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Huang YS, Zheng Q, Yang H, Fu X, Zhang X, Xia C, Zhu Z, Liu YN, Liu WJ. Efficacy of Intermittent or Continuous Very Low-Energy Diets in Overweight and Obese Individuals with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analyses. J Diabetes Res 2020; 2020:4851671. [PMID: 32090119 PMCID: PMC7008267 DOI: 10.1155/2020/4851671] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 01/07/2020] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE This study is aimed at investigating the efficacy of a very low-energy diet (VLED) in overweight and obese individuals with type 2 diabetes mellitus (T2DM). METHODS We thoroughly searched eight electronic resource databases of controlled studies concerning the efficacy and acceptability of intermittent or continuous VLEDs in patients with T2DM compared with other energy restriction interventions. RESULTS Eighteen studies (11 randomized and seven nonrandomized controlled trials) with 911 participants were included. The meta-analyses showed that compared with a low-energy diet (LED) and mild energy restriction (MER), VLED is superior in the reduction of body weight (mean difference (MD) MDLED = -2.77, 95% confidence interval (CI) CILED = -4.81 to - 0.72, P LED = 0.008; MDMER = -6.72, 95%CIMER = -10.05 to - 3.39, P LED = 0.008; MDMER = -6.72, 95%CIMER = -10.05 to - 3.39, P LED = 0.008; MDMER = -6.72, 95%CIMER = -10.05 to - 3.39, P LED = 0.008; MDMER = -6.72, 95%CIMER = -10.05 to - 3.39, P LED = 0.008; MDMER = -6.72, 95%CIMER = -10.05 to - 3.39, P LED = 0.008; MDMER = -6.72, 95%CIMER = -10.05 to - 3.39, P LED = 0.008; MDMER = -6.72, 95%CIMER = -10.05 to - 3.39, I 2 = 0%) and TG level (MD = -0.25, 95%CI = -0.55 to 0.06, P LED = 0.008; MDMER = -6.72, 95%CIMER = -10.05 to - 3.39, I 2 = 0%) and TG level (MD = -0.25, 95%CI = -0.55 to 0.06, P LED = 0.008; MDMER = -6.72, 95%CIMER = -10.05 to - 3.39, P LED = 0.008; MDMER = -6.72, 95%CIMER = -10.05 to - 3.39, P LED = 0.008; MDMER = -6.72, 95%CIMER = -10.05 to - 3.39, P LED = 0.008; MDMER = -6.72, 95%CIMER = -10.05 to - 3.39, P LED = 0.008; MDMER = -6.72, 95%CIMER = -10.05 to - 3.39. CONCLUSION Dietary intervention through VLEDs is an effective therapy for rapid weight loss, glycemic control, and improved lipid metabolism in overweight and obese individuals with T2DM. Thus, VLEDs should be encouraged in overweight and obese individuals with T2DM who urgently need weight loss and are unsuitable or unwilling to undergo surgery. As all outcome indicators have low or extremely low quality after GRADE evaluation, further clinical trials that focus on the remission effect of VLEDs on T2DM are needed.
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Affiliation(s)
- Yi Shan Huang
- Renal Research Institution of Beijing University of Chinese Medicine, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100700, China
| | - Qiyan Zheng
- Renal Research Institution of Beijing University of Chinese Medicine, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100700, China
| | - Huisheng Yang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Xinwen Fu
- Renal Research Institution of Beijing University of Chinese Medicine, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100700, China
| | - Xueqin Zhang
- Renal Research Institution of Beijing University of Chinese Medicine, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100700, China
| | - Chenhui Xia
- Renal Research Institution of Beijing University of Chinese Medicine, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100700, China
| | - Zebing Zhu
- Renal Research Institution of Beijing University of Chinese Medicine, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100700, China
| | - Yu Ning Liu
- Renal Research Institution of Beijing University of Chinese Medicine, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100700, China
- Department of Endocrinology Nephropathy, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100700, China
| | - Wei Jing Liu
- Renal Research Institution of Beijing University of Chinese Medicine, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100700, China
- Institute of Nephrology, Zhanjiang Key Laboratory of Prevention and Management of Chronic Kidney Disease, Guangdong Medical University, Zhanjiang, Guangdong 524001, China
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Brown A, Dornhorst A, McGowan B, Omar O, Leeds AR, Taheri S, Frost GS. Low-energy total diet replacement intervention in patients with type 2 diabetes mellitus and obesity treated with insulin: a randomized trial. BMJ Open Diabetes Res Care 2020; 8:e001012. [PMID: 32049634 PMCID: PMC7039597 DOI: 10.1136/bmjdrc-2019-001012] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/27/2019] [Accepted: 12/28/2019] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES The management of patients with long-standing type 2 diabetes and obesity receiving insulin therapy (IT) is a substantial clinical challenge. Our objective was to examine the effect of a low-energy total diet replacement (TDR) intervention versus standardized dietetic care in patients with long-standing type 2 diabetes and obesity receiving IT. RESEARCH DESIGN AND METHODS In a prospective randomized controlled trial, 90 participants with type 2 diabetes and obesity receiving IT were assigned to either a low-energy TDR (intervention) or standardized dietetic care (control) in an outpatient setting. The primary outcome was weight loss at 12 months with secondary outcomes including glycemic control, insulin burden and quality of life (QoL). RESULTS Mean weight loss at 12 months was 9.8 kg (SD 4.9) in the intervention and 5.6 kg (SD 6.1) in the control group (adjusted mean difference -4.3 kg, 95% CI -6.3 to 2.3, p<0.001). IT was discontinued in 39.4% of the intervention group compared with 5.6% of the control group among completers. Insulin requirements fell by 47.3 units (SD 36.4) in the intervention compared with 33.3 units (SD 52.9) in the control (-18.6 units, 95% CI -29.2 to -7.9, p=0.001). Glycated Hemoglobin (HbA1c) fell significantly in the intervention group (4.7 mmol/mol; p=0.02). QoL improved in the intervention group of 11.1 points (SD 21.8) compared with 0.71 points (SD 19.4) in the control (8.6 points, 95% CI 2.0 to 15.2, p=0.01). CONCLUSIONS Patients with advanced type 2 diabetes and obesity receiving IT achieved greater weight loss using a TDR intervention while also reducing or stopping IT and improving glycemic control and QoL. The TDR approach is a safe treatment option in this challenging patient group but requires maintenance support for long-term success. TRIAL REGISTRATION NUMBER ISRCTN21335883.
