1-year outcome for weight maintenance in 1118 patients
TRANSCRIPT
Hallam CL, Mullins G, Lula SI, Broom J, Cox JSA, Hewlett B LighterLife UK Limited, Harlow, Essex, UK.
IntroductionMaintaining weight loss is highly challenging, particularly in today’s obesogenic environment. Success is likely to be due to the individual’s ability to make and maintain long-term lifestyle changes.
LighterLife Lite is a commercial weight-management programme for patients with BMI 25-29.9 which utilises a low-calorie diet (LCD), providing a daily intake of 800-1200 kcal to achieve weight loss, alongside a unique group based behaviour-change programme, informed by transactional analysis, cognitive behavioural therapy and addiction/change theory (TCBT®). Following completion of LCD, an ongoing weight-maintenance programme further develops this behaviour-change work in weekly group meetings, along with practical support including regular weight checks and advice on healthy eating, portion control and physical activity.
This intervention is designed to sustain lifestyle change by supporting a healthier, more reflective mindset, thereby increasing the likelihood of long-term weight management and reducing associated co-morbidities.
AimTo determine the degree of maintained weight loss in the LighterLife Management weight maintenance programme after 1 year, following a significant initial mean weight loss of 9.7kg (1st 7lb) on the LighterLife Lite LCD, which equated to a 12.9% reduction from baseline.
Method
Patients initially lost weight on the LighterLife Lite LCD. This comprised three fortified-food replacements – providing ≥75% of recommended daily allowances (RDA) for key vitamins and minerals, plus ≥37.5g protein, ≥37.5g carbohydrate, ≥7.5g fibre, and a mean 11.9g fat – alongside a daily calorie/carbohydrate-restricted meal which supplied the balance of required nutrients.
This audit reports on 1118 patients who continued to attend the weight-maintenance programme meetings and have their weight recorded with their weight-management counsellor 1 year after significant mean weight loss of 9.7kg (1st 7lb) in 8 weeks on the LighterLife Lite LCD.
Start 8 wks 1yr p-value
Mean start weight (kg) 75.1 (11st 12lb) 65.4 (10st 4lb) 68.8 (10st 12lb) p<0.01*
Mean BMI 27.6 24.1 25.3 p<0.01*
Mean weight loss 9.7kg (1st 7lb) 6.3kg (1st)
1yr
% keeping off 5% of start weight 69%
% keeping off 10% of start weight 43%
Wei
ght (
kg)
Per
cent
(%)
start
% keeping off 10% of start weight
60
6210
0
20
30
40
50
60
70
80
90
100
64
66
68
70
72
74
75.1kg
65.4kg
43%
69%
68.8kg
76
8wks 1yr
10
0
20
30
40
50
60
70
80
90
100
% keeping off 5% of start weight
Mean weight (kg)
Wei
ght (
kg)
Per
cent
(%)
start60
6210
0
20
30
40
50
60
70
80
90
100
64
66
68
70
72
74
75.1kg
65.4kg
43%
69%
68.8kg
76
8wks 1yr
BM
I kg/
m2
Per
cent
(%)
start20
21
22
23
24
25
26
27
27.6kg/m2
24.1kg/m2
38%
76%
25.3kgm2
28
8wks 1yr
% keeping off >3 BMI units
% keeping off >1 BMI unit
Mean BMI
BM
I kg/
m2
Per
cent
(%)
start
%Keeping off 10% of start weight
20
21 10
0
20
30
40
50
60
70
80
22
23
24
25
26
27
27.6kg/m2
24.1kg/m2
43%
69%
25.3kg
28
8wks 1yr
%Keeping off 5% of start weight
Mean BMI
Wei
ght (
kg)
Per
cent
(%)
start
% keeping off 10% of start weight
60
6210
0
20
30
40
50
60
70
80
90
100
64
66
68
70
72
74
75.1kg
65.4kg
43%
69%
68.8kg
76
8wks 1yr
