ObesityNCT00769717
Evaluation of a Health at Every Size vs a Behavioral Weight Loss Approach for Obese Women
A study testing Wellness-Centered (HUGS) and Weight-Centered (LEARN) in people with Obesity, run by The Reading Hospital and Medical Center at 1 site in United States.
Trial summary
For over four decades the medical literature has observed a relationship between obesity and poorer health outcomes. The causal mechanisms of these poorer outcomes however are unclear. Read more about this study
- Who is it for?
- Ages 30 to 45 years, women onlyHealthy volunteers can take part
- Conditions the study is for
- Obesity
- What is being tested?
- Wellness-Centered (HUGS) and Weight-Centered (LEARN)
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 80 participants
- Where
- 1 siteUnited States
- Study dates
- 25 Sep 2008to 25 Feb 2011
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 30 to 45 years
- Women only
- Healthy volunteers accepted
- Adult
Who may be able to join
- Women ages 30 to 45 years old (at intervention onset);
- BMI between 30 and 45
- Physically inactive
- Practicing birth control if heterosexually active and pre-menopausal.
- English speaking
Who cannot join
- Current smoker
- Use of medications known to affect weight/energy expenditure;
- Pregnant, intending to get pregnant over next two years, or lactating;
- Recent myocardial infarction (within 6 months);
- Congestive heart failure
- Active neoplasms
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- Type 1 and insulin-dependent Type 2 diabetes
- Cerebrovascular disease
- Renal disease
- Cirrhosis
- Bulimia nervosa
- Alcohol and/or Substance Abuse
- Major psychiatric disturbance (suicidality, psychosis, anti-social personality disorder, current manic episode)
- Prior bariatric surgery
- Plans to have bariatric surgery over next 2.5 years
Trial locations and contacts
1 site in 1 country.
United States1 site
The Reading Hospital and Medical Center
West Reading, Pennsylvania, 19611
About this study
Official title: Comparative Health Improvements and Rate of Relapse in Weight-Centered vs. Wellness-Centered Interventions for Obese Women
For over four decades the medical literature has observed a relationship between obesity and poorer health outcomes. The causal mechanisms of these poorer outcomes however are unclear. One assumption that has been supported by correlational data is that increased weight is associated with increased cardiovascular disease (CVD) risk factors (i.e., hypertension, dyslipidemia, and type 2 diabetes). Consequently, obese people are routinely prescribed weight loss programs in order to prevent or control these conditions. Unfortunately, long term weight loss has been met with minimal success for the large majority of people. Furthermore, the data suggesting that weight loss leads to long term health benefits and decreased mortality is limited and contradictory. The purpose of the proposed project is to perform a randomized controlled pilot study comparing the effectiveness of two lifestyle interventions for preventing CVD risk factors (hypertension, dyslipidemia, and type 2 diabetes). The interventions are constitutionally similar; however, the treatment condition is a wellness-focused intervention that teaches healthy living without consideration of weight. The control condition is a traditional curriculum where the prescribed outcome is weight loss. The primary goals of both programs are to reduce hypertension and total cholesterol, and to enhance glucose control. Secondary outcomes of interest are psychological and behavioral in nature (e.g., self-esteem; depressed mood; anxiety; stress; quality of life; dietary habits; and physical activity). We will compare the trajectories of the CVD and psychological/behavioral risk factors for a total period of 24 months (including the time from baseline to the end of the 6-month intervention). Our objectives are to collect data to a) determine whether participants in both programs reduce CVD and psychological/behavioral risk factors at the completion of the 6-month program, and b) compare the persistency of health improvements and rate of relapse at the end of the 18-month follow-up period between the traditional weight loss intervention and the wellness-focused intervention.
- Conditions
- Obesity
- Being tested
- Wellness-Centered (HUGS), Weight-Centered (LEARN)
- Keywords
- obesity, wellness, cardiovascular disease prevention, health at every size, weight loss
- Medical subject headings
- Obesity, Weight Loss
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Wellness-Centered (HUGS)Behavioural
Also called Health At Every Size, Intuitive Eating
A health at every size intervention, the HUGS program was conceived and developed in 1987 by Linda Omichinski, Registered Dietitian. HUGS stands for Health focused, Understanding lifestyle, Group supported, and Self-esteem building. It is an integrated approach that promotes healthy eating, active living, and self acceptance regardless of weight. HUGS teaches strategies to recognize and respond to physiological signs of hunger and satiety to determine food intake. The manualized curriculum is accompanied by the books Tailoring Your Tastes and Staying Off of the Diet Roller Coaster which participants will receive in addition to a booklet of handouts. Kelly Bliss, a psychotherapist and fitness professional with 17 years experience in health-centered approaches for weight management, will deliver the intervention in 2 groups of 20 people that meet weekly for 6 months.
Weight-Centered (LEARN)Behavioural
Also called behavior based weight loss program
The LEARN Program for Weight Management is an evidence-based behavior modification approach to weight loss developed by Dr. Kelly Brownell, Ph.D. Psychologist. LEARN is an acronym that stands for Lifestyle, Exercise, Attitudes, Relationships, and Nutrition. This manualized curriculum shares many principals with the HUGS program in that both emphasize the importance of healthy lifestyle choices and gradual sustainable change. However, the LEARN program makes weight loss an explicit goal and focuses more on food intake levels based on external prescriptions and caloric restriction. Participants in the LEARN program will receive the LEARN Program for Weight Management manual and the LEARN Weight Stabilization and Maintenance Guide along with the LEARN Program CD set. Ann Wellock, a Registered Dietician from The Reading Hospital and Medical Center will deliver the intervention in 2 groups of 20 people that meet weekly for 6 months.
| Study group | Role | What they receive |
|---|---|---|
| Wellness-Centered | Experimental | A health at every size intervention, the HUGS program was conceived and developed in 1987 by Linda Omichinski, Registered Dietitian. HUGS stands for Health focused, Understanding lifestyle, Group supported, and Self-esteem building. It is an integrated approach that promotes healthy eating, active living, and self acceptance regardless of weight. HUGS teaches strategies to recognize and respond to physiological signs of hunger and satiety to determine food intake. The manualized curriculum is accompanied by the books Tailoring Your Tastes and Staying Off of the Diet Roller Coaster which participants will receive in addition to a booklet of handouts. Kelly Bliss, a psychotherapist and fitness professional with 17 years experience in health-centered approaches for weight management, will deliver the intervention in 2 groups of 20 people that meet weekly for 6 months. Receives: Behavioral: Wellness-Centered (HUGS) |
| Weight-Centered | Active comparator | The LEARN Program for Weight Management is an evidence-based behavior modification approach to weight loss developed by Dr. Kelly Brownell, Ph.D. Psychologist. LEARN is an acronym that stands for Lifestyle, Exercise, Attitudes, Relationships, and Nutrition. This manualized curriculum shares many principals with the HUGS program in that both emphasize the importance of healthy lifestyle choices and gradual sustainable change. However, the LEARN program makes weight loss an explicit goal and focuses more on food intake levels based on external prescriptions and caloric restriction. Participants in the LEARN program will receive the LEARN Program for Weight Management manual and the LEARN Weight Stabilization and Maintenance Guide along with the LEARN Program CD set. Ann Wellock, a Registered Dietician from The Reading Hospital and Medical Center will deliver the intervention in 2 groups of 20 people that meet weekly for 6 months. Receives: Behavioral: Weight-Centered (LEARN) |
What is being measured
The primary outcome is the main question the study is designed to answer.
Blood Lipids
LDL, HDL, Total Cholesterol, Triglycerides (mg/dL)
Measured: Baseline, post-intervention, 18-24 months post intervention
Blood Pressure
Systolic and Diastolic (mmHg)
Measured: Baseline, post-intervention, 18-24 months post intervention
Fasting Blood Glucose
measured in mg/DL
Measured: Baseline, post-intervention, 18-24 months post intervention
Waist and Hip Circumference
measured in inches
Measured: Baseline, post-intervention, 18-24 months post intervention
Waist-to-Hip ratio
waist in inches/hips in inches
Measured: Baseline, post-intervention, 18-24 months post intervention
Secondary outcomes (9)
Disordered eating attitudes and behaviors
measured using the Eating Disorder Examination-Questionnaire (version 6), Range: 0-6, higher scores indicate worse outcome
