Abstract
IMPORTANCE: Despite the current enthusiasm for anti-obesity medications, there is a critical need for effective lifestyle interventions that can be broadly implemented. OBJECTIVE: To assess the effectiveness of REWIND, an obesity and diabetes treatment program. DESIGN: Prospective cohort study. SETTING: Virtual, community-based weight management program. PARTICIPANTS: Two-hundred and nineteen participants, BMI ≥ 30 kg/m(2), with and without type 2 diabetes (T2D). INTERVENTION: Three phases: "induction" with meal replacement diet to promote ≥ 15% weight loss; "transition" to everyday foods; and "maintenance" to prevent weight regain. REWIND leveraged teams including community leaders, media personalities, nationally recognized athletes and participants, to disseminate information, and foster belonging, commitment, and resilience. MAIN OUTCOMES: The co-primary outcomes were the change in weight at 6-, 12-, and 18 months. Secondary outcomes were the proportion of patients achieving ≥ 5%, 10%, 15%, and 20% weight loss at 6, 12, and 18 months, and remission rates in T2D at 6-, 12-, and 18-month, respectively. RESULTS: Two hundred and nineteen participants (mean age 49.1 [SD 10.5] years), 37% men, 12% Black, 26% with T2D. Weight decreased from: 114.4 (20.8) kg to 96.1 (18.4) kg at 6 months, to 98.5 (18.1) kg at 12 months, and to 101.1 (20.5) kg at 18 months. Weight loss percentages at 6, 12, and 18 months were ≥ 5%: 95%, 91%, 84%; ≥ 10%: 79%, 72%, 67%; ≥ 15%: 58%, 46%, 47%; and ≥ 20%: 24%, 25%, 22%. Diabetes remission was achieved by 52% and 43% of participants with T2D at 12- and 18-month, respectively. LIMITATIONS: Single geographic region. Weight was self-reported. CONCLUSION: A virtual community-based program for individuals with obesity and T2D facilitated substantial weight loss and T2D remission. This model has the potential for wide-scale implementation in diverse settings.