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Weight Loss with Intensive Behavioral Treatment and Low-Energy Diets: Response of 195 Consecutive Patients
James W. Anderson and Emily A. Furlow, Lexington, KY
Obes 2008;16 suppl 1:S148
Low-energy diets consisting primarily of meal replacement shakes and entrees are very effective tools as part of a behavioral weight-loss program. The weight losses of 195 consecutive patients enrolled in the HMR® Weight Management Program at the University of Kentucky over a 13-month period were reviewed. Patients attended weekly classes, kept records of meal replacement intake and physical activity, and made midweek phone calls. Absolute and percentage weight loss from enrollment were analyzed for those completing 8 weeks of Core classes (completers) and for all patients who completed one week of treatment using last-observation-carried-forward or intention-to-treat (ITT). Demographics for all patients: female, 70%; age, 48 years; BMI, 39 kg/m2; initial weight, 245 pounds (#). Mean weight losses were: ITT (n=195), 32.5# (se 1.6), 13.0% (0.6); completers (n=145), 40.5# (1.8); 16.1% (0.5) in 17.5 weeks. Weight losses for completers by week were: 4, 5.9%; 8, 9.8%; 12, 12.7%, and 16 wks, 15.8%. Overweight individuals (BMI<30) had mean weight losses: ITT (n=20), 19.4#, 11.0%; completers (n=13), 25.7#, 14.3% in 14 weeks. With mild obesity (BMI 30-35) weight losses were: ITT (n=54), 27.2#, 12.1%; completers (n=43), 31.6# (2.0), 15.1% (0.9) in 16 weeks. With moderate obesity (BMI 35-40) weight losses were: ITT (n=43), 28.6#, 12.1%; completers (n=33), 35.8# (2.7), 15.0% (1.0) in 16 weeks. Thus, weight loss and duration of treatment were almost identical with mild and moderate obesity. Patients using meal replacements alone (n=55) lost significantly more weight (31.6#, 14.0%) than those using Healthy Solutions® options that included fruit and vegetables (n=42, 22.9%, 10.8%) in the ITT group (P<0.02) but not in the completer group. Severely obese individuals had significantly greater absolute (P<0.001) and percentage weight loss (P<0.03) with longer duration of treatment (P<0.05) . Mean weight losses for severely obese were: ITT (n=78), 42.0#, 14.0%; completers (n=56), 54.0# (3.2), 18.0% (1.0) in 21 weeks. Intensive behavioral therapy using meal replacements as the core of a low-energy diet is very effective for many overweight or obese individuals.
Baseline data and weight loss of intention-to-treat (ITT) and patients completing Core classes.
All values are mean ± SEM
Measure |
Healthy Solutions |
Medically Supervised |
| ITT |
Completers |
ITT |
Completers |
| N |
56 |
37 |
117 |
93 |
| Age |
47.9±1.8 |
47.8±2.1 |
48.3±1.1 |
48.8±1.2 |
| Women (%) |
63 |
68 |
68 |
67 |
| Baseline BMI |
38.0±0.9 |
37.6±1.2 |
41.6±0.9 |
41.7±1.1 |
| Initial Weight (lbs.) |
241.2±6.6 |
235.5±7.9 |
259.9±6.0 |
261.7±7.3 |
| Weight Loss (lbs.) |
28.2±2.9 |
37.5±3.1 |
36.6±2.2 |
43.4±2.2 |
| Weight Loss (% Initial Weight) |
11.7±1.1 |
15.8±1.1 |
13.9±0.7 |
16.4±0.7 |
| Duration Weight-Loss (weeks) |
12.7±1.2 |
17.6±1.2 |
16.2±1.0 |
19.1±1.0 |
Behavioral Data:
- Class attendance for enrolled patients averaged 95.5%
- Weekly summary forms were submitted 97.8% of the time and midweek calls were completed 93.6% of expected
- Patients reported they did not eat non-prescribed food 6.7 of 7 days/week
- Meal replacement use, with goal of 35/week, averaged > 44/week
- Fruit and vegetable use, for Healthy Solutions— goal 35/week, averaged 39.5/week
- Physical activity— goal 2000 kcal/week—averaged 2409 kcal/week
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