Multicenter evaluation of an interdisciplinary 52-week weight loss program for obesity with regard to body weight, comorbidities and quality of life—a prospective study

Abstract

Objectives:To determine the effectiveness of a structured multidisciplinary non-surgical obesity therapy program on the basis of a temporary low-calorie-diet for 12 weeks, and additional intervention modules to enhance nutritional education, to increase physical activity and to modify eating behavior.Design:Prospective multicenter observational study in obese individuals undergoing a medically supervised outpatient-based 52-week treatment in 37 centers in Germany.Subjects:A total of 8296 participants with a body mass index (BMI) of >30 kg m−2 included within 8.5 years.Measurements:Main outcome measures were body weight loss, waist circumference (WC), blood pressure, quality of life and adverse events.Results:In females, initial body weight was reduced after the 1-year-intervention by 19.6 kg (95% confidence intervals 19.2–19.9 kg) and in males by 26.0 kg (25.2–26.8) according to per protocol analysis of 4850 individuals. Intention-to-treat (ITT) analysis revealed a weight reduction of 15.2 kg (14.9–15.6) in females and 19.4 kg (18.7–20.1) in males. Overall, the intervention resulted in mean reduction in WC of 11 cm; it reduced the prevalence of the metabolic syndrome by 50% and the frequency of hypertension from 47 to 29% of all participants (ITT, all P<0.001). The beneficial effects could be documented for up to 3 years and comprised significant improvement of health-related quality of life. The incidence of adverse effects was low; the only event repeatedly observed and possibly related to either the intervention or the underlying disease was biliary disorders.Conclusion:The present non-surgical intervention program is a highly effective treatment of obesity grades I–III and obesity-related diseases, and therefore, could be a valuable basis for future weight maintenance strategies required for sustained success.

Long-term weight status in regainers after weight loss by lifestyle intervention: status and challenges

“…Also Svetkey et al (43) provided similar data in addition to weight change. Lantz et al (41) and Bischoff et al (36) , showed only the changes in body weight and BMI after 2-years observation. Champagne et al (39) presented additionally the changes related to diet by the application of a FFQ.…”

“…Champagne et al (39) , Kuller et al (40) and Svetkey et al (43) included also overweight participants. In the weight loss period, all authors (36)(37)(38)(39)(40)(41)(42)(43) applied the reduction of energy intake to at least 5020·8-7531·2 kJ/d (37)(38)(39)(40)42,43) even to very low energy diet (41) and with ready-to-use formula (Optifast) (36) . The content of fat in the diet was taken into account especially by Wadden et al (37) , Milson et al (38) , Kuller et al (40) and Svetkey et al (43).…”

“…Each study conducted the education and dietary counselling for participants as individual as well as group sessions and provided this counselling in different forms, mostly faceto-face but also via email or telephone. Phases of meal replacements were applied in the studies performed by Bischoff et al (36) and Wadden et al (37) . The measurements of weight gain during follow-up were different across the studies and included direct weight measurements, self-reports of attained weight and assessment of biomarker concentrations.…”

“…In the first phase (weight reduction period), the effectiveness of different strategies for weight reduction in obese subjects has been investigated (36)(37)(38)(39)(40)(41)(42)(43) . It has been shown that similar responses regarding satiety, hunger and satisfaction exist for diets with different proportion of nutrients (44) .…”

“…It has been shown that similar responses regarding satiety, hunger and satisfaction exist for diets with different proportion of nutrients (44) . In general, the reduced-energy diets result in clinically meaningful weight losses regardless of which macronutrients they emphasise (36)(37)(38)(39)(40)(41)(42)(43)(44) . For long-term weight loss, macronutrient composition should also be considered regarding whether it helps to counteract compensatory mechanisms leading to weight regain after weight loss (45) .…”