Weight loss and long-term follow-up of severely obese individuals treated with an intense behavioral program

Objective: To review weight loss and maintenance for severely obese individuals enrolled in intensive behavioral weight loss program using very-low or low-energy diets. Design: Chart review of consecutively treated patients between 1995 and 2002 seen at three weight loss centers. Subjects: One thousand five hundred and thirty one patients with severe obesity (>= 40 kg/m(2)) treated in three cities ('Study Group'). Of these, 1100 completed the 12-week core curriculum ('Completer Group'). Weight loss >= 100 lbs (> 445 kg) was seen in 268 patients (`100- Pound Group'). Measurements: Charts were reviewed for baseline characteristics, weekly weights, follow-up weights and side effects. Results: In the Study Group, average weight loss +/- s.e. for 998 women was 23.9 +/- 0.6 kg (18.5% of initial body weight (IBW)) and for 533 men was 36.0 +/- 1.0 kg (22.5%) over 30 weeks. For Completers, average weight loss for women was 30.8 +/- 0.6 kg (23.9%) and for men was 42.6 +/- 1.1 kg (26.7%) over 39 weeks. In the 100-Pound Group, average weight loss for women was 58.2 +/- 1.2 kg (41.5%) in 65 weeks and for men was 65.7 +/- 1.5 kg (37.5%) in 51 weeks. Side effects, assessed in 100 patients losing 445 kg, were mild to moderate in severity. Severe adverse events unrelated to the diet were noted in 5% of patients and during weight loss 1% had elective cholecystectomies. Follow-up weights were available for 86% of Completers at an average of 72 weeks with average maintenance of 23 kg or 59% of weight loss; follow-up weights were available for 94% of the 100-Pound Group at an average of 95 weeks with average maintenance of 41 kg or 65% of weight loss maintained. Conclusions: Intensive behavioral treatment with meal replacements is a safe and effective weight-loss strategy for selected severely obese individuals.