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Impact of weight loss on the metabolic syndrome
Phelan S, Wadden TA, Berkowitz RI, Sarwer DB, Womble LG, Cato RK, Rothman R
International Journal of Obesity 2007 Sep;31(9):1442-1448
clinical trial
4/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To evaluate the effects of weight loss on the risk of having metabolic syndrome after 1 year of treatment with lifestyle modification alone, pharmacotherapy alone (sibutramine) or the combination of the two. DESIGN: Randomized, controlled, 1-year clinical trial. PATIENTS: One hundred and eighty women and 44 men, 18 to 65 years of age, with a body mass index of 30 to 45 kg/m2, free of uncontrolled hypertension or type 1 or 2 diabetes. INTERVENTION: Fifteen milligrams of sibutramine per day alone, lifestyle modification counseling alone, sibutramine plus lifestyle modification counseling or sibutramine plus brief lifestyle modification counseling. MEASUREMENTS: The metabolic syndrome, as defined by the Adult Treatment Panel III. RESULTS: Before treatment, 34.8% of the participants had the metabolic syndrome. Metabolic syndrome was more prevalent in caucasians than African Americans (42.5 versus 20.3%; p < 0.03), in males than females (65.1 versus 34.9%; p < 0.002) and in older (> 44 years) than younger (<= 44 years) participants (47.5 versus 20.8%; p < 0.0001). After 1 year of treatment, a moderate decrease in weight (8.0 +/- 8.7 kg) resulted in significant reductions in the prevalence of metabolic syndrome from 34.8 to 27.2% of all participants (p < 0.02). Logistic regression analyses indicated that for each 1 kg of weight lost, the odds of metabolic syndrome were reduced by 8% (CI 0.89 to 0.97; p < 0.003). Lifestyle modification either alone (p < 0.04), or in combination with sibutramine (p < 0.05), significantly reduced the prevalence of metabolic syndrome compared with sibutramine alone. The group effect was removed after controlling for weight loss. CONCLUSIONS: The metabolic syndrome was prevalent in over one-third of obese individuals who sought weight loss treatment, and the prevalence differed by age, sex and ethnicity. Moderate weight loss markedly reduced the odds of metabolic syndrome in this sample.

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