Balanced Deficit Diet Research Articles

Impact on weight and physical function of intensive medical weight loss in older adults with stage II and III obesity.

A 6-month pilot trial compared two strategies for weight loss in older adults with body mass indexes (BMIs) ≥35 kg/m(2) to assess weight loss response, safety, and impact on physical function. Twenty-eight volunteers were randomized to a balanced deficit diet (BDD) (500 kcal/day below estimated energy needs) or an intensive, low-calorie, meal replacement diet (ILCD, 960 kcal/day). Behavioral interventions and physical activity prescriptions were similar for both groups. Primary outcomes were changes in body weight and adverse event frequency; secondary outcomes included measures of physical function and body composition. ILCD average weight change was -19.1 ± 2.2 kg or 15.9 ± 4.6% of initial body weight compared with -9.1 ± 2.7 kg or 7.2 ± 1.9% for BDD. ILCD lost more fat mass (-7.7 kg, 95% CI [-11.9 to -3.5]) but had similar loss of lean mass (-1.7 kg, 95% CI [-4.1 to 0.6]) compared with BDD. There were no significant differences in change in physical function or adverse event frequency. Compared with a traditional BDD intervention, older adults who have severe obesity treated with intensive medical weight loss had greater weight loss and decreases in fat mass without a higher frequency of adverse events. In the short term, however, this did not translate into greater improvements in physical function.

ORDERLY DIETING AND DISORDERED EATING: A CASE REPORT

A moderately obese 49-year-old woman who was enrolled in a nutrition and weight control clinic quickly attained her target weight through an individualized program of balanced deficit diet, routine exercise, and weekly counseling. Weight loss continued until she was 15% below Metropolitan Relative Weight, when family members grew concerned that she had developed an eating disorder. Despite nutritional and behavioral counseling, she has rigorously maintained her exaggerated weight loss. This case report illustrates a potentially serious but often overlooked reason for careful monitoring of patients undergoing treatment for obesity. Health professionals involved in weight control programs should routinely assess patients for potential eating disorders.

The Short-term Effect of a Balanced Deficit Diet on Resting Energy Expenditure.

PURPOSE: To examine the change in REE in response to weight loss across a 4-week period in overweight and obese males and females compared with a no treatment control. METHODS: Thirty-seven subjects (body mass index 25.0-39.9kg/m2; males = 14, females = 23) participated in a 4-week intervention with random assignment to an Experimental Group or a no treatment Control Group. The experimental group was instructed to reduce energy intake to 1200–1500 kcal/d and participate in 100 min/wk of moderate aerobic exercise. The control group was instructed to maintain current eating and exercise behaviors. Assessments were conducted at 0 and 4 weeks. REE was assessed using the dilution technique, and was expressed as absolute REE (kcal/ d), REE relative to body weight, (kcal/kg/d), REE relative to lean body mass (kcal/kgLBM/d). Body weight was assessed using a calibrated scale and lean body mass was assessed using bioelectrical impedance analysis. RESUITS: Thirty-five subjects completed the study (94.6%). There were significant differences (p<0.05) for change in outcomes between the experimental and control groups for body weight (−3.3+1.7 vs. 0.6+1.1 kg) lean body mass (−0.6+0.9 vs. 0.2+0.9 kg), absolute REE (−205.8+193.0 vs. −11.4+ 140.6 kcal/d), and REE relative to lean body mass (−3.3+2.9 vs. −0.4+2.6 kcal/kgLBM/d). There as a trend toward a significant difference between the groups (p = .07) for REE relative to body weight (−1.4+1.9 vs. −0.3+1.5 kcal/kg/d). When the groups were combined, there was a correlation between change in REE and change in body weight was r=0.41 (p<.05), and change in REE and change in lean body mass was r=0.44 (p<.01). CONCLUSIONS: Results indicate that absolute and relative REE are significantly reduced in response to weight loss over a 4-week intervention period, and this may affect subsequent patterns for weight change. However, the modest correlations between change in REE and change in both body weight and lean body mass may suggest that additional physiological mechanisms may influence REE during the acute phase of weight loss. Thus, future studies should examine the influence of other physiological and metabolic mechanisms on REE during weight loss.

