Background: The objective of this analysis was to describe weight loss results at 12 months of a clinical weight management program in which patients selected their treatment preference.

Methods: 3,007 patients (mean ± SD; age = 50 ± 12 years, body mass index = 42 ± 8 kg·m−2, 80% female, 51% black) enrolled in the program at Henry Ford Hospital self-selected a 1,200 to 2,000 kcals hypocaloric, 1,000 to 1,500 kcals low calorie, or 500 to 900 kcals very low calorie meal plan. Meal plans were instructed by a dietitian and the low calorie and very low calorie meal plans incorporated the use of commercial meal replacements. Regular biweekly appointments were conducted by a clinical exercise physiologist. Program termination was at the patient's discretion. Change in body weight was analyzed at 12 months by linear mixed modeling and using the baseline observation carried forward method with repeated measure analysis of variance.

Results: Average program participation was 5 months. Based on an intent-to-treat linear mixed modeling, the very low calorie group had the greatest 12-month weight loss (−13.9 ± 1.0 kg), followed by the low calorie and hypocaloric groups (−9.5 ± 0.6 and −6.0 ± 0.4 kg, respectively; P < 0.05 for both low calorie and hypocaloric vs very low calorie plan). The baseline observation carried forward analysis also demonstrated significant weight loss in all groups at 12 months.

Conclusion: In this real-world weight management program setting of patients who self-selected a meal plan and length of participation, both very low calorie and low calorie plans resulted in more weight loss at 12 months than the hypocaloric plan.

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