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Affiliation(s)
- Adrian Brown
- Nutrition and Dietetic Research Group, Imperial College London, London, UK
- Centre for Obesity Research, Department of Medicine, University College London, London, UK
| | - Anne Dornhorst
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
| | - Barbara McGowan
- Institute of Diabetes, Endocrinology and Obesity, Guy's and St Thomas' Hospital, London, UK
| | - Omar Omar
- Department of Medicine and Clinical Research Core, Weill Cornell Medicine-Qatar, Qatar-Foundation Education City, Doha, Qatar
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Anthony R Leeds
- Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
- Clinical Research Unit, Parker Institute, Frederiksberg Hospital, Copenhagen, Denmark
| | - Shahrad Taheri
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
- Department of Medicine and Clinical Research Core, Weill Cornell Medicine-Qatar, Qatar-Foundation Education City, Doha, Qatar
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Gary S Frost
- Nutrition and Dietetic Research Group, Imperial College London, London, UK
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Kloecker DE, Zaccardi F, Baldry E, Davies MJ, Khunti K, Webb DR. Efficacy of low- and very-low-energy diets in people with type 2 diabetes mellitus: A systematic review and meta-analysis of interventional studies. Diabetes Obes Metab 2019; 21:1695-1705. [PMID: 30924575 DOI: 10.1111/dom.13727] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/11/2019] [Accepted: 03/26/2019] [Indexed: 12/29/2022]
Abstract
AIMS To review systematically and quantify the weight loss achieved through low- (LEDs) and very-low-energy diets (VLEDs) in people with type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS Studies reporting the effects of diet-only interventions of up to 1600 kcal/d in people with T2DM were searched in MEDLINE, EMBASE and CINAHL up to July 2018. Changes in the primary (body weight and body mass index [BMI]) and secondary outcomes (glycated haemoglobin, blood lipids) according to energy restriction and duration of diet were modelled using restricted cubic splines. RESULTS Forty-four studies (3817 participants) were included. The overall quality of the evidence was moderate and limited to short-term interventions up to 4 months. Baseline mean weight and BMI were 92.1 kg and 36.6 kg/m2 . VLEDs of 400 kcal/d led to 5.4% weight loss at 2 weeks, increasing to 17.9% at 3 months. More modest reductions of 7.3% were observed on LEDs of 1200 kcal/d and 2.0% on 1600 kcal/d after 3 months. No clear patterns emerged for secondary outcomes. Publication bias was significant for primary outcomes. CONCLUSIONS Through modelling, we were able to describe effective dietary deficit strategies to achieve weight reduction up to 4 months in people with T2DM. High-quality studies are required to further support clinical practice with evidence-based dietary interventions.
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Affiliation(s)
- David E Kloecker
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Francesco Zaccardi
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Emma Baldry
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK
- National Institute for Health Research, Biomedical Research Centre, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK
- National Institute for Health Research, Collaboration for Leadership in Applied Health Research and Care East Midlands, Leicester General Hospital, Leicester, UK
| | - David R Webb
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK
- National Institute for Health Research, Biomedical Research Centre, Leicester, UK
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Gummesson A, Nyman E, Knutsson M, Karpefors M. Effect of weight reduction on glycated haemoglobin in weight loss trials in patients with type 2 diabetes. Diabetes Obes Metab 2017; 19:1295-1305. [PMID: 28417575 DOI: 10.1111/dom.12971] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/20/2017] [Accepted: 03/31/2017] [Indexed: 01/06/2023]
Abstract
AIM To quantify the effect of weight loss on glycated haemoglobin (HbA1c) at group level, based on data from published weight loss trials in overweight and obese patients with type 2 diabetes (T2D). METHODS A systematic literature search in MEDLINE, EMBASE and Cochrane CENTRAL (January 1990 through December 2012) was conducted to identify prospective trials of energy-reduced diets, obesity drugs or bariatric surgery in adult, overweight and obese patients with T2D. Based on clinical data with follow-up from 3 to 24 months, a linear model was developed to describe the effect of weight reduction on HbA1c. RESULTS The literature search identified 58 eligible articles consisting of 124 treatment groups and 17 204 subjects, yielding a total of 250 data points with concurrent mean changes from baseline in weight and HbA1c. The model-based analyses indicated a linear relationship between weight loss and HbA1c reduction, with an estimated mean HbA1c reduction of 0.1 percentage points for each 1 kg of reduced body weight for the overall population. Baseline HbA1c was a significant covariate for the relationship between weight loss and HbA1c: high HbA1c at baseline was associated with a greater reduction in HbA1c for the same degree of weight loss. The collected trial data also indicated weight-loss-dependent reductions in antidiabetic medication. CONCLUSIONS At group level, weight loss in obese and overweight patients with T2D was consistently accompanied by HbA1c reduction in a dose-dependent manner. The model developed in the present study estimates that for each kg of mean weight loss, there is a mean HbA1c reduction of 0.1 percentage points. HbA1c-lowering is greater in populations with poor glycaemic control than in well controlled populations with the same degree of weight loss. This summary of data from previous trials regarding the effect of weight reduction on HbA1c may be used to support the design and interpretation of future studies that aim to demonstrate the efficacy of weight loss interventions for T2D treatment.
