Weight LossDELISHNCT04302727
Delicious Eating for Life in Southern Homes
A study testing Med-South Weight Loss Intervention and WW in people with Weight Loss and Diet, Healthy, run by University of North Carolina, Chapel Hill at 1 site in United States.
Trial summary
This study will compare a new weight loss program that focuses on a healthy eating pattern, with WW™ (formally Weight Watchers), an effective and widely available weight loss program. Read more about this study
- Who is it for?
- Ages 18 to 75 yearsHealthy volunteers can take part
- Conditions the study is for
- Weight Loss, Diet, Healthy, Cardiovascular Risk Factor
- What is being tested?
- Med-South Weight Loss Intervention and WW
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 360 participants
- Where
- 1 siteUnited States
- Study dates
- 6 Jul 2020to 16 Jun 2024
- Phase
- Interventional
- Are there results?
- Yes, posted in the registrySummary in the doctors' view
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 18 to 75 years
- All sexes
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- Male or female
- English speaking
- Ages 18-75 (inclusive)
- BMI > or = 30 kg/m^2
- Approval for participation by primary care clinician
- Established patient at participating practice defined as at least one prior visit at the practice within the prior 2 years
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- Access to telephone
- No plans to move from the area for at least 1 year
- Free living to the extent that participant has control over dietary intake
- Those with known cardiovascular disease will be allowed to participant
Who cannot join
- Participant in intensive weight loss program (more than 6 visits) in the prior year
- Another family member or household member is a study participant. Only one member of each household may take part in this study.
- Considering bariatric surgery in the next year or prior bariatric surgery
- Type 1 diabetes. Rationale is patients with type 1 diabetes already received intensive dietary counseling with a focus on total and distribution of daily carbohydrates.
- Pregnancy/breastfeeding or intended pregnancy in the next year
- History of malignancy, other than non-melanoma skin cancer, unless surgically or medically cured > 5 years ago or in remission. Patients with localized prostate and breast cancer diagnosed during the course of routine screening will not be excluded.
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- Advanced kidney disease (estimated creatinine clearance < 30 mL/min)
- Known drug or alcohol misuse in the past 2 years
- Known psychosis or major psychiatric illness. Those with major depression who have responded to treatment may participate.
Trial locations and contacts
1 site in 1 country.
United States1 site
UNC Center for Health Promotion and Disease Prevention
Chapel Hill, North Carolina, 27514
About this study
Official title: Randomized Explanatory Trial of a Mediterranean Dietary Pattern Weight Loss Intervention for Primary Care Practices
This study will compare a new weight loss program that focuses on a healthy eating pattern, with WW™ (formally Weight Watchers), an effective and widely available weight loss program. Study researchers have developed an adapted version of the Mediterranean eating pattern to be more acceptable and realistic for southerners; this adapted version is known as "Med-South." Those who take part in the study will be randomly assigned to either the Med-South weight loss program or WW™. Both programs will last for 2 years with measurement visits at the start of the study and at 4-, 12- and 24-month follow-up. While the primary outcome measured by the trial will be weight loss at 24 months, researchers will collect other data which may show additional health benefits of the Med-South diet. The study team will measure blood markers of inflammation, which are known to improve with better diet quality. Researchers will also measure participants' skin carotenoid levels, which increase with greater fruit and vegetable consumption. The study will be conducted within 2 regional catchment areas (n=360 participants) representing a diverse spectrum of patients and settings. Patients with a BMI ≥ 30 kg/m^2 will be enrolled and randomized to intervention or augmented usual care. To assure adequate subgroup representation, ≥ 40% of the sample will have diabetes, ≥ 40% will be male, and ≥ 40% will be African American. The intervention will be delivered in 3 phases over 24 months by research staff: Phase I (4 months) focuses on adopting a Med-style dietary pattern; Phase II (8 months) on weight loss; and Phase III (12 months) on weight loss maintenance. Outcomes will be assessed at 4, 12, and 24 months. The primary outcome is weight loss at 24 months. Secondary outcomes include change in physiologic, behavioral, and psychosocial measures. Researchers will also assess implementation cost and the incremental cost-effectiveness of the intervention relative to the augmented usual care group.
Read the detailed description
Below, each of the treatment arms is described in detail.
Med-South Weight Loss Program
Most weight loss programs offer weekly one-on-one or group counseling sessions for 16-20 weeks. The Med-South Weight Loss Program is different and is given in 3 phases. The program begins with Phase I, a 4-month lifestyle phase that focuses on the "basics" of healthy eating rather than weight loss. Over the next 8 months in Phase II, we focus on weight loss, followed by a year-long (Phase III) phase to help maintain weight loss. In Phase I, the main counseling sessions happen at monthly visits, to which check-in phone calls are added. In Phase II, the main counseling sessions will occur weekly for 6-8 weeks, depending on participants' progress. There are also check in phone calls-the number will vary based on progress. During Phase III, there are 2 main visits and follow-up phone calls. More details about these visits are in the table below.
Some of the counseling visits will be face-to-face with the counselor and some by phone. Only one member of a family may join this study, but other family members are invited to take part in face-to-face and phone counseling sessions. (As of June 2020, due to COVID-19 only one other family member or friend may come with you to in-person visits.) Of the 14 core counseling sessions), the face-to-face format will be required for only 5 (the 1st session of each Phase, after 2 months of the weight loss program, and approximately 1/2 through the year long maintenance phase). (As of June 2020, due to COVID-19, only these visits will be in person. All the others will be by phone or videoconferencing, until further notice based on updated COVID-19 guidelines.) During face-to-face sessions, the participant and the counselor will sit side-by-side and use a web-based program or the paper format to review educational materials, select dietary goals, and list first steps to reach these goals. (As of June 2020, due to COVID-19, counselor and participant will sit more than 6 feet apart and a large wall mounted monitor will be used to review study materials. This protocol will be followed until further notice based on updated COVID-19 guidelines.) If the phone format is used for major counseling sessions, the participant may view the educational content online or use the paper version. The program also includes brief telephone calls to check on progress towards goals selected at previous sessions and provide support for lifestyle change. The number of phone calls will depend on the participant meeting his/her personal weight loss goals in Phase II or keeping the weight off in Phase III. Detail for each Phase is given below.
