Lifestyle interventions can work – even for the severely obese

The severely obese are often treated as hopeless cases when it comes to weigh loss programs and are often referred for more radical treatments such as bariatric surgery.

However, recent results from the Re-Energize with Nutrition, Exercise and Weight Loss (RENEW) trial actually indicate that lifestyle interventions can work even for the extremely obese.

Researcher and lead author Dr Bret H Goodpaster of University of Pittsburgh says:

“One of the goals of the study was to see whether these traditional, although intensive, structured diet and exercise programs could be an alternative to bariatric surgery.  A lot of people, frankly, have given up on the extremely obese. . . . This is among the first steps to providing the evidence that these kinds of interventions can work. They don’t always work in everyone, but they can. And I think it’s part of the solution in these patients.”

The RENEW interventions consisted of 2 types given randomly to 2 groups of patients:

• Group 1: Combination of diet and exercise for 12 months¨
• Group 2: Diet intervention for 12 months plus physical exercise delayed 6 months after study start.

Physical exercise consisted of a 20-minute brisk walk each day, five days per week which was gradually increased to 60 minutes per day. Also part of the intervention are face-to-face  group and individual meetings for the first 6 months and telephone support substituted for some of the group meetings during the 2^nd half of the study.

The study included individuals who had a body mass index (BMI) of over 40 (Obese Class III).

The results showed:

• Significant weight loss in both groups was observed, with greater weight loss in group 1 during the first 6 months . After 12 months, no significant difference between the 2 groups was observed.
• Improvements in blood pressure, insulin resistance, and triglycerides and reductions in waist circumference were also observed after 12 months.

Research evidence is accumulating that lifestyle interventions are effective in managing a wide range of chronic conditions such as diabetes and cardiovascular conditions – and now, in this study – even severe obesity. Despite all these, health insurance companies seldom reimburse these types of interventions but would rather pay for bariatric surgery. Health experts are lamenting this rather shortsighted policy, considering the health risks involved with surgery.

Dr Donna Ryan of the Louisiana State University System in Baton Rouge says:

“So here we have a treatment that works and it’s cost-effective, and it’s just a darn shame that they won’t reimburse for that. It goes back to obesity bias. There’s this pervasive notion that people can do this by themselves, and they can’t.”