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Diet and Physical Activity Reduces Cardiometabolic Risk in Severe Obesity



One of the important indications for weight loss in people with excess weight is to reduce their risk for cardiometabolic complications.

But, as regular readers of these pages are aware by now, diet and exercise may be of limited benefit, especially in individuals with severe obesity.

So exactly how effective are such lifestyle interventions in this population?

This question was now addressed in a randomised controlled trial by Bret Goodpaster from the University of Pittsburgh, PA, and colleagues in a paper recently published in JAMA.

In order to determine the efficacy of a weight loss and physical activity intervention on the adverse health risks of severe obesity, 130 (37% African American) severely obese (class II or III) adult participants without diabetes were enrolled in a one-year intensive lifestyle intervention consisting of diet and physical activity.

However, while one group was randomised to diet and physical activity for the entire 12 months, the other group had the identical dietary intervention but with physical activity starting after 6 months.

A total of 101 (78%) subjects completed the 12-month follow-up assessments.

At 6 months, the initial-activity group lost around 11 Kg whereas the delayed-activity group lost around 8 kg. At 12 months, the corresponding weight loss was around 12 and 10 Kg, respectively.

Not unexpectedly, associated with this weight loss was a significant reduction in waist circumference, visceral abdominal fat, hepatic fat content, blood pressure, and insulin resistance were all reduced in both groups.

While the study shows that diet and exercise alone (irrespective of whether or not exercise is added from the start or after 6 months of dietary weight loss) can lead to significant weight loss with improvement in cardiometabolic risk factors, the question of course remains whether or not these changes remain sustainable.

As we know, most patients tend to regain weight over time and it is highly likely that weight regain will result in a worsening in cardiometabolic risk factors.

Nevertheless, the study shows that even in individuals with severe obesity, clinically meaningful weight loss is possible with diet and exercise alone, that it probably does not matter too much whether or not exercise is started on day one of the program, and that this may well be a reasonable strategy for individuals who can manage to stick with these lifestyle changes over time.

Obviously, whether such efforts are durable in the long term in a relevant number of individuals remains to be seen.

AMS
Edmonton, Alberta

Goodpaster BH, Delany JP, Otto AD, Kuller L, Vockley J, South-Paul JE, Thomas SB, Brown J, McTigue K, Hames KC, Lang W, & Jakicic JM (2010). Effects of diet and physical activity interventions on weight loss and cardiometabolic risk factors in severely obese adults: a randomized trial. JAMA : the journal of the American Medical Association, 304 (16), 1795-802 PMID: 20935337

3 Comments

  1. Nice post, I love the see the positive impact of lifestyle interventions. I would certainly hope that after a 12 month intervention, the patients/clients would now have healthy eating and physical activity habits. That is certainly the desired outcome in the work I do anyways. A few colleages of mine and I (who are all quite active) were just talking about trying out a “Super Size Me” style of intervention were we would put accelerometers on each other and limit ourselves to 3000steps/day (which many of my clients routinely do) and nothing more then light activity for 30 days and see what would happen to us after the month. I am ready to bet there will be weight gain and maybe even higher blood pressure…the problem is we are all training for races or competitions in teh next 8 months and can’t afford to not train for 30 day at the moment

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  2. Hi there,

    This gives me hope that even though I am very overweight, if I can manage to take just some weight off and exercise more than I normally do, that it will help my health.

    Thank you Dr. Sharma

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  3. Diet and Physical Activity Reduces Cardiometabolic Risk in Severe Obesity. In 1999 I had double bypass heart surgery. I weight 367 lb. if I had dieted before my operation I would probably have had a triple bypass. Logic states that, when they opened up my chest they didn’t have big enough tool to keep the chest open wide enough and they had trouble working around all the fat around my organs making it longer to complete what they had to do. I was under for a very long time so they couldn’t do the third bypass even tho it did not need to be done have more flow is better. I couldn’t have exercised before the surgery as I was now using Nitro glycerene quite a lot before my surgery. but I could have been more help to the surgents and my life if I had lost the weight before surgery.
    SO I WANT TO MAKE SURE TO TELL DOCTORS IN ONTARIO And THEIR OBESE , LARGE OVERWEIGHT PATIENTS THAT THER ARE 6 LARGE BORE MRI MACHINES IN THE PROVINCE TO LOOK AFTER THEM STILL NOT ENOUGH IN THE NORTH, THE EAST, THE NORTH EAST, THUNDER BAY, TIMMINS, KENORA, OTTAWA, KINGSTON, WINSOR, SARNIA, HAMILTON, ST. CATHERINES.
    THANKS FOR LISTENING.
    ALAN MOFFAT

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