期刊
AMERICAN JOURNAL OF MEDICINE
卷 126, 期 3, 页码 236-U92出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.amjmed.2012.10.010
关键词
Cardiovascular disease risk; Diabetes; Lifestyle intervention; Severe obesity; Weight loss
资金
- Department of Health and Human Services through National Institutes of Health [DK57136, DK57149, DK56990, DK57177, DK57171, DK57151, DK57182, DK57131, DK57002, DK57078, DK57154, DK57178, DK57219, DK57008, DK57135, DK56992]
- National Institute of Diabetes and Digestive and Kidney Diseases
- National Heart, Lung, and Blood Institute
- National Institute of Nursing Research
- National Center on Minority Health and Health Disparities
- National Institutes of Health (NIH) Office of Research on Women's Health
- Centers for Disease Control and Prevention
- Johns Hopkins Medical Institutions Bayview General Clinical Research Center [M01RR02719]
- Massachusetts General Hospital Mallinckrodt General Clinical Research Center
- Massachusetts Institute of Technology General Clinical Research Center [M01RR01066]
- University of Colorado Health Sciences Center General Clinical Research Center [M01RR00051]
- Clinical Nutrition Research Unit [P30 DK48520]
- University of Tennessee at Memphis General Clinical Research Center [M01RR0021140]
- University of Pittsburgh General Clinical Research Center (GCRC) [M01RR000056]
- Clinical Translational Research Center (CTRC)
- Clinical & Translational Science Award [UL1 RR 024153]
- NIH [DK 046204]
- VA Puget Sound Health Care System Medical Research Service, Department of Veterans Affairs
- Frederic C. Bartter General Clinical Research Center [M01RR01346]
- BodyMedia, Inc.
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. (C) 2013 Elsevier Inc. All rights reserved. The American Journal of Medicine (2013) 126, 236-242
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