TY - JOUR
T1 - The long-term effectiveness of a lifestyle intervention in severely obese individuals
AU - Unick, Jessica L.
AU - Beavers, Daniel
AU - Bond, Dale S.
AU - Clark, Jeanne M.
AU - Jakicic, John M.
AU - Kitabchi, Abbas E.
AU - Knowler, William C.
AU - Wadden, Thomas A.
AU - Wagenknecht, Lynne E.
AU - Wing, Rena R.
PY - 2013/3
Y1 - 2013/3
N2 - Objective: Severe obesity (body mass index [BMI] ≥40 kg/m2) is a serious public health concern. Although bariatric surgery is an efficacious treatment approach, it is limited in reach; thus, nonsurgical treatment alternatives are needed. We examined the 4-year effects of an intensive lifestyle intervention on body weight and cardiovascular disease risk factors among severely obese, compared with overweight (25 ≤BMI <30), class I (30 ≤BMI <35), and class II obese (35 ≤BMI <40) participants. Methods: There were 5145 individuals with type 2 diabetes (45-76 years, BMI ≥25 kg/m2) randomized to an intensive lifestyle intervention or diabetes support and education. The lifestyle intervention group received a behavioral weight loss program that included group and individual meetings, a ≥10% weight loss goal, calorie restriction, and increased physical activity. Diabetes support and education received a less intense educational intervention. Four-year changes in body weight and cardiovascular disease risk factors were assessed. Results: Across BMI categories, 4-year changes in body weight were significantly greater in lifestyle participants compared with diabetes support and education (Ps <.05). At year 4, severely obese lifestyle participants lost 4.9% ± 8.5%, which was similar to class I (4.8% ± 7.2%) and class II obese participants (4.4% ± 7.6%), and significantly greater than overweight participants (3.4% ± 7.0%; P <.05). Four-year changes in low-density-lipoprotein cholesterol, triglycerides, diastolic blood pressure, HbA1c, and blood glucose were similar across BMI categories in lifestyle participants; however, the severely obese had less favorable improvements in high-density-lipoprotein cholesterol (3.1 ± 0.4 mg/dL) and systolic blood pressure (-1.4 ± 0.7 mm Hg) compared with the less obese (Ps <.05). Conclusion: Lifestyle interventions can result in important long-term weight losses and improvements in cardiovascular disease risk factors among a significant proportion of severely obese individuals.
AB - Objective: Severe obesity (body mass index [BMI] ≥40 kg/m2) is a serious public health concern. Although bariatric surgery is an efficacious treatment approach, it is limited in reach; thus, nonsurgical treatment alternatives are needed. We examined the 4-year effects of an intensive lifestyle intervention on body weight and cardiovascular disease risk factors among severely obese, compared with overweight (25 ≤BMI <30), class I (30 ≤BMI <35), and class II obese (35 ≤BMI <40) participants. Methods: There were 5145 individuals with type 2 diabetes (45-76 years, BMI ≥25 kg/m2) randomized to an intensive lifestyle intervention or diabetes support and education. The lifestyle intervention group received a behavioral weight loss program that included group and individual meetings, a ≥10% weight loss goal, calorie restriction, and increased physical activity. Diabetes support and education received a less intense educational intervention. Four-year changes in body weight and cardiovascular disease risk factors were assessed. Results: Across BMI categories, 4-year changes in body weight were significantly greater in lifestyle participants compared with diabetes support and education (Ps <.05). At year 4, severely obese lifestyle participants lost 4.9% ± 8.5%, which was similar to class I (4.8% ± 7.2%) and class II obese participants (4.4% ± 7.6%), and significantly greater than overweight participants (3.4% ± 7.0%; P <.05). Four-year changes in low-density-lipoprotein cholesterol, triglycerides, diastolic blood pressure, HbA1c, and blood glucose were similar across BMI categories in lifestyle participants; however, the severely obese had less favorable improvements in high-density-lipoprotein cholesterol (3.1 ± 0.4 mg/dL) and systolic blood pressure (-1.4 ± 0.7 mm Hg) compared with the less obese (Ps <.05). Conclusion: Lifestyle interventions can result in important long-term weight losses and improvements in cardiovascular disease risk factors among a significant proportion of severely obese individuals.
KW - Cardiovascular disease risk
KW - Diabetes
KW - Lifestyle intervention
KW - Severe obesity
KW - Weight loss
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U2 - 10.1016/j.amjmed.2012.10.010
DO - 10.1016/j.amjmed.2012.10.010
M3 - Article
C2 - 23410564
AN - SCOPUS:84873663262
VL - 126
SP - 236-242.e2
JO - American Journal of Medicine
JF - American Journal of Medicine
SN - 0002-9343
IS - 3
ER -