Randomiseret sammenligning af kursus i sund gastronomisk madlavning versus adfaerdsmodifikation i behandling af svaer overvaegt
Sammanfattning
Introduction: The majority of obese patients can achieve a weight loss of more than 10% of their initial body weigth on an energy-restricted diet, and weight maintenance is acceptable during active dietary change, increased physical activity, and behaviour modification. However, relapse is a major problem after cessation of active treatment. We tested the hypotheseis thant the weight regain is partially attributable to poor compliance due the lack of palatability and culinary pleasure of traditional fat-reduced cuisine. Materials and methods: Fifty-six obese patients of both genders were enrolled in a controlled trial consisting of 12 weeks of initial energy-restricted diet in combination with orlistat, 120 mg t.i.d,. Patients achieving at least 8% weight loss continued the dietary program and were randomised to either 5 months of behaviour modification based on neurolinguistic programming (NLP) or a course in gourmet cookery of similar duration and time. The course, based on newly developed intensive instruction in pleasure-driven gourmet cookery, focussed on increased palatability concepts adapted from the Indo-Mediterranean kitchen. The patients were followed up after 1, 11/2, 2 and 3 years. Results: Forty-nine (88%) of the 56 subjects completed the weight loss phase and lost 8% of their initial body weight, corresponding to an average of 10,5 kg, and were subsequently randomised. The NLP group lost another 0.5 kg during the 5 months of weight maintenance treatment, and the cookery group lost 0.1 kg (n.s). However, the dropout rate in the cookery group was only 1 out of 25 (4%) versus 6 out of 23 (26%) in the NLP group (p< 0.05). There was no difference in weight maintenance at follow-up at 3 years; 56% in the NLP group and 44% in the cookery group had maintained some of the weight loss. Conclusion: Weight loss in obese patients can be maintained to a similar extent through a cookery course as through behaviour modification, but with a lower dropout rate.