Urinary incontinence is a common problem among women that causes distress, diminished quality of life and dramatic limitations in daily functioning. Overweight women are at significantly increased risk of urinary incontinence and over 65% of women with incontinence are overweight. Data from short-term, preliminary studies suggest that weight reduction may significantly reduce incontinence episodes. Thus, weight loss may present a promising new approach to urinary incontinence treatment, one likely to produce a cascade of broader health improvements in addition to reductions in frequency of urinary incontinence. Therefore, we propose to randomize 330 overweight and obese women with urinary incontinence (165 at each of two clinical centers) to a 6-month intensive behavioral weight control program or to usual care to determine the short-term effect of weight loss on frequency of incontinence and quality of life, to identify women most likely to benefit from weight loss and to begin to explore the urodynamic mechanisms underlying incontinence improvement following weight loss. To maximize enduring effects of weight loss on urinary incontinence, it will be necessary to produce sustained weight loss. However, weight maintenance remains a challenge in the obesity field. Therefore, we propose to evaluate an innovative, theory-guided weight maintenance program that will focus on increasing motivation and commitment to behavior change efforts and compare this with a more standard, skills-focused weight maintenance program. After completing the 6-month weight loss program, women in the weight loss arm will be randomized to either a 12-month standard, skill-based maintenance program or to a motivationally-focused maintenance intervention. Outcomes will include weight loss, incontinence frequency and quality of life at 18 months. If effective in women with incontinence, the methods and strategies of this innovative motivationally-focused maintenance intervention can be examined in other obese populations. WIN-Weight Reduction for Incontinence Network-brings together a unique group of outstanding and experienced investigators with expertise in urinary incontinence, obesity treatment and multicenter collaborative clinical trials at three institutions. The proposed study design will allow us to efficiently evaluate both a novel treatment for urinary incontinence and a promising approach to enhancement of weight maintenance, and therefore to make substantive contributions to several clinical arenas critical to women's health.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Project--Cooperative Agreements (U01)
Project #
5U01DK067862-04
Application #
7103642
Study Section
Special Emphasis Panel (ZDK1-GRB-C (J2))
Program Officer
Kusek, John W
Project Start
2003-09-30
Project End
2008-06-30
Budget Start
2006-07-01
Budget End
2007-06-30
Support Year
4
Fiscal Year
2006
Total Cost
$388,785
Indirect Cost
Name
University of Alabama Birmingham
Department
Pediatrics
Type
Schools of Medicine
DUNS #
063690705
City
Birmingham
State
AL
Country
United States
Zip Code
35294
Pinto, Angela Marinilli; Subak, Leslee L; Nakagawa, Sanae et al. (2012) The effect of weight loss on changes in health-related quality of life among overweight and obese women with urinary incontinence. Qual Life Res 21:1685-94
Hart, Chantelle N; Fava, Joseph L; Subak, Leslee L et al. (2012) Time in Bed is Associated with Decreased Physical Activity and Higher BMI in Women Seeking Weight Loss Treatment. ISRN Obes 2012:
Subak, Leslee L; Marinilli Pinto, Angela; Wing, Rena R et al. (2012) Decrease in urinary incontinence management costs in women enrolled in a clinical trial of weight loss to treat urinary incontinence. Obstet Gynecol 120:277-83
Myers, Deborah L; Sung, Vivian W; Richter, Holly E et al. (2012) Prolapse symptoms in overweight and obese women before and after weight loss. Female Pelvic Med Reconstr Surg 18:55-9
Pinto, Angela Marinilli; Kuppermann, Miriam; Nakagawa, Sanae et al. (2011) Comparison and correlates of three preference-based health-related quality-of-life measures among overweight and obese women with urinary incontinence. Qual Life Res 20:1655-62
West, D S; Gorin, A A; Subak, L L et al. (2011) A motivation-focused weight loss maintenance program is an effective alternative to a skill-based approach. Int J Obes (Lond) 35:259-69
Markland, Alayne D; Richter, Holly E; Burgio, Kathryn L et al. (2011) Weight loss improves fecal incontinence severity in overweight and obese women with urinary incontinence. Int Urogynecol J 22:1151-7
Wing, Rena R; West, Delia Smith; Grady, Deborah et al. (2010) Effect of weight loss on urinary incontinence in overweight and obese women: results at 12 and 18 months. J Urol 184:1005-10
Wing, Rena R; Creasman, Jennifer M; West, Delia Smith et al. (2010) Improving urinary incontinence in overweight and obese women through modest weight loss. Obstet Gynecol 116:284-92
Huang, Alison J; Subak, Leslee L; Wing, Rena et al. (2010) An intensive behavioral weight loss intervention and hot flushes in women. Arch Intern Med 170:1161-7

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