Portion-controlled Diet Research Articles

Effect of a Dietary Intervention on Insulin Requirements and Glycemic Control in Type 1 Diabetes: A 12-Week Randomized Clinical Trial.

This study compared the effects of a low-fat vegan diet to those of a portion-controlled diet in people with type 1 diabetes. Over 12 weeks, the average total daily dose of insulin decreased significantly and insulin sensitivity increased significantly in the vegan group, while no significant changes were observed in the group receiving the portion-controlled diet. Total and LDL cholesterol decreased in the vegan group, as did the ratio of blood urea nitrogen to creatinine. A1C decreased in both groups. These findings suggest that a low-fat vegan diet may yield improvements in insulin sensitivity, insulin requirements, glycemic control, and markers of cardiovascular and renal health compared with a portion-controlled diet in people with type 1 diabetes.

606-P: The Effect of a Dietary Intervention on Insulin Requirements in Type 1 Diabetes—A 12-Week Randomized Clinical Trial

Background and Objective: A plant-based has been shown to improve glycemic control and insulin resistance in people with type 2 diabetes. The aim of this study was to test the effect of this diet in people with type 1 diabetes. Methods: Fifty-eight people with type 1 diabetes were randomly assigned to follow a low-fat vegan diet (vegan group, n=29), or a standard portion-controlled diet (control group, n=29) for 12 weeks. All meals were tracked, using the Cronometer mobile application. Insulin sensitivity was assessed, using the carbohydrate to insulin ratio, which was calculated as the number of grams of total dietary carbohydrate to total units of insulin administered. Total insulin dose was calculated as a sum of basal and bolus insulin units injected per day. Results: The consumption of carbohydrates increased in the vegan group by an average of 118 g/day (p=0.002), compared with no significant change in the control group (−18 g/day; p=0.11; treatment effect +137 [95% CI, +65 to +208]; p<0.001). Insulin sensitivity, assessed by the carbohydrate to insulin ratio, increased in the vegan group by 6.2 on average (p=0.002), compared with no significant change in the control group (−0.8; p=0.32; treatment effect +7.0 [95% CI, +3.1 to +10.9]; p=0.001). Total daily dose of insulin decreased by 12.1 units/day in the vegan group (p=0.007), compared with no significant change in the control group (−18 units/day; p=0.66; treatment effect −10.7 [95% CI, −21.3 to −0.2]; p=0.046). Conclusions: This study suggests that a low-fat vegan diet may have beneficial effects on insulin sensitivity and insulin requirements in people with type 1 diabetes. Larger trials are needed to confirm these findings. Trial Registration: ClinicalTrials.gov, NCT04944316 Disclosure H.Kahleova: None. Funding Physicians Committee for Responsible Medicine (330072)

Effectiveness of combined seeds (pumpkin, sunflower, sesame, flaxseed): As adjacent therapy to treat polycystic ovary syndrome in females.

The formation and release of eggs during ovulation are impacted by high amounts of androgens. Seed cycling is powerful in the treatment of polycystic ovary syndrome (PCOS). For efficacy studies, 90 women with PCOS, between 15 and 40 years were selected from the department of gynecology, Tertiary care unit. Women with PCOS were divided into three groups (T0, T1, T2) (20 women/group). Among these three groups, the first was the control group (T0). The second group was the experimental group (T1). In T1, 20 women with PCOS were treated with a portion control diet and METFORMIN 500 mg tab/day for 90 days. The third group was also an experimental group (T2). In this group, 20 women with PCOS were also treated with another treatment plan for 90 days, in which portion control diet and seed cycling were included. During the 12-week efficacy trial, the highest follicle stimulating hormone (FSH) levels were found in the control group T0 (8.18 ± 0.13 mIU/mL). In T2, FSH falls from 6.545 ± 0.16 mIU/mL to 3.51 ± 0.13 mIU/mL throughout a 12-week period. Overall, a portion-controlled diet and seed cycling reduced FSH levels by 1.2% to 2.5%. LH value was 10.118 ± 0.1874 IU/L in the control group (T0), which climbed 12.82 ± 0.15 IU/L, but decreased from 10.62 ± 0.26 IU/L to 9.79 ± 0.17 U/L and 11.015 ± 0.24 IU/L 6.217 ± 0.167 IU/L in the other groups (T1, T2). It was determined that the LH levels were reduced by 1.5%-2% in T2. Conclusively, the seed cycling approach is effective and has significant results in women with PCOS. Seed cycling improves hormonal disturbance in women which promotes a healthy life.

