Journal of Obesity

Review Article

Weight Loss Maintenance in African American Women: A Systematic Review of the Behavioral Lifestyle Intervention Literature

Table 1

Behavioral lifestyle interventions reporting weight maintenance outcomes for african american women (1990–2011) ().


Author and year of publication	Quality ranking score^†	Study design, setting, and length of trial	Participant characteristics^††	Maintenance phase characteristics	Frequency, delivery, and dose (time), of maintenance components	Mean baseline weight (kg) (±SD/SE)	Weight change following intensive intervention phase mean (±SD/SE) weight (kg)	Weight change (kg) from baseline during maintenance phase follow-up (SD/SE)	Adherence to maintenance sessions/components retention (%)

Kumanyika et al. (2002)^‡‡ [44] Trials of Nonpharmacologic Intervention in the Elderly (TONE)	11	Design: RCT Setting: Academic Medical Centers Length of Trial: Up to 34 month	(all overweight participants randomized to a weight loss treatment arm) Weight loss/Sodium AAW: 21 CW: 43 Weight loss AAW: 25 CW: 50 Mean Age (y): AAW: 65.5 (±4.8) CW: 65.8 (±4.5) Income: NDR Education: College graduate: AAW: 25.6% CW: 41.8% Health status: Hypertensive BMI > 27.8 kg/m²	Formal Theoretical Framework: SCT Cultural Adaptations: Yes, attention to cultural diversity, staff training, and printed materials Duration of maintenance phase: 7–28 months (varied by participant) Criteria for entry into WL Maintenance Phase: None Components Targeted at WL Maintenance: Didactic nutrition PA (self) Behavioral Modification Strategies (i) Self-monitoring of food intake, food-related behaviors, and PA (ii) Goal-setting Problem solving Relapse prevention [55]	Frequency, Delivery, and Dose: Months 7-8 Biweekly group or individual session Dose: 60 min (4 sessions total) Months 9+ Monthly group or individual sessions Dose: 60 min (up to 17 sessions) Monthly phone or mail-based contact (up to 17 contacts) [55]	Weight loss/Sodium AAW: 84.0 (±6.9) kg CW: 82.7 (±9.7) kg Weight loss AAW: 82.9 (±9.3) kg CW: 82.3 (±9.0) kg	Weight loss/Sodium AAW: −3.9 (±3.6) kg CW: −3.9 (±3.9) kg Weight loss AAW: −3.3 (±2.8) kg CW: −5.8 (±3.5) kg	12 month Fu Weight loss/Sodium AAW: −4.0 kg CW: −3.7 kg Weight loss AAW: −3.9 kg CW: −5.9 18 month Fu Weight loss/Sodium AAW: −3.6 kg CW: −3.3 kg Weight loss AAW: −3.8 kg CW: −5.0 kg Proxy for end of trial (24 month Fu) Weight loss/Sodium AAW: −2.6 kg CW: −2.7 kg Weight loss AAW: −3.5 kg CW: −4.6 kg	Adherence to maintenance sessions/components: NDR Retention: Weight loss/Sodium AAW: 62% CW: 88% Weight loss AAW: 48% CW: 66%

