One hundred pound weight losses with an intensive behavioral program: changes in risk factors in 118 patients with long-term follow-up.
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).


METHODS
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.


CONCLUSIONS
Intensive behavioral intervention can be very effective with minimal risk for certain severely obese persons.
Anderson
James W
JW
Department of Internal Medicine, College of Medicine, and the Health Management Resources Weight Management Program, University of Kentucky, Lexington, KY 40502-0298, USA. jwandersmd@aol.com
Conley
Shannon B
SB
Nicholas
Amy S
AS
D000328:Adult; D001521:Behavior Therapy; D015992:Body Mass Index; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000178:diet therapy / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D018579:Patient Selection; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss