Backed by More than 60 Published Research Articles
Published Scientific and Research Articles
Osteoarthritis in Obese Individuals
Clinical Context
Obesity and osteoarthritis both reduce mobility. Obesity is a risk factor for osteoarthritis. Osteoarthritis causes overweight or obese people to exercise less and possibly eat more than is appropriate for their low activity levels.
Women with osteoarthritis have slightly reduced lean mass relative to body weight. Therefore, losing and maintaining weight is difficult for people with osteoarthritis. Many individuals may have complicating factors for cardiovascular disease, which could mean that bariatric surgery might not be an option even if otherwise eligible. Therefore, a new solution for weight problems in osteoarthritis is needed.
192
Patients
16 sem.
Total Duration
+12%
Weight Lost
60%
Symptom Relief
Study Methodology
One hundred and ninety-two patients were treated with very low calorie diets (415 to 540 kcal/d) or low calorie diets (810 kcal/d) as liquid diets for eight weeks, followed by a 1,200 kcal/d diet (which included two formula diet portions) for 8 weeks, combined with weekly group education, giving a total of 17 sessions.
Results
More than 12% of initial body weight was lost in both groups, with 60% having a good symptom response in both groups.
Eight out of 96 dropped out from the very low calorie diet group; 6 out of 96 dropped out from the low calorie diet group.
Thus, for this group of individuals there appears to be no advantage in terms of weight loss from using a very low calorie diet over a low calorie diet.
Implications of the Results
A good method of weight loss and maintenance for obese people with osteoarthritis is weight loss sufficient to reduce symptoms, above all pain, and improve mobility and maintain or improve body composition (fat loss, lean tissue retention), improvement of cardiovascular risk and improve or maintain vitamin D status and bone health (during and after weight loss remodelling, which usually results in mineral loss).
Thus, the weight loss approach with the formula diet programmes described in this paper has been shown to deliver a package of health benefits rather than simply weight loss and its maintenance.
Documented Benefits Package
- 1
The evidence relating to obesity and osteoarthritis is reviewed in: Bliddal H, Leeds AR, Christensen R. Osteoarthritis and weight loss. Hard facts, hypotheses and horizons: a scoping review. Obesity Reviews 2014; 15(7):578-86. doi:10.1111/obr.12173. Epub 2014 Apr 22.
- 2
Christensen P, Bliddal H, Riecke BF, Leeds AR, Astrup A, Christensen R. Comparison of low-calorie and very low-calorie diets in sedentary obese individuals: a pragmatic randomised controlled trial in clinical obesity. First published online: 21 MAR 2011 | DOI: 10.1111/j.1758-8111.2011.00006.x.
- 3
Riecke BF, Christensen R, Christensen P, Leeds AR, Boesen M, Lohmander LS, Astrup A, Bliddal H. Comparing two low-energy diets for the treatment of knee osteoarthritis symptoms in obese patients: a randomised clinical trial. Osteoarthritis and Cartilage 2010; 10/1016/j.joca.
Obstructive Sleep Apnoea in Obese Individuals
Clinical Context
Sleep apnoea can originate due to problems in a part of the brain that controls breathing. Obstructive sleep apnoea (OSA) is caused by a blockage in airflow, due to excess fat in the tissue near where air normally passes, and also failure of nearby muscles.
Obstructive sleep apnoea is said to occur when airflow through the mouth and nose stops for more than 10 seconds at least 30 times in 7 hours of sleep. Some surveys indicate that one in four people with diabetes mellitus may have OSA, others that four in five obese people with diabetes suffer from it. There are no precise data on the OSA rate for the general population; perhaps one in 25 or more. Obstructive sleep apnoea may be a factor in raising blood pressure. Those who have suffered but survived a heart attack typically reveal they had sleep apnoea before the event. Sleep apnoea is therefore a condition best avoided.
63
Patients
9 sem.
VLCD Phase
-12 kg
Weight Lost
17 u.
