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BMJ 2010; 341 doi: (Published 03 November 2010) Cite this as: BMJ 2010;341:c6169

A diet and exercise programme works for severely obese people

Severely obese people can lose weight with a lifestyle change programme, and it is better if exercise is started earlier rather than later. In a recent trial, all 130 participants received diet instructions, which prescribed an individualised daily allowance in energy intake and a food composition of up to 30% fat, 55% carbohydrates, and 25% protein. For the first three months of this 12 month trial, participants received two prepackaged replacement meals a day but only one meal in months four to six. In addition, all participants were asked to walk briskly for one hour on five days each week; this could be achieved by accumulating 10 minute bouts.

Two approaches were tested in a randomised manner: starting exercise at study onset or delaying it to six months into the trial. Support was delivered through group, individual, or telephone contacts. All participants had a body mass index of 35 or above and none had diabetes.

At six months, those randomised to early exercise lost more weight than those who received delayed physical activity (10.9 kg v 8.2 kg; P=0.02). The difference wasn’t significant at one year though (12.1 kg v 9.9 kg). On average, all participants lost about 10% body weight, reduced their body mass index by 10 points, and lost about 10 centimetres in waist circumference. Reductions in visceral and subcutaneous fat were seen, as well as improvements in other cardiometabolic risk factors, such as fat in the liver and insulin resistance.

Current guidelines discourage conservative treatments for weight loss and weight maintenance in severely obese people, but this needs to be rethought, says the editorial (p 1835). We need more trials of such interventions and better coverage from payers.

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