Authors
Toubro S. Astrup A.
Institution
Research Department of Human Nutrition, Royal Veterinary and Agricultural
University, Copenhagen, Denmark.
Title
Randomised comparison of diets for maintaining obese
subjects' weight after major weight loss: ad lib, low fat, high carbohydrate
diet v fixed energy intake.
Source
BMJ. 314(7073):29-34, 1997 Jan 4.
Abstract
OBJECTIVES: To compare importance of rate of initial weight loss for long
term outcome in obese patients and to compare efficacy of two different
weight maintenance programmes. DESIGN: Subjects were randomised to either
rapid or slow initial weight loss. Completing patients were re-randomised to
one year weight maintenance programme of ad lib diet or
fixed energy intake diet. Patients were followed up one year
later. SETTING: University research department in Copenhagen, Denmark.
SUBJECTS: 43 (41 women) obese adults (body mass index 27-40) who were
otherwise healthy living in or around Copenhagen. INTERVENTIONS: 8 weeks of
low energy diet (2 MJ/day) or 17 weeks of conventional
diet (5 MJ/day), both supported by an anorectic compound
(ephedrine 20 mg and caffeine 200 mg thrice daily); one year weight
maintenance programme of ad lib, low fat, high carbohydrate
diet or fixed energy intake diet (< or =
7.8 MJ/day), both with reinforcement sessions 2-3 times monthly. MAIN OUTCOME
MEASURES: Mean initial weight loss and proportion of patients maintaining a
weight loss of > 5 kg at follow up. RESULTS: Mean initial weight loss was
12.6 kg (95% confidence interval 10.9 to 14.3 kg) in rapid weight loss group
and 12.6 (9.9 to 15.3) kg in conventional diet group. Rate
of initial weight loss had no effect on weight maintenance after 6 or 12
months of weight maintenance or at follow up. After weight maintenance
programme, the ad lib group had maintained 13.2 (8.1 to 18.3) kg of the
initial weight loss of 13.5 (11.4 to 15.5) kg, and the fixed energy intake
group had maintained 9.7 (6.1 to 13.3) kg of the initial 13.8 (11.8 to 15.7)
kg weight loss (group difference 3.5 (-2.4 to 9.3) kg). Regained weight at
follow up was greater in fixed energy intake group than in ad lib group (11.3
(7.1 to 15.5) kg v 5.4 (2.3 to 8.6) kg, group difference 5.9 (0.7 to 11.1)
kg, P < 0.03). At follow up, 65% of ad lib group and 40% of fixed energy
intake group had maintained a weight loss of > 5 kg (P < 0.07). CONCLUSION:
Ad lib, low fat, high carbohydrate diet was superior to
fixed energy intake for maintaining weight after a major weight loss. The
rate of the initial weight loss did not influence long term outcome.