Residential Obesity Treatment Leads to Weight Loss
Residential, immersion-style obesity treatment programs can help people achieve medically significant weight loss and improve their quality of life, according to new research from Duke University Medical Center.
The Duke study found that patients who stay about 24 days, on average, at a 4-week treatment program focusing on lifestyle change, physical activity and healthful eating lose almost five percent of their total body weight. In such programs, patients immerse themselves in a weight-loss program by staying at a treatment facility for an extended period while participating in a 'day-treatment' approach to lifestyle change.
One year later, the same patients reported an average total weight loss of 10.1 percent. More than 80 percent reported quality of life improvements including improved stamina and self-confidence, better mobility and ability to bend, and improved confidence in their ability to follow a healthy lifestyle.
The results were presented October 16, 2005, at the annual meeting of The North American Association for the Study of Obesity in Vancouver, B.C. The Duke Diet and Fitness Center, a residential treatment center for obesity, funded the study.
"We know this treatment approach offers benefits to patients, but there is a paucity of research on both the short and long-term outcomes of such programs," said clinical psychologist Martin Binks, Ph.D., lead author and director of behavioral health at the Duke Diet and Fitness Center.
Binks noted that the results of the study are comparable to those seen in other behavioral weight loss programs and thus offer support for this intervention as a viable option for patients.
"It's important we provide evidence of the efficacy and health benefits of the immersion style of weight loss management in the hopes that some day, with the cooperation of insurers, it will become available to larger numbers of those in need of significant, medically managed weight loss."
The study tracked 182 patients who enrolled in a four-week treatment program at the Duke Diet and Fitness Center. In addition to following a reduced calorie diet, participants attended classes on health, nutrition, fitness and behavioral health. They also had regular visits with a clinician, nutritionist, exercise physiologist and psychologist or clinical social worker. Typically, the calorie levels ranged between 1,000 to 1,500 calories per day, and patients chose between three diet plans: high-carbohydrate (55 percent of calories from carbs), moderate-carbohydrate (35 percent of calories from carbs) and low-carbohydrate (15-25 percent of calories from carbs).
The mean age was about 51 years old, and the mean body mass index for women varied between 37.7 to 39.5 for the women and 41.5 to 49.4 for the men. BMI is a measurement of body fat based on height and weight, and obesity is defined as a BMI of 30 or greater. Severe obesity is indicated by a BMI greater than or equal to 40.
The one year telephone follow-up survey queried patients about their total weight loss and ten quality of life improvements. Fifty-nine percent of participants completed follow-up survey. There were no significant differences in weight loss among the different diet groups. Of those who responded, 74 percent lost more than five percent of their body weight and 51 percent lost more than 10 percent of their body weight.
"I hope this will motivate health care practitioners to rethink the common attitude that severely overweight people cannot accomplish meaningful weight loss without surgery," said Howard Eisenson, M.D., study co-author and director of the Duke Diet and Fitness Center.
Eisenson notes that men and women who lose 10 percent or more of their total body weight can see medically significant improvements in their health. "We do know that 10 percent weight loss typically leads to improvements in diabetic control, and reduces the risk of progression from prediabetes to diabetes. It also helps reduce blood pressure and cholesterol levels," Eisenson said.
More than 80 percent of people reported quality of life improvements in the following areas: ability to bend; mobility; smaller clothing size; improved overall quality of life; confidence in ability to follow a healthy lifestyle; improved stamina; increased activity level since beginning treatment; and, if it was an issue, better blood sugar and blood pressure control. Self-consciousness about weight improved for 68 percent of participants.
"These quality of life improvements are very important," Binks said. "Focusing on these quality of life goals and enjoying each and every area of improvement - not just weight - may help people succeed in following a healthy lifestyle over the long term."
Co-authors include Truls Ostbye, M.D., Ph.D., Ron Sha, M.D., Ph.D., Ronette Kolotkin, Ph.D., Elisabetta Politi, R.D., and Eric Westman, M.D., all of Duke University Medical Center.