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Treatment of Obesity by Moderate and Severe Caloric Restriction: Results of Clinical Research Trials

Thomas A. Wadden, PhD
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From Syracuse University, Syracuse, New York. Requests for Reprints: Thomas A. Wadden, PhD, Center for Health and Behavior, Syracuse University, 804 University Avenue, Syracuse, NY 13244. Grant Support: By a Research Scientist Development Award (MH00 702-05) from the National Institute of Mental Health (NIMH) and by grant RO1-MH49451-01 from the NIMH.

Copyright 2004 by the American College of Physicians

Ann Intern Med. 1993;119(7_Part_2):688-693. doi:10.7326/0003-4819-119-7_Part_2-199310011-00012
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Recent studies of the treatment of obesity by moderate and severe caloric restriction show that patients treated in randomized trials using a conventional 1200 kcal/d reducing diet, combined with behavior modification, lose approximately 8.5 kg in 20 weeks. They maintain approximately two thirds of this weight loss 1 year later. Patients treated under medical supervision using a very-low-calorie diet (400 to 800 kcal/d) lose approximately 20 kg in 12 to 16 weeks and maintain one half to two thirds of this loss in the following year. Both dietary interventions are associated with increasing weight regain over time, although regain can be minimized with the recognition that obesity, in many cases, is a chronic condition that requires continuing care. Patients who participate in a formal weight-loss maintenance program, exercise regularly, or both are likely to achieve the best long-term results.


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Figure 1.
Weight loss among 68 women randomly assigned to three dietary conditions.

Patients consumed liquid diets providing either 420 kcal/d, 660 kcal/d, or 800 kcal/d during weeks 2 to 13, after consuming a 1200 kcal/d diet of conventional foods the first week. All consumed a refeeding diet during weeks 14 to 19, and a 1200 to 1500 kcal/d diet for the rest of the treatment. There were no significant differences among conditions in weight losses at weeks 13 or 26. Figure reprinted from reference 34, with permission.).

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Figure 2.
Changes in weight at the end of treatment and during a 5-year follow-up period.

Seventy-six women were randomly assigned to treatment by very-low-calorie diet alone (VLCD), behavior therapy combined with a 1200 kcal/d diet of conventional foods (BMOD), or VLCD combined with behavior therapy (COMBINED). Patients in the VLCD condition received a 1200 kcal/d diet the first month, a VLCD during months 2 to 3, and a refeeding diet month 4. Patients in the COMBINED condition consumed the same diet the first 4 months and a 1200 kcal/d diet during months 5 and 6. Those in the BMOD condition consumed a 1200 kcal/d diet during 6 months of treatment. Patients in the COMBINED condition lost significantly more weight at the end of treatment than did those in the two other conditions and significantly more at the 1-year follow-up than did patients in the VLCD condition. There were no statistically significant differences among the three conditions in changes in weight at 3 or 5 years follow-up. (Figure prepared from data reported in reference 39.).

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