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Affiliation(s)
- Anders Gummesson
- Department of Clinical Pathology and Genetics, Sahlgrenska University Hospital, Gothenburg, Sweden
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Rehackova L, Arnott B, Araujo-Soares V, Adamson AA, Taylor R, Sniehotta FF. Efficacy and acceptability of very low energy diets in overweight and obese people with Type 2 diabetes mellitus: a systematic review with meta-analyses. Diabet Med 2016; 33:580-91. [PMID: 26490082 DOI: 10.1111/dme.13005] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 08/28/2015] [Accepted: 10/16/2015] [Indexed: 02/06/2023]
Abstract
AIMS To explore the efficacy and acceptability of very low energy diets in overweight or obese adults with Type 2 diabetes. METHODS Controlled trials and qualitative studies of individuals with Type 2 diabetes that compared very low energy diets with standard care, minimal interventions, other weight loss interventions, less intensive very low energy diet interventions and very low energy diets with additional components were eligible for inclusion. Meta-analyses of changes in weight, blood glucose levels and attrition rates were performed. Acceptability of very low energy diets was assessed by attrition rates, number and severity of side effects, and by qualitative evaluations of the interventions. RESULTS Four randomized, five non-randomized controlled trials and no qualitative studies (21 references, 9 studies, 346 participants) were identified. Meta-analyses showed that very low energy diets induced greater weight losses than minimal interventions, standard care or low energy diets at 3 and 6 months. No conclusive evidence for differences in outcomes between very low energy diets and Roux-en-Y gastric bypass surgery was found. Greater differences in energy prescription between intervention and comparator arms were associated with greater differences in weight loss and fasting blood glucose levels at 3 months. Attrition rates did not differ between the very low energy diets and the comparator arms at any measurement point. CONCLUSIONS Very low energy diets are effective in substantial weight loss among people with Type 2 diabetes. Levels of adherence to very low energy diets in controlled studies appear to be high, although details about behaviour support provided are usually poorly described.
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Affiliation(s)
- L Rehackova
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - B Arnott
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - V Araujo-Soares
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - A A Adamson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - R Taylor
- Magnetic Resonance Centre, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - F F Sniehotta
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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A Review of Commercial and Proprietary Weight Loss Programs. LIFESTYLE MEDICINE 2016. [DOI: 10.1007/978-3-319-24687-1_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Gudzune KA, Doshi RS, Mehta AK, Chaudhry ZW, Jacobs DK, Vakil RM, Lee CJ, Bleich SN, Clark JM. Efficacy of commercial weight-loss programs: an updated systematic review. Ann Intern Med 2015; 162:501-12. [PMID: 25844997 PMCID: PMC4446719 DOI: 10.7326/m14-2238] [Citation(s) in RCA: 216] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Commercial and proprietary weight-loss programs are popular obesity treatment options, but their efficacy is unclear. PURPOSE To compare weight loss, adherence, and harms of commercial or proprietary weight-loss programs versus control/education (no intervention, printed materials only, health education curriculum, or <3 sessions with a provider) or behavioral counseling among overweight and obese adults. DATA SOURCES MEDLINE and the Cochrane Database of Systematic Reviews from inception to November 2014; references identified by program staff. STUDY SELECTION Randomized, controlled trials (RCTs) of at least 12 weeks' duration; prospective case series of at least 12 months' duration (harms only). DATA EXTRACTION Two reviewers extracted information on study design, population characteristics, interventions, and mean percentage of weight change and assessed risk of bias. DATA SYNTHESIS We included 45 studies, 39 of which were RCTs. At 12 months, Weight Watchers participants achieved at least 2.6% greater weight loss than those assigned to control/education. Jenny Craig resulted in at least 4.9% greater weight loss at 12 months than control/education and counseling. Nutrisystem resulted in at least 3.8% greater weight loss at 3 months than control/education and counseling. Very-low-calorie programs (Health Management Resources, Medifast, and OPTIFAST) resulted in at least 4.0% greater short-term weight loss than counseling, but some attenuation of effect occurred beyond 6 months when reported. Atkins resulted in 0.1% to 2.9% greater weight loss at 12 months than counseling. Results for SlimFast were mixed. We found limited evidence to evaluate adherence or harms for all programs and weight outcomes for other commercial programs. LIMITATION Many trials were short (<12 months), had high attrition, and lacked blinding. CONCLUSION Clinicians could consider referring overweight or obese patients to Weight Watchers or Jenny Craig. Other popular programs, such as Nutrisystem, show promising weight-loss results; however, additional studies evaluating long-term outcomes are needed. PRIMARY FUNDING SOURCE None. ( PROSPERO CRD4201-4007155).