Changes in Obesity‐related Attitudes in Women Seeking Weight Reduction

To examine changes in obesity-related attitudes in a sample of obese women who participated in either dieting or non-dieting interventions. A total of 123 obese women were randomly assigned to one of three weight control programs: meal replacement diet, balanced deficit diet, or a non-dieting program. (The first two groups were combined as a single dieting condition.) Participants completed questionnaires (at baseline, Week 20, and Week 40) to assess beliefs and attitudes about obesity, along with measures of self-esteem, depression, and body image. At Weeks 20 and 40, participants in the non-dieting condition reported significantly less negativity about obesity than those in the dieting group. Women in the dieting condition did not report an increase in negative attitudes toward obesity, despite losing significantly more weight than non-dieting participants. Both groups experienced improvements in self-esteem, body image, and depressive symptoms. Improvement in self-esteem was associated with a reduction in negativity about obesity and with improvements in body image. The non-dieting program produced greater reductions in negative attitudes toward obesity than the dieting intervention. Dieting (with successful weight loss), however, did not result in greater negativity toward obesity. Non-dieting programs seem to be useful in obese women for improving self-esteem, body image, and internalized negative attitudes about obesity.

Reducing risk of diabetes: the effects of a commercial lifestyle modification weight‐loss program on glucose tolerance and insulin sensitivity

Introduction Abnormal glucose metabolism is a prelude to the development of type 2 diabetes mellitus. The Diabetes Prevention Program (DPP) showed that intensive lifestyle change program resulting in an average 5.6 kg weight loss over 3 years decreased the likelihood of developing diabetes in high risk adults by 58%. Whether or not a less costly intervention can yield similar results is unknown. The objective of this study was to evaluate the effect on glucose metabolism after 24 weeks in an ongoing weight-loss trial using a low-cost commercial (Weight Watchers, WW) lifestyle modification program. Methods Thirteen non-diabetic overweight and obese individuals were included in the analysis. All were enrolled in the WW program which that includes a balanced deficit diet, exercise, and weekly group meetings (mean age 39.6 ± 4.9 years). Fasting blood collection and oral glucose challenges were performed at baseline and after 24 weeks. Results Table 1 describes changes (24 week-baseline) over the course of 24 weeks. Significant differences refer to within group changes from baseline to week 24. Discussion Significant improvements in fasting insulin and glucose, AUCg and HOMA in the WW group suggest beneficial changes in glucose metabolism as the result of an average 5½% weight loss in this non-diabetic cohort. The WW program may be of significant value to overweight and obese people for the prevention of diabetes. Supported by a grant from Weight Watchers International

Dieting and the development of eating disorders in obese women: results of a randomized controlled trial

Some investigators fear that dieting may precipitate binge eating and other adverse behavioral consequences. The objective of the study was to examine whether dieting would elicit binge eating and mood disturbance in individuals free of these complications before treatment. A total of 123 obese women were randomly assigned to 1) a 1000 kcal/d diet that included 4 servings/d of a liquid meal replacement (MR); 2) a 1200-1500 kcal/d balanced deficit diet (BDD) of conventional foods; or 3) a nondieting (ND) approach that discouraged energy restriction. All women attended weekly group sessions for 20 wk and biweekly sessions from week 20 to week 40. At week 20, participants in the MR, BDD, and ND groups lost 12.1 +/- 6.7%, 7.8 +/- 6.0%, and 0.1 +/- 2.4% of initial weight, respectively (P < 0.001). During the first 20 wk, there were no significant differences among groups in the number of persons who had objective binge episodes or in reports of hunger or dietary disinhibition. Symptoms of depression decreased significantly more (P < 0.001) in the MR and BDD groups than in ND participants. At week 28, significantly more (P < 0.003) cases of binge eating were observed in MR participants than in the 2 other groups. No differences, however, were observed between groups at weeks 40 or 65 (a follow-up visit). At no time did any participant meet criteria for binge-eating disorder. Concerns about possible adverse behavioral consequences of dieting should not dissuade primary care providers from recommending modest energy restriction to obese individuals.

