1-year outcome for weight maintenance in 1118 patients

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


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


Mean BMI

Wei

ght (

kg)

Per

cent

(%)

start


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


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


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


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


92% 86% 79%


82% 69% 63%


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.


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:


Medicalscreening:


Weight-LossPhase:

VLCD and TCBT®,4-12 patients,single-sexfacilitated group,ongoing clinicalmonitoring

Weekly weightchecks



Weight checks

Management:

Ongoing weight-maintenanceprogrammeto assist withlong-term behaviour change

Weight checks


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



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


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.


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:


Medicalscreening:


Weight-LossPhase:

VLCD and TCBT®,4-12 patients,single-sexfacilitated group

Weekly weightchecks



Weight checks

Management:


Weight checks


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


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.


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:


Medicalscreening:


Weight-LossPhase:

VLCD and TCBT®,4-12 patients,single-sexfacilitated group, ongoing clinicalmonitoring

Weekly weightchecks



Weight checks

Management:


Weight checks


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


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


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


1-year outcome for weight maintenance in 1118 patients

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