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Affiliation(s)
- Kimberly A. Gudzune
- From Johns Hopkins University School of Medicine; Johns Hopkins Bloomberg School of Public Health; Welch Center for Prevention, Epidemiology, and Clinical Research; Johns Hopkins Bayview Medical Center; and University of Maryland School of Medicine, Baltimore, Maryland, and Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Ruchi S. Doshi
- From Johns Hopkins University School of Medicine; Johns Hopkins Bloomberg School of Public Health; Welch Center for Prevention, Epidemiology, and Clinical Research; Johns Hopkins Bayview Medical Center; and University of Maryland School of Medicine, Baltimore, Maryland, and Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Ambereen K. Mehta
- From Johns Hopkins University School of Medicine; Johns Hopkins Bloomberg School of Public Health; Welch Center for Prevention, Epidemiology, and Clinical Research; Johns Hopkins Bayview Medical Center; and University of Maryland School of Medicine, Baltimore, Maryland, and Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Zoobia W. Chaudhry
- From Johns Hopkins University School of Medicine; Johns Hopkins Bloomberg School of Public Health; Welch Center for Prevention, Epidemiology, and Clinical Research; Johns Hopkins Bayview Medical Center; and University of Maryland School of Medicine, Baltimore, Maryland, and Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - David K. Jacobs
- From Johns Hopkins University School of Medicine; Johns Hopkins Bloomberg School of Public Health; Welch Center for Prevention, Epidemiology, and Clinical Research; Johns Hopkins Bayview Medical Center; and University of Maryland School of Medicine, Baltimore, Maryland, and Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Rachit M. Vakil
- From Johns Hopkins University School of Medicine; Johns Hopkins Bloomberg School of Public Health; Welch Center for Prevention, Epidemiology, and Clinical Research; Johns Hopkins Bayview Medical Center; and University of Maryland School of Medicine, Baltimore, Maryland, and Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Clare J. Lee
- From Johns Hopkins University School of Medicine; Johns Hopkins Bloomberg School of Public Health; Welch Center for Prevention, Epidemiology, and Clinical Research; Johns Hopkins Bayview Medical Center; and University of Maryland School of Medicine, Baltimore, Maryland, and Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Sara N. Bleich
- From Johns Hopkins University School of Medicine; Johns Hopkins Bloomberg School of Public Health; Welch Center for Prevention, Epidemiology, and Clinical Research; Johns Hopkins Bayview Medical Center; and University of Maryland School of Medicine, Baltimore, Maryland, and Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Jeanne M. Clark
- From Johns Hopkins University School of Medicine; Johns Hopkins Bloomberg School of Public Health; Welch Center for Prevention, Epidemiology, and Clinical Research; Johns Hopkins Bayview Medical Center; and University of Maryland School of Medicine, Baltimore, Maryland, and Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
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Anderson JW, Reynolds LR, Bush HM, Rinsky JL, Washnock C. Effect of a Behavioral/Nutritional Intervention Program on Weight Loss in Obese Adults: A Randomized Controlled Trial. Postgrad Med 2015; 123:205-13. [DOI: 10.3810/pgm.2011.09.2476] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Improving maintenance of lost weight following a commercial liquid meal replacement program: a preliminary study. Eat Behav 2014; 15:95-8. [PMID: 24411759 DOI: 10.1016/j.eatbeh.2013.10.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 10/03/2013] [Accepted: 10/23/2013] [Indexed: 11/23/2022]
Abstract
Clinic-based liquid meal replacement (800kcals/day) programs produce substantial weight loss. Nevertheless, long-term maintenance remains a challenge. A limitation of maintenance programs is that they continue to promote large behavior changes that are initially required to induce weight loss which may be unsustainable long-term. The study aims were to conduct a preliminary assessment of the feasibility, acceptability, and effectiveness of a small changes maintenance intervention (SCM) for 30 patients who completed liquid meal replacement program (LMR). The 20-session SCM delivered over 52 weeks offered no preset goals for maintenance behaviors and all changes in behavior were self-selected. Participants had a median BMI of 40.9 kg/m(2) and weight of 111 kg at the start of LMR. At LMR completion, they lost 18% (21 kg) of body weight. The SCM was completed by 22 patients (73%); 19 completers (86%) attended ≥ 17 of 20 sessions with a median satisfaction rating of 9 (on a scale of 1 to 9). Completers were asked to record self-selected maintenance behaviors daily (median 351 days recorded). The most commonly reported daily behaviors were self-weighing, use of meal replacements and step counting. Median percent regain at week 52 was 14% (2.8 kg) of lost weight (range, -42 to 74%), significantly less than a median of 56% (11 kg) percent regain of lost weight (range, -78 to 110%) in a demographically similar historical control group with no maintenance intervention after LMR completion (P<0.001). Thus, SCM holds promise for improving weight maintenance. Future research should compare SCM to standard maintenance programs that promote large program-directed changes.
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Furlow EA, Anderson JW. A Systematic Review of Targeted Outcomes Associated with a Medically Supervised Commercial Weight-Loss Program. ACTA ACUST UNITED AC 2009; 109:1417-21. [PMID: 19631049 DOI: 10.1016/j.jada.2009.05.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2008] [Accepted: 02/20/2009] [Indexed: 11/24/2022]
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Abstract
OBJECTIVE Very-low-calorie diets (VLCDs), providing <800 kcal/d, have been used since the 1970s to induce rapid weight loss. Previous reviews of the literature have disagreed concerning the relative efficacy of VLCDs vs. conventional low-calorie diets (LCDs) for achieving long-term weight loss. RESEARCH METHODS AND PROCEDURES We sought to update findings on the clinical use, safety, and efficacy of VLCDs and to perform a meta-analysis of randomized trials that compared the long-term efficacy of LCDs and VLCDs. Original research articles were retrieved by a Medline search and from prior reviews of VLCDs. Trials were included only if they were randomized comparisons of LCDs and VLCDs and included a follow-up assessment at least 1 year after maximum weight loss. Data were abstracted by both authors regarding: duration of VLCD, total length of treatment, attrition, short- and long-term weight loss, changes in weight-related comorbidities, and adverse effects. RESULTS Six randomized trials were found that met inclusion criteria. VLCDs, compared with LCDs, induced significantly greater short-term weight losses (16.1 +/- 1.6% vs. 9.7 +/- 2.4% of initial weight, respectively; p = 0.0001) but similar long-term losses (6.3 +/- 3.2% vs. 5.0 +/- 4.0%, respectively; p > 0.2). Attrition was similar with VLCD and LCD regimens. DISCUSSION VLCDs did not produce greater long-term weight losses than LCDs. In the United States, the use of liquid meal replacements as part of a 1000 to 1500 kcal/d diet may provide an effective and less expensive alternative to VLCDs. In Europe, VLCDs are used with less intensive medical supervision than in the United States, which reduces the cost of this approach.