10
0
20
30
40
50
60
70
80
90
100
% keeping off 5% of start weight
Mean weight (kg)
Wei
ght (
kg)
Per
cent
(%)
start60
6210
0
20
30
40
50
60
70
80
90
100
64
66
68
70
72
74
75.1kg
65.4kg
43%
69%
68.8kg
76
8wks 1yr
BM
I kg/
m2
Per
cent
(%)
start20
21
22
23
24
25
26
27
27.6kg/m2
24.1kg/m2
38%
76%
25.3kgm2
28
8wks 1yr
% keeping off >3 BMI units
% keeping off >1 BMI unit
Mean BMI
BM
I kg/
m2
Per
cent
(%)
start
%Keeping off 10% of start weight
20
21 10
0
20
30
40
50
60
70
80
22
23
24
25
26
27
27.6kg/m2
24.1kg/m2
43%
69%
25.3kg
28
8wks 1yr
%Keeping off 5% of start weight
Mean BMI
Conclusion• Thesizeofthegroup(n=1118)demonstratesthatmeaningfulweightmaintenanceover1yearisachievableforlargenumbersofpatients,
given the opportunity to participate in a highly effective programme such as LighterLife Lite, which supports patients’ ability to make lifestyle changes through TCBT®, and an ongoing weight-maintenance programme which supports the sustainability of such changes.
• Inthisgroup,almost70%ofpatientskeptoff5%oftheirstartweightat1year,andover40%keptoff10%.• Maintainingahealthierweightover1yrislikelytobeduetoanindividual’sabilitytomakelifestylechanges.• HistoricdataasdiscussedbyWingetal,2005,demonstratethatweightgainiscommon,regardlessofweight-lossmethod
and particularly with increasing time.
Results
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1-year outcome for weight maintenance in 1118 patients after a mean weight loss of 9.7kg (1st 7lb) using an LCD and behaviour-change programme
Initialassessment:
Informationon programmeand preliminaryscreening
Medicalscreening:
More in-depthscreening forsuitability andmedicationadjustment,if appropriate
Weight-LossPhase:
LCD and TCBT®,4-12 patients,single-sexfacilitated group
Weekly weightchecks
Food-transitionphase:
Single-sexgroups, gradualreintroductionto food over4-12 weeks
Weight checks
Management:
Ongoing weight-maintenanceprogrammeto assist withlong-termbehaviourchange
Weight checks
Data collectionand auditing
Mean weight change over 1 year
Mean BMI change over 1 year
* 2-tail t-test performed on start weight/BMI vs weight/BMI at 8 weeks, start weight/BMI vs weight/BMI at 1 year, and weight/BMI at 8 weeks vs weight/BMI at 1 year, all resulting in p<0.001
J006866 ECO Posters 2012.indd 1 30/04/2012 15:28
Lula SI, Hallam CL, Mullins G, Dyson L, Broom J, Cox JSA, Hewlett B. LighterLife UK Limited, Harlow, Essex, UK.
Conclusion• Thesizeofthegroup(n=5965)demonstratesthatmeaningfulweightmaintenanceover1to3yearsisachievable,giventheopportunity
to participate in a highly effective programme such as LighterLife Total, which supports patients’ ability to make lifestyle changes through TCBT®, and an ongoing weight-maintenance programme which supports the sustainability of such changes.
• Almost25%ofpatientsremainingengagedwiththeirLighterLifeweight-managementcounsellorfor3yearskeptoff20%oftheirstartweight. Over 60% kept off 10% of their start weight, and nearly 80% kept off a clinically significant 5% of their start weight.
• Maintainingahealthierweightovera3-yearperiodislikelytobeduetoanindividual’sabilitytomakelifestylechangesandthisisenhanced by LighterLife’s weight-maintenance programme.
• HistoricdataasdiscussedbyWingetal,2005,demonstratethatweightgainiscommon,regardlessofweight-lossmethodandparticularly with increasing time.
