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One Hundred-pound Weight Losses with an Intensive Behavioral Program: Changes in Risk Factors in 118 Patients with Long-term Follow-up.
Anderson JW, Conley SB, Nicholas AS.
Am J Clin Nutr 2007;86:301-307
Background: Treatment of severe obesity is difficult; in the past, lifestyle measures did not prove effective. Recently, however, intensive behavioral interventions using meal replacements and low-energy diets have enabled some severely obese persons to achieve nonobese weights.
Objective: We assessed rates of weight loss, changes in risk factors and medication requirements, and long-term weight maintenance in patients who lost > 100 pounds (45.5 kg).
Design: Over a 9-year period, we prospectively identified patients who lost > 100 pounds (45.5 kg) and actively recorded follow-up weights. Charts were systematically reviewed to assess outcome measures and side effects. The intervention (HMR® Program for Weight ManagementTM) included meal replacements (shakes and entrees), low-energy diets, weekly classes, and training in record keeping and physical activity. Assessments included weekly weights, laboratory studies, medication use, lifestyle behaviors, side effects, and follow-up weights.
Results: Sixty-three men and 55 women lost > 100 pounds. At baseline, the subjects' average weight was 160 kg, 97% had > 1 obesity-related comorbidity, and 74% were taking medications for comorbidities. Weight losses averaged 61 kg in 44 wks. Medications were discontinued in 66% of patients with a cost savings of $100/mo. Despite medication discontinuation, significant decreases in LDL cholesterol (20%), triacylglycerol (36%), glucose (17%), and systolic (13%), and diastolic (15%) blood pressure values were seen. Side effects were mild, and only 2 patients had severe or serious adverse events. At an average of 5 years of follow-up, patients were maintaining an average weight loss of 30 kg.
| Measure |
Baseline
|
% Change
(end of
weight loss)
|
Weight
(kg) |
159.9 + 3.4 |
-61.0% + 1.6 |
Total Cholesterol
(mmol/L) |
5.38 + 0.08 |
-19.5% + 1.3 |
LDL Cholesterol
(mmol/L) |
3.28 + 0.07 |
-20.2% + 1.9 |
HDL Cholesterol
(mmol/L) |
1.17 + 0.03 |
+1.5% + 2.0 |
Triacylglycerols
(mmol/L) |
1.84 + 0.08 |
-36.2% + 2.6 |
| Fasting Blood Glucose (mmol/L) |
6.22 + 0.23 |
-17.4% + 1.7 |
| Systolic Blood Pressure (mmHg) |
132.9 + 1.5 |
-13.2% + 1.1 |
| Diastolic Blood Pressure (mmHg) |
86.2 + 1.0 |
-15.2% + 1.3 |
± SEM (all such values)
Conclusion: Intensive behavioral intervention can be very effective with minimal risk for certain severely obese persons.
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