Phase I
- 8 total contacts
- 4 core sessions: the first must be in-person; choice of in-person or phone for all others
- 4 follow-up phone calls
- Core session = 45-60 min.
- Follow-up call = 15 min.
- total time: 4 - 5 hours
Phase II
- 14 core sessions: the first and third must be in-person; choice of in-person or phone for all others.
- 6-12 follow-up phone calls
- Core session (In-person) = 45-60 min.
- Core session (phone) = 30-45 min.
- Follow-up call = 20-30 min. Total time 8.7 - 14 hours (core) 4.7 - 9.5 hours (Follow-up)
Phase III
- 2 core sessions (both in-person)
- 12-24 follow-up phone calls (1-2 per month)
- Core session (In-person) = 45-60 min.
- Follow-up call = 15-20 min. Total time 1.25 - 2 hours (Core) 3 - 8 hours (Follow-up) 2-Year Program TOTAL 44 - 60 Contacts -- 21.7 - 38.5 hours
WW™ Weight Loss Program
Those randomized to WW™ will have access to both the Workshop and Digital components of the WW™ program for 2 years. WW offers in-person coaching and community-based learning through weekly Workshops at WW Studios.The Workshop component allows for attending weekly group meeting at a WW™ studio (local WW™ office). (As of June 2020, due to COVID-19, the workshop component will be available in a virtual videoconferencing [Zoom™] format until further notice based on updated COVID-19 guidelines.)
The Digital component can be accessed using the WW™ website or the smart phone App. The digital tools available thought the WW Digital program include food tracking (either manually or with bar code scanning), progress charts, lifestyle coaching with 24/7 chat with a WW Coach, ability to track activity (manually or by syncing a fitness tracking device), incentives for behavior change (WellnessWins), recipes, and even local restaurant recommendations using GPS. Those in the WW group will also have access to Connect, WW's members-only digital community.
The WW™ program uses "SmartPoints" assigned to foods based on energy content and nutritional value, allocating a certain number of points to users daily based on their starting weight, weight loss goals, age and sex. Participants will receive a personalized SmartPoints budget made up of Daily SmartPoints, plus some extra Weekly SmartPoints for those days when a cushion is needed.
- Conditions
- Weight Loss, Diet, Healthy, Cardiovascular Risk Factor
- Being tested
- Med-South Weight Loss Intervention, WW
- Keywords
- Behavioral weight loss, Mediterranean dietary pattern, Lifestyle program, Inflammatory markers
- Medical subject headings
- Weight Loss
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Med-South Weight Loss InterventionBehavioural
Also called Delicious Eating for Life in Southern Homes (DELISH) Weight Loss Program
Phase I is a 4-month lifestyle program focused on the basics of healthy eating. Phase II (8 months) focuses on weight loss, followed by a year-long (Phase III) focused on weight loss maintenance. In Phase I, the main counseling sessions happen at monthly visits, with added check-in phone calls. In Phase II, the main counseling sessions will occur weekly for 6-8 weeks. There are also check-in phone calls - number based on weight loss progress. During Phase III, there are 2 main visits and follow-up phone calls. Counseling visits will be in-person with a health counselor and by phone. Of the 14 core counseling sessions, the in-person format will be required for only 4 (the 1st session of each Phase and after 2 months of the weight loss program). The program also includes brief phone calls to check on progress towards goals for lifestyle change. The number of phone calls will depend on success in meeting personal weight loss goals in Phase II or keeping the weight off in Phase III.
WWBehavioural
Also called Weight Watchers
If participants are randomized to WW™, they will have access to both the workshop and digital components of the WW™ program for 2 years. The workshop component includes the option of attending weekly group meeting at a WW™ studio (local WW™ office). The digital component can be accessed using the WW™ website or the smart phone App. The study research staff will provide basic instructions on how to use the WW™ digital resources.
| Study group | Role | What they receive |
|---|---|---|
| Med-South Weight Loss Intervention | Experimental | The intervention will be delivered in 3 phases over 24 months: Phase I (4 months) provides a foundation for adopting and maintaining a healthful dietary pattern (Med-style, tailored for the southeastern United States); Phase II (8 months) focuses on weight loss; and Phase III (12 months) on maintenance of or continued weight loss, as appropriate. Receives: Behavioral: Med-South Weight Loss Intervention |
| Augmented Usual Care (WW) | Active comparator | The intervention that will be offered to control group participants is WW™ (formerly known as Weight Watchers). The study will provide access to the 'Workshop + Digital' option of WW™ during the 2 year intervention. Receives: Behavioral: WW |
What is being measured
The primary outcome is the main question the study is designed to answer.
Percent Weight Change From Baseline to Month 24
Weight will be collected by study staff who are masked to treatment using scales tested monthly for accuracy up to 350 pounds.
Measured: Baseline, Month 24
Secondary outcomes (26)
Percent Weight Change From Baseline to Months 4 and 12
Weight will be collected by study staff who are masked to treatment using scales tested monthly for accuracy up to 350 pounds.
Measured: Baseline, Months 4 and 12
Percentage Weight From Baseline Through Follow-Up by Sub-Groups
Weight will be collected by study staff who are masked to treatment using scales tested monthly for accuracy up to 350 pounds. Assess difference between study groups in percentage losing ≥ 5% body weight for all participants and across 3 pre-specified subgroups: 1) participants with vs. without diabetes; 2) females vs. males; and 3) Whites vs. African Americans.
Measured: Baseline, Months 4, 12, and 24
Mean Weight Change From Baseline Through Follow-Up
Weight will be collected by study staff who are masked to treatment.