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Affiliation(s)
- Adam Gilden Tsai
- Department of Psychiatry, Center for Weight and Eating Disorders, University of Pennsylvania School of Medicine, 3535 Market Street, Suite 3029, Philadelphia, PA 19104, USA
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Aas AM, Seljeflot I, Torjesen PA, Diep LM, Thorsby PM, Birkeland KI. Blood glucose lowering by means of lifestyle intervention has different effects on adipokines as compared with insulin treatment in subjects with type 2 diabetes. Diabetologia 2006; 49:872-80. [PMID: 16555056 DOI: 10.1007/s00125-006-0205-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2005] [Accepted: 01/14/2006] [Indexed: 01/04/2023]
Abstract
AIMS/HYPOTHESIS Adipokines may be important in mediating signals from adipocytes to insulin-sensitive tissue and vasculature. We studied the effect of different glucose-lowering therapies on serum levels of plasminogen activator inhibitor-1 (PAI-1), high-sensitivity C-reactive protein (hs-CRP), TNF-alpha, leptin, adiponectin and ghrelin in patients with type 2 diabetes. SUBJECTS AND METHODS Twenty-eight patients with poorly controlled type 2 diabetes who were receiving oral hypoglycaemic agents were allocated to one of the following groups, and treated for 1 year: (1) lifestyle intervention (L); (2) insulin treatment (I); and (3) combined treatment (L+I). RESULTS Similar improvements in glycaemic control occurred in all three groups. There was a reduction in body weight of 3.0 kg (median) (95% CI -5.9 to -2.0) in group L, whereas in groups L+I and I body weight increased by 3.5 kg (95% CI 1.5-4.9) and 4.9 kg (95% CI -3.1 to 8.2), respectively. By trend analyses, group L had reduced levels of PAI-1 (p=0.002), hs-CRP (p<0.0001) and TNF-alpha (p=0.006), while no significant changes were observed in the levels of leptin or adiponectin. In group I, the median levels of PAI-1 (p=0.008), TNF-alpha (p=0.058) and leptin (p=0.004) increased. In the L+I group there was a reduction in PAI-1 levels (p=0.014) and an increase in levels of leptin (p<0.001). The differences in changes in the levels of PAI-1, hs-CRP, TNF-alpha and leptin between groups were also significant (all p<0.01). CONCLUSIONS/INTERPRETATION Improvement of glycaemic control through lifestyle intervention in type 2 diabetes had more beneficial effects on adipokine levels than when the same lowering of HbA(1c) was achieved with insulin treatment.
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Affiliation(s)
- A-M Aas
- Department of Nutrition and Dietetics, Aker University Hospital, Trondheimsveien 235, 0514, Oslo, Norway.
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Aas AM, Bergstad I, Thorsby PM, Johannesen O, Solberg M, Birkeland KI. An intensified lifestyle intervention programme may be superior to insulin treatment in poorly controlled Type 2 diabetic patients on oral hypoglycaemic agents: results of a feasibility study. Diabet Med 2005; 22:316-22. [PMID: 15717881 DOI: 10.1111/j.1464-5491.2005.01421.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AIMS The aims of this study were to assess whether, in Type 2 diabetic patients with inadequate glycaemic control on oral hypoglycaemic agents (OHA), a lifestyle intervention programme based on exercise and diet counselling (i) was as effective as insulin treatment in controlling blood glucose, and (ii) could prevent the weight gain usually accompanying the introduction of insulin treatment. METHODS Thirty-eight Type 2 diabetic subjects treated with OHA, HbA(1c) 8-10.5% and body mass index (BMI) 26-40 kg/m2, were randomized to the following treatments: (i) lifestyle intervention (L), (ii) lifestyle intervention + insulin treatment (L+I) and (iii) insulin treatment alone (I). RESULTS There was a reduction in HbA(1c) of -1.2 (interquartile range 1.0), -1.0 (1.7) and -1.5 (2.5)% in group L, L+I and I, respectively, and all treatment groups achieved beneficial changes in blood lipid variables. There was no significant difference between the groups in the change observed in levels of HbA(1c) between start and 12 months of treatment (P = 0.74). There was a significant difference in weight changes between groups (P < 0.01): group L reduced weight by median -3.0 (4.0) kg, groups L+I and I increased weight by 3.5 (3.4) and 4.9 (6.9) kg, respectively. CONCLUSIONS Lifestyle intervention was as effective as insulin treatment in improving glycaemic control in poorly controlled subjects with Type 2 diabetes, and resulted in weight loss during the intervention year. However, glycaemic control deteriorated and body weight increased in the lifestyle intervention group 1 year after the intervention stopped.
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Affiliation(s)
- A M Aas
- Department of Nutrition and Dietetics, Aker University Hospital, Oslo, Norway.