Start Exit 1yr 2yr 3yr
Mean weight (kg) 99.1 (15st 9lb)
73.4 (11st 8lb)
80.6 (12st 10lb)
83.3 (13st 2lb)
84.4 (13st 4lb)
Mean BMI 36.3 26.9 29.5 30.6 31.0
n=patientsavailableat each time point
5965 2044 592
% keeping off 5% of start weight
92% 86% 79%
% keeping off 10% of start weight
82% 69% 63%
% keeping off 20% of start weight
42% 28% 24%
IntroductionMaintaining weight loss is highly challenging, particularly in today’s obesogenic environment. Success is likely to be due to the individual’s ability to make and maintain long-term lifestyle changes.
LighterLife Total is a commercial weight-management programme for patients with BMI ≥30, which utilises a nutritionally complete (energy deficient) very-low-calorie diet (VLCD) to achieve weight loss, alongside a unique group based behaviour-change programme, informed by transactional analysis, cognitive behavioural therapy and addiction/change theory (TCBT®). Following completion of VLCD, an ongoing weight-maintenance programme further develops this behaviour-change work in weekly group meetings, along with practical support including regular weight checks and advice on healthy eating, portion control and physical activity.
This intervention is designed to sustain lifestyle change by supporting a healthier, more reflective mindset, thereby increasing the likelihood of long-term weight management and reducing associated co-morbidities.
AimTo determine the degree of maintained weight loss in the LighterLife Management weight maintenance programme after 1, 2 and 3 years, following a significant initial mean weight loss of 25.7kg (4st 1lb) on the LighterLife Total VLCD, which equated to a 26% reduction from baseline.
Method
Patients initially lost weight on the LighterLife Total VLCD, comprising fortified-food replacements providing a mean daily intake of 50g protein, 50g carbohydrates, 550 kcal and ≥100% RDA (recommended daily intake) for vitamins and minerals.
This audit reports on 5965 patients who continued to attend the weight-maintenance programme meetings and have their weight recorded with their weight-management counsellor for up to 3 years after achieving significant mean weight loss of 25.7kg (4st 1lb) on the LighterLife Total VLCD.
Results
START 1 YEAR 2 YEARS 3 YEARS
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1, 2 and 3-year weight maintenance outcomes in 5965 patients after a mean weight loss of 25.7kg (4st 1lb) using a VLCD and behaviour change programme
Initialassessment:
Informationon programmeand preliminaryscreening
Medicalscreening:
More in-depthscreening forsuitability andmedicationadjustment,if appropriate
Weight-LossPhase:
VLCD and TCBT®,4-12 patients,single-sexfacilitated group,ongoing clinicalmonitoring
Weekly weightchecks
Food-transitionphase:
Single-sexgroups, gradualreintroductionto food over8-24 weeks
Weight checks
Management:
Ongoing weight-maintenanceprogrammeto assist withlong-term behaviour change
Weight checks
Data collectionand auditing
60 0
10
20
3040
50
60
70
8090
10092%99.1kg
73.4kg
82%
42%
86%
69%
28%
78%
63%
24%
Start Weight
% keeping off 5%of start weight
% keeping off 10%of start weight
% keeping off 20%of start weight
Mean weight (kg)
Exit Weight Weight at 1yr Weight at 2yrs Weight at 3yrs
65
70
75
80
85
90
95
100
Wei
ght (
kg)
Per
cent
(%)
80.6kg83.3kg 84.4kg
BM
I (kg
/m2 )
20
22
24
26
28
30
32
34
36
3891%
84%
51%
29%
76%
44%
26%
66%
42%
36.3kg/m2
26.9kg/m2
Start BMI Exit BMI BMI at 1yr BMI at 2yrs BMI at 3yrs0
10
20
3040
50
60
70
8090
100
Per
cent
(%)
% who kept off>2 BMI units
% who kept off>5 BMI units
% who kept off >7 BMI units
Mean BMI
30.6kg/m2
31.0kg/m229.5kg/m2
Mean weight-loss maintenance after 3 years with the LighterLife Total programme
Mean BMI after 3 years with the LighterLife Total programme
J006866 ECO Posters 2012.indd 2 30/04/2012 15:28
Lula SI, Hallam CL, Mullins G, Broom J, Cox JSA, Hewlett B. LighterLife UK Limited, Harlow, Essex, UK.