Measured: Baseline, Months 4, 12, and 24
Mean Change in Systolic Blood Pressure From Baseline Through Follow-Up
Blood pressure assessed by Omron-907xl, average of 3 readings.
Measured: Baseline, Months 4, 12, and 24
Mean Change in Diastolic Blood Pressure From Baseline Through Follow-Up
Blood pressure assessed by Omron-907xl, average of 3 readings.
Measured: Baseline, Months 4, 12, and 24
Mean Change in Total Cholesterol From Baseline Through Follow-Up
Total cholesterol assessed by commercial lab (LabCorp).
Measured: Baseline, Month 4, 12, and 24
Mean Change in HDL-Cholesterol From Baseline Through Follow-Up
HDL-Cholesterol assessed by commercial lab (LabCorp).
Measured: Baseline, Month 4, 12, and 24
Mean Change in Triglycerides From Baseline Through Follow-Up
Triglycerides as assessed by commercial lab (LabCorp).
Measured: Baseline, Month 4, 12, and 24
Mean Change LDL-cholesterol From Baseline Through Follow-up
Calculated from above lipid assessments by commercial lab (LabCorp).
Measured: Baseline, Month 4, 12, and 24
Mean Change in A1c From Baseline Through Follow-Up
A1c assessed by commercial lab (LabCorp).
Measured: Baseline, Month 4, 12, and 24
Mean Change in CRP (C-Reactive Protein) From Baseline Through Follow-Up
CRP assessed by commercial lab (LabCorp).
Measured: Baseline, Month 4, 12, and 24
Mean Change in Interleukin (IL) IL-6 From Baseline Through Follow-Up
Assessed by independent lab blinded to participant arm.
Measured: Baseline, Month 4, 12, and 24
Mean Change in Tumor Necrosis Factor (TNF) TNF-alpha From Baseline Through Follow-Up
Assessed by independent lab blinded to participant arm.
Measured: Baseline, Month 4, 12, and 24
Mean Change in Skin Carotenoids From Baseline Through Follow-Up
Evaluated as the sum of 3 measures assessed by veggie-meter by Longevity Link Corporation. The Veggie Meter produces a score from 0 to 800, with higher scores indicating greater skin carotenoid levels, which suggest a greater intake of fruits and vegetables.
Measured: Baseline, Month 4, 12, and 24
Mean Change in Quality of Life Scale From Baseline Through Follow-Up
The Euro Quality of Life Three Dimensions Questionnaire EQ-5D-3L ( EuroQol five-dimensional three-level questionnaire) scale measures patients' quality of healthy living. It has 5 items (Mobility, Self-care, Usual activities, Pain/discomfort, Depression/anxiety). Each item contains 3 levels: 1=no problems; 2=some problems; 3=extreme problems. The higher the score has the worse the health. Then, the score calculation of the European Five-Dimensional Health Scale is based on the calculation formula published for U.S. populations. Based on 3 combinations of different severity for the 5 items, a score of 0 to 1 is obtained which is called the EQ-5D-3L index and reported here. 0 is the least healthy and 1 is the most healthy.
Measured: Baseline, Month 4, 12, and 24
Mean Change in Alternate Healthy Eating Index (AHEI)-2010 From Baseline Through Follow-Up
The AHEI-2010 is calculated from items on the Willett Food Frequency Questionnaire. It addresses intake of foods and nutrients consistently associated with lower risk for chronic diseases in the literature. The AHEI-2010 score is comprised of 11 sub-scales, each scored from 0 to 10, yielding a total score with a range of 0-110. A higher score indicates a more healthful dietary pattern.
Measured: Baseline, Month 4, 12, and 24
Mean Change in Global Physical Activity Questionnaire (GPAQ) From Baseline Through Follow-Up
The GPAQ was developed by the World Health Organization (WHO) for physical activity surveillance. It collects information on physical activity participation in three settings (or domains) as well as sedentary behavior. The domains are: activity at work, travel to and from places, and recreational activities. The summary measure will be the sum of all moderate and vigorous activity per week (measured in hours) for the domains mentioned with a higher score indicating more physical activity.
Measured: Baseline, Month 4, 12, and 24
Mean Change in Weight Loss Self-Efficacy From Baseline Through Follow-Up
The Weight Efficacy Lifestyle Questionnaire Short-Form (WEL-SF1) is a short version of the original Weight-Efficacy Lifestyle Questionnaire and includes 8 questions and 1 situational component representing "confidence in ability to resist eating." Three of the questions are related to emotional eating situations, two to availability, one to social pressure, one to positive activities, and one to physical discomfort. Scoring: The instrument range scores on a Likert-scale from 0 (not at all confident) to 10 (very confident), with sum scores between 0 and 80. High scores are associated with high eating self-efficacy.
Measured: Baseline, Month 4, 12, and 24
Mean Change in Dietary Self-Regulation From Baseline Through Follow-Up
Treatment Self-regulation Questionnaire (TSRQ) measures the quality of motivation for a particular health goal. Motivation is psychological energy directed at a particular goal such as weight loss. The autonomous self-regulation sub-scale of the TSRQ was used.This 6-item scale will focus on the reasons why people would either start eating a healthier diet or continue to do so. Scoring: Participants rate each statement on a 7-point Likert scale ranging from 1 (not at all true) to 7 (very true). It assesses the degree to which a person's motivation for eating a healthy diet is autonomous or self-determined. Possible scores range from 6 to 42 wtih higher scores indicating greater motivation.
Measured: Baseline, Month 4, 12, and 24
Mean Change in Eating Attitudes From Baseline Through Follow-Up (Cognitive Restraint)
The Cognitive Restraint subscale of the Three Factor Eating Questionnaire has 6 items and measures one of the three dimensions of eating attitudes. The instrument scoring range for each item is based on a Likert-scale from 1 (definitely false) to 4 (definitely true) with scores ranging from 6 and 24. Higher scores indicate greater cognitive restraint.
