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 lowenergy 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.Am J Clin Nutr 2007;86:301-7.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.