Clinical implications of leptin and its potential humoral regulators in long-term low-calorie diet therapy for obese humans.

To address the clinical implications of leptin and to re-examine the relationship between leptin and its potential humoral regulators such as insulin, nonesterified fatty acids (NEFA) and triiodothyronine (T3) in low-calorie diet (LCD) for obese humans. Longitudinal study. University and foundation hospitals. Ten obese men and 10 premenopausal obese women. Five men and five women took 800 kcal/day LCD and another five men and five women took 1400 kcal/day balanced deficit diet (BDD) during 4 weeks. Plasma leptin levels in the LCD group decreased more markedly (46.2+/-14.6 to 13.2+/-3.6 ng/ml) than that expected for the decrement in percentage fat (39.0+/-1.7 to 35.9+/-1.7%) and body mass index (BMI; 35.4+/-2.4 to 33.1+/-2.2 kg/m(2)), while that in the BDD group did not decrease significantly (14.9+/-3.5 to 13.4+/-2.8 ng/ml). The ratio of the decrease in leptin levels to that of BMI during the first week was significantly greater than that during the following 3 weeks (39.5+/-2.7 vs 29.3+/-2.1%, P=0.017). The plasma insulin and T3 levels also fell substantially in the first week and continued to decrease during the entire course. Plasma leptin levels measured weekly in each subject were correlated well with insulin (r=0.586, P=0.0003) and T3 (r=0.785, P=0.0004). Multiple regression analyses after adjustment for the time course and BMI revealed that serum levels of T3 were independently correlated with plasma leptin levels (r=0.928, P<0.0001). The plasma NEFA level was markedly elevated during the first 2 weeks and decreased thereafter. A rapid fall in leptin during the first week of LCD, coordinated by insulin, T3 and NEFA, should be beneficial for responding to decreased energy intake. Inversely, in view of the powerful effect of leptin on energy dissipation, the present findings suggest the potential usefulness of leptin in combination with caloric restriction for the treatment of obesity. The Ministry of Education, Culture, Sports, Science and Technology of Japan and the Ministry of Health, Labour and Welfare of Japan.

Effect of prolonged moderate and severe energy restriction and refeeding on plasma leptin concentrations in obese women

Plasma leptin in humans is subject to both long- and short-term regulation; it correlates with indexes of body fat that can only change slowly. However, short-term fasting causes large and rapid decreases. We tested the interactions between energy intake and fat loss on plasma leptin during prolonged moderate and severe energy restriction, with a view to understanding mechanisms of control. Postabsorptive leptin was measured with an enzyme-linked immunosorbent assay specific for the human peptide in 21 obese women aged 41 +/- 3 y (weight: 102 +/- 4 kg; 48 +/- 1% body fat) after 1 wk of a weight-maintaining diet and then weekly for 4 wk during a total fast (group 1); a 1.9-MJ/d all-protein, very-low-energy diet (VLED) (group 2); or a low-energy, balanced-deficit diet (BDD) providing 50% of maintenance energy (group 3). In groups 1 and 2, leptin was also measured after 1 wk of refeeding with a diet equivalent to the BDD. Mean leptin decreased markedly by up to 66% (P < 0.001) at week 1 of energy restriction and then gradually thereafter. The change in leptin per kilogram fat mass correlated with that in glucose concentrations [r = 0.538 (P = 0.012) at week 1 and r = 0.447 (P = 0.042) at week 4] but not with that in fat mass. During refeeding postfasting, leptin increased (P = 0.008), despite an ongoing loss of fat mass and correlated positively with changes in resting energy expenditure. At times with comparable cumulative energy restriction and fat loss between diets, the percentage change in leptin paralleled that in glucose. In obesity, changes in energy intake over days to weeks are a primary modulator of plasma leptin concentrations that are related to the change in glycemia and are able to override the regulatory influence of fat mass.