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15
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Tsai AG, Wadden TA, Womble LG, Byrne KJ. Commercial and self-help programs for weight control. Psychiatr Clin North Am 2005; 28:171-92, ix. [PMID: 15733618 DOI: 10.1016/j.psc.2004.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Adam Gilden Tsai
- Department of Psychiatry, University of Pennsylvania School of Medicine, Weight and Eating Disorders Program, Philadelphia, PA 19104, USA
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16
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Maeda H, Yamamoto R, Hirao K, Tochikubo O. Effects of agar (kanten) diet on obese patients with impaired glucose tolerance and type 2 diabetes. Diabetes Obes Metab 2005; 7:40-6. [PMID: 15642074 DOI: 10.1111/j.1463-1326.2004.00370.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to evaluate the efficacy of agar diet in combination with a conventional diet (traditional Japanese food) for obese patients with impaired glucose tolerance and type 2 diabetes. METHODS After a 4-week run-in period on their habitual diets, 76 patients were randomly assigned to have conventional diet or conventional diet with agar. Both groups were on these diets for 12 weeks. Body weight, body mass index (BMI), glycaemic control, blood pressure, insulin resistance, total body fat, fat distribution and lipids were assessed before and after the experimental period. RESULTS In both groups, after 12 weeks, mean body weight, BMI, fasting glucose levels, homeostasis model assessment-insulin resistance, and systolic and diastolic blood pressures had decreased significantly from their baseline values. HbA(1)c, visceral fat area, subcutaneous fat area, total body fat, insulin area under the curve after oral glucose tolerance test and total cholesterol decreased significantly in the agar-diet group. After 12 weeks, mean changes of body weight (-2.8 +/- 2.7 kg vs. -1.3 +/- 2.3 kg, p = 0.008), BMI values (-1.1 +/- 1.1 kg/m(2) vs. -0.5 +/- 0.9 kg/m(2), p = 0.009) and total cholesterol (-7.6 +/- 27.5 mg/dl vs. + 2.4 +/- 23.4 mg/dl, p = 0.036) were significantly greater in the agar-diet group than in the conventional diet group. CONCLUSIONS The agar diet resulted in marked weight loss due to the maintenance of reduced calorie intake and to an improvement in metabolic parameters.
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Affiliation(s)
- H Maeda
- HEC Science Clinic, Isogo-ku, Yokohama-shi, Kanagawa 230-0045, Japan
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17
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Anderson JW, Kendall CWC, Jenkins DJA. Importance of weight management in type 2 diabetes: review with meta-analysis of clinical studies. J Am Coll Nutr 2004; 22:331-9. [PMID: 14559925 DOI: 10.1080/07315724.2003.10719316] [Citation(s) in RCA: 247] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Obesity is a major risk factor for development of diabetes, and excessive energy intake is a major contributor to poor glycemic control in Type 2 diabetes. The impact of obesity on risk for diabetes as well as coronary heart disease (CHD) risk factors and the benefits of weight loss in decreasing risk for developing diabetes and improving glycemia and CHD risks were reviewed. A systematic review of the medical literature to assess the impact of obesity and weight gain on risk for diabetes and CHD was done. We performed a meta-analysis of the effects of weight loss for obese diabetic individuals. Controlled clinical trials assessing lifestyle changes on risk for developing diabetes and weight loss effects on glycemia and CHD risk factors were reviewed. Obesity and weight gain can increase risk for diabetes by greater than ninetyfold and CHD by about sixfold. Very-low-energy diets (VLED) decrease fasting plasma glucose values by approximately 50% within two weeks and these changes are sustained with continued energy restriction. Twelve weeks of energy-restricted diets were associated with these significant decreases: body weight, 9.6%; fasting plasma glucose, 25.7%; serum cholesterol, 9.2%; serum triglycerides, 26.7%; systolic blood pressure, 8.1%; and diastolic blood pressure, 8.6%. Larger weight losses were associated with larger reductions in these values. The reviewed data suggest that US health care providers should endorse the American Heart Association's and European diabetes associations' recommendations that diabetic persons achieve and maintain a BMI of
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Affiliation(s)
- James W Anderson
- Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA.
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18
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Reynolds LR, Anderson JW. Practical Office Strategies for Weight Management of the Obese Diabetic Individual. Endocr Pract 2004; 10:153-9. [PMID: 15256334 DOI: 10.4158/ep.10.2.153] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
SUMMARY Obesity is a key component of the insulin-resistance syndrome of type 2 diabetes, and intensifies comorbidities underlying the increased cardiovascular risk of individuals with type 2 diabetes. Weight loss leads to dramatic beneficial effects, with reductions in blood glucose levels and improvements in lipid profiles and blood pressure that often necessitate reductions in medications. Successful long-term weight loss is difficult to achieve in patients with diabetes, as standard dietary approaches often have minimal long-term impact, and intensive management strategies designed to improve glycemic control often contribute to further weight gain in these patients. This article offers a review of newer strategies for enhancing lifestyle change and weight loss in the obese diabetic individual. Use of meal replacements provides structure with portion control, and increased intake of fruits and vegetables promotes a healthier eating style for these patients. Encouraging physical activity such as walking, stair climbing, and gardening can significantly improve cardiorespiratory fitness and glycemic control, and helps patients maintain weight loss. Self-monitoring through lifestyle diaries can reinforce the healthy behaviors necessary for long-term management of obesity. Adjunctive antiobesity medication, medically-supervised intensive weight loss programs, and minimally invasive gastric bypass procedures are important options for patients unable to make significant progress with behavioral changes.
