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Interpreting weight losses from lifestyle modification trials: using categorical data

Abstract

Although studies in obese subjects using weight loss medications typically report mean and categorical weight loss, results from diet and exercise intervention trials typically only report mean weight change from baseline along with a level of significance. These data alone do not give clinicians or administrators the data needed to determine the probability that an individual will achieve clinically relevant weight loss. Thus, it is difficult to decide which patients, employees or health plan enrollee would benefit from the type and level of support used in a clinical trial. Our goal was to assess what fraction of subjects enrolled in lifestyle modification interventions achieved clinically significant weight loss. Thus, we requested categorical weight loss data from several investigators who had published results from studies involving either a high- or low-intensity lifestyle modification intervention arm. These categorical data indicate that a substantial fraction of subjects in each lifestyle modification intervention achieved clinically meaningful weight loss, even when the average weight loss is modest.

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References

  1. The US Department of Health and Human Services, Centers for Disease Control and Prevention. Obesity and Overweight. http://www.cdc.gov/nccdphp/dnpa/obesity/index.htm. (last updated 7 January 2009, Last accessed 9 January 2009).

  2. The Look AHEAD Research Group. The Look AHEAD study: a description of the lifestyle intervention and the evidence supporting it. Obesity 2006; 14: 737–752.

    Article  Google Scholar 

  3. Franz MJ, Van Wormer JJ, Crain AL, Boucher JL, Histon T, Caplan W et al. Weight-loss outcomes: a systematic review and meta-analysis of weight-loss clinical trials with a minimum of 1-year follow-up. J Am Diet Assoc 2007; 107: 1755–1767.

    Article  Google Scholar 

  4. Dansinger ML, Tatsioni A, Wong JB, Chung M, Balk EM . Meta-analysis: the effect of dietary counseling for weight loss. Ann Intern Med 2007; 147: 41–50.

    Article  Google Scholar 

  5. Tsai AG, Wadden TA . Systematic review: an evaluation of major commercial weight loss programs in the United States. Ann Intern Med 2005; 142: 56–66.

    Article  Google Scholar 

  6. Rucker D, Padwal R, Li SK, Curioni C, Lau DC . Long-term pharmacotherapy for obesity and overweight: updated meta-analysis. Br Med J 2007; 335: 1194–1199.

    Article  CAS  Google Scholar 

  7. Douketis JD, Macie C, Thabane L, Williamson DF . Systematic review of long-term weight loss studies in obese adults: clinical significance and applicability to clinical practice. Int J Obes 2005; 29: 1153–1167.

    Article  CAS  Google Scholar 

  8. Crémieux PY, Ghosh A, Yang HE, Buessing M, Buchwald H, Shikora SA . Return on investment for bariatric surgery. Am J Manag Care 2008; 14: e5–e6.

    PubMed  Google Scholar 

  9. The Disease Management Association of America. Obesity Toolkit. DMAA: Washington DC, 2008.

  10. National Institutes of Health. National Heart, Lung and Blood Institute. Clinical guidelines on the identification, evaluation and treatment of overweight and obesity in adults. The evidence report. Obes Res 1998; 6 (Suppl 2): 51S–209S.

    Google Scholar 

  11. US Department of Health and Human Services Food and Drug Administration Center for Drug Evaluation and Research. (2007). Guidance for Industry: Developing Products for Weight Management http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/ucm071612.pdf (last accessed 14 August 2007).

  12. Klein S, Burke LE, Bray GA, Blair S, Allison DB, Pi-Sunyer X et al., American Heart Association Council on Nutrition, Physical Activity, and Metabolism. Clinical implications of obesity with specific focus on cardiovascular disease: a statement for professionals from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation. Circulation 2004; 110: 2952–2967.

    Article  Google Scholar 

  13. Cummings DE, Flum DR . Gastrointestinal surgery as a treatment for diabetes. JAMA 2008; 299: 341–343.

    CAS  PubMed  Google Scholar 

  14. Diabetes Prevention Program Research Group. Effect of weight loss with lifestyle intervention on risk of diabetes. Diabetes Care 2006; 29: 2102–2107.

    Article  Google Scholar 

  15. NHLBI Obesity Education Initiative Expert Panel on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. The practical guide identification, evaluation, and treatment of overweight and obesity in adults. http://www.nhlbi.nih.gov/guidelines/obesity/prctgd_c.pdf (last accessed 25 June 2009).

  16. Rissanen A, Lean M, Rössner S, Segal KR, Sjöström L . Predictive value of early weight loss in obesity management with orlistat: an evidence-based assessment of prescribing guidelines. Int J Obes 2003; 27: 103–109.

    Article  CAS  Google Scholar 

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Acknowledgements

Dr Bessesen receives support from NIH DK02935, the other authors received no support.

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Correspondence to J G Christian.

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Christian, J., Tsai, A. & Bessesen, D. Interpreting weight losses from lifestyle modification trials: using categorical data. Int J Obes 34, 207–209 (2010). https://doi.org/10.1038/ijo.2009.213

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