IntroductionLighterLife Total is a commercial weight-management and behaviour-change programme that has been offered to patients with BMI≥30 since 1996 and has published weight-loss data at ECO demonstrating its efficacy since 1997. It affords the opportunity to lose weight using a nutritionally-complete (energy deficient) VLCD and, significantly, to identify personal psychological motivation for over-consumption, thereby enabling patients to develop robust strategies for more successful weight management in the future.
LighterLife’s unique group based behaviour-change programme is informed by transactional analysis, cognitive behavioural therapy and addiction/change theory (TCBT®). Following completion of VLCD, an ongoing weight-maintenance programme further develops this behaviour-change work in weekly group meetings, along with practical support including regular weight checks and advice on healthy eating, portion control and physical activity.
This intervention is designed to sustain lifestyle change by supporting a healthier, more reflective mindset, thereby increasing the likelihood of long-term weight management and reducing associated co-morbidities.
AimTo demonstrate the year-on-year reproducibility of weight loss achieved using the LighterLife Total VLCD and behaviour-change programme in male and female patients over a 12-week period.
To determine whether the weight loss achieved by male and female patients using the LighterLife Total VLCD and behaviour-change programme over a 12-week period produces consistent amounts of weight loss when examined on a year-on-year basis from 2008 to 2010.
Method
Initialassessment:
Informationon programmeand preliminaryscreening
Medicalscreening:
More in-depthscreening forsuitability andmedicationadjustment,if appropriate
Weight-LossPhase:
VLCD and TCBT®,4-12 patients,single-sexfacilitated group
Weekly weightchecks
Food-transitionphase:
Single-sexgroups, gradualreintroductionto food over8-24 weeks
Weight checks
Management:
Ongoing weight-maintenanceprogrammeto assist withlong-termbehaviourchange
Weight checks
Data collectionand auditing
A random sample (n≥3000) of male and female patients completing 12 weeks of the LighterLife Total VLCD in 2008-2011 was selected from the LighterLite client database. Mean start weight and BMI were recorded at baseline and mean weight loss and BMI reduction were calculated after 12 weeks’ participation.
During the VLCD, patients were in receipt of a mean daily intake of 50g protein, 50g carbohydrate, 550 kcal and ≥100% RDA (recommended daily intake) for vitamins and minerals. They were also weighed weekly and participated in the LighterLife TCBT® behaviour-change programme facilitated by a LighterLife weight-management counsellor in small, single-sex groups.
Conclusion• Reproducibleandhighlyconsistentweight-lossresultsaredemonstrablyachievablewiththeLighterLifeTotalVLCDand
behaviour-change programme, irrespective of participants. • TheTCBT® behavioural-modification work facilitated in small groups alongside the LighterLife Total VLCD may be a factor in compliance
and therefore in the reproducibility of results.
This offered the opportunity to identify ways in which patients had been using food (and drink) to suppress difficult emotions, and to become aware of how old messages might be influencing current behaviour, including food and lifestyle choices. Developing this self-awareness can lead to the development of new coping strategies which enable successful weight management in the future.
