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Weight Control in the Physician's Office
Judith M. Ashley, PhD, RD;
Sachiko T. St Jeor, PhD;
Jon P. Schrage, MD, MPA;
Suzanne E. Perumean-Chaney, MS;
Mary C. Gilbertson, PhD, RD;
Nanette L. McCall, RD;
Vicki Bovee, MS, RD
Arch Intern Med. 2001;161:1599-1604.
Background Lifestyle changes involving diet, behavior, and physical activity are
the cornerstone of successful weight control. Incorporating meal replacements
(1-2 per day) into traditional lifestyle interventions may offer an additional
strategy for overweight patients in the primary care setting.
Methods One hundred thirteen overweight premenopausal women (mean ± SD
age, 40.4 ± 5.5 years; weight, 82 ± 10 kg; and body mass index,
30 ± 3 kg/m2) participated in a 1-year weight-reduction
study consisting of 26 sessions. The women were randomly assigned to 3 different
traditional lifestyle-based groups: (1) dietitian-led group intervention (1
hour per session), (2) dietitian-led group intervention incorporating meal
replacements (1 hour per session), or (3) primary care office intervention
incorporating meal replacements with individual physician and nurse visits
(10-15 minutes per visit).
Results For the 74 subjects (65%) completing 1 year, the primary care office
intervention using meal replacements was as effective as the traditional dietitian-led
group intervention not using meal replacements (mean ± SD weight loss,
4.3% ± 6.5% vs 4.1% ± 6.4%, respectively). Comparison of the
dietitian-led groups showed that women using meal replacements maintained
a significantly greater weight loss (9.1% ± 8.9% vs 4.1% ± 6.4%)
(P = .03). Analysis across groups showed that weight
loss of 5% to 10% was associated with significant (P
= .01) reduction in percentage of body fat, body mass index, waist circumference,
resting energy expenditure, insulin level, total cholesterol level, and low-density
lipoprotein cholesterol level. Weight loss of 10% or greater was associated
with additional significant (P = .05) improvements
in blood pressure and triglyceride level.
Conclusions A traditional lifestyle intervention using meal replacements can be
effective for weight control and reduction in risk of chronic disease in the
physician's office setting as well as in the dietitian-led group setting.
From the Nutrition Education and Research Program (Drs Ashley, St Jeor,
Gilbertson, and Bovee and Mss Perumean-Chaney and McCall) and Department of
Internal Medicine (Dr Schrage), University of Nevada School of Medicine, Reno.
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