5 Steps to prevent Heart Disease

Wednesday, October 21, 2015

Another Look at Look Ahead #1

This is a recent slide from OMA that Ethan Lazarus presented. 

This is a negative outcome lifestyle trial. 
39% maintained greater than 10% weight loss for eight years.  Excellent result.  People who achieved this goal at one year increase exercised to 200 minutes a week to maintain weight loss.
14% gained 5% weight after eight years. 
However, then you look at the control results (DSE).
24% of the control group lost more than 10% of weight after 8 years.  WOW!
Take note:  This shows typical WATERFALL results of all diet trials
I would like to see this type of chart for the control group. 
I would also like to see the results extended out to the full 9.6 years.
Amazingly, only 4% were lost to follow up.  Intention to treat analysis was done. 

Quote from the NEJM paper:
"Weight loss was greater in the intervention group than the control group throughout
 (8.6% vs. 0.7% at 1 year; 6.0% vs. 3.5% at study end)."

Below is a quote from the NEJM study supplement:

“ILI participants were given a calorie goal
of 1200-1500 kcal/day for those who weighed less than 114 kg (250 lbs) and
1500 to 1800 kcal/day for those over 114 kg.
They were encouraged to consume
30% of total calories from fat and at least 15% of calories from protein.”

“Meal replacement products were provided at no cost to help participants adhere to their dietary goals.
During weeks 3 to 19 of the program, individuals were encouraged to replace two meals each day with a liquid shake and one snack with a bar.
The other meal (typically dinner) consisted of conventional foods;
fruits and vegetables were added to reach the calorie goal.
From week 20 on, meal replacements were typically used for one meal per day with conventional foods consumed at the other times.”

“To maximize weight loss, a tool box of additional strategies was available for use with participants after month 6 if the individual had not achieved the 10% weight loss. The tool box included orlistat, a weight loss medication. However, since minimal weight loss benefit was observed with orlistat, the use of this medication was discontinued in 2008.”

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