Results
Year Mean start weight
Mean start BMI
Mean weight after 12 weeks
Mean BMI after 12 weeks
Mean weight loss
Mean BMI reduction
2008102.4kg (16st 2lb)
37.6 82.7kg (13st) 30.419.6kg (3st 1lb)
7.2
2009103.5kg (16st 4lb)
37.8 83.9kg (13st 3lb) 30.719.6kg (3st 1lb)
7.1
2010103.9kg (16st 5lb)
38.0 84.5kg (13st 4lb) 30.919.4kg (3st 1lb)
7.1
2011105.3kg (16st 8lb)
38.2 85.8kg (13st 7lb) 31.219.5kg (3st 1lb)
7.0
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Year-on-year comparison of male and female patients following 12 weeks of a VLCD and behaviour change programme
Year-on-year, both start BMI and the amount of weight loss were found to be consistent.
Weightlosswasalsosignificantoverthe12-weekperiod–amean19.6kg,18.8%weightloss was observed across the 4 years examined. This was well in excess of the clinically significant 10% weight loss known to improve health outcomes by reducing the risk of weight-related co-morbidities.
Wei
ght (
kg)
BM
I (kg
/m2)
Year
10
15
20
25
30
35
40
45
5
20
30
40
50
60
70
80
90
100
110
10
2008 2009
102.4kg
37.6kg/m2
82.7kg
30.4kg/m2
103.5kg
37.8kg/m2
83.9kg
30.7kg/m2
103.9kg
38kg/m2
84.5kg
30.9kg/m2
105.3kg
38.2kg/m2
85.8kg
31.2kg/m2
19.6kg
Mean start weight
19.6kg 19.4kg 19.5kg
7.2kg/m2 7.1kg/m2 7.1kg/m2 7.0kg/m2
2010 2011
Mean weight after 12 weeks Mean weight loss
Mean start BMI Mean BMI after 12 weeks Mean BMI reduction
J006866 ECO Posters 2012.indd 3 30/04/2012 15:28
Hallam CL1, Lula SI1, Broom J1, Mullins G1, Cook D2, Haslam D3 Cox JSA1, Hewlett B1. 1.LighterLifeUKLimited,Harlow,Essex,UK.2.NurseConsultant,ChingfordMedicalPractice,WalthamForrest,Essex,UK.3.GP,WattonPlaceClinic,andbariatricphysician,Luton & Dunstable Hospital, UK.
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Comparison of weight loss in patients with type 2 diabetes using a very-low-calorie diet (VLCD) approach
ResultsStart weight
Start BMI
Exit weight
Exit BMI
Weight loss
BMI reduction
% excess weight lost
Diabetic patients
113.6kg (17st 12lb)
40.4 93.4kg (14st 10lb)
33.2 20.2kg (3st 3lb)
8.5 17.5%
Non-diabetic patients
114.8kg (18st 1lb)
40.9 89.3kg (14st 1lb)
31.9 25.2kg (4st)
9.5 21.7%
2-tail t-test
p=NS p=NS p<0.001 p<0.001 p<0.001 p<0.05 p<0.001
DiscussionBoth patient groups lost a significant amount of weight, and well in excess of the 10% weight reductionknowntoreducetheriskofweight-relatedcomorbidities.Whilethenon-diabeticgroup lost a greater percentage of excess weight, the diabetic group’s weight loss was well in excess of the 50% weight loss expected from previous studies.
The use of TCBT® and small-group support for these obese patients, both diabetic and non-diabetic, may be factors in maintaining compliance with the LighterLife Total VLCD.
Conclusion• Inaweight-loss-resistantcohort,diabeticandnon-diabeticpatientsfollowingtheLighterLifeTotalVLCDandTCBT® behaviour-change
programme achieved weight loss by non-surgical means, commensurate with the reversal of type 2 diabetes.• WhilebariatricsurgeryisrecommendedasatreatmentoptionforadultswithBMI≥40, and for those with BMI 35-40 with type 2 diabetes,
this audit suggests a VLCD such as LighterLife Total is beneficial and a cost-effective alternative, including for known difficult-to-treat type 2 diabetic patients.
