Halo effect of a weight-loss trial on spouses: the DIRECT-Spouse study

Objective: We examined the halo effect of a 2-year weight-loss diet trial, the Dietary Intervention Randomized Controlled Trial (DIRECT), on the weight and nutritional patterns of participants' spouses. Design: DIRECT participants in a research centre workplace were randomly assigned to one of three diets: Low-fat, Mediterranean or Low-carbohydrate. A sample of wives of the DIRECT participants, who attended support update meetings specific to their husband's diet during the first 6 months, were followed for 2 years. Setting: South Israel. Subjects: Seventy-four women (mean age = 51 years, mean BMI =26.6 kg/m(2)). Results: Among the wives of husbands randomised to the Low-fat, Mediterranean and Low-carbohydrate diet, self-reported weight change was respectively -1.48 kg, -2.30 kg and -4.62 kg after 6 months, and +0.39 kg, -3.00 kg and -2.30 kg after 2 years. Weight loss among wives whose husbands were in the alternative diet groups combined (Mediterranean + Low-carbohydrate) was significantly greater than among wives whose husbands were in the Low-fat group after 6 months (P = 0.031) and 2 years (P = 0.034). Overweight wives experienced more weight loss. The weight change of couples was significantly correlated (r = 0.42, P < 0.001). Across all dietary groups, wives had significant improvement in their dietary patterns in all food groups according to their husbands' diets, mainly by a larger significant decrease in carbohydrate consumption in the Low-carbohydrate group (P = 0.013 compared to Low-fat). Six-month weight change among the seventy-four DIRECT participants whose wives took part in the group support sessions was -5.2 kg, compared to -3.5 kg among the 248 DIRECT participants whose wives did not take part in these sessions (P = 0.020). Conclusions: Focusing on the couple as a unit could provide a cost-effective approach to weight-loss programmes.