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Losing Greater Amounts of Weight Leads to Greater Changes in Medical Risk Factors.
May S, Grant L, Gotthelf L.
Obes 2006;14 suppl:A103
Objective: There is some controversy as to whether health professionals should encourage patients to lose larger amounts of weight. The purpose of this analysis was to evaluate whether patients who lose >20% of initial body weight experience greater changes in medical risk factors compared to those who lose lesser amounts of weight.
Method: Patients who had attended the HMR® Program for Weight ManagementTM in 65 clinics were assessed (n = 2564) if they had an initial health risk appraisal (HRA) and follow-up HRA completed between 1/1/03 and 5/1/06. HMR offers a range of weight-loss treatment options, including medically supervised low and very low-calorie diets, moderately restricted diets and phone-based programs as well as long-term maintenance.
Results: Weight change was grouped by % of initial body weight lost at the time of follow-up: >20%, 20—16%, 15—11%, 10—5%. There was a dose-response relationship with patients losing more weight reporting the greatest changes in lifestyle behaviors (physical activity, % dietary fat, and vegetables and fruit) compared to those losing less weight. Patients losing >20% of initial weight had the greatest change in total HRA risk factor score, entering with the highest risk factor score but ending with the lowest (-36, -25, -18, -14 point change, respectively). All measured risk factors (TC/HDL, triglycerides, blood pressure, and fasting blood glucose) decreased significantly (p < .01) more in those losing the most weight as compared to all other groups. There was also a dose-response in terms of % of medications eliminated (cholesterol, blood pressure, oral diabetes, and insulin) — 51.0%, 35.3%, 29.2%, and 21.3%, respectively — at the time of follow-up.
Average time between HRA's was 123 weeks
| Measure |
>20% |
20%—16% |
15%—11% |
10%—5% |
| # Patients |
789 |
501 |
623 |
651 |
| Weight |
-80 lbs. |
-43 lbs. |
-30 lbs. |
-17 lbs. |
| Total Cholesterol/HDL |
-22.5% |
-13.2% |
-12.0% |
-8.1% |
| Triglycerides |
-40.7% |
-19.5% |
-21.7% |
-12.9% |
| Systolic Blood Pressure (mmHg) |
-12 |
-6 |
-6 |
-4 |
| Diastolic Blood Pressure (mmHg) |
-9 |
-5 |
-5 |
-3 |
| Fasting Blood Glucose |
-12.5% |
-6.7% |
-6.9% |
-4.0% |
| Medications Eliminated |
-51.0% |
-35.3% |
-29.2% |
-21.3% |
| Physical Activity (kcals/wk) |
+256% |
+189% |
+98% |
+98% |
| % Dietary Fat |
-32% |
-26% |
-18% |
-13% |
Total Risk
Factor Score |
-36 |
-25 |
-18 |
-14 |
Conclusion: In summary, although all patients in a structured weight management program experienced substantial medical changes with weight loss, those losing >20% of initial body weight had the greatest change in all measured risk factors. The standard 5%—10% of initial weight should not be considered a limit for weight loss.
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