AHI Improvement
Does obstructive sleep apnoea really matter?
OSA causes sleep interrupted by pauses in breathing during sleep. But it can also cause ineffective rest and the sufferer falling asleep at work. Quality of life can be seriously affected by everyday fatigue, poor concentration, irritability, forgetfulness, morning headaches and sexual dysfunction.
What causes sleep apnoea?
Factors linked to OSA include variations in the size and shape of the upper airway, excess weight, and a genetic history of the condition. Scientific studies indicate that the airways in obese individuals are thicker, which obstructs airflow.
This article is important because
It is the first randomised controlled analysis using VLCD in severe and moderate sleep apnoea.
It provides high-quality evidence about the outcome of VLCD diets on weight loss and, consequently, improving OSA symptoms in male patients.
After 9 weeks, those in the control group moved to follow the 9-week diet. All patients were offered a maintenance programme with ongoing support, as well as the option to use a formula product to maintain weight for 1 year.
Results After 1 Year
After 1 year, apnoea-hypopnoea indices improved by 17 units, while body weight was 12 kg less than at the start. 30 out of 63 subjects no longer required CPAP and 6 out of 63 achieved full remission. Those who lost the most weight or had the highest sleep apnoea index benefited most.
- 1
Johansson K, et al. Longer term effects of very low energy diet on obstructive sleep apnoea in cohort derived from randomised controlled trial prospective observational follow-up study. BMJ 2011: 342:d3017 doi: 10.1136/bmj.d3017.
- 2
Foster DG, Borradiale KE, Sanders MH, et al. Randomised study on the effect of Weight loss in obstructive sleep apnea among obese patients with type 2 diabetes. Arch Int Med 2009; 169 (17): 1619-1626.
- 3
Tuomilehto HPI, Seppä JM, Partinen MM et al. Lifestyle intervention with weight reduction: first line treatment in mild obstructive sleep apnoea. Am J Respir Crit Care Med 2009; 179: 320-327.
- 4
Johansson K, Neovius M, Lagerro YT, Harlid R, Rossner S, Granath F, Hemmingsson E. Effect of a very low energy diet on moderate and severe obstructive sleep apnoea in obese men: a randomised controlled trial. BMJ 2009; 339: b4609 doi: 10.1136/bmj.
Weight Maintenance After Loss with a VLCD or LCD Formula Diet
Context
There is a belief that weight regain occurs rapidly after using a VLCD or LCD formula, probably reflecting the failure of nutritionists to implement an effective maintenance strategy. How to maintain a low energy intake diet and higher physical activity are topics that have been under research for years.
3,017
Participants
20
Studies
-12.3 kg
VLCD/LCD Average
27
Analysis Arms
Meta-analysis Methodology
This meta-analysis was designed to evaluate the effects of anti-obesity medications (sibutramine and orlistat), diet or exercise on weight maintenance after a VLCD or LCD. It consisted of a systematic review of English-language articles using MEDLINE, Cochrane Controlled Trial Register and EMBASE, from 1981 to February 2013, engaging expert physicians in the field. Included studies were controlled randomised trials specifically evaluating weight maintenance strategies following a VLCD or LCD.
20 studies, 27 arms and a total of 3,017 participants were included: anti-obesity drugs (3 arms, n=658), meal replacement (4 arms, n=322), high-protein diets (6 arms, n=865), dietary supplements (6 arms, n=261), other diets (3 arms, n=564) and exercise (5 arms, n=347).
During the VLCD/LCD period, the average weight lost was 12.3 kg (median duration: 8 weeks, ranging from 3–16).
Results Compared with Placebo or Control
Compared with placebo or control, the intervention significantly changed weight loss maintenance:
Anti-obesity medications: 3.5 kg less (95% CI -5.5, -1.5; median duration 18 months, range 12–36).
Meal replacement: 3.9 kg less (95% CI -5.0, -2.8; median duration 12 months, range 10–26).
