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

Abstract

Abdominal male obesity is associated with hypertension, abnormal blood lipids and diabetes type 11. For development of a weight loss program for such males, 86 obese men (BMI 37.7 [4.4] kg/m2) (mean [SD] ) from the waiting list of the outpatient clinic were invited to a long-term behavioural modification program, by the means of weekly group sessions The treatment was evaluated after year one and two by weight losses, drop-out rates and changes in medical risk factors – and after one year by a dietary evaluation. Before treatment, 12 x 24-hour dietary recalls were undertaken to survey the eating habits. A normal weight group of 61 men (BMI 23.0 [ 1.9] kg/m2) were randomly selected from the Stockholm County Census Bureau and interviewed in an identical way.

The pre-treatment dietary survey. No major differences were found between the obese and the normal weight men regarding the daily energy intake (2700 kcal, 1100-5000 [median, range] vs 2700 kcal, 1800-4100) and meal patterns. When related to 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 from breakfast-like meals and "cocktail" meals.

The "obese true energy reporters" had greater energy amounts per serving from sandwich meals, breakfast-like meals and from snacks compared to the "normal weight true energy reporters" These obese men had a higher eating frequency and a higher energy-percent from hot dishes of a good nutritional quality. Both groups had a similar variation across the days of the week for energy intake (maximum on Saturdays) 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 one and two years. Frequency attendance during year one was associated with sustained weight 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 improvements of medical risk factors. The successful group (weight loss -10%) and the unsuccessful group (weight gain +1%). In the successful group the energy intake, the fat energy-% and the frequency of snacks of a low nutritional quality decreased together with energy amounts per serving from the "meal" and the "snack" categories, whereas the energy contribution from hot meals of a good nutritional quality increased after one 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 energy amount per serving from "meals" decreased. HDL and LDL/HDL fell.

It was concluded that the obese men underreported their energy intake to a high degree. No specific obese eating style could be detected, only tendencies. The treatment program appears an adequate model for obese men, since low drop-out rates, sustained weight losses and a maintained decrease in obesity related medical risk factors were achieved.