This study was conducted to examine the efficacy of a lifestyle intervention on weight loss and metabolic complications in severely obese individuals. For that purpose, 130 (37% African Americans) severely obese (class II or III) participants without diabetes were recruited and randomized to either diet and physical activity for the entire 12 months or 12-month dietary intervention with physical activity delayed for 6 months. Results revealed an approximately 10% weight loss achieved in this study, which is similar to results obtained in overweight or class I obesity. In addition, nearly 30% of participants achieved more than 10% weight loss, and 10% of participants achieved greater than 20% weight loss at 12 months. The inclusion of physical activity promoted greater weight loss in both groups. Significant reductions in abdominal fat and hepatic steatosis as well as significant improvements in insulin resistance, blood pressure and plasma triglyceride levels were observed in both groups. The authors suggested that the high adherence and retention to the intervention was the consequence of the frequent and structured intervention contact provided in this study. Thus, these results refute the idea that severely obese subjects do not respond to lifestyle intervention as reflected by results showing significant weight loss and beneficial effects on cardiometabolic risk factors after a lifestyle intervention. In their editorial comment, Ryan DH and Kushner R discussed the lack of medical research on nonsurgical therapies in class II and III obesity and the necessity to reimburse lifestyle modification programs.
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