High-protein diets: 1.5 kg less (95% CI -2.1, -0.8; median duration 5 months, range 3–12).
In contrast to the above results, the differences between the following groups were not significant:
Exercise: 0.8 kg (95% CI -2.8, 1.2; median duration 10 months, range 6–12).
Dietary supplements: 0.0 kg (95% CI -1.4, 1.4; median duration 3 months, range 3–14).
Consequently, anti-obesity medications, meal replacements and high-protein diets were associated with improved weight maintenance after using a VLCD or LCD.
Conclusion
Since sibutramine has been withdrawn from Europe, the only current interventions with improvements in weight maintenance after a VLCD or LCD are orlistat, conventional meal replacement with a formula diet, and the use of a high-protein diet.
Original Article
(Article in English)
Not available - 1
Effects of anti-obesity drugs, diet and exercise on weight loss maintenance after a very low-calorie diet or low-calorie diet: a systematic review and meta-analysis of randomised controlled trials. Johansson K, Neovius M, Hemmingsson E. Am J Clin Nutr 2013 published online 30 October 2013.
Transition to Primary Care
Main Result
A care package that includes initial weight loss with a Cambridge Weight Plan programme, followed by food reintroduction and weight maintenance (Counterweight Programme) produced a reduction of more than 15 kg after 1 year in one third of participants.
91
Participants
BMI >40
Clinical Profile
-15 kg
In 1 Year
1/3
Achieved It
Study Description
The study, presented in February 2013 in The British Journal of General Practice by Professor Mike Lean and colleagues from the University of Glasgow and the Counterweight programme team, describes the outcomes of a weight loss intervention in 91 people with BMI >40 living in rural areas or small towns in Scotland.
Severe obesity is increasing rapidly in Scotland: 6% of men and 11% of women are subjects with a BMI greater than 35, and for those over 55 years old, results indicate 3% of men and 5% of women with BMI above 40. Potentially eligible for surgery, some of these cases with BMI exceeding 40 are ineligible for that treatment in those circumstances, as they still require a loss of between 15 and 20 kg for their metabolism to function adequately.
Formula diet programmes, offering a nutrient-complete diet, achieve a lower energy intake deficit than conventional diets. These higher rates of weight reduction have been shown to be safe and the mass losses achieved notable results in older individuals with osteoarthritis (Christensen et al 2011).
Participants in these trials were individuals with a long history free of diabetes; therefore, there is now a need to conduct a similar study in those with type 2 diabetes. Strategies to reduce dropout still need to be refined, as do methods to maintain weight after 1 year.
Two Evaluated Interventions
In the trial for weight loss in individuals with osteoarthritis, participants were randomly assigned to 2 groups to take part in 2 active programmes.
Programme 1
Daily use of a formula product as a meal substitute to help reduce calorie intake to 400 kcal/d after a 15 kg loss, along with close monitoring and use of an 800 kcal/d liquid diet if weight were to increase by more than 2 kg.
Programme 2
The opportunity for 5 weeks on an 800 kcal/d liquid diet every 4 months. This randomised trial will determine whether it is possible to maintain weight and which of the 2 interventions produces the best results.
- 1
Weight loss and maintenance with formula diet now feasible in primary care. Lean M, Brosnahan N, McLoone P, McCombie L, Bell-Higgs A, Ross H, Mackenzie M, Grieve E, Finer N, Reckless J, Haslam D, Sloan B, Morrison D. Feasibility and indicative results from a 12-month low-energy-liquid-diet treatment and maintenance programme for severe obesity. Br J Gen Pract 2013; DOI: 10.3399/bjgp13X663073.
Psoriasis
Clinical Context
Psoriasis is a recurring chronic inflammatory skin condition characterised by patches of thick, scaly redness, which vary depending on circumstances. Genetic and environmental factors play an important role in the development of psoriasis. It is associated with obesity, as it is not observed in very thin individuals, and may be more severe when mass increases. Until the publication of the work described here, there was no medical evidence that weight reduction was beneficial.
