肥満と減量療法のジャーナル

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A Physician-Directed Commercial Low Calorie Diet with Intensive Behavioral Modification Decreases Metabolic Syndrome and Medication Use

Bobbie G Paull-Forney, Frank Dong, Justin B Moore, Jeanene J Fogli, Linda D Gotthelf, James L Early, Elizabeth Ablah

Background: In light of recent Centers for Medicare and Medicaid Services (CMS) recommendations on behavioral therapy for obesity, it is important to assess the outcomes of physician-directed low-calorie diet (LCD) interventions on metabolic risk factors. The aim of this study was to determine the effect of participation in a physiciandirected LCD program coupled with an intensive behavioral intervention on parameters of metabolic syndrome (MetS) and medication usage. Methods: This was a retrospective chart review of 445 participants, who completed at least 12 weeks in a community-based medical weight loss program. MetS was defined using the National Cholesterol Education Program/ Acute Treatment Panel III diagnostic criteria. Logistic regression analysis was conducted to identify factors predicting the MetS status at week 12. Results: Sixty eight percent of participants completing twelve weeks of the program achieved ≥10% initial body weight loss (IBWL). The mean weight loss is 11.8 %IBW. Proportions of participants meeting NCEP/ATP III criteria for MetS decreased for: waist circumference (100% at baseline vs 93.4% at week 12), triglycerides (51.8% at baseline vs 32.1% at week 12), fasting plasma glucose (60.1% at baseline vs 40.8% at week 12) and blood pressure (81.4% at baseline vs 61.1% at week 12). The prevalence of MetS decreased from 96% (n=248) at baseline to 67.8% (n=175) at week 12. Younger age, lower baseline BMI, and higher %IBWL were associated with an increased likelihood of MetS remission at week 12. Use of hypoglycemic and anti-hypertensive agents decreased by 27.5% and 12.8%, respectively, and doses of hypoglycemic and anti-hypertensive agents decreased for 75.3% and 40.4% of participants, respectively. Conclusions: A physician-directed low-calorie diet coupled with an intensive behavioral intervention is an effective option for achieving weight loss, improving individual metabolic risk factors, and reducing the overall need for hypoglycemic and anti-hypertensive medications.