NCT04023942

Brief Summary

Despite standardized intervention strategies, weight loss and weight loss maintenance largely differ from person to person. Factors which may contribute to these individual differences is current object of research. In order to investigate predictors and barriers for weight management and to investigate two different dietary interventions and two different digital tools for weight maintenance, the LION-Study was designed as follows: Step I (screening, baseline phenotyping), step II (weight loss intervention with formula diet), step III (weight maintenance intervention with 4 intervention groups: low carb/newsletter; low carb/app; low fat/newsletter; low fat/app) and step IV (follow-up). Participants are required to attend visits at seven time points. At screening (month 0) a telephone-based screening interview takes place, in order to test eligibility of the potential participant. If the person is eligible, two consecutive baseline face-to-face visits are planned during step I. After completion of the eight weeks weight loss intervention (month 3), an additional visit takes place followed by three consecutive visits in the weight maintenance step (month 6, 9 and 15). The study ends with a final visit after the follow-up (month 27). Additional contacts (face-to-face and telephone) take place during the weight loss intervention step. Participants will regularly receive a bag with the required formula diet meals. During these "pick up" appointments, the study team actively get in face-to-face contact with participants. At the different visits, data are collected by questionnaires, medical investigations (e.g. MRI, motor function, resting metabolic rate), blood withdrawal as well as urine, feces and saliva sampling. Primary objective is to evaluate the effect of two diets (low carb/low fat) and two digital tools (app/newsletter) on long-term weight loss maintenance 12 months after weight loss. Secondary objective is to identify genetic, epigenetic, physiological, psychological and lifestyle factors that predict the success of weight loss and weight loss maintenance.

Trial Health

87
On Track

Trial Health Score

Automated assessment based on enrollment pace, timeline, and geographic reach

Enrollment
272

participants targeted

Target at P75+ for not_applicable obesity

Timeline
Completed

Started Jul 2019

Longer than P75 for not_applicable obesity

Geographic Reach
1 country

1 active site

Status
completed

Health score is calculated from publicly available data and should be used for screening purposes only.

Trial Relationships

Click on a node to explore related trials.

Study Timeline

Key milestones and dates

First Submitted

Initial submission to the registry

July 11, 2019

Completed
6 days until next milestone

Study Start

First participant enrolled

July 17, 2019

Completed
1 day until next milestone

First Posted

Study publicly available on registry

July 18, 2019

Completed
3.5 years until next milestone

Primary Completion

Last participant's last visit for primary outcome

January 19, 2023

Completed
1.1 years until next milestone

Study Completion

Last participant's last visit for all outcomes

February 29, 2024

Completed
Last Updated

December 4, 2024

Status Verified

August 1, 2024

Enrollment Period

3.5 years

First QC Date

July 11, 2019

Last Update Submit

November 29, 2024

Conditions

Keywords

ObesityWeight lossWeight maintenanceLifestyle interventionDietary interventionFormula dietAppNewsletterDigital toolLow carbLow fatMeal challenges

Outcome Measures

Primary Outcomes (1)

  • Weight maintenance 12 months after weight loss intervention

    Body weight change in kg and % (from baseline weight)

    15 months

Secondary Outcomes (10)

  • Weight change after eight weeks of formula diet

    month 3

  • Glucose

    month 0, 3, 6, 9, 12, 15, 27

  • Insulin

    month 0, 3, 6, 9, 12, 15, 27

  • Lipids

    month 0, 3, 6, 9, 12, 15, 27

  • Leptin

    month 0, 3, 6, 9, 12, 15, 27

  • +5 more secondary outcomes

Study Arms (4)

Low carb - App-based group

ACTIVE COMPARATOR

Low carb is defined as 30 energy percent from carbs and consist of 20 energy percent from protein. The daily energy requirement is calculated for each participant individually, based on his/hers resting metabolic rate and physical activity level. Daily energy intake should be 10% lower than the calculated daily energy requirement. Participants assigned to the app-based group works together with a personal coach via app, providing nutritional guidance and support during the 12-month weight maintenance step.

Behavioral: Weight maintenance intervention

Low carb - Newsletter-based group

ACTIVE COMPARATOR

Low carb is defined as 30 energy percent from carbs and consist of 20 energy percent from protein. The daily energy requirement is calculated for each participant individually, based on his/hers resting metabolic rate and physical activity level. Daily energy intake should be 10% lower than the calculated daily energy requirement. The newsletter intervention group gets regularly digital newsletters, in the same frequency as "contacts" take place in the app-based group.

Behavioral: Weight maintenance intervention

Low fat - App-based group

ACTIVE COMPARATOR

Low fat is defined as 25 energy percent from fat and consist of 20 energy percent from protein. The daily energy requirement is calculated for each participant individually, based on his/hers resting metabolic rate and physical activity level. Daily energy intake should be 10% lower than the calculated daily energy requirement. Participants assigned to the app-based group works together with a personal coach via app, providing nutritional guidance and support during the 12-month weight maintenance step.

Behavioral: Weight maintenance intervention

Low fat - Newsletter-based group

ACTIVE COMPARATOR

Low fat is defined as 25 energy percent from fat and consist of 20 energy percent from protein. The daily energy requirement is calculated for each participant individually, based on his/hers resting metabolic rate and physical activity level. Daily energy intake should be 10% lower than the calculated daily energy requirement. The newsletter intervention group gets regularly digital newsletters, in the same frequency as "contacts" take place in the app-based group.

Behavioral: Weight maintenance intervention

Interventions

Weight maintenance intervention (52 weeks): After randomization, participants will follow either a low carb or a low fat diet and get nutritional assistance either by an app or a newsletter, based on the group they got randomized to (low carb/app, low carb/newsletter, low fat/app, low fat/newsletter).