60
Patients
800–1,000
kcal/day CWP
-15.4 kg
More than control
DLQI
Improved Index
Methodology and Results
60 patients presenting with obesity and psoriasis were randomised to regular weight control or to a Cambridge Weight Plan diet of 800–1,000 kcal/d, followed by a 1,200 kcal/d diet for 8 weeks as preparation for a maintenance programme.
The diet-treated group lost 15.4 kg more than the group under regular control. The dermatological quality index (DLQI) improved significantly after the diet, compared with the regular control group, and the psoriasis area and severity index (PASI) showed major improvement.
Results will be presented in late 2014.
- 1
Effect of Weight Loss on the severity of Psoriasis. Jensen, P., et al. JAMA Dermatol doi: 10.1001/jamadermatol.2013.722 (published on line 29 May 2013).
- 2
Miller IM, Ellervik C, Yazdanyar S, et al. (2013) Meta-analysis of psoriasis, cardiovascular disease, and associated risk factors. J Am Acad Dermatol 69: 1014-24.
- 3
Jensen P, Zachariae C, Christensen R et al. (2014) Effect of Weight Loss on the Cardiovascular Risk Profile of Obese Patients with Psoriasis. Acta Derm Venereol doi: 10.2340/00015555-1824.
- 4
Geiker N R W, Jensen P, Zachariae C et al. (2014) Effect of weight loss on the severity of psoriasis: one year follow-up. T5: S41.04. Obesity Reviews 15(S2): 170-1. doi: 10.1111/obr.12151/
Osteoarthritis — Additional Articles
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Improved nutritional status and bone health after diet-induced weight loss in sedentary osteoarthritis patients: a prospective cohort study
(Article in English)
P Christensen, EM Bartels, BF Riecke, H Bliddal, AR Leeds, A Astrup, K Winther and R Christensen. European Journal of Clinical Nutrition (2012) 66, 504–509; doi:10.1038/ejcn.2011.201; published online 21 December 2011.
Effects of an intensive weight loss program on knee joint loading in obese adults with knee osteoarthritis
(Article in English)
P Christensen, EM Bartels, BF Riecke, H Bliddal, AR Leeds, A Astrup, K Winther and R Christensen. European Journal of Clinical Nutrition (2012) 66, 504–509; doi:10.1038/ejcn.2011.201; published online 21 December 2011.
Comparing two low-energy diets for the treatment of knee osteoarthritis symptoms in obese patients: a pragmatic randomized clinical trial
(Article in English)
P Christensen, EM Bartels, BF Riecke, H Bliddal, AR Leeds, A Astrup, K Winther and R Christensen. European Journal of Clinical Nutrition (2012) 66, 504–509; doi:10.1038/ejcn.2011.201; published online 21 December 2011.
Comparison of a low-energy diet and a very low-energy diet in sedentary obese individuals: a pragmatic randomized controlled trial
(Article in English)
P Christensen, EM Bartels, BF Riecke, H Bliddal, AR Leeds, A Astrup, K Winther and R Christensen. European Journal of Clinical Nutrition (2012) 66, 504–509; doi:10.1038/ejcn.2011.201; published online 21 December 2011.
Sleep Apnoea — Additional Articles
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Effect of a very low energy diet on moderate and severe obstructive sleep apnoea in obese men: a randomised controlled trial
(Article in English)
Kari Johansson, PhD student, Martin Neovius, postdoctoral research fellow, Ylva Trolle Lagerros, physician, Richard Harlid, physician, Stephan Rössner, professor, Fredrik Granath, statistican, Erik Hemmingsson, postdoctoral research fellow. BMJ 2009;339:b4609 doi:10.1136/bmj.b4609.
Does medically induced weight loss improve obstructive sleep apnoea in the obese: review of randomized trials
(Article in English)
P Christensen, EM Bartels, BF Riecke, H Bliddal, AR Leeds, A Astrup, K Winther and R Christensen. European Journal of Clinical Nutrition (2012) 66, 504–509; doi:10.1038/ejcn.2011.201; published online 21 December 2011.