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Affiliation(s)
- L Raymond Reynolds
- Lexington VA Medical Center and Department of Internal Medicine, Division of Endocrinology and Molecular Medicine, University of Kentucky at Lexington, 40506-0298, USA
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19
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Anderson JW, Luan J, Høie LH. Structured weight-loss programs: meta-analysis of weight loss at 24 weeks and assessment of effects of intervention intensity. Adv Ther 2004; 21:61-75. [PMID: 15310080 DOI: 10.1007/bf02850334] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Obesity is increasing in epidemic proportions globally while current therapies continue to be suboptimal. In this investigation, weight loss in obese individuals after 24 weeks with different nutrition interventions was compared. The impact of intervention intensity was assessed. Inclusion criteria were established and a comprehensive literature review was performed. These nutrition interventions were identified and analyzable: meal replacements (MRs); energy-restricted (>1500 kcal/d) diets (ERDs); low-energy (800-1500 kcal/d) diets (LEDs); soy very low energy (<800 kcal/d) diets (VLEDs) referred to as SOYs; and VLEDs. Intensity was assessed using the following parameters: physician visits, clinic visits, and hours of class over 24 weeks; an intensity score represents an adjusted sum of the values. Weight losses at 24 weeks as percentage of baseline weights (95%, confidence intervals) were as follows: MRs, 9.1% (5.7-12.5); ERDs, 8.5% (4.9-12.1); LEDs, 11.4% (8.9-13.1); SOYs, 16.5% (13.9-19.1); and VLEDs, 21.3% (20.1-22.5). Weight loss with SOYs was significantly greater than with MRs and ERDs; weight loss with VLEDs was significantly greater than with any other diet. Energy intake was the most significant (P<.0001) regression variable related to weight loss; however, the intensity of intervention (P=.0003) was significantly stronger than initial body weight or duration of treatment. Medically supervised VLEDs are the most effective intervention for facilitating substantial weight loss over 24 weeks. SOY may promote more rapid weight loss over the first 8 weeks than other interventions. MRs appear to be equally effective with ERDs and LEDs with lower levels of intervention intensity.
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Affiliation(s)
- James W Anderson
- Department of Internal Medicine, University of Kentucky, Lexington, Kentucky, USA
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20
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Harder H, Dinesen B, Astrup A. The effect of a rapid weight loss on lipid profile and glycemic control in obese type 2 diabetic patients. Int J Obes (Lond) 2003; 28:180-2. [PMID: 14610532 DOI: 10.1038/sj.ijo.0802529] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To test the effect of low calorie diet (LCD) on body weight, lipid profile, and glycemic control in obese type 2 diabetes mellitus (DM) patients. DESIGN Dietary intervention. SETTING Department of Human Nutrition, Copenhagen. SUBJECTS Outpatients: 11 type 2 DM patients (three males/eight females) (10 completed), four on oral hypoglycemic agents (OHA). Body mass index (BMI) 36.8 +/- 5.5 kg/m2 and age 62 +/- 5.7 y. INTERVENTIONS In all, 8 weeks full meal-replacement diet: eight sachets of a nutrition powder (Nutrilett, 850 kcal/day). Lipid profile assessed by NMR spectroscopy. RESULTS Mean body weight fell by 10.9 kg (approximately 11%, P<0.001). Fasting insulin, fasting blood glucose, hemoglobin A1c, fasting plasma triglycerides, total cholesterol, and low-density lipoprotein (LDL) cholesterol fell significantly. There were large positive changes (statistically insignificant) in LDL subclass distribution and a similar shift in high-density lipoprotein subclass distribution. Medication was discontinued in all four subjects taking OHA for 2 weeks prior to the intervention and throughout the whole 8-week intervention period. CONCLUSION LCD is effective in improving glycemic control and blood lipids through weight loss in overweight type 2 DM patients.
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Affiliation(s)
- H Harder
- Department of Human Nutrition, Centre for Advanced Food Studies, The Royal Veterinary and Agricultural University, Rolighedsvej, Frederiksberg C, Denmark
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21
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Heymsfield SB, van Mierlo CAJ, van der Knaap HCM, Heo M, Frier HI. Weight management using a meal replacement strategy: meta and pooling analysis from six studies. Int J Obes (Lond) 2003; 27:537-49. [PMID: 12704397 DOI: 10.1038/sj.ijo.0802258] [Citation(s) in RCA: 328] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Although used by millions of overweight and obese consumers, there has not been a systematic assessment on the safety and effectiveness of a meal replacement strategy for weight management. The aim of this study was to review, by use of a meta- and pooling analysis, the existing literature on the safety and effectiveness of a partial meal replacement (PMR) plan using one or two vitamin/mineral fortified meal replacements as well as regular foods for long-term weight management. DESIGN A PMR plan was defined as a program that prescribes a low calorie (>800<or=1600 kcal/day) diet whereby one or two meals are replaced by commercially available, energy-reduced product(s) that are vitamin and mineral fortified, and includes at least one meal of regular foods. Randomized, controlled PMR interventions of at least 3 months duration, with subjects 18 y of age or older and a BMI>or=25 kg/m(2), were evaluated. Studies with self-reported weight and height were excluded. Searches in Medline, Embase, and the Cochrane Clinical Trials Register from 1960 to January 2001 and from reference lists identified 30 potential studies for analysis. Of these, six met all of the inclusion criteria and used liquid meal replacement products with the associated plan. Overweight and obese subjects were randomized to the PMR plan or a conventional reduced calorie diet (RCD) plan. The prescribed calorie intake was the same for both groups. Authors of the six publications were contacted and asked to supply primary data for analysis. Primary data from the six studies were used for both meta- and pooling analyses. RESULTS Subjects prescribed either the PMR or RCD treatment plans lost significant amounts of weight at both the 3-month and 1-year evaluation time points. All methods of analysis indicated a significantly greater weight loss in subjects receiving the PMR plan compared to the RCD group. Depending on the analysis and follow-up duration, the PMR group lost approximately 7-8% body weight and the RCD group lost approximately 3-7% body weight. A random effects meta-analysis estimate indicated a 2.54 kg (P<0.01) and 2.43 kg (P=0.14) greater weight loss in the PMR group for the 3-month and 1-y periods, respectively. A pooling analysis of completers showed a greater weight loss in the PMR group of 2.54 kg (P<0.01) and 2.63 kg (P<0.01) during the same time period. Risk factors of disease associated with excess weight improved with weight loss in both groups at the two time points. The degree of improvement was also dependent on baseline risk factor levels. The dropout rate for PMR and RCD groups was equivalent at 3 months and significantly less in the PMR group at 1 y. No reported adverse events were attributable to either weight loss regimen. CONCLUSION This first systematic evaluation of randomized controlled trials utilizing PMR plans for weight management suggests that these types of interventions can safely and effectively produce significant sustainable weight loss and improve weight-related risk factors of disease.
