The efficacy of a long-term multidimensional treatment of obesity in clinical practice

  • Beatrice Dragani
  • Elona Xhebraj
  • Maria Teresa Di Bonifacio
  • Guido Malatesta
  • Natascia Pantoni
  • Sonia Pompilii
  • Paolo De Cristofaro
Original Article


Obesity is a multidimensional chronic and progressive disease that requires long-term follow-up by an integrated approach. The aim of our work was, through a retrospective observational study, to confirm that obesity treatment needs of a long-term multidimensional approach. We observed the data collected in the past from 205 patients (body mass index >25) from the medical records at our Nutritional Centre. Fat mass and fat-free mass were determined by anthropometry. Resting energy expenditure and respiratory quotient were measured by indirect calorimetry. Dietary programmes were established on the basis of metabolic analysis. Physical activity was encouraged in term of lifestyle change. The observed patients were divided into five groups. All groups showed a reduction of weight, waist circumference and arm fat area. There was correlation between all parameters. Our approach results in a long-term sustainment of the weight loss achieved up to a 5-year period, through psychological improvements as well as improved eating behaviour and general wellbeing.


Obesity Long-term follow-up Multidimensional approach Anthropometry Indirect calorimetry 



The authors wish to warmly acknowledge Dr Pamela Di Giovanni (Department of Biological Sciences, University “G. D’Annunzio”, Chieti, Italy) for her statistical analysis work.

Conflict of interest

The authors have no conflict of interest. None of them had any personal or financial affiliation with any organization involved in the study.


  1. 1.
    Serdula MK, Mokdad AH, Williamson DF, Galuska DA, Mendlein JM, Heath GW (1999) Prevalence of attempting weight loss and strategies for controlling weight. JAMA 282:1353–1358CrossRefGoogle Scholar
  2. 2.
    French SA, Jeffery RW, Folsom AR, McGovern P, Williamson DF (1996) Weight loss maintenance in young adulthood: prevalence and correlations with health behaviour and disease in population-based sample of women aged 55–69 years. Int J Obes Relat Metab Disord 20:303–310Google Scholar
  3. 3.
    Wing RR, Hill JO (2001) Successful weight loss maintenance. Annu Rev Nutr 21:323–341CrossRefGoogle Scholar
  4. 4.
    Kassirer J, Angell M (1998) Losing weight: an ill-fated New Year’s resolution. N Engl J Med 338:52CrossRefGoogle Scholar
  5. 5.
    Kramer FM, Jeffery RW, Forster JL, Snell MK (1989) Long-term follow-up of behavioural treatment for obesity: patterns of weight regain among men and women. Int J Obes Relat Metab Disord 13:123–136Google Scholar
  6. 6.
    Wing RW, Phelan S (2005) Long-term weight loss maintenance. Am J Clin Nutr 82(Suppl):222S–225SGoogle Scholar
  7. 7.
    Frisancho AR (1981) New norms of upper limbs fat and muscle areas for assessment of nutritional status. Am J Clin Nutr 34:2540–2545Google Scholar
  8. 8.
    Bishop A (1981) National Health and Nutrition Examination Survey (NHANES). Am J Clin Nutr 34:2530–2539Google Scholar
  9. 9.
    Lohman TG, Roche AF, Martorell R (1988) Anthropometric standardization reference manual. Human Kinetics Books, ChampagneGoogle Scholar
  10. 10.
    Durnin J, Womersley J (1981) Body fat assessed from total body density and its estimation from skinfold thickness: measurements on 481 men and women aged from 16 to 72 years. Br J Nutr 32:77–97CrossRefGoogle Scholar
  11. 11.
    Mifflin MD, St Jeor ST, Hill LA, Scott BJ, Daugherty SA, Koh YO (1990) A new predictive equation for resting energy expenditure in healthy individuals. Am J Clin Nutr Feb 51(2):241–247Google Scholar
  12. 12.
    Dragani B, Malatesta G, Di Ilio C, De Cristofaro P (2006) Dynamic monitoring of restricted eating disorders by indirect calorimetry: a useful cognitive approach. Eat Weight Disord 11:e9–e14Google Scholar
  13. 13.
    Livelli di Assunzione Raccomandata di Energia e Nutrienti per la Popolazione Italiana (LARN) (1996) Società Italiana di Nutrizione UmanaGoogle Scholar
  14. 14.
    Levy RL, Finch EA, Crowell MD, Talley NJ, Jeffery RW (2007) Behavioral intervention for the treatment of obesity: strategies and effectiveness data. Am J Gastroenterol 102:2314–2321CrossRefGoogle Scholar
  15. 15.
    Latner JD, Stunkard AJ, Wilson GT, Jackson ML, Zelitch DS, Labouvie E (2000) Effective long-term treatment of obesity: a continuing care model. Int J Obes 24:893–898CrossRefGoogle Scholar
  16. 16.
    Craddock D (1977) The free diet: 150 cases personally followed-up after 10–18 years. Int J Obes 1:12734Google Scholar
  17. 17.
    Binnie GAC (1977) Ten years follow-up of obesity. J R Coll Gen Pract 27:492–495Google Scholar
  18. 18.
    Hill JO (2005) Obesity treatment: does one size fit all? Am J Clin Nutr 81:1253–1254Google Scholar
  19. 19.
    Jakicic JM, Clark K, Coleman E, Donnelly JE, Foreyt J, Melanson E, Volek J, Volpe SL (2001) American College of Sports Medicine Position Stand. Appropriate intervention strategies for weight loss and prevention of weight regain for adults. Med Sci Sports Exerc 33(12):2145–2156Google Scholar
  20. 20.
    Garrow JS (1981) Alternative treatments for grade III obesity Treat obesity seriously. Churchill Livingstone, London, pp 76–83Google Scholar
  21. 21.
    Linet OI (1982) Long term efficacy of medical treatments for obesity. Klin Wochenschr 80:115–120CrossRefGoogle Scholar
  22. 22.
    Björvell H, Rössner S (1985) Long term treatment of severe obesity four year follow up of results of combined behavioural modification programme. Br Med J (Clin Res Ed) 291(6492):379–382CrossRefGoogle Scholar
  23. 23.
    Latner JD, Wilson GT, Stunkard AJ, Jackson ML (2002) Self-help and long-term behaviour therapy for obesity. Behav Res Ther 40:805–812CrossRefGoogle Scholar
  24. 24.
    Klem ML, Wing RR, McGuire MT, Seagle HM, Hill JO (1997) A descriptive study successful at long-term maintenance of substantial weight loss. Am J Clin Nutr 66:239–246Google Scholar
  25. 25.
    Kayman S, Bruvold W, Stern JS (1990) Maintenance and relapse after weight loss in women: behavioural aspects. Am J Clin Nutr 52:800–807Google Scholar
  26. 26.
    Iris Shai RD, Schwarzfuchs D, Henkin Y et al, Dietary Intervention Randomized Controlled Trial (DIRECT) Group (2008) Weight loss with a low-carbohydrate, mediterranean, or low-fat diet. N Engl J Med 359(3):229–241Google Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Beatrice Dragani
    • 1
    • 2
    • 3
  • Elona Xhebraj
    • 1
  • Maria Teresa Di Bonifacio
    • 1
  • Guido Malatesta
    • 1
  • Natascia Pantoni
    • 1
  • Sonia Pompilii
    • 1
  • Paolo De Cristofaro
    • 1
  1. 1.Centro Regionale di Fisiopatologia della NutrizioneASL TeramoItaly
  2. 2.Dipartimento di Scienze BiomedicheUniversità “G. D’Annunzio”ChietiItaly
  3. 3.PescaraItaly

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