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A programme of behaviour modification and nutrition counselling in the treatment of obesity: a randomised 2-y clinical trial

International Journal of Obesity volume 27, pages 1127–1135 (2003)Cite this article

Abstract

OBJECTIVE: To compare two group treatment programmes for obese outpatients. Both programmes included behaviour modification, nutrition counselling, very-low-calorie diet (VLCD) and a continuous measuring of metabolic and anthropometrical status, but they differed regarding the treatment intensiveness. The main aim was to study whether intensive treatment gives a larger weight reduction compared with less intensive treatment and what level of input from health care personnel is needed to reach adequate treatment results.

DESIGN: A 2-y randomised clinical trial.

SUBJECTS: A total of 43 obese subjects aged 24–60 y, BMI 35 kg/m2 (29–48).

INTERVENTION: Two programmes were used. Both were based on group therapy and were supervised by a dietitian and a psychologist. Group 1 received a continuous intensive treatment with planned group meetings every fortnight during the first year and six group meetings the second year. Group 2 had planned group meetings every third month. Anthropometrical and metabolic data were measured every third month in both groups. The VLCD periods were the same.

RESULTS: There was no evidence that a more intensive treatment promotes a larger weight reduction. Weight reduction after 1 y: group 1, −7.6 (±0.97) kg, BMI −2.6 (±0.3) kg/m2; group 2, −6.4 (±1.16) kg, BMI −2.2 (±0.4) kg/m2. Weight reduction after 2 y: group 1, −6.8 (±1.4) kg, BMI −2.4 (±0.3) kg/m2; group 2, −8.6 (±1.6) kg, BMI −3.0 (±0.3) kg/m2. The dropout rate was 26%.

CONCLUSION: There were no significant differences in weight reduction, compliance or dropout rate between the groups and there was no evidence that a more intensive treatment promotes a larger weight reduction. This observation is of value when setting up treatment programmes. To measure the metabolic and anthropometrical status during the treatment and to give continuous feedback to the subjects seem to be important factors for compliance. Both treatment programmes gave highly significant weight reductions in the range of 5–10%, which has been referred to as a realistic goal for the treatment of obese patients.

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References

  1. Faith M, Fontaine K, Cheskin L, Allison D . Behavioral approaches to the problems of obesity. Behav Modif 2000; 24: 459–493.

    CAS  PubMed  Google Scholar 

  2. Freeman A, Pretzer J, Fleming B, Simon KM . Comprehensive handbook of cognitive therapy. Plenum Press: New York; 1990.

    Google Scholar 

  3. WHO. Obesity, preventing and managing the global epidemic. World Health Organization: Geneva; 1997.

  4. SBU — The Swedish Council on Technology Assessment in Health Care. Obesity: a grave epidemic investigated, 2002. http://www.sbu.se.

  5. Glenny A-M, Meara SO, Melville A, Sheldon TA, Wilson C . The treatment and prevention of obesity: a systematic review of the literature. Int J Obes Relat Metab Disord 1997; 21: 715–737.

    CAS  PubMed  Google Scholar 

  6. Brownell KD, Brownell KD, Marlatt GA, Lichtenstein E, Wilson TG . Understanding and preventing relapse. Am Psychol 1986; 41: 765–782.

    CAS  PubMed  Google Scholar 

  7. Perri MG, Sears SF, Clark JE . Strategies for improving maintenance of weight loss. Diabetes Care 1993; 16: 200–209.

    CAS  PubMed  Google Scholar 

  8. Melin I . Obesitas. Handbook for practical treatment of obesity and metabolic syndrome based, on cognitive behavior modification and conventional treatment. Studentlitteratur AB: Lund; 1995 (in Swedish).

    Google Scholar 

  9. Kristal AR, Glanz K, Curry SJ, Patterson RE . How can stages of change be best used in dietary interventions? J Am Diet Assoc 1999; 99: 679–684.

