Changes in Body Composition, Cardiovascular Disease Risk Factors, and Eating Behavior after an Intensive Lifestyle Intervention with High Volume of Physical Activity in Severely Obese Subjects: A Prospective Clinical Controlled Trial
We examined the effects of a 10–14-weeks inpatient lifestyle modification program, including minimum 90？min of physical activity (PA) five days/week, on body composition, CVD risk factors, and eating behavior in 139 obese subjects (BMI ？kg/m2). Completion rate was 71% in the intensive lifestyle intervention (ILI) group and 85% among waiting list controls. Compared to controls body weight ( (95% CI:？ , )？kg, ), fat mass ( (95% CI:？ , )？kg, ), fat free mass ( (95% CI:？ , )？kg, ) and visceral fat ( (95% CI:？ , )？cm2, ) were reduced in the ILI-group after 10–14 weeks. Within the ILI-group weight loss was (95% CI:？ , )？kg, and (95% CI:？ , )？kg, , after six and 12 months, respectively. Systolic BP, glucose, triglycerides, and LDL-C were reduced, and HDL-C was increased (all ) after 10–14 weeks within the ILI group. The reduction in glucose and increase in HDL-C were sustained after 12 months (all ). After one year, weight loss was related to increased cognitive restraint and decreased uncontrolled eating (all ). Thus, ILI including high volume of PA resulted in weight loss with almost maintenance of fat-free mass, favorable changes in CVD risk factors, and eating behavior in subjects with severe obesity. 1. Introduction Severe obesity (SO: BMI ≥ 40？kg/m2 or BMI 35–39.9？kg/m2 combined with at least one weight-related comorbidity) is associated with a high prevalence of comorbidities as well as high mortality rates and represents a significant public health concern [1–3]. The main goals in the treatment of SO are to reduce comorbidity and mortality. Reduction of fat mass (FM), especially visceral fat area (VFA), and maintenance of fat-free mass (FFM) may lead to improvements in obesity-related cardiovascular disease (CVD) risk factors [4] and minimize the decrease in resting energy expenditure (REE) following weight loss [5–9]. In subjects with a BMI < 35？kg/m2 physical activity (PA) and cardiorespiratory fitness have been shown to reduce morbidity and CVD mortality [10–13]. Despite minimal weight loss, favorable changes in body composition (BC) by PA have been demonstrated [14–16], and increased PA is recommended for weight loss maintenance [17, 18]. The mechanisms for the influence of PA on weight loss maintenance are not fully understood, but in addition to PA affecting weight directly through energy expenditure, increased sensitivity for satiety signals and increased inhibitory control of the drive to eat may be involved [19]. However, subjects with SO often experience difficulties with PA due to increased body weight (BW), reduced mobility, and medical
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