Behavioral Intervention Benefits Severely Obese

By Brunk, Doug | Clinical Psychiatry News, December 2010 | Go to article overview

Behavioral Intervention Benefits Severely Obese


Brunk, Doug, Clinical Psychiatry News


SAN DIEGO -- Obese patients with a body mass index of 40 kg/[m.sup.2] or greater who were enrolled in a behavioral weight loss program achieved similar levels of weight loss and reductions in cardiovascular disease risk factors, compared with their counterparts with lesser degrees of obesity, results from a large ongoing trial showed.

The findings suggest that behavioral weight loss programs are a viable treatment option for class III obese patients, Jessica L. Unick, Ph.D., said at the meeting.

"Severe obesity is the fastest-growing segment of the overweight population, increasing at a rate of two to three times faster than obesity alone," said Dr. Unick of the centers for behavioral and preventive medicine at Miriam Hospital, Brown University Providence, R.I. "Given these alarming statistics as well as the known health consequences associated with this magnitude of obesity, it's critical that we begin to identify successful treatment options for this population."

Behavioral weight loss programs are typically recommended for individuals with a BMI of less than 40, she said. As a result, "severely obese individuals are often excluded from clinical weight loss trials. ... Therefore, we have limited data regarding the effectiveness of behavioral weight loss programs in this population."

Dr. Unick and her associates examined whether severely obese patients randomized to the intensive lifestyle intervention arm of the Look AHEAD trial achieved similar weight loss, experienced comparable changes in cardiovascular disease risk factors, and had been equally adherent to program recommendations at 1 year of treatment, compared with those who had lesser degrees of obesity. Look AHEAD is an ongoing, multicenter, randomized clinical trial examining the long-term effects of an intensive lifestyle intervention program on cardiovascular morbidity and mortality in 5,145 overweight or obese patients from 16 centers in the United States. The individuals will be followed for up to 13.5 years.

To be eligible for Look AHEAD, patients had to have type 2 diabetes, be 45-16 years of age, have a BMI of at least 25 (or at least 27 if taking insulin), have a hemoglobin [A.sub.lc] level of 11 % or lower, and meet certain cardiovascular disease cutoff values, including triglycerides below 600 mg/dL and a blood pressure of less than 160/100 mm Hg. The patients were randomized to an intensive lifestyle intervention or to diabetes support and education. The study conducted by Dr. Unick and her associates evaluated only the 2,503 patients randomized to the intensive lifestyle intervention.

The researchers grouped participants into four categories based on BMI: overweight (25-29), class I obese (30-34), class II obese (35-39), and class III obese (40 or greater). Mean age at baseline was 59 years. For the first 6 months, participants attended three weekly group meetings and one individual meeting per month. This was reduced to two group meetings and one individual meeting per month during months 7-12.

Patients in the intensive lifestyle intervention arm were asked to reduce their daily dietary intake to 1,200-1,800 calories.

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