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BioMed Research International
Volume 2013 (2013), Article ID 191209, 7 pages
Clinical Study

Baseline Obesity Status Modifies Effectiveness of Adapted Diabetes Prevention Program Lifestyle Interventions for Weight Management in Primary Care

1Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Ames Building, Palo Alto, CA 94301, USA
2Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA

Received 30 September 2013; Accepted 13 November 2013

Academic Editor: Pierpaolo De Feo

Copyright © 2013 Kristen M. J. Azar et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objective. To examine whether baseline obesity severity modifies the effects of two different, primary care-based, technology-enhanced lifestyle interventions among overweight or obese adults with prediabetes and/or metabolic syndrome. Patients and Methods. We compared mean differences in changes from baseline to 15 months in clinical measures of general and central obesity among participants randomized to usual care alone ( ) or usual care plus a coach-led group ( ) or self-directed individual ( ) intervention, stratified by baseline body mass index (BMI) category. Results. Participants with baseline BMI had greater reductions in mean BMI, body weight (as percentage change), and waist circumference in the coach-led group intervention, compared to usual care and the self-directed individual intervention ( for all). In contrast, the self-directed intervention was more effective than usual care only among participants with baseline BMIs between . Mean weight loss exceeded 5% in the coach-led intervention regardless of baseline BMI category, but this was achieved only among self-directed intervention participants with baseline BMIs . Conclusions. Baseline BMI may influence behavioral weight-loss treatment effectiveness. Researchers and clinicians should take an individual’s baseline BMI into account when developing or recommending lifestyle focused treatment strategy. This trial is registered with NCT00842426.