Changes in body composition, cardiovascular disease risk factors, and eating behavior after an intensive lifestyle intervention with high volume of physical activity in severely obese subjects: a prospective clinical controlled trial

Abstract

We examined the effects of a 10-14-weeks inpatient lifestyle modification program, including minimum 90 min of physical activity (PA) five days/week, on body composition, CVD risk factors, and eating behavior in 139 obese subjects (BMI 42.6 ± 5.2 kg/m²). Completion rate was 71% (n = 71) in the intensive lifestyle intervention (ILI) group and 85% (n = 33) among waiting list controls. Compared to controls body weight (-17.0 (95% CI: -18.7, -15.3) kg, P < 0.0001), fat mass (-15.2 (95% CI: -17.4, -13.1) kg, P < 0.0001), fat free mass (-1.2 (95% CI: -2.2, -0.2) kg, P = 0.016) and visceral fat (-86.6(95% CI: -97.4, -75.7) cm², P < 0.0001) were reduced in the ILI-group after 10-14 weeks. Within the ILI-group weight loss was -23.8 (95% CI: -25.9, -21.7) kg, P < 0.0001 and -20.3 (95% CI: -23.3, -17.3) kg, P < 0.0001, after six and 12 months, respectively. Systolic BP, glucose, triglycerides, and LDL-C were reduced, and HDL-C was increased (all P ≤ 0.006) after 10-14 weeks within the ILI group. The reduction in glucose and increase in HDL-C were sustained after 12 months (all P < 0.0001). After one year, weight loss was related to increased cognitive restraint and decreased uncontrolled eating (all P < 0.05). Thus, ILI including high volume of PA resulted in weight loss with almost maintenance of fat-free mass, favorable changes in CVD risk factors, and eating behavior in subjects with severe obesity.

Trial registration: ClinicalTrials.gov NCT01675713.

Figure 1

The schedule of the nonrandomised controlled clinical trial and the prospective follow-up study; participant recruitment, assessments, and stays during the lifestyle programme at NIMI Ringerike.

Figure 2

Flow of participants throughout the study.

Figure 3

(a) Mean (95% CI) percentage weight loss during followup. (b) Mean (95% CI) percentage reduction in VFA during followup. (c) Mean (95% CI) percentage reduction in FM during followup.

Figure 4

BMI value for each subject within the ILI-group at week 0, week, 10–14, six, and 12 months. Note: two subjects had a BMI < 35 kg/m² at week 0 due to a small weight reduction between the time of referring and the start of the treatment program.

Figure 5

The prevalence of metabolic syndrome within the ILI-group at week 0, weeks 10–14, six, and 12 months (n = 52). P < 0.0001 for change in the proportion of participants diagnosed with metabolic syndrome across the four measurement time points (Cochran's Q test).

Figure 6

Mean (95% CI) scores of eating behavior (TFEQ-21) at week 0, weeks 10–14, six, and 12 months followup. ^# P < 0.007 for differences in changes between ILI-group and controls, *P < 0.02 for changes within the ILI-group from weeks 10–14 to six months, **P = 0.012 for changes within the ILI-group from six to 12 months, and ***P < 0.04 for changes within the ILI-group from week 0 to 12 months.