Successful long-term maintenance of substantial weight loss: one program's experience

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).

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.

Obese African-American women's perspectives on weight loss and bariatric surgery

BACKGROUND

African-American (AA) women have higher rates of obesity and obesity-related diseases but are less likely than other women to undergo bariatric surgery or have success with conventional weight loss methods.

OBJECTIVE

To explore obese AA women's perceptions regarding barriers to weight loss and bariatric surgery.

DESIGN

Focus groups to stimulate interactive dialogue about beliefs and attitudes concerning weight management. PARTICIPANTS AND APPROACH: We partnered with a community organization to recruit women who were AA, were > or = 18 years old, and had a body mass index (BMI) of > or = 30 kg/m2. We audiotaped the 90-minute focus groups and used content analysis for generating and coding recurring themes.

RESULTS

In our sample of 41 participants, the mean age was 48.8 years and mean BMI was 36.3. Most participants were unmarried, had some postsecondary education, and reported good or fair health. About 85% knew someone who had undergone bariatric surgery. Qualitative analysis of 6 focus group sessions revealed that the most common barriers to weight loss were lack of time and access to resources; issues regarding self-control and extrinsic control; and identification with a larger body size. Common barriers to bariatric surgery were fears and concerns about treatment effects and perceptions that surgery was too extreme or was a method of last resort.

CONCLUSIONS

Only through the elimination of barriers can AA women receive the care needed to eliminate excess weight and prevent obesity-related morbidity and mortality.

Weight loss and long-term follow-up of severely obese individuals treated with an intense behavioral program

OBJECTIVE

To review weight loss and maintenance for severely obese individuals enrolled in intensive behavioral weight loss program using very-low or low-energy diets.

DESIGN

Chart review of consecutively treated patients between 1995 and 2002 seen at three weight loss centers.

SUBJECTS

One thousand five hundred and thirty one patients with severe obesity (>or=40 kg/m(2)) treated in three cities ('Study Group'). Of these, 1100 completed the 12-week core curriculum ('Completer Group'). Weight loss >or=100 lbs (>45 kg) was seen in 268 patients ('100-Pound Group').

MEASUREMENTS

Charts were reviewed for baseline characteristics, weekly weights, follow-up weights and side effects.

RESULTS

In the Study Group, average weight loss+/-s.e. for 998 women was 23.9+/-0.6 kg (18.5% of initial body weight (IBW)) and for 533 men was 36.0+/-1.0 kg (22.5%) over 30 weeks. For Completers, average weight loss for women was 30.8+/-0.6 kg (23.9%) and for men was 42.6+/-1.1 kg (26.7%) over 39 weeks. In the 100-Pound Group, average weight loss for women was 58.2+/-1.2 kg (41.5%) in 65 weeks and for men was 65.7+/-1.5 kg (37.5%) in 51 weeks. Side effects, assessed in 100 patients losing >45 kg, were mild to moderate in severity. Severe adverse events unrelated to the diet were noted in 5% of patients and during weight loss 1% had elective cholecystectomies. Follow-up weights were available for 86% of Completers at an average of 72 weeks with average maintenance of 23 kg or 59% of weight loss; follow-up weights were available for 94% of the 100-Pound Group at an average of 95 weeks with average maintenance of 41 kg or 65% of weight loss maintained.

CONCLUSIONS

Intensive behavioral treatment with meal replacements is a safe and effective weight-loss strategy for selected severely obese individuals.

Bupropion SR enhances weight loss: a 48-week double-blind, placebo- controlled trial

OBJECTIVE

To critically examine the efficacy of bupropion SR for weight loss.

RESEARCH METHODS AND PROCEDURES

This 24-week multicenter, double-blind, placebo-controlled study randomized obese adults to placebo, bupropion SR 300, or 400 mg/d. Subjects were counseled on energy-restricted diets, meal replacements, and exercise. During a 24-week extension, placebo subjects were randomized to bupropion SR 300 or 400 mg/d in a double-blinded manner.

RESULTS

Of 327 subjects enrolled, 227 completed 24 weeks; 192 completed 48 weeks. Percentage losses of initial body weight for subjects completing 24 weeks were 5.0%, 7.2%, and 10.1% for placebo, bupropion SR 300, and 400 mg/d, respectively. Compared with placebo, net weight losses were 2.2% (p = 0.0468) and 5.1% (p < 0.0001) for bupropion SR 300 and 400 mg/d, respectively. The percentages of subjects who lost >or=5% of initial body weight were 46%, 59%, and 83% (p vs. placebo < 0.0001) for placebo, bupropion SR 300, and 400 mg/d, respectively; weight losses of >or=10% were 20%, 33%, and 46% (p vs. placebo = 0.0008) for placebo, bupropion SR 300, and 400 mg/d, respectively. Withdrawals, changes in pulse and blood pressure did not differ significantly from placebo at 24 weeks. Subjects who completed 48 weeks maintained mean losses of initial body weight of 7.5% and 8.6% for bupropion SR 300 and 400 mg/d, respectively.

DISCUSSION

Bupropion SR 300 and 400 mg/d were well-tolerated by obese adults and were associated with a 24-week weight loss of 7.2% and 10.1% and sustained weight losses at 48 weeks.

Obesity and disease management: effects of weight loss on comorbid conditions

OBJECTIVE

This review is designed to quantitate the effects of obesity and weight gain on risk for coronary heart disease (CHD) and to review the effects of weight loss on CHD risk factors.

RESEARCH METHODS AND PROCEDURES

After a comprehensive review of the literature related to body weight and weight gain on CHD risk, the relative risks (RRs) were tabulated. Values were averaged and meta-analysis techniques were used to estimate the variance-adjusted RR.

RESULTS

Young persons with higher body mass index values have a significantly higher risk for CHD than do slender young people. For every 1% above a desirable body mass index, the risk for CHD increases by 3.3% for women and by 3.6% for men. Every kilogram of weight gain after high school increases risk for CHD by 5.7% for women and 3.1% for men. Weight loss significantly decreases major CHD risk factors. For every kilogram of weight loss the following favorable changes occur: fasting serum cholesterol, -1.0%; low-density lipoprotein cholesterol, -0.7%; triglycerides, -1.9%; high-density lipoprotein cholesterol, +0.2%; systolic blood pressure, -0.5%; diastolic blood pressure, -0.4%; and blood glucose, -0.2 mM.

DISCUSSION

Obesity and/or weight gain are associated with major risk for CHD. Weight loss significantly improves serum lipid parameters, blood pressure, and fasting blood glucose values. Effective treatment approaches are available for most overweight or obese individuals but a major challenge is to enable these individuals to engage in these programs. Professional and consumer education is essential for advancing effective intervention strategies for overweight individuals.