Measured: baseline, post intervention, 18-24 months post intervention
Intuitive eating behaviors
Ability to engage in 'adaptive' eating (e.g., recognize internal signs of hunger and satiety) measured the Intuitive Eating Scale. Range: 1-5, higher scores indicate a better outcome
Measured: baseline, post intervention, 18-24 months post intervention
Maladaptive eating behaviors
Measured using the 'emotional eating' and 'uncontrolled eating' eating sub-scales of the Three-Factor Eating Questionnaire -Revised 18, Range: 0-100, higher scores indicate worse outcome
Measured: baseline, post intervention, 18-24 months post intervention
Fruit and vegetable intake
Assessed with the questions: "I eat 2 or more servings of fruit/vegetables on average each day." from the Red Lotus Health and Well-being Questionnaire, Range 0: (none of the time) to 5 (all of the time), higher scores indicate better outcome
Measured: baseline, post intervention, 18-24 months post intervention
Physical activity
Assessed with the question: "I participate in moderately vigorous physical activity for about 30 minutes on average most days of the week." from the Red Lotus Health and Well-being Questionnaire, Range 0: (none of the time) to 5 (all of the time), higher scores indicate better outcome
Measured: baseline, post intervention, 18-24 months post intervention
Self-esteem
measured using the Rosenberg Self-esteem Scale, Range: 0-30, higher scores indicate a better outcome
Measured: baseline, post intervention, 18-24 months post intervention
Overall health and well-being status/Quality of life
measured using the Red Lotus Health and Well-being Questionnaire, Range: 15-75, higher scores indicate a better outcome
Measured: baseline, post intervention, 18-24 months post intervention
Psychological distress
measured using the Depression Anxiety Stress Scale-21, Range: 0-168, higher scores indicate a worse outcome
Measured: baseline, post intervention, 18-24 months post intervention
Dietary habits
Assessment of foods most often consumed, measured using the Dietary Risk Assessment screener, Range 0-125, higher scores indicate higher worse outcome
Measured: baseline, post intervention, 18-24 months post intervention
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted9 Oct 2008 (estimated)
- Study start25 Sep 2008
- Primary completion25 Feb 2011
- Study completion25 Feb 2011
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (3)Papers the sponsor has linked to this study.
- Other trials for ObesityStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- 1:1 Parallel assignment
- Masking
- Quadruple blind
- Who is masked
- Participant, Care provider, Investigator, Outcomes assessor
- Enrolment
- 80 participants (actual)
Sponsor and investigators
- Lead sponsor
- The Reading Hospital and Medical Center
- Sponsor type
- University, hospital or other
- Collaborators
- The Edna G. Kynett Memorial Foundation
- Responsible party
- Principal investigator, Janell Mensinger, PhD, FAED, Villanova University
- Investigators
- Janell L Mensinger, Ph.D., Principal investigator, Villanova University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT00769717
- Sponsor's protocol ID
- TRHMC 02708
- Status last verified
- Nov 2019
- First submitted
- 8 Oct 2008
- Last updated
- 3 Dec 2019
- Results posted
- No
- Data monitoring committee
- No
Publications
Mensinger JL, Calogero RM, Stranges S, Tylka TL. A weight-neutral versus weight-loss approach for health promotion in women with high BMI: A randomized-controlled trial. Appetite. 2016 Oct 1;105:364-74. doi: 10.1016/j.appet.2016.06.006. Epub 2016 Jun 8.
PubMed 27289009Mensinger JL, Calogero RM, Tylka TL. Internalized weight stigma moderates eating behavior outcomes in women with high BMI participating in a healthy living program. Appetite. 2016 Jul 1;102:32-43. doi: 10.1016/j.appet.2016.01.033. Epub 2016 Jan 29.
