or not complying, are com-
diet and food choices,'''' ma aged Although there are several possibili- bined with subjects who received the
stress,'^'' enhanced mental health,''''^ and ties, the positive combined effects of treatment. True, the effect of a program.
November/December 2008, Vol. 23, No. 2 127
designed to use these treatments can obese. The cost associated with over- on the body composition of ovenveight
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