Short- and long-term changes in serum leptin dieting obese women: effects of caloric restriction and weight loss.

This study examined the effects of caloric restriction and weight loss on serum leptin concentrations in 49 obese women who participated in a 40-week weight loss program. During the first 12 weeks, half the subjects were provided a 1000 kcal/day low-calorie diet (LCD), compromised of portion-controlled foods, whereas the other half were prescribed a 1200 kcal/day balanced deficit diet (BDD) consisting of self-selected table foods. Thereafter, subjects in both conditions were instructed to consume approximately 1200-1800 kcal/day of self-selected foods, depending on their desired weight change. During the first 6 weeks, weight and serum leptin fell significantly more (P < 0.05) in women in the LCD condition than in the BDD condition. In the former group, the 55% reduction in baseline leptin was 10 times greater than the relative reduction in body weight. Stepwise multiple regression analysis revealed that degree of caloric restriction, but not weight loss, contribution significantly to the variance in the change in leptin at week 6. By contrast, long-term changes in leptin, when subjects had increased their calorie intake, were more strongly related to changes in weight and fat. At week 40, for example, weight loss account for 47% of the variance in the change in leptin. Serum leptin and body fat remained highly correlated after weight loss (r = 0.79, P < 0.001), as before (r = 0.66, P < 0.001). After treatment, however, we observed a greater-than-expected reduction in serum leptin concentrations, as expressed per kilogram of body fat. The significance of this finding remains to be determined.

Changes in bone mineral content in obese dieting women

Significant reductions in total-body bone mineral density (BMD) have been reported in obese women who consume very—low-calorie diets. A reduction in bone mass is highly correlated with an increased risk of osteoporosis. The present study investigated whether strength training would prevent such reductions in dieters. Twenty-one healthy obese women weighing (mean ± SD) 91.1 ± 9 kg and aged 38 ± 9 years were randomly assigned to receive either diet alone or diet PlUs resistance training. Both groups consumed a 925-kcal/d portion-controlled diet for the first 16 of 17 weeks and a 1,000 to 1,500-kcal/d balanced deficit diet thereafter. Bone mineral content (BMC), BMD, fat-free mass (FFM), and fat mass were measured with dual-energy x-ray absorptiometry (DEXA) before and after 24 weeks of dieting. No significant changes in total-body or lumbar spine BMC and BMD were observed in either condition at the end of treatment. However, both groups demonstrated a significant loss of both BMC and BMD in the femoral neck and greater trochanter. Diet plus resistance training was not associated with a significantly better outcome on either of these measures versus diet alone. The results suggest that increasing the energy content of very—low-calorie diets to 925 kcal/d may prevent the loss of total BMD, but not the loss from the femoral neck and greater trochanter. These findings raise a concern in light of the high frequency of dieting in American women.

A prospective study of weight maintenance in obese subjects reduced to normal body weight without weight-loss training

We examined the pattern of weight maintenance in 24 obese women [body mass index (BMI; in kg/m2) 27.6 +/- 0.4 who were provided foods for a balanced deficit diet until each had lost > or = 10 kg and attained normal body weight (BMI 22.9 +/- 0.4). At 1 y subjects had regained a mean of 42% of their weight loss, which increased to 87% at 4 y. At 4 y 44% of patients had regained < 75%, whereas 37% had regained > or = 100% of the weight originally lost. The amount of weight gained was markedly different from that observed in 24 pair-matched never-obese control subjects over the same length of follow-up. Because the results reported herein were obtained without teaching the subjects weight-control skills, they may be regarded as reflective of the natural history of weight maintenance in this population and may serve as a reference for various weight-intervention programs. The pattern of weight rebound observed in this study is very similar to the pattern observed in combined results from published diet and behavioral-modification programs, which raises important questions regarding the efficacy of these approaches in long-term weight maintenance.

