Very low calorie diet (VLCD) followed by a randomized trial of corset treatment for obesity in primary care

Objective. The primary objective was to investigate the feasibility and cost-effectiveness of weight reduction using very low calorie diet (VLCD) in groups. The secondary objective was to investigate whether subsequent corset treatment could maintain the weight reduction long term. Design. Participants, consecutively included in groups of 8-14 subjects, underwent three months of VLCD with lifestyle advice at group meetings. Subjects attaining >= 8 kg reduction were randomized to corset (A) or no corset (B) treatment for nine months. Weight was registered at all meetings and after 24 months. Costs were calculated using current salaries and anti-obesity drug prices as at 2008. Settings. Primary care in Skaraborg, Sweden. Subjects. A total of 26 men and 65 women aged 30-60 years with BMI >= 30-< 45 kg/m(2). Main outcome measures. Weight changes and costs of treatment. Results. VLCD (dropout n = 14) resulted in a mean weight reduction of 20.1 +/- 6.6 kg (20 men) and 15.7 +/- 4.7 kg (57 women). These 77 subjects were randomized to treatment A (n = 39) or B (n = 38). Compliance with corset was only 20% after three months. After one year (dropout n = 17) weight loss was 11.7 +/- 8.1 kg (A) and 9.3 +/- 6.9 kg (B), p = 0.23 and after two years (dropout n = 22) 6.1 +/- 7.0 kg and 4.4 +/- 7.3 kg respectively, p = 0.94. Serum glucose and lipids were altered favourably. The cost per participant of treatments A and B was SEK 4440 and SEK 1940 respectively. Conclusions. VLCD in groups was feasible and reduced weight even after one year. The cost of treatment was lower than drug treatment. Corset treatment suffered from poor compliance and could therefore not be evaluated.