OBJECTIVE: To compare three non-dieting interventions that focused on lifestyle change rather than weight loss, in terms of the sustainability of improvements in lifestyle behaviors, psychological well-being and medical symptoms at 2 years. METHOD: In Dunedin, New Zealand in 2002/2003, 225 obese/overweight women (BMI >= 28; 25 to 68 years) participated in a randomised, intention-to-treat trial comparing two group programs (P1, P2) and a self-guided mail-delivered program (P3). Only P1 included intensive relaxation response training. All three non-dieting interventions involved a 10-week program, followed by an eight-month support phase. Participants completed baseline, 1-year and 2-year assessments. Outcomes included behavioral, psychological and medical symptom measures and a composite success score. RESULTS: 118 participants completed the 2-year follow-up. Only among P1 participants were the reductions in psychological distress and medical symptoms achieved at 1 year, also maintained at 2 years. At 2 years, P1 participants had significantly greater increases in stress management behaviors than those in P2 (p < 0.05), and significantly greater success scores than those in P3 (p < 0.05). In all three programs, mean weight was unchanged at 2 years. CONCLUSION: Inclusion of relaxation response training in a healthy lifestyle program facilitates long-term maintenance of psychological and medical symptom improvements even in the absence of weight loss.
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