Measured: Baseline, Month 4, 12, and 24
Mean Change in Eating Attitudes From Baseline Through Follow-Up (Uncontrolled Eating)
The uncontrolled eating subscale of the Three Factor Eating Questionnaire has 9 items and measures one of the three dimensions of eating attitudes. The instrument scoring range for each item is based on a Likert-scale from 1 (definitely false) to 4 (definitely true) with scores ranging from 9 and 36. Higher scores indicate greater uncontrolled eating.
Measured: Baseline, Month 4, 12, and 24
Mean Change in Eating Attitudes From Baseline Through Follow-Up (Emotional Eating)
The emotional eating subscale of the Three Factor Eating Questionnaire has 3 items and measures one of the three dimensions of eating attitudes. The instrument scoring range for each item is based on a Likert-scale from 1 (definitely false) to 4 (definitely true) with scores ranging from 3 and 12. Higher scores indicate greater emotional eating.
Measured: Baseline, Month 4, 12, and 24
Mean Change in Diet Self-Efficacy From Baseline Through Follow-Up
Perceived self-efficacy is regarded as a suitable predictor of reported health behaviors. This 5-item scale of perceived self-efficacy measures self-efficacy related to healthful eating behaviors. Responses are on a 4-point scale of 'very uncertain' to 'very certain.' Total scores range from 5-20 with higher scores indicating higher perceived self-efficacy.
Measured: Baseline, Month 4, 12, and 24
Mean Change in Self-Weighing Behaviors From Baseline Through Follow-Up
EARLY Self-Weighing Questionnaire: This is a 1-item screener measures frequency of self-weighing. It was adapted from the Pound of Prevention Health Habits Questionnaire. Those reporting a higher weighing frequency had greater 24-month weight loss or less weight gain. Scoring: Higher scores indicate higher frequency of self-weighing. Responses are based on a 7-point scale ranging from 1 = never; 2 = once a year or less; 3= every couple of months; 4 = about once a month; 5 = about once a week; 6 = about once a day; and 7 = more than once a day.
Measured: Baseline, Month 4, 12, and 24
Economic Outcome--Incremental Cost-Effectiveness
Computed as the incremental cost per kilogram of weight loss relative to control. The budgetary assessment will quantify the total and per participant costs of intervention delivery from the health system perspective using an Activity Based Costing (ABC) approach and cost tracking forms that the health economist (Finkelstein) has developed and refined in past behavioral trials. Using this approach, all relevant labor, materials and supplies, contracted services, and other relevant costs required to deliver the interventions will be captured by key activities
Measured: Month 24
Economic Outcome--Incremental Cost Per Quality Adjusted Life Year (QALY) Gained
The numerator for this analysis will be the incremental program delivery costs of the intervention relative to control, minus any cost offsets based on differences in health services and medication use across arms. The denominator will be the incremental QALYs based on average differences in Euro Quality of Life five Dimensions Questionnaire (EQ-5D-5L) scores across arms collected at each assessment point. These scores can be used to quantify net QALY differences during the intervention period.
EQ-5D-5L scale measures patients' quality of healthy living. It has 5 items (Mobility, Self-care, Usual activities, Pain/discomfort, Depression/anxiety). The score calculation of the European Five-Dimensional Health Scale is based on the calculation formula published by the EuroQol Group. Based on 5 combinations of different severity levels, a score of 0 to 1 is obtained. 0 is the least healthy and 1 is the most healthy.
Measured: Month 24
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted10 Mar 2020
- Study start6 Jul 2020
- Primary completion16 Jun 2024
- Study completion16 Jun 2024
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Posted resultsParticipant flow, outcome measures and adverse events reported by the sponsor.
- Publications (9)Papers the sponsor has linked to this study.
- Other trials for Weight LossStudies of the same condition, open and under way.
- More trials run by University of North Carolina, Chapel HillThe sponsor's other registered studies.
- 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
- Study participants will be randomized to either the intervention group (Med-Diet Weight Loss Program) or an enhanced usual care control group (WW); both groups will participate in the respective programs for two years.
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 360 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of North Carolina, Chapel Hill
- Sponsor type
- University, hospital or other
- Collaborators
- National Heart, Lung, and Blood Institute (NHLBI)
- Responsible party
- Sponsor
- Investigators
- Carmen D Samuel-Hodge, PhD, Principal investigator, University of North Carolina, Chapel HillThomas C Keyserling, MD, Principal investigator, University of North Carolina, Chapel Hill
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04302727
- Sponsor's protocol ID
- 19-1712
- Other IDs
- 1R61HL142680-01A1, 4R33HL142680-02, 5R33HL142680-03
- Acronym
- DELISH
- Status last verified
- Jun 2025
- First submitted
- 6 Mar 2020
- Last updated
- 3 Nov 2025
- Results posted
- Yes, on ClinicalTrials.gov
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: Deidentified individual data that supports the results will be shared beginning 9 to 36 months following publication provided the investigator who proposes to use the data has approval from an Institutional Review Board (IRB), Independent Ethics Committee (IEC), or Research Ethics Board (REB), as applicable, and executes a data use/sharing agreement with UNC.
Publications
Keyserling TC, Samuel-Hodge CD, Pitts SJ, Garcia BA, Johnston LF, Gizlice Z, Miller CL, Braxton DF, Evenson KR, Smith JC, Davis GB, Quenum EL, Elliott NT, Gross MD, Donahue KE, Halladay JR, Ammerman AS. A community-based lifestyle and weight loss intervention promoting a Mediterranean-style diet pattern evaluated in the stroke belt of North Carolina: the Heart Healthy Lenoir Project. BMC Public Health. 2016 Aug 5;16:732. doi: 10.1186/s12889-016-3370-9.
