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Behavioural intervention for weight loss maintenance vs. standard weight advice in adults with obesity: a randomised controlled trial in the UK (NULevel Trial)

Lookup NU author(s): Professor Falko Sniehotta, Dr Elizabeth EvansORCiD, Dr Kirby Sainsbury, Professor Ashley AdamsonORCiD, Dr Frauke Becker, Dr Heather BrownORCiD, Dr Stephan Dombrowski, Dan JacksonORCiD, Denise Howel, Dr Karim Ladha, Emerita Professor Elaine McCollORCiD, Professor Patrick OlivierORCiD, Dr Alison SteelORCiD, Professor Luke ValeORCiD, Rute Vieira, Professor Martin White, Emeritus Professor Pete Wright, Professor Vera Araujo-SoaresORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Background Scalable weight loss maintenance interventions for adults with obesity are lacking but vital for the health and economic benefits of weight loss to be fully realised. We examined the effectiveness and cost-effectiveness of a low-intensity technology-mediated behavioural intervention to support weight loss maintenance in adults with obesity after clinically-significant weight loss (≥5%), compared to standard lifestyle advice. Methods and Findings The NULevel trial was an open-label randomised controlled superiority trial in 288 adults recruited April 2014 to May 2015 with weight loss of ≥5% within the previous 12 months, from a pre-weight loss BMI of ≥30kg/m2. Participants were self-selected and the majority self-certified previous weight loss. We used a web-based randomisation system to assign participants to either standard lifestyle advice via newsletter (control arm) or a technology-mediated low intensity behavioural weight loss maintenance programme (intervention arm). The intervention comprised a single face-to-face goal-setting meeting, self-monitoring and remote feedback on weight, diet and physical activity via links embedded in short message service (SMS). All participants were provided with wirelessly-connected weighing scales but only participants in the intervention arm were instructed to weigh themselves daily and that they would receive feedback on their weight. After 12 months we measured the primary outcome, weight (kg) and also frequency of self-weighing, objective physical activity (via accelerometry), psychological variables and cost-effectiveness. The study was powered to detect a between-group weight difference of ±2.5kg at follow up. Overall, 264 participants (92%) completed the trial. Mean weight gain from baseline to 12 months was 1.8kg (95% CI 0.5 to 3.1) in the intervention group (n=131) and 1.8kg (95% CI 0.6 to 3.0) in the control group (n=133). There was no evidence of an effect on weight at 12 months (difference in adjusted mean weight change from baseline: -0.07; 95% CI 1.7 to -1.9, p = 0.9). Intervention participants weighed themselves more frequently than control participants and were more physically active. Intervention participants reported greater satisfaction with weight outcomes, more planning for dietary and physical activity goals and for managing lapses, greater confidence for healthy eating, weight loss and weight loss maintenance. Potential limitations such as the use of connected weighing study in both trial arms, the absence of a measurement of energy intake and the recruitment from one region of the UK are discussed. Conclusions There was no difference in the weight loss maintenance of participants who received the NULevel intervention compared to participants who received standard lifestyle advice via newsletter. The intervention affected some, but not all, process-related secondary outcomes of the trial. Trial registration This trial is registered with the ISRCTN registry (ISRCTN14657176; registration date 20 March 2014).

Publication metadata

Author(s): Sniehotta FF, Evans EH, Sainsbury K, Adamson A, Batterham A, Becker F, Brown H, Dombrowski SU, Jackson D, Howell D, Ladha K, McColl E, Olivier P, Rothman AJ, Steel A, Vale L, Vieira R, White M, Wright PC, Araújo-Soares V

Publication type: Article

Publication status: Published

Journal: PLoS Medicine

Year: 2019

Volume: 16

Issue: 5

Online publication date: 07/05/2019

Acceptance date: 28/03/2019

Date deposited: 29/03/2019

ISSN (electronic): 1549-1277

Publisher: Public Library of Science


DOI: 10.1371/journal.pmed.1002793


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Funder referenceFunder name
MR/J000477/1Medical Research Council (MRC)