Weight-Loss and Exercise Study Compares Center- and Home-Based Programs

January 10, 2005 — Nicknamed the "treadmill twins," Trudi Morales and Janet Kilbride welcome the opportunity to talk while they walk on a pair of adjoining treadmills. They talk about politics, their jobs — and their recent success in losing weight.

Janet Brewer walks too, but either at a mall or in her neighborhood. And like the "twins," she's been watching the reading on her bathroom scale drop.

All three women are among the first group of participants in a weight loss and exercise study under way at the University of Central Florida. The study, conducted in the School of Nursing, is funded by a five-year, $2 million grant from the National Institute of Nursing Research at the National Institutes of Health.

The study is comparing two weight-loss and exercise programs that are identical except for their base location and delivery of treatment. "Center-based" participants attend classes and walk for exercise at a center established in the Central Florida Research Park, adjacent to the UCF campus. "Home-based" participants learn by reading and talking to consultants over the phone and walk for exercise at self-selected locations. All of the participants are postmenopausal women, 50 to 65 years old, healthy and nonsmoking and were initially 20 to 50 pounds overweight.

"Recent data suggests that a home-based program may be as effective as a center-based one for weight reduction," said Professor Karen Dennis, principal investigator for the project. "This is the first study to compare the effectiveness of the two different settings in supporting weight loss in postmenopausal women."

Dennis said that alternatives to traditional medical center or office visits are needed for those who want to lose weight under medical supervision. "In a nation with an unrelenting epidemic of obesity, the need for treatment far exceeds the capacity of the health-care system to provide care on an individual basis," she added.

Dennis has found that many people will not, for personal or financial reasons, enroll in intensive, time-consuming weight-loss programs. They need a program that works within the time constraints imposed by their work schedules and family commitments. Thus, there is considerable interest in home-based approaches to weight loss and exercise.

In designing the center- and home-based programs, Dennis included the five components of weight-loss treatment known to be successful: behavioral techniques, cognitive change, social support, nutrition and exercise. Her research team includes a dietician, exercise physiologist, psychologist, statistician and nurse practitioner.

During the first six months, all of the study participants learn and incorporate new eating and exercise strategies. They receive support through meetings or phone calls from research-team members and maintain food and exercise logs. Home-based women are paired with a "buddy" from the same program. During the following six months, the participants taper their number of contacts with team members. For one additional year, the study monitors the longer-term success of the participants.

Like many people, Janet Brewer leads a busy life, working at her job, maintaining a home and squeezing in time for hobbies. She's found, however, that as she's grown older, her lifestyle has become more sedentary. As a result, her daily energy expenditure has decreased, which is a contributing factor in weight gain.

When Brewer entered the weight loss and exercise study in January 2004, she hoped to be assigned to the center-based program. "I thought that's how I'd be most successful," she explained. But as luck would have it — the participants are randomly assigned to either the center- or home-based program — Brewer landed in the home-based group.

At the beginning of the study, Brewer attended an orientation to the program with other participants in her group. Afterwards, each participant's weight, body composition, cholesterol, blood sugar and bold pressure were measured. Their cardiovascular fitness was also assessed.

Then the work began. Brewer started to monitor everything she ate and to walk routinely for exercise. Once a week, she spoke on the phone with a dietician for 20 minutes. She also maintained food and exercise logs, which she submitted by mail.

"When I started, I measured, weighed and recorded every bite I took. It was a challenge," Brewer said with a laugh. "I ate cold meals for the first few weeks." She also recorded all of the ways she exercised: bicycling, gardening, swimming, cleaning up from the hurricanes, and the program's requisite 45-minute walks, three times a week.

While Brewer followed the home-based program, Joy Ungerer, a retired resident of Orlando, followed the center-based program. She used the same dietary strategies as Brewer, but attended weekly, hour-long meetings at the center with other participants in the center-based group. She submitted the same types of logs as Brewer, but in person. And three times a week, she walked for 45 minutes on a treadmill at the center.

"The program showed me that you can eat anything as long as it's in moderation," said Ungerer, who has become an expert at selecting healthy food from restaurant menus. "It's really not a diet, it's a way of life." Over the past year she has lost 38 pounds and her blood sugar and cholesterol levels have dropped to much healthier levels. She feels terrific about her accomplishments.

Brewer has since realized that the center-based program would never have fit into her schedule. "I've enjoyed the home-based group," she shared. "Knowing that you're achieving a healthier lifestyle is just tremendous."

This past year, Brewer lost more than 23 pounds — and gained confidence in her ability to stick with a new way of eating. In describing the exciting, yet potentially diet-sabotaging prospect of a Caribbean cruise with her husband, Brewer said she's not worried about gaining weight.

"I know I can maintain," she said proudly.

The UCF Weight Loss and Exercise Study is currently recruiting postmenopausal women to participate in its January 2005 programs. For further information, please call 407-823-1837.

— Karen Guin