Changes in health-related quality of life with intensive behavioural therapy combined with liraglutide 3.0 mg per day.

This study examined the effects of intensive behavioural therapy (IBT) for obesity (IBT-alone), IBT plus liraglutide 3.0 mg/day (IBT-liraglutide), and IBT-liraglutide combined with 12 weeks of a portion-controlled diet (Multicomponent) on changes in general health-related (HR) quality of life (QoL) and weight-related QoL. Adults with obesity (79.3% female; 54.0% white; 44.7% black; mean age = 47.6 ± 11.8 years and body mass index = 38.4 ± 4.9 kg/m2 ) were randomized to IBT-alone (n = 50), IBT-liraglutide (n = 50) or Multicomponent (n = 50). General HRQoL was measured with the Short Form-36 (SF-36), and weight-related QoL was assessed with the Impact of Weight on Quality of Life-Lite scale. At week 52, participants in the three groups lost 6.1 ± 1.3%, 11.5 ± 1.3% and 11.8 ± 1.3% of initial body weight, respectively. Both liraglutide-treated groups were significantly more likely than IBT-alone to achieve clinically meaningful improvements in total weight-related QoL. They also both achieved greater improvements than IBT-alone in weight-related public distress and in general mental health, as measured by the SF-36 mental component summary score. Independent of treatment group, greater categorical weight loss was associated with greater improvements in several domains of both general and weight-related QoL. The addition of liraglutide to IBT appeared to improve aspects of both general HRQoL and weight-related QoL.

The Effect of Vegan Diets on Blood Pressure in Adults: A Meta-Analysis of Randomized Controlled Trials

BackgroundVegan diets are increasing in popularity and have beneficial effects on glycemia and blood lipids, but the evidence is inconclusive regarding their effect on blood pressure. The purpose of this study was to review the effect of vegan diets on blood pressure in adults. MethodsWe searched MEDLINE, EMBASE, CENTRAL, and ClinicalTrials.gov for records that compared a vegan diet with any less restrictive diet and reported pre- and postintervention systolic and diastolic blood pressures. Two reviewers independently screened abstracts for randomized, controlled clinical trials in individuals ≥18 years of age and older. We used the PRISMA guidelines to select 11 clinical trials from 1673 records. Data synthesis was performed through a random-effects model. ResultsThe pooled data included 983 participants. Compared with less restrictive diets, a vegan diet did not result in a significant change in systolic (−1.33 mm Hg; 95% confidence interval [CI], −3.50-0.84; P = .230) or diastolic (−1.21 mm Hg; 95% CI, −3.06-0.65; P = .203) blood pressure. A prespecified subgroup analysis of studies with baseline systolic blood pressure ≥130 mm Hg revealed that a vegan diet resulted in a mean decrease in the systolic (−4.10 mm Hg; 95% CI, −8.14 to −0.06; P = .047) and diastolic (−4.01 mm Hg; 95% CI, −5.97 to −2.05; P = 0.000) blood pressures. ConclusionThe changes in blood pressure induced by a vegan diet without caloric restrictions are comparable with those induced by dietary approaches recommended by medical societies and portion-controlled diets.

Effects of addictive-like eating behaviors on weight loss with behavioral obesity treatment.

