Eating habits, weight reduction strategies and long-term treatment results in obese men : The "Gustaf" study

Sammanfattning: Eating habits, weight reduction strategies and long-term treatment resultsin obese men. The "Gustaf" study. Ingalena Andersson Obesity Unit and Health Behaviour Research, Department of Medicine, HuddingeHospital, Karolinska Institute, Stockholm, Sweden. Abdominal male obesity is associated with hypertension, abnormal blood lipidsand diabetes type 11. For development of a weight loss program for such males, 86obese men (BMI 37.7 [4.4] kg/m2) (mean [SD] ) from the waiting list ofthe outpatient clinic were invited to a long-term behavioural modification program,by the means of weekly group sessions The treatment was evaluated after year oneand two by weight losses, drop-out rates and changes in medical risk factors - andafter one year by a dietary evaluation. Before treatment, 12 x 24-hour dietary recalls were undertaken to survey the eatinghabits. A normal weight group of 61 men (BMI 23.0 [ 1.9] kg/m2) were randomly selectedfrom the Stockholm County Census Bureau and interviewed in an identical way. The pre-treatment dietary survey. No major differences were found betweenthe obese and the normal weight men regarding the daily energy intake (2700 kcal,1100-5000 [median, range] vs 2700 kcal, 1800-4100) and meal pattems. When relatedto energy balance specifications, far more obese men underreported their energy intake.The obese men had a higher energy contribution from protein and a lower from alcohol,compared to the normal weight men They also had a higher daily eating frequency frombreakfast-like meals and "cocktail" meals. The "obese true energy reporters" had greater energy amounts per servingfrom sandwich meals, breakfast-like meals and from snacks compared to the "normalweight true energy reporters" These obese men had a higher eating frequencyand a higher energy-percent from hot dishes of a good nutritional quality. Both groupshad a similar variation across the days of the week for energy intake (maximum onSaturdays) and for eating frequency. The "obese true energy reporters"gained weight slightly during the survey. The treatment program. The drop-out rates were low: 22% and 34% after oneand two years. Frequency attendance during year one was associated with sustainedweight loss after two years In spite of a modest weight loss after one year, 5.4%,this weight loss was maintained after two years, 5.2%, together with sustained improvementsof medical risk factors The successful group (weight loss -10%) and the unsuccessful group (weightgain +1%). In the successful group the energy intake, the fat energy-% and thefrequency of snacks of a low nutritional quality decreased together with energy amountsper serving from the "meal" and the "snack" categories, whereasthe energy contribution from hot meals of a good nutritional quality increased afterone year. Waist and hip circumferences, systolic and diastolic blood pressures, s-cholesterol,LDL, HDL, s-insulin and b-glucose also decreased. In the unsuccessful group the energyamount per serving from "meals" decreased. HDL and LDL/HDL fell. It was concluded that the obese men underreported their energy intake to a highdegree. No specific obese eating style could be detected, only tendencies. The treatmentprogram appears an adequate model for obese men, since low drop-out rates, sustainedweight losses and a maintained decrease in obesity related medical risk factors wereachieved. Keywords: behaviour therapy, BMI, dietary survey, energy intake, food habits,long-term, meal pattems, men, obesity, patient compliance, patient drop-outs, riskfactors, weight loss ISBN 91-628-2611-5 /