PubMed 26829370Mensinger, J. L., & Meadows, A. (2017). Internalized weight stigma mediates and moderates physical activity outcomes during a healthy living program for women with high body mass index. Psychology of Sport and Exercise, 30, 64-72. doi:10.1016/j.psychsport.2017.01.010
Study at a glance
From the registry record, last updated by the sponsor on 3 Dec 2019. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Comparative Health Improvements and Rate of Relapse in Weight-Centered vs. Wellness-Centered Interventions for Obese Women
- ClinicalTrials.gov ID
- NCT00769717
- Acronym / sponsor ID
- TRHMC 02708
- Conditions
- Obesity
- Keywords
- obesity, wellness, cardiovascular disease prevention, health at every size, weight loss
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 80 participants (actual)
- Lead sponsor
- The Reading Hospital and Medical CenterUniversity, hospital or other
- Collaborators
- The Edna G. Kynett Memorial Foundation
- Study start
- 25 Sep 2008 (actual)
- Primary completion
- 25 Feb 2011 (actual)
- Study completion
- 25 Feb 2011 (actual)
- First posted
- 9 Oct 2008 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
For over four decades the medical literature has observed a relationship between obesity and poorer health outcomes. The causal mechanisms of these poorer outcomes however are unclear. One assumption that has been supported by correlational data is that increased weight is associated with increased cardiovascular disease (CVD) risk factors (i.e., hypertension, dyslipidemia, and type 2 diabetes). Consequently, obese people are routinely prescribed weight loss programs in order to prevent or control these conditions. Unfortunately, long term weight loss has been met with minimal success for the large majority of people. Furthermore, the data suggesting that weight loss leads to long term health benefits and decreased mortality is limited and contradictory. The purpose of the proposed project is to perform a randomized controlled pilot study comparing the effectiveness of two lifestyle interventions for preventing CVD risk factors (hypertension, dyslipidemia, and type 2 diabetes). The interventions are constitutionally similar; however, the treatment condition is a wellness-focused intervention that teaches healthy living without consideration of weight. The control condition is a traditional curriculum where the prescribed outcome is weight loss. The primary goals of both programs are to reduce hypertension and total cholesterol, and to enhance glucose control. Secondary outcomes of interest are psychological and behavioral in nature (e.g., self-esteem; depressed mood; anxiety; stress; quality of life; dietary habits; and physical activity). We will compare the trajectories of the CVD and psychological/behavioral risk factors for a total period of 24 months (including the time from baseline to the end of the 6-month intervention). Our objectives are to collect data to a) determine whether participants in both programs reduce CVD and psychological/behavioral risk factors at the completion of the 6-month program, and b) compare the persistency of health improvements and rate of relapse at the end of the 18-month follow-up period between the traditional weight loss intervention and the wellness-focused intervention.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Quadruple blind (participant, care provider, investigator, outcomes assessor)
- Number of arms
- 2
- Model description
- 1:1 Parallel assignment
| Arm | Type | Receives |
|---|---|---|
| Wellness-Centered | Experimental | Behavioral: Wellness-Centered (HUGS)A health at every size intervention, the HUGS program was conceived and developed in 1987 by Linda Omichinski, Registered Dietitian. HUGS stands for Health focused, Understanding lifestyle, Group supported, and Self-esteem building. It is an integrated approach that promotes healthy eating, active living, and self acceptance regardless of weight. HUGS teaches strategies to recognize and respond to physiological signs of hunger and satiety to determine food intake. The manualized curriculum is accompanied by the books Tailoring Your Tastes and Staying Off of the Diet Roller Coaster which participants will receive in addition to a booklet of handouts. Kelly Bliss, a psychotherapist and fitness professional with 17 years experience in health-centered approaches for weight management, will deliver the intervention in 2 groups of 20 people that meet weekly for 6 months. |
| Weight-Centered | Active comparator | Behavioral: Weight-Centered (LEARN)The LEARN Program for Weight Management is an evidence-based behavior modification approach to weight loss developed by Dr. Kelly Brownell, Ph.D. Psychologist. LEARN is an acronym that stands for Lifestyle, Exercise, Attitudes, Relationships, and Nutrition. This manualized curriculum shares many principals with the HUGS program in that both emphasize the importance of healthy lifestyle choices and gradual sustainable change. However, the LEARN program makes weight loss an explicit goal and focuses more on food intake levels based on external prescriptions and caloric restriction. Participants in the LEARN program will receive the LEARN Program for Weight Management manual and the LEARN Weight Stabilization and Maintenance Guide along with the LEARN Program CD set. Ann Wellock, a Registered Dietician from The Reading Hospital and Medical Center will deliver the intervention in 2 groups of 20 people that meet weekly for 6 months. |
Who may qualify
- Ages
- 30 to 45 years
- Sex
- Female only
- Healthy volunteers
- Accepted
- Age groups
- Adult
Key inclusion criteria (5 listed)
- Women ages 30 to 45 years old (at intervention onset);
- BMI between 30 and 45
- Physically inactive
- Practicing birth control if heterosexually active and pre-menopausal.
