Obese Patients Shed 100 Pounds in Intense Behavior Program

LEXINGTON, Ky., Aug. 28 -- Intensive behavioral therapy helped severely obese patients lose at least 100 pounds in 44 weeks and maintain 60% of the loss at five years, researcher here reported.

Of 656 severely obese patients (average weight 352 pounds) enrolled in a University of Kentucky weight-management program, 118 patients (18%) lost a mean of 134 pounds by 44 weeks, James W. Anderson, M.D., of the University of Kentucky, and colleagues, reported in the August issue of the American Journal of Clinical Nutrition.

At 3.6 years, 66% of the patients were able to discontinue medications, and at an average follow-up of five years, the patients were still down 66 pounds, the researchers reported.

The findings came from a carefully controlled program in which patients, for the most part, ate prepared and measured meal replacements (shakes and entres), thereby eliminating most of the need to make choices or deal with food preparation.

Lifestyle or pharmacologic interventions are usually not successful for severe obesity, the researchers wrote. Although very-low-energy diets have been used successfully to treat some patients with severe obesity, only limited information has been available about long-term follow-up.

Minimally invasive bariatric techniques have reduced the mortality and morbidity associated with these procedures, but gastric bypass is expensive and has an operative mortality rate of 0.2% to 2.0% and a complication rate of 20% or more, they wrote.

The observational study included patients enrolled from January 1995 through December 2003 in the university's Health Management Resources Weight Management Program.

The patients were given two treatment choices, which included meals measured at 2,000 kcal a day. These were the medically supervised option, which provided meal replacement in the form of five shakes a day or three shakes plus two entres a day and oversight by program physicians for four or more weeks and then biweekly, plus laboratory studies.

Patients in the second option, the healthy solutions program, had no medical supervision or lab studies and used three shakes, two entres, and five or more servings of fruit and vegetables daily.

All patients attended core classes for 12 weeks and then ongoing classes until they reached their weight goal or entered maintenance. Patients were encouraged to use additional shakes, entres or nutrition bars to curb hunger and avoid other foods.

Sixty-three men and 55 women lost 100 pounds or more. At baseline, the patients' average weight was 352 lbs, and 97% had one or more obesity-related comorbidity, while 74% were taking medication for these disorders.

Comorbidities included dyslipidemia (74.5%), hypertension (72.9%), diabetes (18%), as well as degenerative joint disease, obstructive sleep apnea, and GERD.

Weight loss averaged 134 pounds in 44 weeks, the training period. Medication was reduced for all patients, and drugs were discontinued for 66% with a cost savings of a month.

Despite stopping medication, the researchers reported significant decreases in LDLs (20%), triacylglycerol (36%), glucose (17%), and systolic (13%) and diastolic (15%) blood pressure values.

Side effects were mild -- constipation, dizziness, headache, fatigue, hair loss, nausea, for example -- while two patients had severe or serious adverse events.

These included a side effect related to abdominal pain, which was managed symptomatically. Another patient had an event related to the program and was hospitalized after week 28 for an elective cholecystectomy.

Men had significantly higher initial weights than did women, but baseline BMI values did not differ significantly.

Although men lost significantly more weight and lost weight at a more rapid pace than women did, as a percentage of baseline weight, the losses did not differ significantly between the sexes.

The researchers noted that they did not have estimates of energy intake from food eaten other than that provided by the meal replacements, so that they may have underestimated total energy intakes.

Overall, 64% of the patients lost more than half their weight by using only shakes for meal replacement. Physical activity came to 2,000 kcal a week, represented by walking at least seven miles a week, and 21 miles by week 40.

Most of the patients participated actively for more than 18 months during the weight loss and initial maintenance activities, and most returned for retreatment during the five-year follow-up.

Moreover, many continued to use shakes and entrees for indefinite period. These lifestyle changes undoubtedly contributed to their success in weight maintenance, the researchers said.

The other authors reported no personal or financial conflicts of interest.