Abstract
Objective: The aim of this prospective case-control study was to assess the long-term effectiveness of interdisciplinary cognitive-behavioural-nutritional therapy, combined with daily physical exercise and relaxation sessions, on weight and psychosocial issues during a 6-week in-hospital stay. Setting: Five years (60±1 months) later, the patients were readmitted for a one-day medical evaluation including a physical examination and laboratory work-up, and the completion of a detailed questionnaire focusing on dietary and psychosocial factors that may affect weight loss/regain. Subjects: The follow-up population consisted of 55 morbidly obese subjects aged 49.5±2 years (45 females and 10 males; BMI: 40±0.7 kg/m2). During their initial 6-week in-hospital stay, they lost an average of 7.6±0.4 kg. Results: Five years later, 25.5% of the patients had lost a further 11.9±1.8 kg, 20% maintained their initial weight loss (0.6±0.4 kg), and 54.5% regained weight (10.4±1 kg). The weight changes significant correlated with the degree of psychosocial difficulties (p<0.001), eating behaviour problems (p<0.001), dietary fat intake (p<0.005) and total energy intake (p<0.05). Fasting plasma insulin and blood glucose concentrations were significantly higher in the patients who regained weight after five years, and significantly lower in those who had lost more weight. Conclusion: As a whole, these results show the efficacy of an interdisciplinary approach to the long-term treatment of morbidly obese patients. It is likely that an outpatient psychological follow-up would have improved this therapeutic success.
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References
Wardle J.: Obesity and behavior change: matching problems to practice. Int. J. Obes. Relat. Metab. Disord., 20 (Suppl. 1), S1–S8, 1996.
Glenny A.M., O’Meara S., Melville A., Scheldon T.A., Wilson C.: The treatment and prevention of obesity: a systematic review of the literature. Int. J. Obes. Relat. Metab. Disord., 21, 715–737, 1997.
Fossati M., Painot D., Delgado H., Muggler C., Bernstein M., Golay A.: Approche cognitivo-comportementale nutritionnelle quantitative chez des patientes obèses mangeuses compulsives. Journal de Thérapie Comportementale et Cognitive, 9 (Suppl. 3), 83–87, 1999.
Painot D., Jotterand S., Kammer A., Fossati M., Golay A.: Simultaneous nutritional cognitive-behavioral therapy in obese patients. Pat. Educ. Counsel., 42, 47–52, 2001.
Björvell H., Rössner S.: A ten-year follow-up of weight change in severely obese subjects treated in a combined behavioral modification program. Int. J. Obes. Relat. Metab. Disord., 16, 623–625, 1992.
Polivy J.: Psychological consequences of food restriction. Am. J. Diet. Assoc., 96, 589–592, 1996.
Wadden T.A., Forster G.D., Letizia K.A.: Response of obese binge eaters to treatment by behavior therapy combined with VLCD. J. Consult. Clin. Psychol., 60, 808–811, 1992.
Hakala P.: Weight reduction programs at a rehabilitation center and health center based on group counseling and individual support: Short- and long-term follow-up study. Int. J. Obes. Relat. Metab. Disord., 18, 483–489, 1994.
Hakala P., Karvetti R.L., Rönnemaa T.: Group vs individual weight reduction programs in the treatment of severe obesity — a five-year follow-up study. Int. J. Obes. Relat. Metab. Disord., 17, 97–102, 1993.
Schalch A., Ybarra J., Adler D., Delétraz M., Lehmann T., Golay A.: Evaluation of a psycho-educational nutritional program in diabetic patients. Pat. Educ. Counsel., 44, 171–178, 2000.
Miller W.C., Koceja D.M., Hamilton E.J.: A meta analysis of the past 25 years of weight loss research using diet, exercise or diet plus exercise intervention. Int. J. Obes. Relat. Metab. Disord., 21, 941–947, 1997.
Klem M.L., Wing R.R., McGuire M.T., Seagle H.M., Hill J.O.: A descriptive study of individuals successful at long-term maintenance of substantial weight loss. Am. J. Clin. Nutr., 66, 239–246, 1997.
Jakicic J.M., Clark K., Coleman E., Donnelly J.E., Foreyt J., Melanson E., Volek J., Volpe S.L.; American College of Sports Medicine: American College of Sports Medicine position stand. Appropriate intervention strategies for weight loss and prevention of weight regain for adults. Med. Sci. Sports Exerc., 33, 2145–2156, 2001.
Skender M.L., Goodbrick G.K., Del Junco D.J., et al.: Comparison of 2-year weight loss trends in behavioral treatments of obesity: diet, exercise, and combination intervention. Am. J. Diet. Assoc., 96, 342–346, 1996.
Huang M.H., Yang R.C., Hu S.H.: Preliminary results of triple therapy for obesity. Int. J. Obes. Relat. Metab. Disord., 20, 830–836, 1996.
Brownell K.D.: Exercise and obesity treatment: psychological aspects. Int. J. Obes., 19 (Suppl. 4), S122–S125, 1995.
