Intensive program helps obese lose weight for good

NEW YORK (Reuters Health) - Morbidly obese people who lose 100 pounds or more through an intensive behavioral program can keep much of the weight off long-term, a new study shows.

Five years after participating in the program, men and women remained about 66 pounds lighter, on average, than they had been before beginning the diet, Dr. James W. Anderson and colleagues from the University of Kentucky in Lexington found. The study participants also had significant drops in LDL, the "bad" cholesterol, glucose (blood sugar), and blood pressure.

"Although it is difficult to estimate, maintenance of a high percentage of these risk factor reductions would probably reduce coronary heart disease risk by more than 50 percent," Anderson and his team write in the American Journal of Clinical Nutrition.

Surgery is the current treatment of choice for severe obesity, defined as having a body mass index (BMI) of 40 or higher or being 100 pounds or more over one's ideal body weight. The BMI is the ratio of height to weight, with a normal BMI ranging from 18.5 to 24.9.

However, the surgery is costly and has a high rate of complications, the researchers note. Intensive behavioral interventions using shakes to replace some or all meals are helpful to some severely obese individuals, they add.

To investigate how successful this approach was long-term, the researchers followed 118 patients who had lost 100 pounds or more for up to nine years. Before beginning the program, the 63 men and 55 women weighed about 350 pounds, on average; 97 percent had at least one obesity-related illness; and nearly 75 percent were taking medication for these conditions.

Patients lost an average of about 135 pounds over 44 weeks. Two thirds were able to quit taking drugs for their obesity-related conditions. Average LDL cholesterol dropped 20 percent, and triacylglycerol, glucose, and blood pressure were also significantly reduced.

Eighty-eight percent of the patients had mild to moderate side effects such as headache and fatigue. Two had more serious side effects; one patient developed severe abdominal pain and the other required surgery to remove the gall bladder, which the researchers determined was related to the diet.

Two years after participation in the program, patients maintained an average weight loss of 84 pounds; at five years, patients weighed 66 pounds less than they had at the program's outset.

"An intensive, medically supervised, behavioral weight management intervention using meal replacements effectively enabled certain severely obese persons to lose (at least 100 pounds) and to maintain approximately one half that weight loss for five years," the researchers conclude.

SOURCE: American Journal of Clinical Nutrition, August 2007.