To examine the relationship between food cravings and food addiction as defined by the Yale Food Addiction Scale (YFAS) and to assess the effects of these variables on weight loss during a 14-week group lifestyle modification program. Data were from 178 participants who were prescribed a 1000-1200kcal/day portion-controlled diet and provided with weekly group lifestyle modification sessions. Participants completed the Food Craving Inventory and YFAS pre- and post-treatment. Weight was measured weekly. Participants with YFAS-defined food addiction (6.7%) reported more frequent overall food cravings relative to those without food addiction. More frequent food cravings at baseline were associated with less weight loss over the 14weeks. Analyzed categorically, participants in the highest tertile of baseline food cravings lost 7.6 ± 0.5% of initial weight, which was significantly less compared to those in the lowest tertile who lost 9.1 ± 0.5%. Percent weight loss did not differ significantly between participants with YFAS-defined food addiction (6.5 ± 1.2%) and those who did not meet criteria (8.6 ± 0.3%). Addictive-like eating behaviors significantly declined from pre- to post-treatment. Participants with frequent food cravings lost less weight than their peers. Targeted interventions for food cravings could improve weight loss in these individuals. Few participants met YFAS-defined criteria for food addiction. Addictive-like eating behaviors tended to decline during behavioral weight loss, but neither baseline nor change in YFAS scores predicted weight loss.

A Commercially Available Portion-Controlled Diet Program Is More Effective for Weight Loss than a Self-Directed Diet: Results from a Randomized Clinical Trial.

To examine changes in weight and related outcomes in response to a commercial weight loss program compared to a self-directed diet in adults with overweight or obesity. Participants were randomly assigned [stratified by body mass index (BMI) and age] to a commercial weight loss program (n = 38) or to a self-directed Dietary Approaches to Stop Hypertension (DASH) diet (n = 40) for a 16-week period. Daily energy intake goals were 1,500 kcal/d for men and 1,200 kcal/d for women, except for the first week of the commercial program (1,000 kcal/d). This study was registered at http://ClinicalTrials.gov (NCT03017443). Primarily Caucasian (71%) women (n = 61) and men (n = 17) from the greater metropolitan area of the city of Chicago, IL, USA. with a mean baseline BMI of 34.4 kg/m2, body weight of 95.7 kg, and age of 50.4 years. Data = mean (95% CI). At week 16, the commercial program group lost significantly more body weight [-5.9 (-7.5, -4.3) kg vs. -1.8 (-2.9, -0.8) kg; or -6.4 vs. -1.8% of initial body weight, respectively], fat mass [-4.4 (-5.7, -3.1) kg vs. -1.2 (-2.1, -0.4) kg] and total body circumference (chest + waist + hip + upper arm + thigh) [-16.9 (-21.5, -12.3) cm vs. -5.8 (-9.0, -2.6) cm] (p < 0.01 for all). Additionally, more participants in the commercial program group lost a clinically meaningful amount of weight, defined as ≥5% of initial body weight, at week 16 (58% vs. 13%, p < 0.001). The commercial program resulted in greater weight loss and improvements in body composition/anthropometric parameters compared to a self-directed DASH diet over a 16-week period. Some important limitations were that no objective measurements of dietary intake or physical activity were collected to potentially ascertain the independent or combined effects of these components on weight loss (or lack thereof). Additionally, future research is warranted in order to understand the effects of this program, and similar programs, on longer term changes in body weight, in particular weight loss maintenance, as weight regain is common following the cessation of a structured weight loss intervention.

Changes in Eating Behaviors of Children with Obesity in Response to Carbohydrate-Modified and Portion-Controlled Diets.

This study's objective was to determine whether two distinct carbohydrate (CHO)-modified diets and a standard portion-controlled (PC) diet differentially impacted children's eating behaviors and whether eating behavior scores predicted lower BMI among children with obesity. Children (n = 102) aged 7-12 years with obesity were randomly assigned to a 12-month intervention of a low-carbohydrate (LC), reduced glycemic load (RGL), or standard PC diet. The Three-Factor Eating Questionnaire (TFEQ) was completed at baseline, 3, 6, and 12 months by parents to characterize their child's hunger (H), disinhibition (D), and cognitive restraint (CR). Baseline and follow-up TFEQ scores by diet were evaluated relative to BMI status over time. All diet groups showed increased CR and decreased H and D from baseline to 3 months, with differences from baseline remaining at 12 months for CR and H. Lower BMI status during study follow-up was associated with different TFEQ scores by diet group (LC and RGL: higher CR; PC: lower H), adjusting for sex, age, and race. Higher CR at follow-up was predicted by race and higher baseline CR; only lower H at baseline predicted lower H at follow-up. Eating behaviors improved significantly with all diets during the initial 3 months; higher CR and lower H were sustained at treatment's end. BMI outcomes were associated with different eating behaviors in CHO-modified diet groups compared with PC diets. Targeting diets of children with obesity with specific baseline characteristics may lead to improved outcomes.