PubMed 27495295Keyserling TC, Samuel Hodge CD, Jilcott SB, Johnston LF, Garcia BA, Gizlice Z, Gross MD, Savinon CE, Bangdiwala SI, Will JC, Farris RP, Trost S, Ammerman AS. Randomized trial of a clinic-based, community-supported, lifestyle intervention to improve physical activity and diet: the North Carolina enhanced WISEWOMAN project. Prev Med. 2008 Jun;46(6):499-510. doi: 10.1016/j.ypmed.2008.02.011. Epub 2008 Feb 15.
PubMed 18394692Keyserling TC, Sheridan SL, Draeger LB, Finkelstein EA, Gizlice Z, Kruger E, Johnston LF, Sloane PD, Samuel-Hodge C, Evenson KR, Gross MD, Donahue KE, Pignone MP, Vu MB, Steinbacher EA, Weiner BJ, Bangdiwala SI, Ammerman AS. A comparison of live counseling with a web-based lifestyle and medication intervention to reduce coronary heart disease risk: a randomized clinical trial. JAMA Intern Med. 2014 Jul;174(7):1144-57. doi: 10.1001/jamainternmed.2014.1984.
PubMed 24861959Embree GG, Samuel-Hodge CD, Johnston LF, Garcia BA, Gizlice Z, Evenson KR, DeWalt DA, Ammerman AS, Keyserling TC. Successful long-term weight loss among participants with diabetes receiving an intervention promoting an adapted Mediterranean-style dietary pattern: the Heart Healthy Lenoir Project. BMJ Open Diabetes Res Care. 2017 Mar 29;5(1):e000339. doi: 10.1136/bmjdrc-2016-000339. eCollection 2017.
PubMed 28405344Samuel-Hodge CD, Holder-Cooper JC, Gizlice Z, Davis G, Steele SP, Keyserling TC, Kumanyika SK, Brantley PJ, Svetkey LP. Family PArtners in Lifestyle Support (PALS): Family-based weight loss for African American adults with type 2 diabetes. Obesity (Silver Spring). 2017 Jan;25(1):45-55. doi: 10.1002/oby.21700. Epub 2016 Dec 2.
PubMed 27911049Samuel-Hodge CD, Garcia BA, Johnston LF, Gizlice Z, Ni A, Cai J, Kraschnewski JL, Gustafson AA, Norwood AF, Glasgow RE, Gold AD, Graham JW, Evenson KR, Trost S, Keyserling TC. Translation of a behavioral weight loss intervention for mid-life, low-income women in local health departments. Obesity (Silver Spring). 2013 Sep;21(9):1764-73. doi: 10.1002/oby.20317. Epub 2013 May 24.
PubMed 23408464Samuel-Hodge CD, Johnston LF, Gizlice Z, Garcia BA, Lindsley SC, Bramble KP, Hardy TE, Ammerman AS, Poindexter PA, Will JC, Keyserling TC. Randomized trial of a behavioral weight loss intervention for low-income women: the Weight Wise Program. Obesity (Silver Spring). 2009 Oct;17(10):1891-9. doi: 10.1038/oby.2009.128. Epub 2009 Apr 30.
PubMed 19407810Keyserling TC, Wu Q, Ammerman AS, Berkowitz SA, Buse JB, Couper DJ, Evenson KR, Hursting SD, Sotres-Alvarez D, Lyons K, Saraiya VM, Alick CL, Skinner HG, Nelson C, Kruse LM, Mathers AN, Fung TT, Jilcott Pitts SB, Finkelstein EA, Samuel-Hodge CD. Weight Loss Intervention Promoting an Adapted Mediterranean-Style Dietary Pattern: The DELISH Randomized Clinical Trial. JAMA Netw Open. 2026 Aug 3;9(8):e2629006. doi: 10.1001/jamanetworkopen.2026.29006.
PubMed 42623075Saraiya VM, Berkowitz SA, Johnston LF, Couper DJ, Sotres-Alvarez D, Lyons KM, Thaxton CK, Skinner HG, Samuel-Hodge CD, Keyserling TC. An Evaluation of Primary Care Clinician Referrals for Behavioral Weight Loss Counseling. J Prim Care Community Health. 2024 Jan-Dec;15:21501319241308054. doi: 10.1177/21501319241308054.
PubMed 39690977
Study at a glance
From the registry record, last updated by the sponsor on 3 Nov 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Randomized Explanatory Trial of a Mediterranean Dietary Pattern Weight Loss Intervention for Primary Care Practices
- ClinicalTrials.gov ID
- NCT04302727
- Acronym / sponsor ID
- DELISH / 19-1712
- Conditions
- Weight Loss, Diet, Healthy, Cardiovascular Risk Factor
- Keywords
- Behavioral weight loss, Mediterranean dietary pattern, Lifestyle program, Inflammatory markers
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 360 participants (actual)
- Lead sponsor
- University of North Carolina, Chapel HillUniversity, hospital or other
- Collaborators
- National Heart, Lung, and Blood Institute (NHLBI)
- Study start
- 6 Jul 2020 (actual)
- Primary completion
- 16 Jun 2024 (actual)
- Study completion
- 16 Jun 2024 (actual)
- First posted
- 10 Mar 2020 (actual)
- Results
- Posted 3 Nov 2025
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This study will compare a new weight loss program that focuses on a healthy eating pattern, with WW™ (formally Weight Watchers), an effective and widely available weight loss program. Study researchers have developed an adapted version of the Mediterranean eating pattern to be more acceptable and realistic for southerners; this adapted version is known as "Med-South." Those who take part in the study will be randomly assigned to either the Med-South weight loss program or WW™. Both programs will last for 2 years with measurement visits at the start of the study and at 4-, 12- and 24-month follow-up. While the primary outcome measured by the trial will be weight loss at 24 months, researchers will collect other data which may show additional health benefits of the Med-South diet. The study team will measure blood markers of inflammation, which are known to improve with better diet quality. Researchers will also measure participants' skin carotenoid levels, which increase with greater fruit and vegetable consumption. The study will be conducted within 2 regional catchment areas (n=360 participants) representing a diverse spectrum of patients and settings. Patients with a BMI ≥ 30 kg/m^2 will be enrolled and randomized to intervention or augmented usual care. To assure adequate subgroup representation, ≥ 40% of the sample will have diabetes, ≥ 40% will be male, and ≥ 40% will be African American. The intervention will be delivered in 3 phases over 24 months by research staff: Phase I (4 months) focuses on adopting a Med-style dietary pattern; Phase II (8 months) on weight loss; and Phase III (12 months) on weight loss maintenance. Outcomes will be assessed at 4, 12, and 24 months. The primary outcome is weight loss at 24 months. Secondary outcomes include change in physiologic, behavioral, and psychosocial measures. Researchers will also assess implementation cost and the incremental cost-effectiveness of the intervention relative to the augmented usual care group.
