Summary

Analysis of the case records of very obese individuals who lost over 100 pounds using a combination of strict calorie reduction and physical exercise showed an impressive improvement in cardiovascular risk factors - LDL-cholesterol, triglycerides, fasting glucose, and blood pressure.

Introduction

Those of us who have tried to lose a few pounds have probably wondered how really obese people manage to lose large amounts, and how they fare afterwards. A publication in the American Journal of Clinical Nutrition provides some insight into the results achieved by intensive behavioral modification. Success is possible in a certain number of such persons. Here's a summary of what was done and what was accomplished.

What was done

The University of Kentucky has run a weight loss program in conjunction with Health Management Resources of Boston, Massachusetts, since 1985. Their data base was searched in order to identify 100 persons who had lost over 100 pounds (45.5 kg). Patients who were identified were followed for an average of 5 years (2 years was the minimum follow-up).

The program used for weight loss had two treatment choices: the Medically Supervised option and the Healthy Solutions option. The Medically Supervised option provided only meal replacements (shakes or entrées) during the weight loss phase; patients took 5 shakes a day, or 3 shakes and 2 entrées a day. They were seen weekly by the doctor for 4 weeks or more, and then every 2 weeks; lab exams were done every 2 weeks or monthly. The Healthy Solutions option didn't require medical supervision or lab studies. The patients took 3 shakes, 2 entrées, and 5 or more servings of fruit and vegetables daily.

Patients attended weekly core classes for 12 weeks or more, until they reached their weight goal or entered the maintenance program. The 90-minute classes restated the treatment components, which included physical activity (at least 2000 exercise-calories weekly), as well as the selected dietary measures. When patients reached their goal (or their weight loss slowed) they entered the maintenance program for at least 6 months - weekly classes, daily recordkeeping, and exercise.

This study analyzed patients who achieved a weight loss of 100 pounds or more. Charts were systematically reviewed to assess changes in health, risk factors, medications, side effects, activity levels, and follow-up weights.

What was found

Over 9 years 656 patients with severe obesity enrolled in the program; 118 of them (18%) lost more than 100 pounds and were included in the analyses. There were 63 men and 55 women. Their average age at baseline was 43; average weights 384 pounds (men) and 317 (women); average body mass index (BMI) 52.7; and co-existing health problems (abnormal lipids, high blood pressure, diabetes, osteoarthritis, sleep apnea, and/or gastroesophageal reflux disease) were present in 97%, with 74% taking medications.

The men lost an average of 100 pounds in 24 weeks, while the women took 31 weeks to achieve this. Both men and women had reached their lowest weight level by 44 weeks. Over half of them lost more than half their weight loss by using shakes only for meal replacement. In the first week the patients' physical activity averaged the equivalence of one mile a day, but this had increased to 3 miles a day by week 40.

There were significant, and relevant, changes in blood lipid levels, fasting glucose levels, and blood pressure. Despite discontinuation of medications in 2/3 of the patients, there were the following average reductions in these values for the whole group:

Total cholesterol: -19.5%

LDL cholesterol: -20.2%

HDL cholesterol: +1.5%

Triglycerides: -36.2%

Fasting glucose: -17.5%

Systolic blood pressure: -13.2%

Diastolic blood pressure: -15.2%

Only two patients had serious side effects - severe abdominal pain of unknown cause, and inflammation of the gall-bladder. Other side effects were mild or moderate - dizziness, hair loss, headache, abdominal cramps, nausea, or diarrhea - seen chiefly during the initial treatment period.

Unfortunately, patients regained almost half their weight loss, on average, over the first 30 months after baseline. The average weight gains increased significantly (15 pounds) over the next 30 months. At 60 months (5 years) the subjects were maintaining an average weight loss of 66 pounds.

Discussion

In those obese individuals who managed to loose 100 pounds using a combination of strict calorie reduction and physical exercise, there was an impressive improvement in the risk factors measured: LDL-cholesterol, triglycerides, fasting glucose, and blood pressure. The investigators consider the reductions to translate to a probable 50% reduction in coronary heart disease risk.

The dietary regimes used were relatively free from side effects, although mild to moderate symptoms (dizziness, headache, nausea, abdominal cramps, and diarrhea) were reported, but in general the participants tolerated the treatment well, in spite of having serious co-existing disorders (congestive heart failure, dialysis patients, etc).

Long-term maintenance of weight loss was a problem in these patients, too. At 5 years after starting the program, their average weight loss (from baseline) was 66 pounds. Studies have shown that the likelihood of maintaining a satisfactory weight loss are higher with the following measures:

• Regular physical activity
• Low fat intake
• Generous intake of fruit and vegetables
• Regular use of meal replacements (shakes or entrées)
• Self-monitoring
• Ongoing treatment or coaching

Source

One hundred-pound weight loss with an intensive behavioral program: changes in risk factors in 118 patients with long-term follow-up.
JW. Anderson, SB. Conley, AS. Nicholas , Am J Clin Nutr , 2007, vol. 86, pp. 301--307

Links

• Lifestyle Changes Save Older Overweight People
• Is Obesity More Damaging Than Inactivity?
• Overweight Baby Boomers at Risk of a Poor Quality of Life, Later