The long term effectiveness of combined therapy by behavior modification and very low calorie diet: 2 years follow-up

Seventy refractory obese subjects were assigned to one of three treatments; (a) very low calorie diet (VLCD) alone; (b) behavior modification alone; and (c) combined therapy by VLCD and behavior modification. Fifteen obese patients were treated by VLCD for 1-2 months on the outpatient clinic; 16 obese patients were treated by a combined therapy and 39 subjects were treated by behavior modification alone. Formula diet used in this program was Optifast 70 (420 kcal/day). The behavior modification had been performed for 4 months with eight group meetings, using the revised textbook based on the Learn Program (University of Pennsylvania). Effects on weight reduction and its maintenance during 2 years follow-up were compared in each treatment group. There were no significant differences between average weight loss of patients treated by VLCD (7.5 +/- 2.1 kg/month) and that attained by the combined therapy (8.3 +/- 2.3 kg/month). At 2 years after the termination of the VLCD treatment, 67 percent of patients had regained more than half of their reduced weight, with an average weight regain of 4.3 +/- 3.5 kg. In contrast, 12 of 16 (75 percent) and 33 of 39 (85 percent) patients had maintained their reduced weight for 2 years after the combined therapy or the behavior modification program. Continuing weight loss of 1.0 +/- 0.7 kg by the combined therapy and 1.3 +/- 2.2 kg by the behavior modification were observed at 2 years of follow-up. Weight reducing effect of combined therapy by behavior modification and VLCD was almost identical with that obtained by VLCD alone in a short term observation of one month.(ABSTRACT TRUNCATED AT 250 WORDS)