Author(s): Anderson JW, Conley SB, Nicholas AS
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Abstract 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 >or=100 pounds (45.5 kg). DESIGN: Over a 9-y period, we prospectively identified patients who lost >or=100 pounds (45.5 kg) and actively recorded follow-up weights. Charts were systematically reviewed to assess outcome measures and side effects. The intervention included meal replacements (shakes and entrées), 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 >or=100 pounds. At baseline, the subjects' average weight was 160 kg, 97\% had >or=1 obesity-related comorbidity, and 74\% were taking medications for comorbidities. Weight losses averaged 61 kg in 44 wk. 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 y of follow-up, patients were maintaining an average weight loss of 30 kg. CONCLUSION: Intensive behavioral intervention can be very effective with minimal risk for certain severely obese persons.
This article was published in Am J Clin Nutr
and referenced in Journal of Obesity & Weight Loss Therapy