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Intensive behavioral program is a successful treatment option for severely obese patients with BMI > 40.
Gotthelf L, Anderson JW, Grant L.
Obes Res 2005;13 suppl:A203.
Objective: The prevalence of severe obesity, BMI > 40 kg/m2, has increased dramatically in the past 10 years. Although bariatric surgery is often recommended, an intensive behavioral program is another treatment option with successful outcomes.
Method: This study assessed the outcomes for patients with a BMI > 40 kg/m2 who enrolled in 3 Health Management Resources™ (HMR®) Weight Management Programs from 1/95–12/03. HMR is a structured, ongoing treatment program focusing on lifestyle changes: > 2,000 kcals/wk of physical activity, use of meal replacements, and > 35 servings of vegetables/fruits.
Results: During the time period, 1717 patients with a starting BMI > 40 attended at least one class (intent-to-treat, ITT). We are reporting on 1136 patients who completed at least 12 weeks in weight loss treatment. The average entering weight was 307 lbs. and BMI 48.4 kg/m2. The average weight loss was 78.1 lbs. over an average of 37.2 weeks. Seventy percent of patients entered the maintenance program and, at the time of follow-up (avg 55.4 wks), were maintaining 69% (54 lbs.) of this weight loss. The average treatment time (including weight loss and maintenance) was 92.7 weeks (1.8 years). 272 patients (24% of 12-week completers) lost > 100 lbs. Their average weight loss was 136.9 lbs. over an average of 56.3 weeks. While mild gastrointestinal symptoms, orthostatic dizziness, and fatigue were common, no serious side effects were encountered. Nearly 87% of these patients entered the maintenance program and were maintaining an average of 69% of this weight loss (94.5 lbs.) over an average of 139.5 weeks (2.7 yrs).
Conclusion: An intensive, ongoing treatment program is an option for people with a BMI > 40 kg/m2. The absence of mortality and low risk of serious side effects compare favorably with the 1% risk of death and 20% adverse event profile associated with bariatric surgery. Behavioral programs have the advantage of teaching healthy lifestyle behaviors that are critical for long-term weight-loss maintenance and to reduce co-morbidities and future health risks.
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