Medically safe rate of weight loss for the treatment of obesity: A guideline based on risk of gallstone formation

doi:10.1016/S0002-9343(99)80394-5

The American Journal of Medicine

Volume 98, Issue 2, February 1995, Pages 115-117

https://doi.org/10.1016/S0002-9343(99)80394-5 Get rights and content

Objective

Currently recommended rates of weight loss for obese persons are not based on demonstrated health risks. The authors attempt to determine a medically safe rate of weight loss based on currently available data on the risk of gallstone formation during active weight loss.

Methods

AN prospective studies published in the English language on the formation of gallstones in obese persons duiring active weight loss were reviewed and evaluated. A statistical analysis was performed using studies of at least 4 weeks' duration that included information on diet composition, rates of weight loss, length of follow-up, and incidence of gallstone formation. A statistical model was fit to the data from the studies that met the criteria.

Results

Nine subject groups derived from five published reports met the criteria for inclusion in the analysis. When the results of these groups were evaluated statistically, a curvilinear relationship between incidence of gallstone formation and rate of weight loss was demonstrated. The relationship was best described by an exponential regression curve, with an adjusted r² of 0.98 and a dramatically increasing risk of gallstone formation at rates of weight loss above 1.5 kg per week.

Conclusion

Risk of gallstone formation in obese persons during active weight loss seems to increase in an exponential fashion. The data suggest that rates of weight loss should not exceed an average of 1.5 kg per week.

References (13)

WeinsierRL et al.
Recommended therapeutic guidelines for professional weight control programs
Am J Clin Nutr
(1984)
BernsteinRA et al.
Gallbladder disease II. Utilization of the life table method in obtaining clinically useful information
J Chronic Dis
(1977)
DiehlAK
Epidemiology and natural history of gallstone disease
Gastroenterol Clin North Am
(1991)
Canadian Task Force on the Treatment of Obesity
National Task Force on the Prevention Treatment of Obesity
Very low calorie diets
JAMA
(1993)

There are more references available in the full text version of this article.

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^*: Supported in part by the National Institutes of Health, Core Clinical Nutrition Research Center grant P01 CA28103 and General Clinical Research Center grant RR-32.

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EditorialMedically safe rate of weight loss for the treatment of obesity: A guideline based on risk of gallstone formation*

Objective

Methods

Results

Conclusion

Am J Clin Nutr

J Chronic Dis

Gastroenterol Clin North Am

Very low calorie diets

JAMA

Editorial
Medically safe rate of weight loss for the treatment of obesity: A guideline based on risk of gallstone formation*