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17-10-2010 | General practice | Article

Diet plus exercise ‘ does work in severely obese’

Abstract

JAMA 2010; Advance online publication

People who are severely obese are just as likely as overweight or obese people to stick to a diet and exercise plan - and may benefit more from it, report US researchers in the Journal of the American Medical Association.

"Our results directly counter the dogma that these severely obese individuals do not respond to lifestyle intervention," say Bret Goodpaster (University of Pittsburgh, Pennsylvania) and colleagues.

The team studied 130 participants aged 30-55 years who received lifestyle advice through group, individual and telephone meetings four times a month. Half of the group also started a program of moderate-intensity physical activity straight away, while the other half began exercising after 6 months.

The researchers report that adherence by severely obese participants to the program was similar to that seen in previous trials of overweight or obese patients. And these heaviest participants, class III obese patients with a body mass index (BMI) of 40 kg/m2 or above, lost more weight than did class II patients with a BMI of 35-40 kg/m2, at 10.9% versus 7.0%, respectively.

Although the intervention did not result in the degree of weight loss typically achieved with bariatric surgery, the authors point out that participants achieved significant reductions in waist circumference and hepatic fat, improvements that were boosted by physical activity, as well as in insulin resistance, blood pressure and visceral abdominal fat.

Noting that bariatric surgery is performed in only around 1% of severely obese adults annually, "making it an unlikely public health solution", the authors conclude that their data "make a strong case that serious consideration should be given by health care systems to incorporating more intensive lifestyle interventions".

GP News is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Caroline Price