Levine M.D., Marcus M.D., Moulton P.: Exercise in the treatment of binge eating disorder. Int. J. Eat. Disord., 19 (Suppl. 2), 171–177, 1996.
Golay A., Allaz A.F., Morel Y., de Tonnac N., Tankova S., Reaven G.: Similar weight loss with low or high carbohydrate diets. Am. J. Nutr., 63, 174–178, 1996.
Golay A., Maisonnave M., Delétraz M., Guzman-Fossati M., De Luzy F., Victorion M., Delgado H.: Une nouvelle approche psycho-pédagogique du traitement de l’obésité. Nervure, 12 (Suppl. 2), 28–34, 1999.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, DSM-IV. Washington DC, American Psychiatric Press, 1994.
Garner D.M.: EDI 2. Eating Disorder Inventory, 2nd Professional Manual. New York, Psychological Assessment Resources, 1990.
Beck A.T., Ward C.H., Mendelson M., Mock J., Erbaugh J.: An inventory for measuring depression. Arch. Gen. Psychiatr., 4, 561–571, 1961.
Lehmann T., Jacquemet S., Bernstein M., Golay A.: Outil de diagnostic des troubles du comportement alimentaire en cas de surcharge pondérale. Cah. Nutr. Diét., 34 (Suppl. 3), 161–166, 1999.
Ybarra J., De Stefano M., Kammer A., de Tonnac N., Lehmann T., Golay A.: Interest of prognostic score for optimal clinical management of obese patients. Diabetes Metab., 29, 418–423, 2003.
Herbert V., Lank S., Gottlieb C.W.: Coated charcoal immuno assay of insulin. J. Clin. Endocrinol. Metab., 25, 1375–1384, 1965.
Walsh B.T., Devlin M.J,: Eating disorders: progress and problems. Science, 280, 1387–1390, 1998.
Mussell M.P., Mitchel J.E., de Zwaan M., Crosby R.D., Seim H.C., Crow S.J.: Clinical characteristics associated with binge eating in obese females: a descriptive study. Int. J. Obes. Relat. Metab. Disord., 20, 324–331, 1996.
Raymond N.C., Mussell M.P., Mitchell J.E., de Zwaan M., Crosby R.D.: An age-matched comparison of subjects with binge eating disorder and bulimia nervosa. Int. J. Eat. Disord., 18 (Suppl. 29), 135–143, 1995.
Telch C.F., Agras W.S.: Do emotional states influence binge eating in the obese? Int. J. Eat. Disord., 20 (Suppl. 3), 271–279, 1996.
Purnell J.Q., Kahn S.E., Albers J.J., Nevin D.N., Brunzell J.D., Schwartz R.S.: Effect of weight loss with reduction of intra-abdominal fat on lipid metabolism in older men. J. Clin. Endocrinol. Metab., 85 (Suppl. 3), 977–982, 2000.
Olefsky J., Reaven G.M., Farquhar J.W.: Effects of weight reduction in obesity: studies of lipid and carbohydrate metabolism in normal and hyperlipoproteinemic subjects. J. Clin. Invest., 53, 64–76, 1974.
Sorbis R., Petersson B.G., Nilsson-Ehle P.: Effects of weight reduction on plasma lipoproteins and adipose tissue metabolism in obese subjects. Eur. J. Clin. Invest., 11, 491–498, 1981.
Golay A, Münger R., Felber J.P.: Obesity and NIDDM: the retrograde regulation concept. Diabetes Rev., 5 (Suppl. 1), 69–82, 1997.
Petersen K.F., Hendler R., Price T., Perseghin G., Rothman D.L., Held N., Amatruda J.M., Shulman G.I.: 13C/31P NMR Studies on the mechanism of insulin resistance in obesity. Diabetes 47, 381–386, 1998.
Goldstein D.J.: Beneficial health effects of modest weight loss. Int. J. Obes. Relat. Metab. Disord., 16, 397–415, 1992.
Andersen R.E., Wadden T.A., Bartlett S.J., Vogt R.A., Weinstock R.S.: Relation of weight loss to changes in serum lipids and lipoproteins in obese women. Am. J. Clin. Nutr., 62, 350–357, 1995.
Lehmann T., Golay A., James R.W., Pometta D.: Effects of two hypocaloric diets fat restricted or rich in monounsaturated fat, on body weight loss and plasma lipoprotein distribution. Nutr. Metab. Cardiovasc. Dis., 5, 290–296, 1995.
Dattilo A.M., Kris-Etherton P.M.: Effects of weight reduction on blood lipids and lipoprotein: a meta analysis. Am. J. Clin. Nutr., 56, 320–328, 1992.
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Golay, A., Buclin, S., Ybarra, J. et al. New interdisciplinary cognitive-behavioural-nutritional approach to obesity treatment: A 5-year follow-up study. Eat Weight Disord 9, 29–34 (2004). https://doi.org/10.1007/BF03325042
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DOI: https://doi.org/10.1007/BF03325042