Increased frequency of dietitian visits is associated with improved body mass index outcomes in obese youth participating in a comprehensive pediatric weight management program.

Comprehensive weight management (CWM) interventions are most effective for obese youth when they include multiple components, such as nutrition, physical activity, and behavioral strategies. However, effectiveness of different approaches to delivering the nutrition component is unknown. Our aim was to evaluate two dietary approaches and extent of registered dietitian (RD) involvement on outcomes of obese youth participating in a CWM program. A retrospective review of CWM patients was conducted before and after redesign of the nutrition component. The earlier clinical model (CM1) introduced a portion-controlled diet at an RD visit after the initial medical visit, whereas the later clinical model (CM2) introduced a reduced glycemic load diet at the initial medical visit. CWM patients were included if they had at least one RD visit and an initial and 3- to 6-month medical follow-up visit during CM1 or CM2. Differences between CM1 and CM2 groups regarding changes in BMI and programmatic success (BMI change ≤0) were evaluated. Median BMI change during follow-up did not differ between CM1 (n=41) and CM2 (n=51) groups (p=0.41). In a multiple logistic regression model combining study groups, each additional RD visit was associated with a 28% increased odds of success (odds ratio [95% confidence interval]: 1.28 [1.00, 1.64]; p=0.05). The probability of success exceeded 78% with ≥1 RD visit/month versus 43% with minimal RD exposure. Increased frequency of RD visits is associated with improved BMI outcomes in obese youth participating in a CWM program regardless of dietary intervention implemented.

Pilot testing of a portion-controlled, commercially available diet on presurgical weight loss and metabolic outcomes in patients undergoing bariatric surgery.

Weight loss prior to bariatric surgery is often recommended, but success with weight loss varies. The current study piloted the efficacy of a structured, low-glycemic portion-controlled diet (PCD) intervention compared to usual dietary care (UDC). The study randomized 73 subjects in a 12-week, controlled, randomized design. Participants' height, weight, BMI, percent body fat, fasting lipids, and glucose were measured at baseline and after 12 weeks. Although both groups had significant BMI reductions, there were no differences based upon diet and no effect on percent body fat or metabolic outcomes (all p values >0.10). Although patients were able to reduce their BMI through dietary intervention, losses were minimal. Both groups may have been less adherent or motivated to adopt dietary recommendations because of their upcoming bariatric surgery.

Weight Loss Intervention in Survivors of ER/PR-negative Breast Cancer.

Numerous studies have found that increased body size (weight or body mass index) is a risk factor for breast cancer development, recurrence, and death. The detrimental relationship between body size and breast cancer recurrence may be more pronounced among women with estrogen receptor (ER)/progesterone receptor (PR)-negative breast cancer. Considering the limited availability of treatments, and the association between body size and recurrence, alternative treatments are needed for ER/PR-negative breast cancer survivors, particularly overweight survivors. The objective of this pilot study was to examine the feasibility of a 12-week, multi-component meal-replacement weight loss intervention among overweight or obese ER/PR-negative breast cancer survivors; and to obtain preliminary data on changes in anthropometrics, biomarkers, and health-related quality of life (QOL). The 12-week intervention included a portion-controlled diet (including meal replacements) and a multi-component intervention (including behavioral techniques, diet modification, physical activity, and social support). The goal of the intervention was to help participants lose 5% or more of their initial weight by reducing their caloric intake and increasing their physical activity (to at least 15 minutes each day). Paired t-tests assessed changes in continuous measures. Body weight was measured weekly and mixed-model regression analysis assessed change in weight over time. Nineteen ER/PR-negative breast cancer survivors with a mean age of 59 years participated in the study. All but two of the participants completed the 12-week intervention. Women lost an average of 6.3 ± 4.9 kg (P < 0.001), equivalent to 7.5% of their baseline weight. There were significant reductions in waist circumference (P = 0.001), percent fat mass (P < 0.001), total cholesterol (P = 0.026), and triglycerides (P = 0.002); and improvements in health-related QOL (P = 0.017). Findings suggested that a meal-replacement weight loss approach among ER/PR-negative breast cancer survivors was feasible and was well received.