Detailed description
Below, each of the treatment arms is described in detail.
Med-South Weight Loss Program
Most weight loss programs offer weekly one-on-one or group counseling sessions for 16-20 weeks. The Med-South Weight Loss Program is different and is given in 3 phases. The program begins with Phase I, a 4-month lifestyle phase that focuses on the "basics" of healthy eating rather than weight loss. Over the next 8 months in Phase II, we focus on weight loss, followed by a year-long (Phase III) phase to help maintain weight loss. In Phase I, the main counseling sessions happen at monthly visits, to which check-in phone calls are added. In Phase II, the main counseling sessions will occur weekly for 6-8 weeks, depending on participants' progress. There are also check in phone calls-the number will vary based on progress. During Phase III, there are 2 main visits and follow-up phone calls. More details about these visits are in the table below.
Some of the counseling visits will be face-to-face with the counselor and some by phone. Only one member of a family may join this study, but other family members are invited to take part in face-to-face and phone counseling sessions. (As of June 2020, due to COVID-19 only one other family member or friend may come with you to in-person visits.) Of the 14 core counseling sessions), the face-to-face format will be required for only 5 (the 1st session of each Phase, after 2 months of the weight loss program, and approximately 1/2 through the year long maintenance phase). (As of June 2020, due to COVID-19, only these visits will be in person. All the others will be by phone or videoconferencing, until further notice based on updated COVID-19 guidelines.) During face-to-face sessions, the participant and the counselor will sit side-by-side and use a web-based program or the paper format to review educational materials, select dietary goals, and list first steps to reach these goals. (As of June 2020, due to COVID-19, counselor and participant will sit more than 6 feet apart and a large wall mounted monitor will be used to review study materials. This protocol will be followed until further notice based on updated COVID-19 guidelines.) If the phone format is used for major counseling sessions, the participant may view the educational content online or use the paper version. The program also includes brief telephone calls to check on progress towards goals selected at previous sessions and provide support for lifestyle change. The number of phone calls will depend on the participant meeting his/her personal weight loss goals in Phase II or keeping the weight off in Phase III. Detail for each Phase is given below.
Phase I
- 8 total contacts
- 4 core sessions: the first must be in-person; choice of in-person or phone for all others
- 4 follow-up phone calls
- Core session = 45-60 min.
- Follow-up call = 15 min.
- total time: 4 - 5 hours
Phase II
- 14 core sessions: the first and third must be in-person; choice of in-person or phone for all others.
- 6-12 follow-up phone calls
- Core session (In-person) = 45-60 min.
- Core session (phone) = 30-45 min.
- Follow-up call = 20-30 min. Total time 8.7 - 14 hours (core) 4.7 - 9.5 hours (Follow-up)
Phase III
- 2 core sessions (both in-person)
- 12-24 follow-up phone calls (1-2 per month)
- Core session (In-person) = 45-60 min.
- Follow-up call = 15-20 min. Total time 1.25 - 2 hours (Core) 3 - 8 hours (Follow-up) 2-Year Program TOTAL 44 - 60 Contacts -- 21.7 - 38.5 hours
WW™ Weight Loss Program
Those randomized to WW™ will have access to both the Workshop and Digital components of the WW™ program for 2 years. WW offers in-person coaching and community-based learning through weekly Workshops at WW Studios.The Workshop component allows for attending weekly group meeting at a WW™ studio (local WW™ office). (As of June 2020, due to COVID-19, the workshop component will be available in a virtual videoconferencing [Zoom™] format until further notice based on updated COVID-19 guidelines.)
The Digital component can be accessed using the WW™ website or the smart phone App. The digital tools available thought the WW Digital program include food tracking (either manually or with bar code scanning), progress charts, lifestyle coaching with 24/7 chat with a WW Coach, ability to track activity (manually or by syncing a fitness tracking device), incentives for behavior change (WellnessWins), recipes, and even local restaurant recommendations using GPS. Those in the WW group will also have access to Connect, WW's members-only digital community.
The WW™ program uses "SmartPoints" assigned to foods based on energy content and nutritional value, allocating a certain number of points to users daily based on their starting weight, weight loss goals, age and sex. Participants will receive a personalized SmartPoints budget made up of Daily SmartPoints, plus some extra Weekly SmartPoints for those days when a cushion is needed.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
- Model description
- Study participants will be randomized to either the intervention group (Med-Diet Weight Loss Program) or an enhanced usual care control group (WW); both groups will participate in the respective programs for two years.
| Arm | Type | Receives |
|---|---|---|
| Med-South Weight Loss Intervention | Experimental | Behavioral: Med-South Weight Loss InterventionThe intervention will be delivered in 3 phases over 24 months: Phase I (4 months) provides a foundation for adopting and maintaining a healthful dietary pattern (Med-style, tailored for the southeastern United States); Phase II (8 months) focuses on weight loss; and Phase III (12 months) on maintenance of or continued weight loss, as appropriate. |
| Augmented Usual Care (WW) | Active comparator | Behavioral: WWThe intervention that will be offered to control group participants is WW™ (formerly known as Weight Watchers). The study will provide access to the 'Workshop + Digital' option of WW™ during the 2 year intervention. |
Who may qualify
- Ages
- 18 to 75 years
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (10 listed)
- Male or female
- English speaking
- Ages 18-75 (inclusive)
- BMI > or = 30 kg/m^2
- Approval for participation by primary care clinician
Key exclusion criteria (9 listed)
- Participant in intensive weight loss program (more than 6 visits) in the prior year
- Another family member or household member is a study participant. Only one member of each household may take part in this study.