IntroductionType 2 diabetes is an obesity-driven chronic progressive condition, exacerbated by insulin/sulphonylureatreatmentcausingweightgain.Whilebariatricsurgeryandarecentvery-low-calorie diet (VLCD) study (Lim et al, 2011) demonstrate reversibility of this pathology, significant weight loss by standard dietary measures in type 2 diabetes is difficult; studies demonstrate only 50% of the weight loss achieved by non-diabetic patients (Avenell et al, 2004).
LighterLife Total is a commercial weight-management programme for patients with BMI≥30 which utilises a nutritionally-complete (energy deficient) VLCD to achieve weight loss, alongside a unique group based behaviour-change programme, informed by transactional analysis, cognitive behavioural therapy and addiction/change theory (TCBT®). Following completion of VLCD, an ongoing weight-maintenance programme further develops this behaviour-change work in weekly group meetings, along with practical support including regular weight checks and advice on healthy eating, portion control and physical activity.
This intervention is designed to sustain lifestyle change by supporting a healthier, more reflective mindset, thereby increasing the likelihood of long-term weight management and reducing associated co-morbidities.
Whilediabeticpatientsonmedicationhavealreadyengagedwithhealthcareprofessionalsandreceived advice on dietary adjustment and lifestyle changes to manage their condition, this type of intervention is clearly unsuccessful for weight management, given their mean weight on commencement of the LighterLife VLCD and TCBT® behaviour-change programme.
AimThis audit compares data from patients taking oral hypoglycaemic or insulin medication for type 2 diabetes vs non-diabetics matched for BMI, age and gender, all of whom participated in the LighterLife Total VLCD for a period of 12 weeks.
Method
Initialassessment:
Informationon programmeand preliminaryscreening
Medicalscreening:
More in-depthscreening forsuitability andmedicationadjustment,if appropriate
Weight-LossPhase:
VLCD and TCBT®,4-12 patients,single-sexfacilitated group, ongoing clinicalmonitoring
Weekly weightchecks
Food-transitionphase:
Single-sexgroups, gradualreintroductionto food over8-24 weeks
Weight checks
Management:
Ongoing weight-maintenanceprogrammeto assist withlong-termbehaviourchange
Weight checks
Data collectionand auditing
An audit of our database identified 494 type-2 diabetic patients taking oral hypoglycaemic or insulin medication (169 male, 325 female) who had completed 12 weeks of the LighterLife Total VLCD, in receipt of a mean daily intake of 50g protein, 50g carbohydrate, 550 kcal and ≥100% RDA (recommended daily intake) for vitamins and minerals. They were matched for BMI, age and gender with non-diabetic patients from the database.
During VLCD participation, all patients identified were weighed weekly and participated in the LighterLife TCBT® behaviour-change programme facilitated by a LighterLife weight management counsellor in small, single-sex groups. This offered the opportunity to identify ways in which patients had been using food (and drink) to suppress difficult emotions and influence current behaviour, developing new coping strategies which enable successful weight management in the future.
All patients also attended 4-weekly reviews with their physician, who adjusted medication as appropriate on commencement of, and during their participation in, the LighterLife Total VLCD. Those in the type-2 diabetic group were typically advised to continue their metformin, stop sulphonylurea and halve insulin dosage.
Wei
ght (
kg)
0
5
T2DM
20.2kg
Non-diabetic patients
25.2kg
10
15
20
25
30
Mean weight loss of T2DM individuals vs non-diabetic individuals undergoing 12-week VLCD
weight loss: p<0.001
89.3kg
93.4kg
Wei
ght (
kg)
75
80
85
90
95
100
105
110
115
120
Start weight
114.8kg
113.6kg
89.3kg
93.4kg
Exit weight70
T2DM
Non-diabetic patients
Start weight: p>0.05(not significant)
Exit weight: p<0.001
Mean weight change of T2DM individuals vs non-diabetic individuals undergoing 12-week VLCD
J006866 ECO Posters 2012.indd 4 30/04/2012 15:28