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One hundred–pound weight losses with an intensive behavioral program: changes in risk factors in 118 patients with long-term follow-up^1,2

¹ From the Department of Internal Medicine, College of Medicine, and the Health Management Resources Weight Management Program (JWA), the Graduate Center for Nutritional Sciences (SBC), and the College of Pharmacy (ASN), University of Kentucky, Lexington, KY

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 100 pounds (45.5 kg).

Design: Over a 9-y period, we prospectively identified patients who lost 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 100 pounds. At baseline, the subjects' average weight was 160 kg, 97% had 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.

Key Words: Severe obesity • intensive behavioral treatment • meal replacements • long-term weight maintenance • hypertension • diabetes • low-energy diets