Effects on body weight, eating behavior, and quality of life of a low-energy diet combined with behavioral group treatment of persons with class II or III obesity: A 2-year pilot study

Abstract

Objective: Obesity is associated with reduced health-related quality of life (HRQoL). Outcomes of nonsurgical weight loss treatment on HRQoL are inconsistent and it is unclear how much weight reduction, or what type of treatment, is required for significant improvements. This study aimed to evaluate the effects of a lifestyle intervention program on weight, eating behaviors, and HRQoL, and to describe participants' experiences of treatment.

Methods: This 2-year intervention trial in persons with class II or III obesity comprised a 3-month liquid low-energy diet (880 kcal/d) followed by a 3-month reintroduction to regular foods, combined with behavioral group treatment.

Results: Fifty-five participants (73% women) were included, mean (SD) age 43.2 (12.4) years, and mean body mass index 42.0 (6.0) kg/m². Mean weight loss at 6, 12, and 24 months was 18.9%, 13.7%, and 7.2%, respectively. Short- and long-term effects on eating behavior were favorable. Twelve of 14 HRQoL domains were improved at 6 months, compared to eight domains at 12 months. After 24 months, 2 of 14 domains, physical and psychosocial functioning, were improved. The treatment program was well accepted by the participants.

Conclusions: Substantial weight loss after 6 months was associated with extensive improvements in HRQoL, comprising the physical, psychosocial, and mental domains. Significant weight regain was observed between 6 and 24 months follow-up. Modest weight loss after 24 months was associated with moderate improvement in physical functioning and large improvement in psychosocial functioning. The effect on psychosocial functioning is most likely related to both weight loss and behavioral treatment.

Keywords: behavior therapy; eating behavior; low‐energy diet; quality of life; weight loss.

FIGURE 1

Percentage of participants who met different categorical weight losses (≥5%, ≥10%, and ≥15%) at 3, 6, 12, and 24 months after starting treatment, with follow‐up of 51, 47, 42, and 36 participants, respectively. The weight loss categories are cumulative

FIGURE 2

Comparison of the Short Form 36‐item Health Survey (SF‐36) health profile between the study group at baseline, and a gender‐ and age‐matched reference sample (n = 715) from the general Swedish population. All comparisons are significant (p < 0.001; Mann–Whitney U‐test). The scores for the SF‐36 scales range from 0 to 100, and higher scores indicate better health‐related quality of life (HRQoL). PF, physical functioning; RP, role physical; BP, bodily pain; GH, general health; VT, vitality; SF, social functioning; RE, role emotional; MH, mental health; SF‐36, Short Form 36‐item Health Survey. The effect sizes (Cohen's d) of the between‐group differences were: PF = 1.41, RP = 0.82, BP = 0.83, GH = 1.19, VT = 1.19, SF = 0.70, RE = 0.49, and MH = 0.63