A Pilot Internet‐Based Behavioral Weight Loss Intervention with or without Commercially Available Portion‐Controlled Foods

To evaluate the short-term impact of portion-controlled food provision in combination with an Internet behavioral weight loss program on weight, blood cholesterol, and blood glucose levels. Fifty participants, mean age 46 ± 10.7 years and mean body mass index 35.1 ± 3.8 kg/m2 , were randomized to one of two study groups, an Internet behavioral weight loss program (Internet-alone; n = 25) or an Internet behavioral weight loss program plus a commercially available portion-controlled diet (Internet + PCD; n = 25) for 12 weeks. An intent-to-treat analysis found that the mean weight change in the Internet + PCD group was -5.7 ± 5.6 kg and in the Internet-alone group (n = 25) was -4.1 ± 4.0 kg (P = 0.26). Participants in the Internet + PCD group achieved significantly greater improvements in blood glucose (-2.6 ± 5.7 vs. 1.4 ± 11.0 mg/dl; P = 0.05) and LDL cholesterol (-8.2 ± 18.0 vs. -0.6 ± 21.0 mg/dl; P = 0.04), compared with Internet-alone group. These data suggest that there may be short-term clinical benefit in using a PCD in conjunction with a behavioral Internet-based weight loss program to enhance weight loss and improve health indicators.

A randomized comparison of a commercially available portion-controlled weight-loss intervention with a diabetes self-management education program

Objective:This study examined the efficacy of a commercially available, portion-controlled diet (PCD) on body weight and HbA1c over 6 months in obese patients with type 2 diabetes.Research Design and Methods:One-hundred participants with a mean±s.d. age of 55.6±10.6 year, body weight of 102.9±18.4 kg and HbA1c of 7.7±1.3% were randomly assigned to a 9-session group lifestyle intervention that included a PCD or to a 9-session group program of diabetes self-management education (DSME). Participants in the two groups were prescribed the same goals for energy intake (1250–1550 kcal per day) and physical activity (200 min per week).Results:While both groups produced significant improvements in weight and HbA1c after 6 months of treatment, PCD participants lost 7.3 kg [95% confidence interval (CI): −5.8 to −8.8 kg], compared with 2.2 kg (95% CI: −0.7 to −3.7 kg) in the DSME group (P<0.0001). Significantly more PCD than DSME participants lost ⩾5% of initial weight (54.0% vs 14.0%, P<0.0001) and ⩾10% (26.0% vs 6.0%, P<0.0001). HbA1c declined by 0.7% (95% CI: −0.4 to −1.0%) in the PCD group, compared with 0.4% (95% CI: −0.1 to −0.7%) in DSME (P<0.026). Across both groups, larger weight losses were associated with greater reductions in HbA1c (r=0.52, P<0.0001).Conclusions:These findings demonstrate that a commercially available portion-controlled meal plan can induce clinically meaningful improvements in weight and glycemic control in obese individuals with type 2 diabetes. These data have implications for the management of obesity in primary care, as now provided by the Centers for Medicare and Medicaid Services.

Role of Carbohydrate Modification in Weight Management among Obese Children: A Randomized Clinical Trial

To compare the effectiveness and safety of carbohydrate (CHO)-modified diets with a standard portion-controlled (PC) diet in obese children. Obese children (n=102) aged 7-12 years were randomly assigned to a 3-month intervention of a low-CHO (LC), reduced glycemic load (RGL), or standard PC diet, along with weekly dietary counseling and biweekly group exercise. Anthropometry, dietary adherence, and clinical measures were evaluated at baseline and 3, 6, and 12 months. Analyses applied intention-to-treat longitudinal mixed models. Eighty-five children (83%) completed the 12-month assessment. Daily caloric intake decreased from baseline to all time points for all diet groups (P<.0001), although LC diet adherence was persistently lower (P<.0002). At 3 months, body mass index z score was lower in all diet groups (LC, -0.27 ± 0.04; RGL, -0.20 ± 0.04; PC, -0.21 ± 0.04; P<.0001) and was maintained at 6 months, with similar results for waist circumference and percent body fat. At 12 months, participants in all diet groups had lower body mass index z scores than at baseline (LC, -0.21 ± 0.04; RGL, -0.28 ± 0.04; PC, -0.31 ± 0.04; P<.0001), and lower percent body fat, but no reductions in waist circumference were maintained. All diets demonstrated some improved clinical measures. Diets with modified CHO intake were as effective as a PC diet for weight management in obese children. However, the lower adherence to the LC diet suggests that this regimen is more difficult for children to follow, particularly in the long term.