Kumanyika et al. (2005)^‡ [3] Healthy Eating and Lifestyle Program (HELP)	11	Design: RCT Setting: Academic Medical Center Length of Trial: 15 or 21 months (cohort dependent)	AAW: ( AAW Phase 2 completers) Group HELP maintenance AAW: Mean Age (y): 47.4 (±11.1) Education: >HS = 80% Self-HELPmaintenance AAW: Mean Age (y): 46.2 (±8.6) Education: >HS = 61% Clinic only AAW: Mean Age (y): 46.1 (±10.1) Education: >HS = 67% Income: NDR Health status: BMI 30–50 kg/m² Medically cleared	Formal Theoretical Framework: SCT Cultural Adaptations: Yes, study logo; adapted materials specific to AA; inclusion of AA interventionist Duration of maintenance phase: 18 months (cohorts 1 and 2) 12 months (cohorts 3 and 4) Criteria for entry into WL Maintenance Phase: Attended postphase 1 data collection Components Targeted at WL Maintenance: Didactic Nutrition PA (self and occasional S weekend group walks) Behavioral Modification Strategies (i) Self-monitoring of food intake and PA (ii) Goal-setting (iii) Problem solving (iv) Relapse prevention	Frequency, Delivery, and Dose: Group HELP maintenance Months 7–9 biweekly group class Dose 60 min (6 total classes) Months 10+ once monthly group class Dose: 60 min (8 classes total for cohorts 1 and 2; 3 classes total for cohorts 3 and 4) Group walking held occasionally Individualized nutrition, PA or behavioral consultations upon request 3 clinic visits (cohorts 1 and 2) 2 clinic visits (cohorts 3 and 4) Self -HELP Maintenance Self-help kit (local restaurant and fitness guide, diaries, pedometer) 1 in-person group meeting Teams formed to promote peer support Once monthly call Group walking held occasionally 3 clinic visits (cohorts 1 and 2) 2 clinic visits (cohorts 3 and 4) Clinic only 3 clinic visits (cohorts 1 and 2) 2 clinic visits (cohorts 3 and 4)	100.8 (±15.9) kg	Group HELP maintenance −1.6 kg (±3.3) kg Self-HELP maintenance −2.0 (±4.1) kg Clinic only −1.6 (±3.7) kg	12 month Fu NDR End of Trial (12 or 18 month Fu depending on cohort) Group HELP maintenance −0.8 (±4.4) kg Self-HELP maintenance −1.3 (±5.5) kg Clinic only −1.4 (±5.7) kg	Adherence to maintenance sessions/components: Group HELP Mean attendance 40% at biweekly classes Mean attendance 31% at monthly classes Self-HELP 35–55% of participants were successfully reached for the monthly phone-based contact Retention: 66% (all treatments)

Svetkey et al. (2008)^‡‡ [56] Weight Loss Maintenance Trial (WLM) Post-intervention weight change crudely calculated from data presented in the manuscript	11	Design: RCT Setting: Academic Medical Centers Length of Trial: 36 months	(Randomized to phase II) Self-directed maintenance AAW: 90 CW: 131 Technology maintenance AAW: 90 CW: 130 Personal contact maintenance AAW: 87 CW: 126 Mean Age (y): AAW: 53 (±9.0) CW: 57 (±9.0) [8] Income: AAW: 42% $60,000/y CW: 71% $60,000/y [8] Education: College degree or higher: AAW: 56% CW: 72% [8] Health status: BMI 25–45 kg/m² Hypertensive and/or dyslipidemic	Formal Theoretical Framework: SCT Cultural Adaptations: Yes, Minority Implementation committee, AA cultural-training for all interventionists, cultural sensitivity training, development of specific strategies for enhancing intervention effectiveness for AA [57] Duration of maintenance phase: 30 months Criteria for entry into WL Maintenance Phase: 4 kg loss during IWL phase Components Targeted at WL Maintenance: Continue calorie control/DASH diet pattern Didactic Nutrition PA (self, goal: 225 min/wk) Behavioral Modification Strategies (i) Self-monitoring, food intake, weight, and PA (ii) Problem-solving (iii) Goal-setting Relapse prevention MI	Frequency Delivery, and Dose: Self-directed maintenance One individual in-person session and printed materials Technology maintenance Unlimited access to an interactive web-site Dose: encouraged to log on at least once per week Personal contact maintenance Once monthly individual in-person or phone-based sessions Dose: 5–15 minutes and every 4th month 45–60 minutes (30 sessions total)	AAW: 94.8 (±15.2) kg CW: 89.5 (±15.2) kg	AAW: −7.1 kg CW: −8.0 kg	12 month Fu NDR 18 month Fu NDR End of Trial (36 month Fu) Self-directed (based on adjusted values) AAW: −1.8 (se = 0.6) kg CW: −2.2 (se = 0.6) kg Technology (based on adjusted values) AAW: −1.3 (se = 0.6) kg CW: −3.0 (se = 0.6) kg Personal contact (based on adjusted values) AAW: −2.2 (se = 0.6) kg CW: −3.9 (se = 0.6) kg	Adherence to maintenance sessions/components: Self-directed maintenance NA Technology maintenance 77% logged on at least 1/week Personal contact maintenance 91% of attendance at offered sessions Self-report frequency weighing/week AAW: 3.0 (0.1) CW: 2.6 (0.1) Retention: Self-directed maintenance 94% (all participants) Technology maintenance 93% (all participants) Personal contact maintenance 94% (all participants)

