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Is long-term weight loss possible?

Published online by Cambridge University Press:  09 March 2007

Michael E. J. Lean
Michael E. J. Lean*
Affiliation:
Department of Human Nutrition, University of Glasgow,
*
*Corresponding author: M. E. J. Lean, fax +44 141 211 4844, email [email protected]
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Abstract

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Any intervention which causes negative energy balance is guaranteed to be efficacious in producing weight loss, which will continue while there is negative energy balance or be maintained as long as the new energy balance is maintained. In clinical practice compliance is rarely 100 % so the efficiency of even the most efficacious treatment is usually low. However, recent evidence-based guidelines have recognized the clinical benefits of moderate (5–10 %) weight loss, which is achievable using a variety of interventions. Long-term studies of ‘weight loss’ are, in reality, combinations of weight loss (usually completed in 1–6 months) followed by variable weight maintenance, set in the context of progressive adult weight gain in an obesogenic environment. Few studies have adopted specific and separate strategies for weight loss and weight maintenance. Meta-analyses conducted by non-expert methodologists have failed to recognize these distinctions, and have criticized the available research without understanding the different needs of studies with weight change as the outcome variable, which require randomized controlled trials (RCT), and those with weight loss as the treatment, intended to improve metabolic or biomedical outcome measures. An RCT design is inapplicable to studies of biomedical end points (e.g. cardiac risk factors) when weight loss is the treatment. Because fixed weight loss cannot be prescribed there is always a range of weight changes in any study, and single-sample studies with regression analysis provide the best design. An RCT study design does not give useful information about clinical value as the control group is always ‘treated’ to some extent. Placebo- (or control)-subtracted differences are misleading because in an RCT all subjects recruited to active treatment, including non-responders, are continued on treatment for the full duration of the study. In routine clinical practice, treatments are changed in the light of early experience as a therapeutic trial to optimize the results for each individual, and audit is required to evaluate ‘long term weight loss’.

Keywords

ObesityDiabetesDietClinical trialAudit
Type
Research Article
Information
British Journal of Nutrition , Volume 83 , Issue S1 , June 2000 , pp. S103 - S111
Copyright
Copyright © The Nutrition Society 2000

