The challenge of keeping it off, a descriptive systematic review of high-quality, follow-up studies of obesity treatments.

The aim of this systematic review is to answer the question: Is substantial, stable, and long‐term weight loss a viable goal for adults with obesity? To answer this question, we conducted a broad systematic search of non‐surgical and non‐pharmacological obesity treatment studies with the following strict criteria: (a) minimum 3‐year follow‐up, (b) 5% body mass lost, (c) no continued interventions in the follow‐up‐period, (d) prospective design, and (e) less than 30% attrition from the start of the follow‐up period. While the search revealed a very large number of published articles, only eight studies met the inclusion criteria. Several of the nonincluded studies report a majority of participants achieving satisfactory weight loss and little regain, especially among studies with continued interventions during the follow‐up period. In contrast, the eight high‐quality studies included in this study demonstrate a trend of weight regain towards pretreatment baseline. This review concludes that the majority of high‐quality follow‐up treatment studies of individuals with obesity are not successful in maintaining weight loss over time. The results suggest that excess weight can be lost but is likely regained over time, for the majority of participants

The effect of addition of modified guar gum to a low-energy semisolid meal on appetite and body weight loss

Int J Obes Relat Metab Disord 2001 Mar;25(3):307-15 Related Articles, Books, LinkOut The effect of addition of modified guar gum to a low-energy semisolid meal on appetite and body weight loss. Kovacs EM, Westerterp-Plantenga MS, Saris WH, Goossens I, Geurten P, Brouns F. Department of Human Biology, Maastricht University, Maastricht, The Netherlands. [email protected] OBJECTIVE: To investigate the effect of addition of modified guar gum (GG) to a low-energy semisolid meal on appetite and body weight (BW) loss. SUBJECTS: Twenty eight mainly overweight male volunteers (age, 19-56 y; body mass index, 29+/-2 kg x m(-2); BW, 89.4+/-9.2 kg). DESIGN: Baseline of one week with self-selected diet. Three treatments of 2 weeks with a low-energy diet divided over three times a day, consisting of a semisolid meal with (SSM+) or without GG (SSM) or a solid meal (SM) with the same energy content (947 kJ) and macronutrient composition, and a dinner of the subject's own choice. Washout periods lasted 4 weeks. RESULTS: Compared to baseline values, reduction in energy intake and BW loss were similar for SSM+, SSM and SM. Appetite (hunger, desire to eat or estimation of how much one could eat) was increased in SSM and in SM compared to baseline, but not in SSM+. Satiety and fullness in SSM+, SSM and SM were similar to baseline. Any intervention was more effective on BW loss when it took place the first time compared to the second and third times (2.6+/-0.2 kg, 1.7+/-0.2 kg and 1.1+/-0.2 kg, respectively; P<0.001). The SM-SSM+-SSM sequence was more effective on BW loss compared to the SSM+-SSM-SM sequence (5.6+/-1.0 and 2.5+/-0.6 kg, respectively; P<0.05). CONCLUSION: All the three treatments were equally effective with respect to BW loss. GG addition to a semisolid meal prevented an increase in appetite, hunger and desire to eat, which increase was present in the other treatments. However, differences between treatments were not statistically significant. The order effect shows that repeated 2-week bouts of dieting become increasingly ineffective. The sequence SM-SSM+-SSM was more effective than the sequence SSM+-SSM-SM, probably because compliance was relatively higher with the SSM+ or SSM diet, and compliance decreased towards the end of the complete experiment

Carbohydrate intake and obesity

The prevalence of obesity has increased rapidly worldwide and the importance of considering the role of diet in the prevention and treatment of obesity is widely acknowledged. This paper reviews data on the effects of dietary carbohydrates on body fatness. Does the composition of the diet as related to carbohydrates affect the likelihood of passive over-consumption and long-term weight change? In addition, methodological limitations of both observational and experimental studies of dietary composition and body weight are discussed. Carbohydrates are among the macronutrients that provide energy and can thus contribute to excess energy intake and subsequent weight gain. There is no clear evidence that altering the proportion of total carbohydrate in the diet is an important determinant of energy intake. However, there is evidence that sugar-sweetened beverages do not induce satiety to the same extent as solid forms of carbohydrate, and that increases in sugar-sweetened soft drink consumption are associated with weight gain. Findings from studies on the effect of the dietary glycemic index on body weight have not been consistent. Dietary fiber is associated with a lesser degree of weight gain in observational studies. Although it is difficult to establish with certainty that fiber rather than other dietary attributes are responsible, whole-grain cereals, vegetables, legumes and fruits seem to be the most appropriate sources of dietary carbohydrate. © 2007 Nature Publishing Group