West et al. (2008) [11] Diabetes Prevention Program (DPP) Data reported for the IL arm only	11	Design: RCT Setting: Academic Medical Centers Length of Trial: 36 months	IL intervention arm AAW: 120 CW: 381 Age (y): AAW: 77.4% > 40 y CW: 75.6% > 40 y Income: NDR Education: NDR Health status: Impaired glucose tolerance	Formal Theoretical Framework: SCT Cultural Adaptations: Yes, case managers of same ethnic group, print materials tailored for ethnic group, literacy adaptations Duration of Maintenance phase: 24 months Criteria for entry into WL Maintenance Phase: None Components Targeted at WL Maintenance: Continued adherence to Fat and Calorie Control Didactic Nutrition PA (S and self: goal, 150 min/wk) Behavioral Modification Strategies (i) Self-monitoring food intake and PA (ii) Goal-setting Individual “Tool-box”	Frequency, Delivery, and Dose: At least one bimonthly individual, in-person session Dose: 15–45 minutes Contacted at least once by phone in between sessions (However, coaches could meet with individuals as often as needed) Group-based courses (3/year) Maintenance campaigns to promote adherence (3-4/year) [59]	AAW: 82.0 (±14.8) kg CW: 95.1 (±21.2) kg	AAW: −4.7 (±5.1) kg CW: −7.5 (±5.6) kg	12 month Fu AAW: −4.4 ± 6.0 kg CW: −7.8 ± 7.4 kg 18 month Fu AAW: −3.9 ± 6.1 kg CW: −6.6 ± 8.2 kg End of maintenance phase (36 month Fu) AAW: −2.1 ± 6.3 kg CW: −4.2 ± 7.5	Adherence to maintenance sessions/components: Mean 50.3 (±21.8) sessions (all IL participants) [58] Retention: AAW: 64% CW: 69%

Kumanyika et al. (2009)^‡ [50] Supporting Healthy Activity and Eating Right Everyday study (SHARE)	11	Design: RCT Setting: Academic Medical Center Length of Trial: 24 Months	Family High Support AAW: Mean Age (y): 47.3 (±7.3) Income: NDR Education: >HS = 86% Family Low Support AAW: Mean Age (y): 50.2 (±8.2) Income: NDR Education: >HS = 77% Individual High Support AAW: Mean Age (y): 48.2 (±7.7) Income: NDR Education: >HS = 83% Individual Low Support AAW: Mean Age (y): 46.8 (±6.6) Income: NDR Education: >HS = 71% Health status: Healthy or medically cleared	Formal Theoretical Framework: NDR Cultural Adaptations: Yes, AA program counselors, culturally-based content, community-based field trips Duration of maintenance phase: 18 months Criteria for entry into WL Maintenance Phase: None Components Targeted at WL Maintenance: Calorie control Didactic Nutrition PA (S and self, goal 180 min/wk) Behavioral Modification Strategies (i) Self-monitoring PA (ii) Problem solving	Frequency, Delivery, and Dose: Months 7–12 Biweekly groups sessions Dose: 90 minutes 2-3 in-person individual sessions Dose: 45–60 minutes (14-15 session total) Months 13–24 Once monthly group sessions Dose: 90 minutes Three in-person individual sessions Dose: 45–60 (15 sessions total) Quarterly newsletter (6 newsletters)	Family High Support 103.1 (±11.3) kg Family Low Support 106.5 (±16.3) kg Individual High Support 102.9 (±21.2) kg Individual Low Support 97.3 (±16.1)	Family High Support −5.1 (±4.4) kg Family Low Support −5.0 (±4.8) kg Individual High Support −3.8 (±5.4) kg Individual Low Support −3.4 (±4.1)	12 month Fu Family High Support −5.9 (±5.2) kg Family Low Support −6.4 (±6.5) kg Individual High Support −4.4 (±5.6) kg Individual Low Support −2.1 (±3.7) kg 18 month Fu Family High Support −4.8 (±6.7) kg Family Low Support −5.1 (±6.3) kg Individual High Support −3.6 (±7.0) kg Individual Low Support −3.0 (±3.6) kg End of Trial (24 month Fu) Family High Support −3.0 (±6.1) kg Family Low Support −3.1 (±6.6) kg Individual High Support −1.1 (±7.23) kg Individual Low Support −3.2 (±6.4) kg	Adherence to maintenance sessions/components: Months 7–12 Group Sessions Median 0–4 sessions attended across treatments Individual sessions Median 0-1 session across treatments Months 13–24 Group sessions Median 0 sessions attended across treatments Individual sessions Median 0 sessions attended across treatments Retention: Family High Support 66% Family Low Support 68% Individual High Support 69% Individual Low Support 55%

