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Am J Med. 2013 Mar;126(3):236-42, 242.e1-2. doi: 10.1016/j.amjmed.2012.10.010.

The long-term effectiveness of a lifestyle intervention in severely obese individuals.

Collaborators (398)

Brancati FL, Swartz L, Cheskin L, Clark JM, Stewart K, Rubin R, Arceci J, Ball S, Charleston J, Diggins D, Johnson M, Lambert J, Michalski K, Jiggetts D, Sapun C, Bray GA, Rau K, Strate A, Greenway FL, Ryan DH, Williamson D, Armand B, Arceneaux J, Bachand A, Begnaud M, Berhard B, Caderette E, Cerniauskas B, Creel D, Crow D, Duncan C, Guay H, Johnson C, Jones L, Kora N, LaFleur K, Landry K, Lingle M, Perault J, Puckett C, Shipp M, Smith M, Tucker E, Lewis CE, Thomas S, Safford M, DiLillo V, Bragg C, Dobelstein A, Gilbert S, Glasser S, Hannum S, Hubbell A, Jones J, Lee D, Luketic R, Oden L, Raines J, Roche C, Truman J, Webb N, Azuero C, King J, Morgan A, Nathan DM, Cagliero E, Hayward K, Turgeon H, Delahanty L, Anderson E, Bissett L, Goldman V, Harlan V, Michel T, Larkin M, Stevens C, Miller K, Chen J, Blumenthal K, Winning G, Tsay R, Cyr H, Pinto M, Horton ES, Jackson SD, Hamdy O, Caballero A, Bain S, Bovaird E, Fargnoli B, Spellman J, Goebel-Fabbri A, Lambert L, Ledbury S, Malloy M, Ovalle K, Blackburn G, Mantzoros C, McNamara A, Spellman K, Hill JO, Miller M, Van Dorsten B, Regensteiner J, Coelho L, Cohrs P, Green S, Hamilton A, Hamilton J, Leshchinskiy E, Munkwitz L, Rome L, Worley T, Craul K, Smith S, Foreyt JP, Reeves RS, Pownall H, Balasubramanyam A, Jones P, Burrington M, Chen CH, Gardner AC, Gee M, Griggs S, Hamilton M, Holley V, Joseph J, Palencia J, Schmidt J, White C, Johnson KC, Gresham C, Connelly S, Brewer A, Coday M, Jones L, Lichtermann L, Vosburg S, Taylor J, Kitabchi AE, Nyenwe E, Lambeth H, Brewer A, Clark D, Crisler A, Force D, Green D, Kores R, Jeffery RW, Thorson C, Bantle JP, Redmon J, Crow RS, Crow S, Raatz SK, Brelje K, Campbell C, Carls J, Carmean-Mihm T, Devonish J, Finch E, Fox A, Hoelscher E, James LD, Maddy VA, Ockenden T, Rice BI, Skarphol T, Tucker AD, Voeller MS, Walcheck C, Pi-Sunyer X, Patricio J, Heshka S, Pal C, Allen L, Chong L, Gluck M, Hirsch D, Holowaty MA, Horowitz M, Rau N, Steinberg DB, Wadden TA, Maschak-Carey BJ, Berkowitz RI, Braunstein S, Foster G, Glick H, Kumanyika S, Schwartz SS, Allen M, Bell Y, Brock J, Brozena S, Carvajal R, Chomentowski H, Crerand C, Davenport R, Diamond A, Fabricatore A, Goldberg L, Hesson L, Hudak T, Iqbal N, Jones-Corneille L, Kao A, Kuehnel R, Lipschutz P, Mullen M, Jakicic JM, Kelley DE, Wesche-Thobaben J, Kuller LH, Kriska A, Otto AD, Ewing L, Korytkowski M, Edmundowicz D, Yamamoto ME, Danchenko R, Elnyczky B, Garcia DO, Grove GA, Harper PH, Harrier S, Helbling NL, Ives D, Mancino J, Mathews A, Murray TY, Ritchea JR, Urda S, Wolf DL, Wing RR, Bright R, Pera V, Jakicic J, Tate D, Gorin A, Gallagher K, Bach A, Bancroft B, Bertorelli A, Carey R, Charron T, Chenot H, Chula-Maguire K, Coward P, Cronkite L, Currin J, Daly M, Egan C, Ferguson E, Foss L, Gauvin J, Kieffer D, Lessard L, Maier D, Massaro JP, Monk T, Nicholson R, Patterson E, Phelan S, Raynor H, Raynor D, Robinson N, Robles D, Tavares J, Haffner SM, Hazuda HP, Montez MG, Lorenzo C, Coleman CF, Granado D, Hathaway K, Isaac JC, Ramirez N, Saenz R, Kahn S, Montgomery B, Knopp R, Lipkin E, Trence D, Barrett T, Bartell J, Greenberg D, Murillo A, Richmond BA, Socha J, Thomas A, Wesley A, Knowler WC, Bolin P, Killean T, Manus C, Krakoff J, Curtis JM, Glass J, Michaels S, Bennett PH, Morgan T, Begay S, Bloomquist P, Costa T, Fallis B, Hermes J, Hollowbreast DF, Johnson R, Meacham M, Nelson J, Percy C, Poorthunder P, Sangster S, Scurlock N, Shovestull LA, Smiley J, Toledo K, Tomchee C, Tonemah D, Peters A, Ruelas V, Sengardi SG, Hillstrom KM, Konersman K, Serafin-Dokhan S, Espeland MA, Bahnson JL, Wagenknecht LE, Reboussin D, Rejeski W, Bertoni AG, Lang W, Lawlor MS, Lefkowitz D, Miller GD, Reynolds PS, Ribisl PM, Vitolins M, Chen H, West DS, Friedman LM, Craven BL, Dotson KM, Hodges A, Williams CC, Anderson A, Barnes JM, Barr M, Beavers DP, Beckner T, Davis C, Del Valle-Fagan T, Feeney PA, Goode C, Griffin J, Harvin L, Hogan P, Gaussoin SA, King M, Lane K, Neiberg RH, Walkup MP, Wall K, Windham T, Nevitt M, Schwartz A, Shepherd J, Rahorst M, Palermo L, Ewing S, Hayashi C, Maeda J, Marcovina SM, Chmielewski J, Gaur V, Soliman EZ, Prineas RJ, Campbell C, Zhang ZM, Alexander T, Keasler L, Hensley S, Li Y, Moran R, Foushee R, Hall NJ, Evans M, Harrison B, Hubbard VS, Yanovski SZ, Kuczmarski R, Cooper LS, Kaufman P, Gregg EW, Williamson DF, Zhang P.

Abstract

OBJECTIVE:

Severe obesity (body mass index [BMI] ≥40 kg/m(2)) 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/m(2)) 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, HbA(1c), 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.

Copyright © 2013 Elsevier Inc. All rights reserved.

PMID:
23410564
[PubMed - indexed for MEDLINE]
PMCID:
PMC3574274
Free PMC Article

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