Also known as: Dietary Intervention
Low carb - App-based groupLow carb - Newsletter-based groupLow fat - App-based groupLow fat - Newsletter-based group

Eligibility Criteria

Age18 Years - 65 Years
Sexall
Healthy VolunteersNo
Age GroupsAdult (18-64), Older Adult (65+)

You may qualify if:

  • Age: 18 - 65 years
  • BMI: 30,0 - 39,9 kg/m2
  • Owner of a smartphone
  • Caucasian
  • No severe diseases
  • Informed written consent

You may not qualify if:

  • Diabetes mellitus
  • Severe cardiovascular and/or respiratory disease
  • Untreated high blood pressure
  • Severe kidney disease
  • Active cancer (or in remission)
  • Inflammatory bowel disease
  • Severe chronic infections and/or inflammations
  • Severe mental-health disorders
  • Neurodegenerative disorders
  • Endocrine diseases
  • Lipedema
  • Pregnancy and lactation
  • Vigorous weight fluctuations (\> 5 kg) in the last 3 months
  • Immobility
  • Surgery in the last 3 months
  • +3 more criteria

Contact the study team to confirm eligibility.

Sponsors & Collaborators

Study Sites (1)

Institute for Nutritional Medicine, Technical University of Munich

Munich, Bavaria, 80992, Germany

Location

Related Publications (4)

  • Reik A, Schauberger G, Wiechert M, Hauner H, Holzapfel C. Association Between the Postprandial Response to an Oral Glucose Tolerance Test and Anthropometric Changes After an 8-Week Low-Calorie Formula Diet - Results From the Lifestyle Intervention (LION) Study. Mol Nutr Food Res. 2024 Jun;68(12):e2400106. doi: 10.1002/mnfr.202400106. Epub 2024 Jun 8.

    PMID: 38850172BACKGROUND
  • Reik A, Holzapfel C. Randomized Controlled Lifestyle Intervention (LION) Study for Weight Loss and Maintenance in Adults With Obesity-Design and Methods. Front Nutr. 2020 Nov 10;7:586985. doi: 10.3389/fnut.2020.586985. eCollection 2020.

    PMID: 33240920BACKGROUND
  • Junker D, Wu M, Reik A, Raspe J, Rupp S, Han J, Nabauer SM, Wiechert M, Somasundaram A, Burian E, Waschulzik B, Makowski MR, Hauner H, Holzapfel C, Karampinos DC. Impact of baseline adipose tissue characteristics on change in adipose tissue volume during a low calorie diet in people with obesity-results from the LION study. Int J Obes (Lond). 2024 Sep;48(9):1332-1341. doi: 10.1038/s41366-024-01568-6. Epub 2024 Jun 26.

    PMID: 38926461BACKGROUND
  • Somasundaram A, Wu M, Reik A, Rupp S, Han J, Naebauer S, Junker D, Patzelt L, Wiechert M, Zhao Y, Rueckert D, Hauner H, Holzapfel C, Karampinos DC. Evaluating Sex-specific Differences in Abdominal Fat Volume and Proton Density Fat Fraction at MRI Using Automated nnU-Net-based Segmentation. Radiol Artif Intell. 2024 Jul;6(4):e230471. doi: 10.1148/ryai.230471.

    PMID: 38809148BACKGROUND

MeSH Terms

Conditions

ObesityWeight LossAlzheimer Disease

Interventions

Diet Therapy

Condition Hierarchy (Ancestors)

OverweightOvernutritionNutrition DisordersNutritional and Metabolic DiseasesBody WeightSigns and SymptomsPathological Conditions, Signs and SymptomsBody Weight ChangesDementiaBrain DiseasesCentral Nervous System DiseasesNervous System DiseasesTauopathiesNeurodegenerative DiseasesNeurocognitive DisordersMental Disorders

Intervention Hierarchy (Ancestors)

Nutrition TherapyTherapeutics

Study Officials

  • Christina Holzapfel, PhD

    TUM School of Medicine, Technical University of Munich

    PRINCIPAL INVESTIGATOR

Study Design

Study Type
interventional
Phase
not applicable
Allocation
RANDOMIZED
Masking
NONE
Purpose
TREATMENT
Intervention Model
PARALLEL
Model Details: This clinical study is a single-center 2\*2 factorial randomized trial. For the weight maintenance step, participants will be randomized into one of the four weight maintenance intervention arms.
Sponsor Type
OTHER
Responsible Party
PRINCIPAL INVESTIGATOR
PI Title
Principal investigator

Study Record Dates

First Submitted

July 11, 2019

First Posted

July 18, 2019

Study Start

July 17, 2019

Primary Completion

January 19, 2023

Study Completion

February 29, 2024

Last Updated

December 4, 2024

Record last verified: 2024-08

Data Sharing

IPD Sharing
Will share

We will apply principles which meet standards of findability, accessibility, interoperability, and reusability (FAIR) in the management of data in our project. The owner of the data will be the Institute for Nutritional Medicine at TUM School of Medicine, Technical University of Munich. The data and samples will be safely stored for long term and can be easily accessed and/or downloaded by the study team. For collaboration partners defined dataset and samples will be provided with well-defined license and access conditions.

Shared Documents
STUDY PROTOCOL
Time Frame
Immediately following publication. No end date.
Access Criteria
On request participant data collected during the trial, after deidentification and according to informed consent. Researches who provide a methodologically sound proposal. On request to principle investigator (Christina Holzapfel, christina.holzapfel@tum.de).

Locations