Fitzgibbon et al. (2010) [60]	11	Design: RCT Setting: University Length of Trial: 18 months	I: 107 AAW C: 106 AAW Mean Age (y): I: 46.4 (±8.4) C: 45.5 (±8.4) Median Income: $42,500/y Education (y): I: 14.6 (±2.0) C: 15.1 (±1.9) Health status: BMI 30–50 kg/m² Healthy or medically cleared (Disease prevalence: NDR)	Formal Theoretical Framework: SCT Cultural Adaptations: Yes, attention to food and activity cultural preferences, AA peer mentors, religion and spirituality intertwined into messaging. Duration of maintenance phase: 12 months Criteria for entry into WL Maintenance Phase: None Components Targeted at WL Maintenance: General calorie fat control, increased fiber, FV	Frequency, Delivery, and Dose: Months 7–12 Twice weekly group S PA Dose: 60 minutes Once weekly didactic session (took place prior to one of the S PA sessions) Dose: 30 minutes (48 sessions total) Once monthly MI session Dose: 20–30 minutes (6 sessions total)	I: 104.3 (±15.6) kg C: 105.8 (±17.8) kg	I: −3.0 (±4.9) kg C: +0.2 (±3.7) kg	12 month Fu NDR End of maintenance (18 month Fu) I: −2.3 (±7.4) kg C: +0.5 (±4.7) kg	Adherence to maintenance sessions/components: Percentage of maintenance classes attended = 27% 30% of participants attended at least half of the offered maintenance classes Retention: I: 87% C: 92%

Martin et al. (2008)^‡‡ [61]	10	Design: RCT Setting: Community Clinic Length of Trial: 18 months	I: 68 AAW C: 69 AAW Mean Age (y): I: 40.8 (±12.7) C: 42.6 (±11.4) Income: <$16,000/y Education: Graduated HS I: 83% C: 74% Health status: Healthy and medically cleared (Disease prevalence: NDR)	Formal Theoretical Framework: NDR Cultural Adaptations: Yes, menus and recipes books Duration of maintenance phase: 12 months Criteria for entry into WL Maintenance Phase: None Components Targeted at WL Maintenance: Self-directed	Frequency, Delivery, and Dose: Three clinic visits for follow-up assessments by research staff (I and C) Dose: NDR	I: 101.2 (±20.6) kg C: 103.4 (±18.0) kg	I: −1.4 kg C: +0.3 kg	12 month Fu I: −1.4 (±3.7) kg C: −0.3 (±3.6) kg End of Trial (18 month Fu) I: −0.5 (±3.3) kg C: +0.1 (±3.8) kg	Adherence to maintenance sessions/components: NDR Retention: 63% (I and C)