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Affiliation(s)
- S B Heymsfield
- Obesity Research Center, St Luke's-Roosevelt Hospital, Columbia University College of Physicians and Surgeons, New York, NY, USA.
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22
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Anderson JW, Konz EC. Obesity and disease management: effects of weight loss on comorbid conditions. OBESITY RESEARCH 2001; 9 Suppl 4:326S-334S. [PMID: 11707561 DOI: 10.1038/oby.2001.138] [Citation(s) in RCA: 213] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
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.
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Affiliation(s)
- J W Anderson
- Veterans Administration Medical Center, Graduate Center for Nutritional Sciences, University of Kentucky, Lexington, 40511, USA.
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Anderson JW, Vichitbandra S, Qian W, Kryscio RJ. Long-term weight maintenance after an intensive weight-loss program. J Am Coll Nutr 1999; 18:620-7. [PMID: 10613414 DOI: 10.1080/07315724.1999.10718897] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This prospective study assessed long-term weight maintenance of patients completing an intensive very-low-calorie diet (VLCD) weight-loss program. SUBJECTS Individuals who had completed the 12-week core education program and lost > or = 10 kg were recruited. RESULTS Of 154 eligible subjects, follow-up weights were obtained at > or = 2 years in 112 subjects (72.7%, 72 women, 40 men). Subjects had an average initial body mass index of 37.3 kg/m2 and an average weight loss of 29.7 kg in five months. Six hundred and forty-five follow-up weights (median, five per subject) were obtained over two to seven years of follow-up from clinic visits (70%) and self-report by telephone or mail (30%). Subjects regained an average of 2.5% per month of their lost weight during the first two to three years of follow-up; however, their weight stabilized over the next four years. Subjects regained an average of 73.4% of their weight loss during the first three years. The average weight loss maintained for 112 subjects was 22.8% of initial weight loss after an average of 5.3 years of follow-up. When successful weight maintenance was defined as maintaining a weight loss of 5% or 10% of initial (pre-treatment) body weight, 40% were maintaining a 5% weight loss at five years and 25% were maintaining a weight loss of 10% at 7 years. Multiple regression analyses suggested that age had a significant (p=0.004) and positive effect on weight maintenance. CONCLUSIONS This study suggests that weight maintenance after an intensive VLCD program is improving but still needs intensive efforts to enable most individuals to maintain a substantial percentage of their weight loss long-term.
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Affiliation(s)
- J W Anderson
- VA Medical Center and University of Kentucky (HMR) Weight Management Program, Lexington, USA
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Tremble JM, Donaldson D. Is continued weight gain inevitable in type 2 diabetes mellitus? THE JOURNAL OF THE ROYAL SOCIETY FOR THE PROMOTION OF HEALTH 1999; 119:235-9. [PMID: 10673844 DOI: 10.1177/146642409911900406] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Prevention and treatment of obesity are major clinical problems encountered in the management of Type 2 diabetes mellitus (DM); indeed, up to 90% of such patients are regarded as being overweight. Except for a brief period following diagnosis, when presumably enthusiasm to adopt lifestyle change is at its greatest, weight gain is generally progressive unless severe hyperglycaemia or complications intervene. Even a relatively modest weight loss of 10% can have major benefits in terms not only of reducing the risk of developing DM in the first place, but also in improving metabolic control after the disorder has become established. Behavioural therapy (BT) in combination with hypocaloric diet achieves weight loss in the short-term, but is poorly sustained in the long-term. Exercise has metabolic benefits beyond its rather minimal effects on short-term weight loss in that it may also aid long-term weight control. The difficulties encountered in maintaining lifestyle change do, however, suggest the need for ongoing intervention--perhaps including a regular period on a stricter dietary regimen (800-1000 kcalday-1), possibly a very low calorie diet (VLCD)(< 800 kcalday-1) or even the use of orlistat, a pancreatic lipase inhibitor which reduces the absorption of dietary fat. Realistically, the aim should be for long-term weight stability.
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Anderson JW, Pi-Sunyer FX, Danforth E, Dujovne CA, Greenway F, Hill JO, Lucas CP, O'Neil PM, Smith DK. Clinical trial design for obesity agents: a workshop report. OBESITY RESEARCH 1998; 6:311-5. [PMID: 9688109 DOI: 10.1002/j.1550-8528.1998.tb00355.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- J W Anderson
- Metabolic Research Group, VA Medical Center and University of Kentucky, Lexington, USA
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O'Meara S, Glenny AM, Wilson C, Melville A, Sheldon TA. Effective management of obesity. Qual Health Care 1997; 6:170-5. [PMID: 10173776 PMCID: PMC1055480 DOI: 10.1136/qshc.6.3.170] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- S O'Meara
- NHS Centre for Reviews and Dissemination, University of York
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