Slide 8-13. Trigger foods are those commonly eaten foods which provide added calories in the diet. They are frequently eaten as snacks in response to stress or boredom. Their identity as a trigger food is not defined by the biochemistry of the food, but rather by the behavioral response to its ingestion. Minimizing and controlling the intake of those trigger foods that an individual patient identifies can help control total fat and calorie intake. These are not junk foods to be eliminated, but rather individual eating behaviors to be modified.

Slide 8-14. The vertically integrated system of care employs widely available meal replacements and portion-controlled meals to reduce caloric intake effectively. These special foods increase patient confidence in the number of calories they are eating and the use of meal replacements has been shown produce results superior to calorie-counting. Shown here is an intervention in 300 men and women at six sites throughout the United States taking 2 meal replacement shakes per day as part of a 1200 Cal/day diet for 12 weeks, followed by 1 shake per day for the next 24 months. Weight loss was about 7% of starting weight but about 50% of excess fat in these mildly overweight patients. Subjects continuing to the end of the study (approximately 56% of the initial group) maintained much of their weight loss.

Slide 8-15. In this study, patients were told to restrict their favorite foods by counting calories between 1200 and 1500 Calories per day or to use two meal replacements as part of an overall diet of 1200 to 1500 Calories. The markedly increased weight loss in the meal replacement group over the first twelve weeks can be attributed to the enhanced dietary compliance mediated by the use of meal replacements. Both groups were then given one meal replacement per day over two years and both groups lost additional weight.

Slide 8-16. With caloric restriction there is an adaptive decrease in metabolic rate shown here in several individuals. The modest effects of exercise on resting energy expenditure are also shown here. However, despite the adaptive decrease in metabolic rate, caloric restriction results in weight loss. Therefore, this adaptation to caloric restriction compensates only partially for the reduction in total calorie intake. Exercise is beneficial from a behavioral standpoint as the single behavior most correlated with continued dietary compliance. However, it leads to modest or no weight loss as an isolated intervention.

Slide 8-17. All weight loss is due to the reduction of total calorie intake and/or increased energy expenditure regardless of whether diet, drugs or surgery are used. Shown here is the reduction in body weight to a minimum at 6 months with a weight regain over the next 12 months regardless of whether behavior therapy alone, a very low calorie diet or the combination of both was used. This type of response is characteristic of most weight loss regimens.