Intense sweeteners use and weight change among women: a critique of the Stellman and Garfinkel study.

The purpose of this study was to evaluate the work of Stellman and Garfinkel who speculated, based on epidemiologic data, that users of intense sweeteners are more likely than nonusers to gain weight. We analyzed the study's design and statistical analysis to determine whether the conclusions of Stellman and Garfinkel were supported by the data. Several methodological flaws and inappropriate statistical analyses were identified. These included: use of data from an unrelated study for which they were not intended; failure to correct for bias due to convenience sampling; use of data from a subpopulation without validation; and stratification of subjects by outcome data. Our analysis indicates that the data from the study in question do not allow one to draw conclusions about a relationship between use of intense sweeteners and weight change. Furthermore, data from well-designed clinical trials have shown that aspartame is not associated with weight gain, and when used as part of a balanced deficit diet, can facilitate weight loss.

Controlled trial of the metabolic effects of a very-low-calorie diet: short- and long-term effects

Resting energy expenditure (REE), weight, and body composition were measured up to seven times in 13 obese women during a 24-wk study. Patients were randomly assigned to a very-low-calorie diet (VLCD, 500 kcal/d) or a balanced-deficit diet (BDD, 1200 kcal/d). After 8 wk of supplemented fasting, REE of the VLCD patients decreased by 17% whereas that of the BDD patients was virtually unchanged. REE of the VLCD patients increased during 12 subsequent weeks of realimentation such that differences in REE between the two groups were not statistically significant at week 24 (VLCD = -11%, BDD = -2%). Reductions in weight and fat-free mass (FFM) were 12.1% and 3.6% for the VLCD patients and 10.6% and 4.1% for the BDD patients, respectively. There were no significant differences between the groups in pre- to posttreatment changes in REE normalized to FFM. Results suggest that REE recovers partially after consumption of a VLCD. They also provide evidence of a possible metabolic advantage of weight loss by a more moderate restriction.

Effects of an intermittent, low-fat, low-calorie diet in the behavioral treatment of obesity

This study tested whether the efficacy of behavior therapy for obesity might be improved by the use of an intermittent, low-fat, low-calorie diet. Eighty-five obese women were randomly assigned either to (a) behavior therapy plus a continuous 1200-calorie per day balanced deficit diet or to (b) behavior therapy plus an intermittent, low-fat, 800-calorie per day diet, used 4 days per week. Clients in each protocol received 26 weekly treatment sessions followed by a 6-month maintenance program. At 1-, 2-, 3-, and 4-month evaluations, clients in the intermittent diet condition demonstrated significantly greater weight losses than subjects in the standard treatment. However, the results of 5-, 6-, and 12-month evaluations indicated that the longer term weight losses were equivalent across conditions.

An evaluation of the effect of aspartame on weight loss

This study explores whether the addition of aspartame-sweetened foods and beverages to a low fat, hypocaloric diet enhances compliance and resulting weight loss. Fifty-nine obese (130-225% of ideal body weight), free living men and women were randomly assigned to either a Balanced Deficit Diet (BDD) or a BDD supplemented with aspartame. Over a 12-week weight loss period, volunteers attended weekly support group meetings including behavior modification training and exercise instruction. Males achieved a clinically significant weight loss (greater than 23 lb) in both study groups, while females lost an average of 12.8 lb in the control group vs. 16.5 lb in the experimental group. In both treatment groups, sleep, general energy level, level of physical activity, and feeling of well-being showed clinically meaningful improvement. This study suggests possible advantages to supplementing a BDD with aspartame-sweetened foods as part of a multidisciplinary weight loss program. The small sample size prohibits definitive conclusions but does provide the protocol for a larger, outpatient clinical trial.