A Comparison of Low Glycemic Index and Staged Portion-Controlled Diets in Improving BMI of Obese Children in a Pediatric Weight Management Program

A Comparison of Low Glycemic Index and Staged Portion-Controlled Diets in Improving BMI of Obese Children in a Pediatric Weight Management Program

EFFECT OF AN EDUCATIONAL INTERVENTION ON WEIGHT AND BLOOD PRESSURE IN OBESE HYPERTENSIVE PATIENTS. TWO YEARS OF FOLLOW-UP: PP.38.497

Objective: To assess the effect on weight and blood pressure of an educational intervention in obese hypertensive patients. Material and Methods: A before-after study was conducted to evaluate the effect of a 12-month educational intervention on weight and blood pressure in obese hypertensive patients. The individualized educational programme consisted of: nutrition information, motivation test, individualized portion-controlled diet and reinforcement of information once a month with measurement of weight, waist circumference (WC) and BMI. Measurements of BMI (kg/m2), WC (cms), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were performed at the beginning of the study, one year later (when the educational intervention ended) and two years later. Results: 61 patients were studied (32 men, 29 women), aged 59.84 ± 14.59. BMI decreased in 56 patients (91.8%) and WC in 54 patients (88.5%). The evolution of BMI and WC was: BMI0 33.68 ± 3.56, BMI1 31.65 ± 4.29, BMI2 31.27 ± 3.94, WC0 107.36 ± 10.65, WC1 104.04 ± 10.94, WC2 102.75 ± 10.36. There were differences statistically significant among BMI0 and BMI1 (average reduction 2.03, IC95% 1.46, 2.59, p < 0.05). BMI1 and BMI2 were similar. The average reduction of WC was 3.31 (IC95% 1.94, 4.68), p < 0.05, at one year and 4.61 (IC95% 3.06, 6.17), p < 0.05, at two years. The evolution of SBP, DBP and MAP was: SBP0 138.33 ± 15.30, SBP1 136.12 ± 16.26, SBP2 125.76 ± 15.30, DBP0 83.77 ± 8.37, DBP1 82.29 ± 9.45, DBP2 75.69 ± 7.42, MAP0 102.71 ± 10.08, MAP1 101.14 ± 11.16, MAP2 92.5 ± 11.11. The reduction in blood pressure at one year is not statistically significant, but it reaches statistical significance at two years: average reduction in SBP 12.89 mmHg (IC95% 8.63–17.10) p < 0.05, in DBP 8.30 (IC95% 5.88–10.72) p < 0.05 and in MAP 10.45 (IC95% 7.24–13.67) p < 0.05. Conclusion: An individualized educational intervention in obese hypertensive patients lowers BMI, WC and blood pressure among studied individuals. Waist circumference continues its reduction after concluding the intervention.

Effect of Pioglitazone on Energy Intake and Ghrelin in Diabetic Patients

OBJECTIVETo measure ghrelin and energy intake in the laboratory after pioglitazone treatment.RESEARCH DESIGN AND METHODSThis was a parallel, three-arm study with 51 obese diabetic subjects randomized to either 1) pioglitazone plus a portion-controlled diet (Pio+PC), 2) pioglitazone plus American Diabetes Association (ADA) dietary advice (Pio+ADA), or 3) metformin plus ADA advice (Met+ADA). Energy intake and the suppressive response of a meal on ghrelin were measured at weeks 0 and 16. Mixed models tested if changes from week 0 to 16 differed by group.RESULTSThe Pio+ADA group had a significantly larger increase (P < 0.05) in energy intake ([adjusted means ± SE] 207 ± 53 kcal) compared with the Pio+PC (50 ± 46 kcal) and Met+ADA (52 ± 49 kcal) groups. Change in restraint and disinhibition (variables associated with eating behavior) mediated weight change. Ghrelin suppression increased in the Pio+ADA group, which gained weight.CONCLUSIONSA portion-controlled diet attenuated the increase in energy intake after pioglitazone. Ghrelin responded to weight change not pioglitazone exposure.