References

Blonk, MC, Jacobs, MAJM, Biesheuvel, EHE, Weda-Manak, WL, Heine, RJ (1994) Influences of weight loss in type 2 diabetic patients: little long term benefit from group behaviour therapy and exercise training. Diabetic Medicine 11, 449–457.CrossRefGoogle ScholarPubMed
Bray, GA, Blackburn, GL, Ferguson, JM, Greenway, FL, Jain, AK, Mendel, CM, Mendels, J, Ryan, DH, Schwartz, SL, Scheinbaum, ML, Seaton, TB (1999) Sibutramine produces dose-related weight loss. Obesity Research 7, 189–198.CrossRefGoogle ScholarPubMed
Brown, SA, Upchurch, S, Anding, R, Winter, M, Ramirez, G (1996) Promoting weight loss in type II diabetes. Diabetes Care 19, 613–624.CrossRefGoogle ScholarPubMed
Glenny, A-M, O'Meara, S, Melville, A, Sheldon, TA, Wilson, C (1997) The treatment and prevention of obesity: a systematic review of the literature. International Journal of Obesity 21, 715–737.CrossRefGoogle ScholarPubMed
Goldstein, DJ (1992) Beneficial health effects of modest weight loss. International Journal of Obesity 16, 397–415.Google ScholarPubMed
Hakala, P (1994) Weight reduction programmes at a rehabilitation centre and a health centre based on group counselling and individual support: short- and long-term follow-up study. International Journal of Obesity 18, 483–489.Google Scholar
Hankey, CR, Lean, MEJ (1996) Estimation of energy requirements and reported dietary intakes in overweight subjects with ischaemic disease. International Journal of Obesity 20, (Suppl. 4), 29.Google Scholar
Heitmann, BL, Garby, L (1999) Patterns of long-term weight changes in overweight developing Danish men and women aged between 30 and 60 years. International Journal of Obesity 23, 1074–1078.CrossRefGoogle ScholarPubMed
Lean, MEJ (1997) Sibutramine — a review of clinical efficacy. International Journal of Obesity 21, S30-S36.Google ScholarPubMed
Lean, MEJ, Powrie, JK, Anderson, AS, Garthwaite, PH (1990) Obesity, weight loss and prognosis in type 2 diabetes. Diabetic Medicine 7, 228–233.CrossRefGoogle ScholarPubMed
Lean, MEJ, Han, TS, Prvan, T, Richmond, PR, Avenell, A (1997) Weight loss with high and low carbohydrate 1200 kcal diets in free living women. European Journal of Clinical Nutrition 51, 243–248.CrossRefGoogle ScholarPubMed
Manning, RM, Jung, RT, Leese, GP, Newton, RW (1998) The comparison of four weight reduction strategies aimed at overweight patients with diabetes mellitus: four-year follow up. Diabetic Medicine 15, 497–502.3.0.CO;2-W>CrossRefGoogle ScholarPubMed
Miller, WC, Koceja, DM, Hamilton, EJ (1997) A meta-analysis of the past 25 years of weight loss research using diet, exercise or diet plus exercise intervention. International Journal of Obesity 21, 941–947.CrossRefGoogle ScholarPubMed
NIH (1998) Clinical Guidelines on the Identification, Evaluation and Treatment of Overweight and Obesity in Adults — the Evidence Report. Bethesda, MD: National Institutes of Health, National Heart, Lung and Blood Institute.Google Scholar
Prochaska, JO &, Di, Clemente C (1986) Towards a comprehensive model of change. In Treating Addictive Behaviour. [W, Miller, N, Heather, editors]. New York: Plenum Press.Google Scholar
SIGN (1996) Obesity in Scotland: Integrating Prevention with Weight Management. Scottish Intercollegiate Guidelines Network. www.show.scot.nhs.uk/sign/home.htm.Google Scholar
Sjöström, L, Rissanen, A, Andersen, T, Boldrin, M, Golay, A, Koppeschaer, HP, Krempf, M (1998) Randomised placebo-controlled trial of orlistat for weight loss and prevention of weight regain in obese patients. European Multicentre Orlistat Study Group. Lancet 18, 167–172.CrossRefGoogle Scholar
Svedsen, OL, Hassager, C, Christiansen, C (1994) Six months' follow up on exercise added to a short term diet in overweight postmenopausal women — effects on body composition, resting metabolic rate, cardiovascular risk factors and bone. International Journal of Obesity 18, 692–698.Google Scholar
Thomas, PR (1995) Weighing the Options. Criteria for Evaluating Weight Management Programs. Institute of Medicine. Washington, D.C.: National Academic Press.CrossRefGoogle Scholar
Uusitupa, M, Laitinen, J, Siitonen, O, Vanninen, E, Pyorala, K (1993) The maintenance of improved metabolic control after intensified diet therapy in recent type 2 diabetes. Diabetes Research Clinical Practice 19, 227–238.CrossRefGoogle ScholarPubMed
Williamson, DF, Pamuk, E, Thun, M, Flanders, D, Byers, T, Heath, C (1995) Prospective study of intentional weight loss and mortality in never-smoking overweight US white women aged 40–64 years. American Journal of Epidemiology 141, 1128–1141.CrossRefGoogle ScholarPubMed
Williamson, DR, Pamuk, E, Thun, M, Flanders, D, Byers, T, Heath, C (1999) Prospective study of intentional weight loss and mortality in overweight white men aged 40–64 years. American Journal of Epidemiology 149, 491–503.CrossRefGoogle ScholarPubMed
Yanovski, SZ, Bain, RP, Williamson, DF (1999) Report of a National Institutes of Health Centers for Disease Control and Prevention workshop on the feasibility of conducting a randomized clinical trial to estimate the long term health effects of intentional weight loss in obese persons. American Journal of Clinical Nutrition 69, 366–372.CrossRefGoogle Scholar