    CAS  PubMed  Google Scholar 

  10. Foreyt JP, Goodrick GK . Factors common to successful therapy for the obese patient. Med Sci Sports Exerc 1991; 23: 292–297.

    CAS  PubMed  Google Scholar 

  11. Nordhamn K, Södergren E, Olsson E, Karlström B, Vessby B, Berglund L . Reliability of anthropometric measurements in overweight and lean subjects: consequences for correlations between anthropometrics and other variables. Int J Obes Relat Metab Disord 2000; 24: 652–657.

    CAS  PubMed  Google Scholar 

  12. Vessby B, Karlström B, Boberg M, Lithell H, Berne C . Polyunsaturated-fatty acids may impair blood glucose control in type 2 diabetic patients. Diab Med 1992; 9: 126–133.

    CAS  Google Scholar 

  13. Lithell H, Bruse Å, Gustafsson I-B, Höglund NJ, Karlström B, Ljunghall K, Sjölin K, Venge P, Werner I, Vessby B . A fasting and vegetarian diet treatment trial on chronic inflammatory disorders. Acta Derm Venerol 1983; 63: 397–403.

    CAS  PubMed  Google Scholar 

  14. Vessby B, Boberg M, Karlström B, Lithell H, Werner I . Improved metabolic control after supplemented fasting in over-weight type II diabetes. Acta Med Scand 1984; 216: 67–74.

    CAS  PubMed  Google Scholar 

  15. Melin I, Vessby B, Karlström B, Lithell H . Supplemented fasting of obese outpatients — a useful model? Näringsforskning (Scand J Nutr) 1987; 31: 27–29 (in Swedish).

    Google Scholar 

  16. Nordic Council of Ministers. Nordic nutrition-recommendations 1996. Nord 1996: 28 (in Swedish) (Nordiska Ministerrådet, Nordiska näringsrekommendationer) Copenhagen.

  17. Lappalainen R, Sjödén P-O, Hursti T, Vesa V . Hunger and craving responses and reactivity to food stimuli during fasting and dieting. Int J Obes Relat Metab Disord 1990; 14: 679–688.

    CAS  Google Scholar 

  18. Melin I, Rössner S . Practical clinical behaviour treatment of obesity. Patient Educ Counsel 2003; 49: 75–83.

    Google Scholar 

  19. Mattfeldt-Beman MK, Corrigan SA, Stevens VJ, Sugars CP, Dalcin AT, Givi MJ, Copeland KC . Participants' evaluation of a weight-loss program. J Am Diet Assoc 1999; 99: 66–71.

    CAS  PubMed  Google Scholar 

  20. Wadden TA, Foster GD, wang J, Pierson RN, Yang MU, Moreland K, Stunkard AJ, VanItallie TB . Clinical correlations of short-term and long-term weight loss. Am J Clin Nutr 1992; 56: 271–274.

    Google Scholar 

  21. Wadden TA, Sternberg JA, Letizig KA, Stunkard AJ, Foster GD . Treatment of obesity by very low calorie diet, behavior therapy, and their combination: a five-year perspective. Int J Obes Relat Metab Disord 1989; 13: 39–46.

    Google Scholar 

  22. Wing RR, Hill JO . Successful weight maintenance. Annu Rev Nutr 2001; 21: 323–341.

    CAS  PubMed  Google Scholar 

  23. Foster GD, Wadden TA, Vogt RA, Brewer G . What is reasonable weight loss? Patients' expectations and evaluations of obesity treatment outcomes. J Consult Clin Psychol 1997; 65: 79–85.

    CAS  PubMed  Google Scholar 

  24. Goldstein DJ, Portvin JH . Long-term weight loss: the effect of pharmacological agents. Am J Clin Nutr 1994; 60: 647–657.

