A programme of behaviour modification and nutrition counselling in the treatment of obesity:: a randomised 2-y clinical trial

Objective: To compare two group treatment programmes for obese outpatients. Both programmes included behaviour modification, nutrition counselling, very-low-calorie diet (VLCD) and a continuous measuring of metabolic and anthropometrical status, but they differed regarding the treatment intensiveness. The main aim was to study whether intensive treatment gives a larger weight reduction compared with less intensive treatment and what level of input from health care personnel is needed to reach adequate treatment results. Design: A 2-y randomised clinical trial. Subjects: A total of 43 obese subjects aged 24-60 y, BMI 35 kg/m(2) (29-48). Intervention: Two programmes were used. Both were based on group therapy and were supervised by a dietitian and a psychologist. Group 1 received a continuous intensive treatment with planned group meetings every fortnight during the first year and six group meetings the second year. Group 2 had planned group meetings every third month. Anthropometrical and metabolic data were measured every third month in both groups. The VLCD periods were the same. Results: There was no evidence that a more intensive treatment promotes a larger weight reduction. Weight reduction after 1 y: group 1, -7.6 (+/-0.97) kg, BMI -2.6 (+/-0.3) kg/m(2); group 2, -6.4 (+/-1.16) kg, BMI -2.2 (+/-0.4) kg/m(2). Weight reduction after 2 y: group 1, -6.8 (+/-1.4) kg, BMI -2.4 (+/-0.3) kg/m(2); group 2, -8.6 (+/-1.6) kg, BMI -3.0 (+/-0.3) kg/m(2). The dropout rate was 26%. Conclusion: There were no significant differences in weight reduction, compliance or dropout rate between the groups and there was no evidence that a more intensive treatment promotes a larger weight reduction. This observation is of value when setting up treatment programmes. To measure the metabolic and anthropometrical status during the treatment and to give continuous feedback to the subjects seem to be important factors for compliance. Both treatment programmes gave highly significant weight reductions in the range of 5-10%, which has been referred to as a realistic goal for the treatment of obese patients.