- Considering bariatric surgery in the next year or prior bariatric surgery
- Type 1 diabetes. Rationale is patients with type 1 diabetes already received intensive dietary counseling with a focus on total and distribution of daily carbohydrates.
- Pregnancy/breastfeeding or intended pregnancy in the next year
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 |
|---|---|---|
| Med-South Weight Loss InterventionAlso: Delicious Eating for Life in Southern Homes (DELISH) Weight Loss ProgramPhase I is a 4-month lifestyle program focused on the basics of healthy eating. Phase II (8 months) focuses on weight loss, followed by a year-long (Phase III) focused on weight loss maintenance. In Phase I, the main counseling sessions happen at monthly visits, with added check-in phone calls. In Phase II, the main counseling sessions will occur weekly for 6-8 weeks. There are also check-in phone calls - number based on weight loss progress. During Phase III, there are 2 main visits and follow-up phone calls. Counseling visits will be in-person with a health counselor and by phone. Of the 14 core counseling sessions, the in-person format will be required for only 4 (the 1st session of each Phase and after 2 months of the weight loss program). The program also includes brief phone calls to check on progress towards goals for lifestyle change. The number of phone calls will depend on success in meeting personal weight loss goals in Phase II or keeping the weight off in Phase III. | Behavioural | Med-South Weight Loss Intervention |
| WWAlso: Weight WatchersIf participants are randomized to WW™, they will have access to both the workshop and digital components of the WW™ program for 2 years. The workshop component includes the option of attending weekly group meeting at a WW™ studio (local WW™ office). The digital component can be accessed using the WW™ website or the smart phone App. The study research staff will provide basic instructions on how to use the WW™ digital resources. | Behavioural | Augmented Usual Care (WW) |
Primary outcome
Percent Weight Change From Baseline to Month 24
Time frame: Baseline, Month 24
Weight will be collected by study staff who are masked to treatment using scales tested monthly for accuracy up to 350 pounds.
26 secondary outcomes
Percent Weight Change From Baseline to Months 4 and 12
Time frame: Baseline, Months 4 and 12
Percentage Weight From Baseline Through Follow-Up by Sub-Groups
Time frame: Baseline, Months 4, 12, and 24
Mean Weight Change From Baseline Through Follow-Up
Time frame: Baseline, Months 4, 12, and 24
Mean Change in Systolic Blood Pressure From Baseline Through Follow-Up
Time frame: Baseline, Months 4, 12, and 24
Mean Change in Diastolic Blood Pressure From Baseline Through Follow-Up
Time frame: Baseline, Months 4, 12, and 24
Mean Change in Total Cholesterol From Baseline Through Follow-Up
Time frame: Baseline, Month 4, 12, and 24
Mean Change in HDL-Cholesterol From Baseline Through Follow-Up
Time frame: Baseline, Month 4, 12, and 24
Mean Change in Triglycerides From Baseline Through Follow-Up
Time frame: Baseline, Month 4, 12, and 24
Mean Change LDL-cholesterol From Baseline Through Follow-up
Time frame: Baseline, Month 4, 12, and 24
Mean Change in A1c From Baseline Through Follow-Up
Time frame: Baseline, Month 4, 12, and 24
Mean Change in CRP (C-Reactive Protein) From Baseline Through Follow-Up
Time frame: Baseline, Month 4, 12, and 24
Mean Change in Interleukin (IL) IL-6 From Baseline Through Follow-Up
Time frame: Baseline, Month 4, 12, and 24
Mean Change in Tumor Necrosis Factor (TNF) TNF-alpha From Baseline Through Follow-Up
Time frame: Baseline, Month 4, 12, and 24
Mean Change in Skin Carotenoids From Baseline Through Follow-Up
Time frame: Baseline, Month 4, 12, and 24
Mean Change in Quality of Life Scale From Baseline Through Follow-Up
Time frame: Baseline, Month 4, 12, and 24
Mean Change in Alternate Healthy Eating Index (AHEI)-2010 From Baseline Through Follow-Up
Time frame: Baseline, Month 4, 12, and 24
Mean Change in Global Physical Activity Questionnaire (GPAQ) From Baseline Through Follow-Up
Time frame: Baseline, Month 4, 12, and 24
Mean Change in Weight Loss Self-Efficacy From Baseline Through Follow-Up
Time frame: Baseline, Month 4, 12, and 24
Mean Change in Dietary Self-Regulation From Baseline Through Follow-Up
Time frame: Baseline, Month 4, 12, and 24
Mean Change in Eating Attitudes From Baseline Through Follow-Up (Cognitive Restraint)
Time frame: Baseline, Month 4, 12, and 24
Mean Change in Eating Attitudes From Baseline Through Follow-Up (Uncontrolled Eating)
Time frame: Baseline, Month 4, 12, and 24
Mean Change in Eating Attitudes From Baseline Through Follow-Up (Emotional Eating)
Time frame: Baseline, Month 4, 12, and 24
Mean Change in Diet Self-Efficacy From Baseline Through Follow-Up
Time frame: Baseline, Month 4, 12, and 24
Mean Change in Self-Weighing Behaviors From Baseline Through Follow-Up
Time frame: Baseline, Month 4, 12, and 24
Economic Outcome--Incremental Cost-Effectiveness
Time frame: Month 24
Economic Outcome--Incremental Cost Per Quality Adjusted Life Year (QALY) Gained
Time frame: Month 24
Results and safety
Loading the posted results from ClinicalTrials.gov…
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 3 Nov 2025.
- Posted resultsParticipant flow, baseline, all outcome measures and adverse events.