Djuric et al. (2009) [62] Weight change at end of trial crudely calculated from data presented in the manuscript	10	Design: RCT, pilot Setting: University Length of Trial: 18 months	I (spirituality and dietary counseling maintenance): 12 AAW C (dietary counseling only maintenance): 12 AAW Mean Age (y): I: 55.0 C: 56.0 Income: I: <$30,000/year = 25% C: <$30,000/year = 25% Education: I: College graduate: 67% C: College graduate: 50% Health status: Breast cancer survivors BMI 30–45 kg/m²	Formal Theoretical Framework: SCT Cultural Adaptations: Yes, spirituality Duration of maintenance phase: 12 months Criteria for entry into WL Maintenance Phase: None Components Targeted at WL Maintenance: Calorie/Portion and Fat Control Didactic Nutrition PA (self, goal 150 min/wk) Behavioral Modification Strategies (i) Self-monitoring of food intake and activity Spirituality counseling (I only)	Frequency, Delivery, and Dose: I (spirituality and dietary counseling maintenance) Months 7–18 Dietary counseling, 1 individual in-person session at month 12, otherwise once monthly phone based sessions Dose: NDR (12 sessions total) Months 7–9 Spirituality counseling Once weekly individual phone-based sessions (up to 12 sessions) ߙ Months 10–12 biweekly individual phone-based sessions (up to 6 sessions) Months 13–18 Once monthly individual phone-based sessions (up to 6 sessions) Dose: 17–45 minutes/call C (dietary counseling only maintenance) Months 7–18 Dietary Counseling, one individual in-person session at month 12, otherwise once monthly phone based sessions Dose: NDR (up to 12 sessions) I and C: Months 7–18 once monthly mailed newsletter (12 newsletters)	I: 93.8 (±11.3) kg C: 94.9 (±14.8) kg	I: −1.0 (±6.5) kg C: −2.6 (±5.1) kg	12 month Fu NDR End of Trial (18 month Fu) I: −0.7 kg C: −2.2 kg	Adherence to maintenance sessions/components: I (spirituality and dietary counseling maintenance) Spirituality counseling calls ranged from 2–26 completed per participant Retention: 92% (all participants)

Kumanyika et al. (1991) [13] Hypertension Prevention Trial (HPT)	9	Design: RCT Setting: Academic Medical Centers Length of Trial: 36 months	(weight loss tx arms only) AAW: 28 CW:43 Age (y): 25–49 (all participants) Income: NDR Education: College graduate: 48% (all participants) Health status: Healthy, normotensive	Formal Theoretical Framework: NDR Cultural Adaptations: NDR Duration of maintenance phase: 30 months Criteria for entry into WL Maintenance Phase: None Components Targeted at WL Maintenance: Didactic Nutrition Behavioral Modification Strategies	Frequency Delivery, and Dose: Months 7–36 Bimonthly individual/group sessions Dose: NDR (15 sessions offered) Bimonthly mailed newsletter (15 newsletters sent) [63]	AAW: 77.2 (±9.9) kg CW: 78.0 (±10.9) kg	AAW: −2.6 (±3.9) kg CW: −4.7 (±4.3) kg	12 month Fu AAW: −1.4 ± 2.9 kg CW: −3.3 ± 5.7 kg 18 month Fu AAW: −0.03 ± 4.7 kg CW: −1.7 ± 5.8 kg End of Trial (36 month Fu) AAW: +2.6 ± 4.7 kg CW: −1.2 ± 7.2 kg	Adherence to maintenance sessions/components: NDR Retention: AAW: 93% CW: 93%

