Long-term effects on weight loss and maintenance by intensive start with diet and exercise

This 36-month study aimed to determine whether exercise intervention added to weight loss treatment in the beginning or at 6 months is effective for weight loss and long-term weight maintenance. A total of 120 obese adults (body mass index >30) were randomly assigned to intensified behavioral modification (iBM), iBM+ additional exercise from 0 to 3 months (CWT1), iBM+ additional exercise from 6 to 9 months (CWT2), and a control group (CON). Questionnaires and measurements were collected at baseline, 3, 9, 24, and 36 months. The intervention consisted of an 12 months intensified weight-loss period followed by a 24 months weight-maintenance period. Eighty (67%) subjects (mean age 46.0 years, BMI 36.2) completed the trial. Compared with the control group, all three intervention groups had significant weight loss during the 36-month intervention period (p < 0.001). The achieved weight loss remained significant at 36 months in the iBM (-6.8%, p < 0.001), the CWT1 (-5.8%, p < 0.001), and the CWT2 group (-3.9%, p < 0.001). The CWT1 group showed significant reduction in waist circumference at 9 months (-11.3 cm, p < 0.001), at 24 months (-8.8 cm, p < 0.001), and at 36 months (-8.7 cm, p < 0.001). Intensified behavioral modification alone and with exercise resulted in clinically significant weight loss and long-term weight maintenance. The addition of exercise at the onset promoted greater reductions in waist circumference. In the treatment of obesity, including severe obesity, more intensive lifestyle interventions with exercise should be incorporated.

Effective Weight Loss and Maintenance by Intensive Start with Diet and Exercise

INTRODUCTION

This 24-month study aimed to determine whether exercise intervention added to weight loss treatment at 6 months is effective for weight loss and maintenance.

METHODS

A total of 120 obese subjects (body mass index > 30) were randomly assigned to intensified behavioral modification (iBM) (n = 30), behavioral modification + exercise from 0 to 3 months (circuit weight training group 1 [CWT1]) (n = 30), behavioral modification + exercise from 6 to 9 months (CWT2) (n = 30), and a control group (CON) (n = 30). Health behavior, weight, waist circumference, and 2-h glucose tolerance test with insulin measurements were measured at 0, 3, 9, and 24 months.

RESULTS

Eighty-five subjects (mean age = 46 yr, body mass index = 36.3, 75.3% women) completed the trial. A significant weight loss occurred in CWT1 (-8.5 kg, P > 0.001), iBM (-5.5 kg, P > 0.001), and CWT2 (-4.4 kg, P = 0.007). CWT1 showed the highest reduction in waist circumference at 9 months (mean difference = -11.5 cm, P < 0.001) and 24 months (mean difference = -8.8 cm, P < 0.001). Both fasting and 2-h insulin values improved in the intervention groups compared with CON. A significant decrease in 2-h insulin values from baseline was found in CWT1 and CWT2. Matsuda index improved in the CWT1 group from the baseline to 24 months (2.03, P = 0.025).

CONCLUSION

The most effective weight loss regimen is a combination of iBM and weight training introduced from the very beginning of the weight loss period. Treatment of morbid obesity should include an intensive start with exercise and diet regardless of weight status.

Lifestyle intervention has a beneficial effect on eating behavior and long-term weight loss in obese adults

OBJECTIVE

To investigate the change in eating behavior and the factors related with the change among successful dieters (maintained a weight loss of ≥5% of original weight).

METHODS

Obese adult subjects (21 male, 55 female) were randomized into three-year lifestyle intervention (n=59) and control groups (n=17). Eating behavior (cognitive restraint of eating, uncontrolled eating and emotional eating) was evaluated by the TFEQ-18 and motivation to lose weight and tolerance to problems by a separate questionnaire. Weight, height and body mass index were measured.

RESULTS

Weight decreased more in the intervention group than in the control group (5.0% vs 0.6%, p=0.027). Cognitive restraint increased twice as much in the intervention group compared to the control group (16.0 vs. 7.0, p=0.044). The increment in cognitive restraint was positively associated with weight loss and high baseline motivation and tolerance to problems. Cognitive restraint increased in both successful (n=27) and unsuccessful dieters (n=32), but only the successful dieters were able to decrease uncontrolled eating in the long term.

CONCLUSIONS

Our results showed that intensive lifestyle counseling improved cognitive restraint which was associated with enhanced weight loss among obese adults. Successful dieters also showed a long-term improvement of uncontrolled eating. Eating behavior should be evaluated and followed before and during lifestyle interventions in order to support the change, e.g. by finding methods to control eating at risk situations and strengthening motivation and tolerance to problems.