ARS | Publication request: Lifestyle modification with diet and exercise in obese patients with heart failure

Submitted to: Journal of Obesity & Weight Loss Therapy
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: March 8, 2012
Publication Date: March 15, 2012
Citation: Pritchett, A.M., Deswal, A., Aguilar, D., Foreyt, J.P., Chan, W., Mann, D.L., Ballantyne, C., Bozkurt, B. 2012. Lifestyle modification with diet and exercise in obese patients with heart failure - A pilot study. Journal of Obesity & Weight Loss Therapy. 2(2):1-8.

Interpretive Summary: In obese heart failure patients, the issue of weight loss and efforts made to lose excess weight is an important concern. However, little research has been done to investigate the safety and health benefits and risk of lifestyle changes and intentional weight loss programs on patients with heart failure (HF) and metabolic syndrome. The study compared the physical effects of a lifestyle modification, which included moderate walking, a reduced calorie diet, and meeting with a dietician, against standard medical treatment for HF and metabolic syndrome. The treatment group tolerated the lifestyle modification program well with no adverse cardiac or metabolic effects. Both the control and treatment group showed weight loss; however, there was no significant difference in the weight loss between the two groups. While the study didn't indicate an increase in weight loss through a combination of medical and lifestyle therapies, it was demonstrated that such lifestyle therapies are well tolerated by patients with HF and metabolic syndrome. It is quite possible that such life changes may benefit patients in daily life choices and weight loss management after being discharged from the hospital. Further investigation is needed to determine if such lifestyle change programs have other health benefits and implications in treating overweight and obese patients with HF and metabolic syndrome.

Technical Abstract: There is a paucity of data regarding intentional weight loss in obese heart failure patients. This study sought to ascertain the safety and effectiveness of a lifestyle modification program in patients with systolic heart failure and metabolic syndrome. Patients (n=20) with systolic heart failure (ejection fraction < 50%) and metabolic syndrome were randomized to standard medical therapy (Control) versus medical therapy and lifestyle modification (Lifestyle) and followed prospectively for 3 months. Lifestyle modification involved a walking program and reduced calorie diet with 2 meal replacement products (Slim Fast) daily. Patients attended weekly meetings with a dietitian for 12 weeks. Endpoints were obtained at baseline and 3 months and included physical exam, laboratory values, quality of life questionnaire, 6-minute walk, and brachial ultrasound. At 3 months, 5 patients in each group had lost weight. Excluding 1 patient in each group who had increased diuretic dosing, the overall change in weight was -0.84 +/- 3.82 and -0.50 +/- 3.64 kg (p=0.85) in the control versus lifestyle groups, respectively. No significant differences in the defined endpoints were noted. None of the patients had an adverse event that was related to weight loss or exercise. This study is the first to assess the effects of a comprehensive program of dietary, behavioral, and exercise modifications in this population. Institution of lifestyle modification in patients with systolic heart failure and metabolic syndrome was well tolerated, but did not result in significant weight loss.