Kumanyika et al. (1991) [13] Trials of Hypertension (TOHP)	9	Design: RCT Setting: Academic Medical Centers Length of Trial: 18 months	(weight loss arms only) AAW: 33 CW: 48 Age (y): 30–54 (all participants) Income: NDR Education: College graduate: 50% (all participants)	Formal Theoretical Framework: NDR Cultural Adaptations: NDR Duration of maintenance phase: 12 months Criteria for entry into WL Maintenance Phase: None Components Targeted at WL	Frequency, Delivery, and Dose: Varied by participant but could include one or a combination of: (a) monthly informal group sessions (b) group weigh-in (c) individual weigh-in (d) individual counseling Dose: NDR [64]	AAW: 79.9 (±10.0) kg CW: 79.7 (±10.8) kg	AAW: −1.9 (±3.5) kg CW: −4.9 (±4.8) kg	12 month Fu AAW: −1.1 ± 4.1 kg CW: −3.6 ± 5.2 kg End of Trial (18 month Fu) AAW: −0.02 ± 4.1 kg CW: −2.5 ± 6.3 kg	Adherence to maintenance sessions/components: 90% participation (including make-up, all participants) Retention: AAW: 97% CW: 100%

Stevens et al. (2001) [65] Trial of Hypertension Prevention II (TOHPII)	9	Design: RCT Setting: Academic Medical Centers Length of Trial: 36 months	I: 64 AAW C: 49 AAW Mean Age (y): I: 43.4 (±6.1) (all participants) C: 43.3 (±6.1) (all participants) Income: NDR and Education: NDR Health Status: Systolic BP < 140 mmHg Diastolic BP 83–89 BMI: 24.4 to 37.4 kg/m² (all women)	Formal Theoretical Framework: NDR Cultural Adaptations: NDR Duration of maintenance phase: 32 months Criteria for entry into WL Maintenance Phase: None Components Targeted at WL Maintenance: Didactic Nutrition PA (SD) (30–45, four to five days per week) Behavioral Modification Strategies (i) Goal-setting (ii) Problem-solving (iii) Self-monitoring of food intake and PA	Frequency, Delivery, and Dose: [66] Months 5–7: biweekly group sessions 6 biweekly group sessions Months 8–1. 7: once monthly group sessions Months 18+: biweekly individual contact (phone, face to face, and mail) Attendance at 3 of 6 minimodules yearly (each module was 3–6 group session)	I: 84.1 (±11.9) kg (all women) C: 82.9 (±10.9) kg (all women)	I: AAW: −2.1 (CI: −3.0 to −1.3) kg CW: −3.6 (CI: −4.4 to −2.8) kg C: AAW: +0.3 (CI: −0.6 to +1.2) kg CW: +0.2 (CI: −0.4 to +0.7) kg	12 monthFu NDR 18 month Fu I: AAW: −0.4 (CI: −1.6 to 0.9) kg CW: −1.7 (CI: −2.6 to −0.7) kg C: AAW: +0.4 (CI: −0.8 to 1.6) kg CW: 0.4 (CI: −0.3 to 1.2) kg 36 month Fu I: AAW: +0.5 (CI: −1.1 to 2.0) kg CW: 0.8 (CI: 0.3 to 1.9) kg C: AAW: +1.7 (CI: 0.2 to 3.1) kg CW: 1.4 (CI: 0.3 to 2.5) kg	Adherence to maintenance sessions/components: Months 6–18: median sessions attended, 11 Months 19–36: median sessions attended, 7.5 Retention: I: AAW: 97% CW: 98% C: AAW: 100% CW: 97%

Yancey et al. (2006) [67]	9	Design: RCT Setting: Community, Urban Length of Trial: 12 months	AAW I: 188 C: 178 Mean Age (y): I: 58.0 (±0.9) C: 60.1 (±0.5) Income: I: $40,000–59,000 C: $40,000–59,000 Education (y): I: 15.06 (±2.16) C: 14.98 (±2.24) Health status: NDR	Formal Theoretical Framework: Social Ecological Model Cultural Adaptations: Yes, trial specific to black women, chosen study site, AA instructors Duration of maintenance period: 10 months Criteria for entry into WL Maintenance Phase: None Components Targeted at WL Maintenance: Self-directed Free fitness club membership (I and C)	Frequency, Delivery, and Dose: No contact	I: 81.5 kg () C: 82.7 kg ()	I: +0.05 kg C: +0.3 kg	End of maintenance (12 month Fu) I: +1.4 kg C: +1.02 kg	Adherence to maintenance sessions/components: NDR Retention: I: 72% C: 72%

