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 (X40 kg/m 2) treated in three cities ('Study Group'). Of these, 1100 completed the 12-week core curriculum ('Completer Group'). Weight loss X100 lbs (445 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 loss7s.e. for 998 women was 23.970.6 kg (18.5% of initial body weight (IBW)) and for 533 men was 36.071.0 kg (22.5%) over 30 weeks. For Completers, average weight loss for women was 30.870.6 kg (23.9%) and for men was 42.671.1 kg (26.7%) over 39 weeks. In the 100-Pound Group, average weight loss for women was 58.271.2 kg (41.5%) in 65 weeks and for men was 65.771.5 kg (37.5%) in 51 weeks. Side effects, assessed in 100 patients losing 445 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.

BackgroundObesity increases the risk for diabetes and cardiovascular events, with a corresponding growth in medical costs. High intensity lifestyle intervention (HILI) is the cornerstone for weight management. We assessed the effectiveness of clinic-based HILI on weight loss and associated clinical outcomes by duration of program participation and comorbid conditions.MethodsThis was a retrospective cohort study of patients who enrolled in HILI weight management programs at Health Management Resources (HMR) clinics located across the U.S. Patients completed health risk assessments (HRA) and were enrolled for up to 24 months at the time of follow-up HRA. HMR programs provide weekly group coaching to achieve reduced calorie intake, increased fruit/vegetable intake, and physical activity ≥2,000 kcal/wk. A Markov model predicted avoidance of diabetes and cardiovascular events and projected cost savings due to weight loss.ResultsOf the 500 patients included in the analysis, 67% were female and mean age was 54.1 years (s.d. 11.6). The baseline weight and BMI were 243.5 lbs (range 144.0–545.0) and 38.8 kg/m2 (range 25.4–85.0), respectively. Overall, patients lost an average of 47.4 lbs (18.9% of initial body weight [IBW]); the amount of weight loss was consistent among those with diabetes/pre-diabetes (50%), high/moderate risk for dyslipidemia (60%), hypertension/pre-hypertension (86%), and severe obesity (37%). The mean IBW lost was 16.4%, 19.3%, 20.7% for ≤6 months (n = 165), 7–12 months (n = 140), 13–24 months (n = 195) of program participation, respectively. The simulation model estimated 22 diabetes and 30 cardiovascular events and $1,992,370 medical costs avoided over 5 years in the 500 patients evaluated.ConclusionPatients in the HMR clinic-based HILI program achieved substantial weight loss regardless of duration of program participation, risk profile and comorbid status. The HMR program could be an effective strategy to prevent costly diabetes and cardiovascular events, particularly in high risk patients.

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