Comparison of Behavior Therapy With and Without Very-Low-Energy Diet in the Treatment of Morbid Obesity

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Abstract
Background: Very-low-energy diets (VLEDs) together with behavior therapy (BT) are widely used in the treatment of morbid obesity, but there is no evidence of their long-term effectiveness as compared with behavior therapy alone. Methods: Fifty-nine morbidly obese patients (25 men and 34 women; mean weight, 132.8 ±20.7 kg; mean age, 43.1 ±9.2 years) were treated with combined therapy of VLED and BT or BT alone. No maintenance program was used. Eighty-seven percent of eligible patients were contacted 4.8 to 6.2 years after the program. Results: During treatment, 56% of patients dropped out of the VLED+BT group and 28% from the BT group (P=.03). High scores on the Symptom Checklist—90R before treatment predicted dropout from the VLED+BT group, but not from BT. At the end of therapy, mean weight change was -22.9 kg in the VLED+BT group and -8.9 kg in the BT group (P<.001). The overall weight change from pretreatment to the 5-year follow-up was greater in the VLED+BT group than in the BT group (-16.9 kg vs -4.9 kg, respectively; P=.03). Men succeeded better in the VLED+BT group than in BT. Among the dropouts, the mean weight change from baseline was +5.2 kg in the VLED+BT group and +13.0 kg in the BT group. Conclusions: Our data suggest that in the treatment of morbid obesity, VLED combined with BT may produce a better 5-year maintenance than BT alone, especially among men. A satisfactory weight loss can be achieved without a maintenance program. Arch Intern Med. 1997;157:1581-1585