West et al. (2007) [14] Weight change crudely extrapolated from Figure 1 in the manuscript	9	Design: RCT Setting: University Length of Trial: 18 months	MI group AAW: 43 CW: 66 Attention control group AAW: 41 CW: 67 Mean Age (y): 53 ± 10 (all participants) Education: College education or higher: 35% (all participants) Income: NDR Health Status: Type 2 Diabetes (no insulin use) BMI 27–50 kg/m²	Formal Theoretical Framework: NDR Cultural Adaptations: NDR Duration of maintenance phase: 12 months Criteria for entry into WL Maintenance Phase: None Components Targeted at WL Maintenance: Calorie and fat control Didactic Nutrition PA (self, goal 150 min/wk) Behavioral Modification Strategies (i) Goal-setting (ii) Problem-solving (iii) Self-monitoring of food intake and PA (iv) Stimulus control (v) Relapse prevention MI or Attention Control sessions	Frequency, Delivery, and Dose: Months 7–12 Biweekly group sessions Dose: NDR (12 sessions total) Months 7–12 Two individual MI or Attention Control sessions Dose: 45 minutes per session (5 sessions total) Months 13–18 Once monthly group session Dose: NDR (6 sessions total)	MI group 97 (±17) kg (all participants) Attention control group 97 (±15) kg (all participants)	MI group AAW: −3.4 kg CW: −5.3 kg Attention control group AAW: −2.9 kg CW: −3.4 kg	12 month Fu MI group AAW: −2.9 kg CW: −5.9 kg Attention control group AAW: −1.8 kg CW: −3.3 kg End of maintenance phase (18 month Fu) MI group AAW: −1.9 kg CW: −4.4 kg Attention control group AAW: −1.0 kg CW: −2.0 kg	Adherence to maintenance sessions/components: Group sessions 7–12 months 57% attendance 13–18 months 48% attendance Food diaries submitted 7–12 months 7 ± 9 diaries 13–18 months 5 ± 9 diaries Retention: 93% (all participants)

Rickel et al. (2011)^‡‡ [15] Treatment of Obesity in Underserved Rural Settings (TOURS) Weight change crudely calculated from data presented in the manuscript	9	Design: RCT Setting: Community, rural Length of Trial: 18 months	AAW: 43 CW: 181 Mean Age (y): AAW: 58.0 (±0.9) CW: 60.1 (±0.5) Income: AAW: <$50,000/y: 70% CW: <$50,000/y: 66% Education: High school degree or less AAW: 28% WW: 39% Health status: BMI > 30.0 kg/m²	Formal Theoretical Framework: NDR Cultural Adaptations: Southern-focused Duration of maintenance phase: 12 months Criteria for entry into WL Maintenance Phase: None Components Targeted at WL Maintenance: Calorie control Didactic Nutrition PA (self, goal 30 min/day walking) Behavioral Modification Strategies (i) Problem solving (ii) Self-monitoring [68]	Frequency, Delivery, and Dose: All treatment groups received handouts describing how to use problem solving to deal with obstacles related to WL maintenance Extended care maintenance Phone-based counseling Biweekly individual phone-based counseling sessions Dose: 15–20 minutes (26 sessions) OR Face to Face counseling Biweekly in-person group session Dose: 60 minutes (26 sessions)	AAW: 99.9 (±2.6) kg CW: 95.8 (±1.1)	AAW: −6.8 (±0.80) kg CW: −10.7 (±0.38) kg	12 month Fu NDR End of Trial (18 month Fu) Extended care maintenance AAW: −4.9 kg CW: −9.2 kg Control AAW: −5.5 kg CW: −6.5 kg	Adherence to maintenance sessions/components: Record keeping (hours) Phone-based 16.0 (±18.1) hours Face to face 15.7 (±18.9) hours Control 10.4 (±15.7) hours Counseling time Phone-based 10.2 (±12.4) hours Face to face 21.3 (±16.0) hours Control NA Retention: 96% (all participants)

