Randomized Arms (2:1 Ratio)
Arm A · n = 226
Weight-Loss Program
Intensive 6-month behavioral: weekly group sessions, 1200–1500 kcal/day diet, ≥200 min/week exercise (modeled on Look AHEAD/DPP)
Arm B · n = 112
Structured Education
4 group sessions on general weight loss, physical activity, healthful eating (control)
Note: Both groups received a self-help bladder control booklet at enrollment.
Weight Loss at 6 Months
−8.0%
Intervention (7.8 kg lost)
95% CI −9.0 to −7.0
−1.6%
Control (1.5 kg lost)
95% CI −2.7 to −0.4
P < 0.001
Between-group difference
Primary Outcome: Any Incontinence Episodes
−47%
Intervention (24→13 ep/wk)
95% CI −54 to −40
−28%
Control (24→17 ep/wk)
95% CI −41 to −13
P = 0.01
Between-group difference
% Change in Episodes by Type
Clinically Meaningful Reduction (≥70% Fewer Episodes)
Patient Perceptions (All P < 0.001)
73.1%
vs
53.2%
Less frequent episodes
75.8%
vs
54.3%
Incontinence less of a problem
75.8%
vs
46.8%
Satisfied with change
Clinical Bottom Line
Moderate weight loss (~8%) through a 6-month behavioral program significantly reduces urinary incontinence in overweight/obese women, with the greatest benefit for stress incontinence (58% vs 33% reduction). Weight loss should be recommended as first-line treatment for incontinence in this population alongside pelvic floor therapy.