Behavior therapy for obesity: where are we now?

To describe the short-term and long-term results of lifestyle modification for obesity. Randomized controlled trials, which compared different diet and activity interventions were reviewed. Studies that investigated the efficacy of new technologies to provide lifestyle modification, such as web-based delivery, also were examined. In general, comprehensive lifestyle modification programs delivered in person induce a loss of approximately 10% of initial weight in 16-26 weeks of treatment. The use of portion-controlled diets, which typically involve the use of meal replacement products, was associated with significantly larger weight losses in the short term. In contrast, interventions delivered via the Internet induced a loss of approximately 5%. However, web-based programs appear to have potential in facilitating the continuation on patient-provider contact, which along with high levels of physical activity, appear to be key strategies for successful long-term weight control. Recent studies also have suggested that the combination of lifestyle modification with long-term use of pharmacotherapy holds promise for maximizing initial weight losses and promoting long-term maintenance.

The Effects of a Commercially Available Weight Loss Program among Obese Patients with Type 2 Diabetes: A Randomized Study

The purpose of this study was to assess the effects of a commercially available weight loss program on weight and glycemic control among obese patients with type 2 diabetes. Participants included 69 patients (49 females, 20 males) with type 2 diabetes who had a mean ± SD age of 52.2 ± 9.5 years, a body mass index of 39.0 ± 6.2 kg/m2, and hemoglobin A1c (HbA1c) of 7.5 ± 1.6%. Over half (52.2%) of the participants were African American. Participants were randomly assigned to: 1) a portion-controlled diet (NutriSystem® D™) (PCD) or 2) a diabetes support and education (DSE) program. After the initial 3 months, the PCD group continued on the PCD for the remaining 3 months, and the DSE group crossed over to PCD for the remaining 3 months. The primary comparison for this study was at 3 months. At 3 months, the PCD group lost significantly more weight (7.1 ± 4%) than the DSE group (0.4 ± 2.3%) (P < 0.0001). From 3 to 6 months the change in weight for both groups was statistically significant. After 3 months, the PCD group had greater reductions in HbA1c than the DSE group (−0.88 ± 1.1 vs 0.03 ± 1.09; P < 0.001). From 3 to 6 months the PCD group had no further change in HbA1c, while the DSE group showed a significant reduction. These data suggest that obese patients with type 2 diabetes will experience significant improvements in weight, glycemic control, and cardiovascular disease risk factors after the use of a commercially available weight management program.

Lifestyle Modification for the Management of Obesity

Several expert panels have recommended that obese individuals attempt to lose 10% of their initial body weight through a combination of diet, physical activity, and behavior therapy (frequently referred to as lifestyle modification). This article reviews the short-and long-term results of lifestyle modification and methods to improve them. Randomized controlled trials were examined that compared different diet and activity interventions for inducing and maintaining weight loss. Studies that compared different methods of providing lifestyle modification, including on-site vs. Internet-based delivery, also were examined. A comprehensive lifestyle modification program was found to induce a loss of approximately 10% of initial weight in 16 to 26 weeks of group or individual treatment, delivered on-site. Comprehensive Internet-based programs induced a loss of approximately half this size. Patients' consumption of portion-controlled diets, including liquid meal replacements, was associated with significantly greater short-term weight loss than was the consumption of isocaloric diets comprised of conventional foods. Factors associated with long-term weight control included continued patient-practitioner contact (whether on-site or by e-mail), high levels of physical activity, and the long-term use of pharmacotherapy combined with lifestyle modification. In summary, lifestyle modification induces clinically significant weight loss that is associated with the prevention or amelioration of cardiovascular risk factors.