    CAS  PubMed  Google Scholar 

  25. Tuomilehto J, Lindström J, Eriksson J, Valle TT, Hämäläinen H, Ilannen-Parikka P, Keianen-Kiukaanniemi S, Laakso M, Louhe-ranta A, Rastas M, Salminen V, Uustitupa M . Prevention of type two diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001; 344: 1343–1350.

    CAS  PubMed  Google Scholar 

  26. Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346: 393–403.

  27. Goldstein DJ . Beneficial health effects of modest weight loss. Int J Obes Relat Metab Disord 1992; 16: 397–415.

    CAS  PubMed  Google Scholar 

  28. Sjöström CD, Lissner L, Sjöström L . Relationships between changes in body compositions and changes in cardiovascular risk factors: the SOS Intervention Study. Swedish obese subjects. Obes Res 1997; 5: 519–530.

    PubMed  Google Scholar 

  29. Saris WH . Very-low-calorie diets and sustained weight loss. Obes Res 2001; 4: 295–301.

    Google Scholar 

  30. Paisey RB, Frost J, Harvey P, Paisey A, Bower L, Paisey RM, Taylor P, Belka I . Five year results of a prospective very low calorie diet or conventional weight loss programme in type 2 diabetes. J Hum Nutr Diet 2002; 15:121–127.

    CAS  PubMed  Google Scholar 

  31. Pekkarinen T, Mustajoki P . Comparison of behavior therapy with and without very low-energy diet in the treatment of morbid obesity. Arch Intern Med 1997; 157: 1581–1585.

    CAS  PubMed  Google Scholar 

  32. Lindroos AK, Torgerson JS . Obesity treatment: an overview of a dietary perspective. Scand J Nutr 2001; 45: 2–7.

    Google Scholar 

  33. National Task Force on Prevention and Treatment of Obesity. Very low-calorie diets. JAMA 1993; 270: 967–974.

  34. Mertz W, Tsui JC, Judd JT, Reiser S, Hallfrisch J, Morris ER, Stee E . What are people really? eating The relation between energy intake derived from estimated diet records and intake determined to maintain body weight. Am J Clin Nutr 1991; 54: 291–295.

    CAS  PubMed  Google Scholar 

  35. Cameron ME, Van Stavern W . A manual on methodology for food consumption studies. Oxford University Press: Oxford; 1988.

    Google Scholar 

  36. Andersson I, Rössner S . Weight development, dropout pattern and changes in obesity-related risk factors after two years treatment of obese men. Int J Obes Relat Metab Disord 1997; 21: 211–216.

    CAS  PubMed  Google Scholar 

  37. Greene GW, Rossi SR, Rossi JS, Velicer WF, Fava JL, Prochaska JO . Dietary applications of the Stages of Change Model. J Am Diet Assoc 1999; 99: 673–678.

    CAS  PubMed  Google Scholar 

  38. WHO Working Group. Therapeutic patient education. Continuing education programs for health care providers in the field of prevention of chronic diseases. WHO: Geneva; 1998.

  39. O'Meara, Glenny AM, Wilson C, Melville A, Sheldon TA . Effective management of obesity. Qual Health Care 1997; 6: 170–175.

    CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine/Obesity Unit, Huddinge University Hospital, Karolinska Institute, Stockholm, Sweden

    I Melin

  2. Department of Public Health and Caring Sciences/Geriatrics Clinical Nutrition Research, Uppsala University, Uppsala, Sweden

    B Karlström, R Mohsen & B Vessby

  3. Department of Psychology, University of Tampere, Tampere, Finland

    R Lappalainen

  4. Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden

    L Berglund

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  1. I Melin
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  5. R Mohsen
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  6. B Vessby
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Correspondence to I Melin.

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Melin, I., Karlström, B., Lappalainen, R. et al. A programme of behaviour modification and nutrition counselling in the treatment of obesity: a randomised 2-y clinical trial. Int J Obes 27, 1127–1135 (2003). https://doi.org/10.1038/sj.ijo.0802372

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