- Background: PubMed 27495295Keyserling TC, Samuel-Hodge CD, Pitts SJ, Garcia BA, Johnston LF, Gizlice Z, Miller CL, Braxton DF, Evenson KR, Smith JC, Davis GB, Quenum EL, Elliott NT, Gross MD, Donahue KE, Halladay JR, Ammerman AS. A community-based lifestyle and weight loss intervention promoting a Mediterranean-style diet pattern evaluated in the stroke belt of North Carolina: the Heart Healthy Lenoir Project. BMC Public Health. 2016 Aug 5;16:732. doi: 10.1186/s12889-016-3370-9.
- Background: PubMed 18394692Keyserling TC, Samuel Hodge CD, Jilcott SB, Johnston LF, Garcia BA, Gizlice Z, Gross MD, Savinon CE, Bangdiwala SI, Will JC, Farris RP, Trost S, Ammerman AS. Randomized trial of a clinic-based, community-supported, lifestyle intervention to improve physical activity and diet: the North Carolina enhanced WISEWOMAN project. Prev Med. 2008 Jun;46(6):499-510. doi: 10.1016/j.ypmed.2008.02.011. Epub 2008 Feb 15.
- Background: PubMed 24861959Keyserling TC, Sheridan SL, Draeger LB, Finkelstein EA, Gizlice Z, Kruger E, Johnston LF, Sloane PD, Samuel-Hodge C, Evenson KR, Gross MD, Donahue KE, Pignone MP, Vu MB, Steinbacher EA, Weiner BJ, Bangdiwala SI, Ammerman AS. A comparison of live counseling with a web-based lifestyle and medication intervention to reduce coronary heart disease risk: a randomized clinical trial. JAMA Intern Med. 2014 Jul;174(7):1144-57. doi: 10.1001/jamainternmed.2014.1984.
- Background: PubMed 28405344Embree GG, Samuel-Hodge CD, Johnston LF, Garcia BA, Gizlice Z, Evenson KR, DeWalt DA, Ammerman AS, Keyserling TC. Successful long-term weight loss among participants with diabetes receiving an intervention promoting an adapted Mediterranean-style dietary pattern: the Heart Healthy Lenoir Project. BMJ Open Diabetes Res Care. 2017 Mar 29;5(1):e000339. doi: 10.1136/bmjdrc-2016-000339. eCollection 2017.
- Background: PubMed 27911049Samuel-Hodge CD, Holder-Cooper JC, Gizlice Z, Davis G, Steele SP, Keyserling TC, Kumanyika SK, Brantley PJ, Svetkey LP. Family PArtners in Lifestyle Support (PALS): Family-based weight loss for African American adults with type 2 diabetes. Obesity (Silver Spring). 2017 Jan;25(1):45-55. doi: 10.1002/oby.21700. Epub 2016 Dec 2.
- Background: PubMed 23408464Samuel-Hodge CD, Garcia BA, Johnston LF, Gizlice Z, Ni A, Cai J, Kraschnewski JL, Gustafson AA, Norwood AF, Glasgow RE, Gold AD, Graham JW, Evenson KR, Trost S, Keyserling TC. Translation of a behavioral weight loss intervention for mid-life, low-income women in local health departments. Obesity (Silver Spring). 2013 Sep;21(9):1764-73. doi: 10.1002/oby.20317. Epub 2013 May 24.
- Background: PubMed 19407810Samuel-Hodge CD, Johnston LF, Gizlice Z, Garcia BA, Lindsley SC, Bramble KP, Hardy TE, Ammerman AS, Poindexter PA, Will JC, Keyserling TC. Randomized trial of a behavioral weight loss intervention for low-income women: the Weight Wise Program. Obesity (Silver Spring). 2009 Oct;17(10):1891-9. doi: 10.1038/oby.2009.128. Epub 2009 Apr 30.
- Derived from this study: PubMed 42623075Keyserling TC, Wu Q, Ammerman AS, Berkowitz SA, Buse JB, Couper DJ, Evenson KR, Hursting SD, Sotres-Alvarez D, Lyons K, Saraiya VM, Alick CL, Skinner HG, Nelson C, Kruse LM, Mathers AN, Fung TT, Jilcott Pitts SB, Finkelstein EA, Samuel-Hodge CD. Weight Loss Intervention Promoting an Adapted Mediterranean-Style Dietary Pattern: The DELISH Randomized Clinical Trial. JAMA Netw Open. 2026 Aug 3;9(8):e2629006. doi: 10.1001/jamanetworkopen.2026.29006.
- Derived from this study: PubMed 39690977Saraiya VM, Berkowitz SA, Johnston LF, Couper DJ, Sotres-Alvarez D, Lyons KM, Thaxton CK, Skinner HG, Samuel-Hodge CD, Keyserling TC. An Evaluation of Primary Care Clinician Referrals for Behavioral Weight Loss Counseling. J Prim Care Community Health. 2024 Jan-Dec;15:21501319241308054. doi: 10.1177/21501319241308054.
- Individual participant dataSharing planned: Yes. Deidentified individual data that supports the results will be shared beginning 9 to 36 months following publication provided the investigator who proposes to use the data has approval from an Institutional Review Board (IRB), Independent Ethics Committee (IEC), or Research Ethics Board (REB), as applicable, and executes a data use/sharing agreement with UNC.
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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.
Carmen D Samuel-Hodge, PhD principal investigator
University of North Carolina, Chapel Hill
Thomas C Keyserling, MD principal investigator
University of North Carolina, Chapel Hill
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Med-South Weight Loss Intervention and WW in people with Weight Loss and Diet, Healthy, run by University of North Carolina, Chapel Hill 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 10 inclusion and 9 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 Nov 2025. 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?
Yes. Results are posted in the registry (first posted 3 Nov 2025). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.
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?
Percent Weight Change From Baseline to Month 24 (time frame: Baseline, Month 24). 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 NCT04302727, which also lists 9 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 Nov 2025.