- English speaking
Key exclusion criteria (15 listed)
- Current smoker
- Use of medications known to affect weight/energy expenditure;
- Pregnant, intending to get pregnant over next two years, or lactating;
- Recent myocardial infarction (within 6 months);
- Congestive heart failure
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Wellness-Centered (HUGS)Also: Health At Every Size, Intuitive EatingA health at every size intervention, the HUGS program was conceived and developed in 1987 by Linda Omichinski, Registered Dietitian. HUGS stands for Health focused, Understanding lifestyle, Group supported, and Self-esteem building. It is an integrated approach that promotes healthy eating, active living, and self acceptance regardless of weight. HUGS teaches strategies to recognize and respond to physiological signs of hunger and satiety to determine food intake. The manualized curriculum is accompanied by the books Tailoring Your Tastes and Staying Off of the Diet Roller Coaster which participants will receive in addition to a booklet of handouts. Kelly Bliss, a psychotherapist and fitness professional with 17 years experience in health-centered approaches for weight management, will deliver the intervention in 2 groups of 20 people that meet weekly for 6 months. | Behavioural | Wellness-Centered |
| Weight-Centered (LEARN)Also: behavior based weight loss programThe LEARN Program for Weight Management is an evidence-based behavior modification approach to weight loss developed by Dr. Kelly Brownell, Ph.D. Psychologist. LEARN is an acronym that stands for Lifestyle, Exercise, Attitudes, Relationships, and Nutrition. This manualized curriculum shares many principals with the HUGS program in that both emphasize the importance of healthy lifestyle choices and gradual sustainable change. However, the LEARN program makes weight loss an explicit goal and focuses more on food intake levels based on external prescriptions and caloric restriction. Participants in the LEARN program will receive the LEARN Program for Weight Management manual and the LEARN Weight Stabilization and Maintenance Guide along with the LEARN Program CD set. Ann Wellock, a Registered Dietician from The Reading Hospital and Medical Center will deliver the intervention in 2 groups of 20 people that meet weekly for 6 months. | Behavioural | Weight-Centered |
Primary outcome
Blood Lipids
Time frame: Baseline, post-intervention, 18-24 months post intervention
LDL, HDL, Total Cholesterol, Triglycerides (mg/dL)
Blood Pressure
Time frame: Baseline, post-intervention, 18-24 months post intervention
Systolic and Diastolic (mmHg)
Fasting Blood Glucose
Time frame: Baseline, post-intervention, 18-24 months post intervention
measured in mg/DL
Waist and Hip Circumference
Time frame: Baseline, post-intervention, 18-24 months post intervention
measured in inches
Waist-to-Hip ratio
Time frame: Baseline, post-intervention, 18-24 months post intervention
waist in inches/hips in inches
9 secondary outcomes
Disordered eating attitudes and behaviors
Time frame: baseline, post intervention, 18-24 months post intervention
Intuitive eating behaviors
Time frame: baseline, post intervention, 18-24 months post intervention
Maladaptive eating behaviors
Time frame: baseline, post intervention, 18-24 months post intervention
Fruit and vegetable intake
Time frame: baseline, post intervention, 18-24 months post intervention
Physical activity
Time frame: baseline, post intervention, 18-24 months post intervention
Self-esteem
Time frame: baseline, post intervention, 18-24 months post intervention
Overall health and well-being status/Quality of life
Time frame: baseline, post intervention, 18-24 months post intervention
Psychological distress
Time frame: baseline, post intervention, 18-24 months post intervention
Dietary habits
Time frame: baseline, post intervention, 18-24 months post intervention
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 3 Dec 2019.
- Results publication: PubMed 27289009Mensinger JL, Calogero RM, Stranges S, Tylka TL. A weight-neutral versus weight-loss approach for health promotion in women with high BMI: A randomized-controlled trial. Appetite. 2016 Oct 1;105:364-74. doi: 10.1016/j.appet.2016.06.006. Epub 2016 Jun 8.
- Results publication: PubMed 26829370Mensinger JL, Calogero RM, Tylka TL. Internalized weight stigma moderates eating behavior outcomes in women with high BMI participating in a healthy living program. Appetite. 2016 Jul 1;102:32-43. doi: 10.1016/j.appet.2016.01.033. Epub 2016 Jan 29.
- Results publicationMensinger, J. L., & Meadows, A. (2017). Internalized weight stigma mediates and moderates physical activity outcomes during a healthy living program for women with high body mass index. Psychology of Sport and Exercise, 30, 64-72. doi:10.1016/j.psychsport.2017.01.010
- Link to request second publication (disordered eating mediation and moderation) from ResearchGateLink provided by the sponsor.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Janell L Mensinger, Ph.D. principal investigator
Villanova University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Wellness-Centered (HUGS) and Weight-Centered (LEARN) in people with Obesity, run by The Reading Hospital and Medical Center at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 5 inclusion and 15 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 3 Dec 2019. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Blood Lipids (time frame: Baseline, post-intervention, 18-24 months post intervention). The study lists 5 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT00769717, which also lists 3 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 3 Dec 2019.