At randomization, all participants were given a self-help behavioral-treatment booklet with instructions for improving bladder control.17 The booklet provided basic information about incontinence, how to locate pelvic-floor muscles and how to perform daily exercises with them, how to use pelvic-floor muscles to avoid stress incontinence, and how to control urinary urgency, as well as instructions on completing voiding diaries. Incontinence was not discussed further in either the control group or the weight-loss group.
Women assigned to the control group were scheduled to participate in four education sessions at months 1, 2, 3, and 4. During these 1-hour group sessions, which included 10 to 15 women, general information was presented about weight loss, physical activity, and healthful eating habits, according to a structured protocol.
The weight-loss program was designed to produce an average loss of 7 to 9% of initial body weight within the first 6 months of the program and was modeled after that used in the following two large clinical trials: Look AHEAD (Action for Health in Diabetes),18 (link),19 (link) a lifestyle intervention trial intended to achieve and maintain weight loss in patients with diabetes, and the Diabetes Prevention Program.20 (link) The participants in the weight-loss program met weekly for 6 months in groups of 10 to 15 for 1-hour sessions that were led by experts in nutrition, exercise, and behavior change and were based on a structured protocol. The participants were given a standard reduced-calorie diet (1200 to 1500 kcal per day), with a goal of providing no more than 30% of the calories from fat. To improve adherence, the participants were provided with sample meal plans and were given vouchers for a meal-replacement product (Slim-Fast) to be used for two meals a day during months 1 to 4 and for one meal a day thereafter.
The participants were encouraged to gradually increase physical activity (brisk walking or activities of similar intensity) until they were active for at least 200 minutes each week. Behavioral skills, including self-monitoring, stimulus control, and problem-solving, were emphasized.
Women assigned to the control group were scheduled to participate in four education sessions at months 1, 2, 3, and 4. During these 1-hour group sessions, which included 10 to 15 women, general information was presented about weight loss, physical activity, and healthful eating habits, according to a structured protocol.
The weight-loss program was designed to produce an average loss of 7 to 9% of initial body weight within the first 6 months of the program and was modeled after that used in the following two large clinical trials: Look AHEAD (Action for Health in Diabetes),18 (link),19 (link) a lifestyle intervention trial intended to achieve and maintain weight loss in patients with diabetes, and the Diabetes Prevention Program.20 (link) The participants in the weight-loss program met weekly for 6 months in groups of 10 to 15 for 1-hour sessions that were led by experts in nutrition, exercise, and behavior change and were based on a structured protocol. The participants were given a standard reduced-calorie diet (1200 to 1500 kcal per day), with a goal of providing no more than 30% of the calories from fat. To improve adherence, the participants were provided with sample meal plans and were given vouchers for a meal-replacement product (Slim-Fast) to be used for two meals a day during months 1 to 4 and for one meal a day thereafter.
The participants were encouraged to gradually increase physical activity (brisk walking or activities of similar intensity) until they were active for at least 200 minutes each week. Behavioral skills, including self-monitoring, stimulus control, and problem-solving, were emphasized.