McNabb et al. (1993) [69]	7	Design: NRCT, pilot Setting: Community Clinic, Urban Length of Trial: 12 months	I: 13 AAW C: 10 AAW Mean Age (y): I: 57 C: 62 Income: NDR Education: I: Completed HS: 89% C: Completed HS: 85% Health status: Type 2 Diabetes 120% IBW	Formal Theoretical Framework: NDR Cultural Adaptations: Yes, trial specific to AA women Duration of maintenance period: 7.5 months Components Targeted at WL Maintenance: Self-directed Criteria for entry into WL Maintenance Phase: None	Frequency, Delivery, and Dose: No contact	I: 93.5 (±17.8) kg C: NDR	I: −4.1 kg C: NDR	End of trial (12 month Fu) I: −4.4 kg C: +1.4 kg	Adherence to maintenance sessions/components: NDR Retention: I: 77% C: 100%

Tsai et al. (2010)^‡ [16]	7	Design: RCT, pilot Setting: University Clinic, Urban Length of Trial: 12 months	( women) I: AAW: 18 C: AAW: 19 Mean Age (y): AAW: 48.3 (±12.8) Income: NDR	Formal Theoretical Framework: NDR Cultural Adaptations: NDR Duration of maintenance phase: 6 months	Frequency, Delivery, and Dose: 2 in-person PCP visits Dose: 2-3 minutes devoted to discussing weight control (I and C)	I: AAW: 98.7 ± 16.4 kg CW: 76.2 ± 10.3 kg C: AAW: 99.6 ± 14.3 kg CW: 100.9 ± 20.0 kg	I: AAW: −4.5 kg CW: −6.6 kg C: AAW: +0.5 kg CW: +2.1 kg	End of trial (12 month Fu): I: AAW: −1.6 kg CW: −3.2 kg C: AAW: −0.2 kg CW: −1.1 kg	Adherence to maintenance sessions/components: NDR Retention: 94% (all participants)

Banks-Wallace (2007) [70] Weight change crudely calculated from Table 1 in the manuscript	5	Design UCT, pilot Setting NDR Duration of Trial: 18 months	AAW Mean Age (y): 50.3 Income: 62% < $24,000 Education: Completed HS: 100% Health status: Hypertensive	Formal Theoretical Framework: NDR Cultural Adaptations: Yes, trial specific to AA women Duration of Maintenance Phase: 6 months Criteria for entry into WL Maintenance Phase: None Components Targeted at WL Maintenance: Self-directed	Frequency, Delivery, and Dose: No contact	93.7 (±13.1) kg	−8.5 kg	End of trial (18 month Fu) +11.7 kg	Adherence to maintenance sessions/components: NDR Retention: 71%

Total quality ranking score = [(Design: RCT = 4; pilot RCT = 3; nonrandomized controlled trial = 2; single group design = 1) + (Primary intervention focus on weight control: 1 = No; 2 = Yes) + (Inclusion of a formal maintenance program: 1 = No; 2 = Yes) + (Cultural Adaptations: 1 = no adaptations; 2 = limited to recruitment of AA participants; 3 = studies reporting adapting intervention-related content and other adaptations such as cultural sensitivity staff training)].
^††Data reported for AAW or CW only unless indicated otherwise.
^‡Weight change by sex/ethnicity obtained from main study author for AAW completers only.
^‡‡Intention to treat or multiple imputations analysis.
AAW: african american women; BMI: body mass index; BP: blood pressure; C: control; CI: confidence interval; CW: caucasian women; DASH: dietary approaches to stop hypertension; FU: follow-up; HS: high school; I: intervention; IBW: ideal body weight; IL: intensive lifestyle; MI: motivational interviewing; NA: not applicable; NDR: no data reported; NRCT: non-randomized controlled trial; PA: physical activity; PCP: primary care physician; S: supervised; SD: standard deviation; SCT: social cognitive theory; SE: standard error; UCT: uncontrolled trial; WL: weight loss; Y: years.