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OTC 2006 6-10 Year Retrospective Study of Regain Avoidance

Summary:

At eight (8) years, OTC patients (who completed the recommended aftercare program):

• Mean 15% of pretreatment body weight lost
• 90% maintained medically-significant weight loss
• Only 10% regained their lost weight
• 58% of pretreatment weight loss maintained

By comparison to other non-surgical studies:

• OTC with 18+ months behavioral aftercare: 15% at 8 years
• Weight Watchers: 3% at 2 years
• Best long-term study with aftercare: 3% at 8 years
• Best short-term study with aftercare: 9% at 2 years

Abstract:

Background: Numerous studies suggest a combination of medically-supervised diet, education and long-term behavioral aftercare is an effective combination to treat and manage obese patients.

Objective: To demonstrate the long-term efficacy of OTC's recommended behavioral therapy program on avoidance of regain in high-BMI patients.

Research Method and Procedures: Thirty obese patients (77% female, current mean age 55.3, 95% CI 52-59) who had completed at least four months of medically-supervised weight loss with at least 16 weeks of education (behavior/nutrition/exercise) followed by at least 18 months of post-diet behavioral therapy (OTC's recommended program) were randomly selected from a population of approximately 850 patients treated with weight loss and behavioral aftercare at the clinic from 2001 - 2004. Their outcomes were obtained and compared to a control group random sample of thirty obese patients, selected from the same population, who had completed an equivalent length of weight loss but did not participate in behavioral aftercare. Patients were asked a series of questions by telephone and asked to come into the clinic for measured weights. 75% of the focus group weights were measured in the clinic.

Results of Focus Group: At mean 8 years (95% CI 5.6 - 10.3 years) after initially presenting with mean body mass index (BMI) of 40.4 kg/m2 (95% CI 37.8 - 43.6 kg/m2) randomly selected patients completing at least four months of a medically-supervised Very Low Calorie Diet (VLCD) with education (behavior/nutrition/exercise) and OTC's recommended program of 18 months of behavioral aftercare had reduced their mean BMI to 33.7 kg/m2 (95% CI 31.8 -35.7 kg/m2), representing mean weight loss maintenance of 15% of pretreatment body weight (95% CI 10% - 20%) or 41.2 lbs (95% CI 26 - 56 lbs). The patients are exercising mean 180 min/wk (95% CI 124 - 237 min/wk). 90% had maintained medically-significant weight loss of at least 10%. Only 10% of the patients in the sample regained all their lost weight.

Results of Control Group: At mean 5.8 years (95% CI 3.6 - 8.0 years) after initially presenting with BMI of 34 kg/m2 (95% CI 30 - 37.9 kg/m2), randomly selected patients completing at least four months of a medically-supervised Very Low Calorie Diet (VLCD) with education (behavior/nutrition/exercise) but who did not participate in OTC's recommended program of 18 months of behavioral aftercare had reduced their mean BMI to 32.9 kg/m2 (95% CI 30.6 - 35.2), representing mean weight loss maintenance of 7.6% of initial body weight (95% CI 2.8% - 12.4%) or 6.7 lbs (95% CI negative 16 - +29 lbs). Half had maintained medically-significant weight loss of at least 10%. 22.7% of the patients regained all their lost weight. Unlike the focus group, in this group, two-thirds of the weights were self-reported, and those measured were, on average, 5% higher than the self-reported weights. (At the time of this writing, OTC had completed its study of the focus group but is still in the process of contacting the final eight patients in the control group, and obtaining additional measured weights. The remaining measurements are not expected to materially change the control group results.)

Conclusions: For high-BMI patients, OTC's multi-disciplinary combination of VLCD, 16+ weeks of education (behavioral/nutrition/exercise) followed by 18 months of behavioral aftercare provides significant weight loss with few and minor complications and with long-term efficacy comparable to surgical alternatives. The combination of reduced weight and accompanied increase in fitness likely leads to significant reduction in comorbitities. Without the aftercare component, the program still provides long-term medically-significant weight loss with likely therapeutic reduction in comorbidities, but not to the same extent.

Statement of Independence: This study was prepared and paid for by OTC as part of its own internal research program for the education of its staff and patients and to provide information often requested for referring physicians. It was not funded or sponsored by any product supplier or other third-party. OTC is a free-standing clinic, not affiliated with any product and does not accept fees, stipends or subsidies from any supplier.

© 2006 Obesity Treatment Center Medical Group. All Right Reserved. No portion of this manuscript may be used in support of a product/service or for any other reason without the explicit written authorization of the author.

National Outcomes

Published studies show that the combination of diet and behavioral therapy is effective and efficacious. OTC would appear on this chart as VLCD + BT, 58% at eight years.

Success rate defined as maintenance of all weight (100%) initially lost, or maintenance of at least 9 to 11 kg of the initial weight loss and time of observation in 21 study groups. VLCD, very-low-calorie diet; BT, behavior therapy; CD, conventional diet. Adapted from Ayyad and Andersen Obes Rev, 2000, 1,113-119.