Effect of a very low-energy diet on moderate and severe obstructive sleep apnoea: case reports
(Article in English)
P Christensen, EM Bartels, BF Riecke, H Bliddal, AR Leeds, A Astrup, K Winther and R Christensen. European Journal of Clinical Nutrition (2012) 66, 504–509; doi:10.1038/ejcn.2011.201; published online 21 December 2011.
Diabetes — Additional Articles
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Using a low energy formula diet in obese patients with long-standing insulin-treated Type 2 diabetes produces significantly greater weight loss, improvement in glucose control and insulin reductions compared to gold standard clinical care over a 12 week period
(Article in English)
AC Brown, S Taheri, A Dornhorst, N Kapoor, B McGowan, AR Leeds and G Frost.
VLED and formula LED in the management of type 2 diabetes: defining the clinical need and research requirements
(Article in English)
Lean, M. Clinical Obesity 2011; 1(1): 41-49. DOI: 10.1111/j.1758-8111.2010.00007.x.
A systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes: 0·5 could be a suitable global boundary value
(Article in English)
Lucy M. Browning, Shiun Dong Hsieh and Margaret Ashwell. Nutrition Research Reviews (2010), 23, 247–269. doi:10.1017/S0954422410000144.
National Diabetes Institute Malaysia Diabetes Asia 2010 Conference. Sleep Apnoea, Obesity and Diabetes – Mechanisms and Treatment
(Article in English)
Anthony R Leeds. University of Surrey UK, University of Copenhagen Denmark, and Cambridge Weight Plan. October 6th to 10th 2010, Kuching, Sarawak, Malaysia.
Trials — Additional Articles
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Comparison of a low-energy diet and a very low-energy diet in sedentary obese individuals: a pragmatic randomized controlled trial
(Article in English)
P. Christensen, H. Bliddal, B. F. Riecke, A. R. Leeds, A. Astrup and R. Christensen. Clinical Obesity © 2011 International Association for the Study of Obesity. doi: 10.1111/j.1758-8111.2011.00006.x.
A weight loss formula diet improved vitamin D status in obese, older individuals: a cohort study exploring safety in a randomised controlled trial
(Article in English)
Christensen P, Bartels EM, Riecke BF, Bliddal H, Leeds AR, Astrup A, Winther K, Christensen R. Obesity Reviews 2011; 12 (Suppl 1) 59-60 (T5:OS3.4).
Improved nutritional status after a weight loss formula diet: a cohort study exploring safety in a randomised controlled trial
(Article in English)
Christensen P, Riecke BF, Bliddal H, Leeds AR, Astrup A, Winther K, Christensen R. Obesity Reviews 2010; 11 (suppl 1): 247 (T3:PO.81).
Rheumatology · Surgery · Psoriasis
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Rheumatology
Osteoarthritis – a role for weight management in rheumatology practice: an update
(Article in English)
H. Bliddal, P. Christensen, B. F. Riecke, J. Aaboe, R. Frederiksen, E. Bartels, R. Christensen. © 2011 The Authors Clinical Obesity © 2011 International Association for the Study of Obesity. DOI: 10.1111/j.1758-8111.2010.00008.x.
Surgery
Ergem: effects of roux-en-y gastric bypass surgery on energy metabolism
(Article in English)
Schmidt JB, Gregersen NT, Pedersen S, Hansen DL, Worm D, Madsbad S, Astrup A and Sjödin A. © 2011 The Authors. Obesity Reviews 12 (Suppl. 1) (2011) 63–279.
Psoriasis
Weight loss and skin manifestations in obese patients with psoriasis – a controlled randomized cross-over study
(Article in English)
Larsson LK, Geiker NRW, Jensen P, Zachariae C, Astrup A and Skov L. © 2011 The Authors. Obesity Reviews 12 (Suppl. 1) (2011) 63–279.