Background: Obesity is recognized as a major risk factor for cardiovascular disease. An estimated 70%-88% of cardiac rehabilitation patients are overweight or obese. However, standard cardiac rehabilitation programs result in minimal weight loss.
Purpose: The purpose of this study was to compare the effectiveness of a structured weight loss intervention (WLI) to the previous usual care (UC) weight loss intervention in cardiac rehabilitation (CR) patients.
Methods: A retrospective chart review was performed with weight loss as the main outcome. The study population consisted of 87 CR patients with a BMI <= 27 kg/m2. The WLI consisted of two 10-week sessions in which patients received education, in a group setting, from a registered dietitian (RD) and certified kinesiologist (CK). Patients were encouraged to attend 2 sessions that constituted the complete program; however, they were given the option of attending only 1 session. Each WLI patient received a meal plan with a 500-1,000 calorie/d deficit and an exercise prescription intended to expend 1,500 calories/wk. Patients were expected to attend twice weekly exercise classes at the center or to participate in a home program monitored by the center kinesiologists. Weekly WLI sessions were 90 minutes in length: the initial 30 minutes was dedicated to individual feedback from the RD. This was followed by a 60-minute group lesson designed to improve nutrition knowledge and skills and to promote behavior change. Goal setting, self-monitoring of exercise and eating behaviors, and use of support systems were emphasized. The usual care for weight loss prior to institution of the WLI was individual counseling from an RD on a monthly basis and participation in a standard CR exercise program.
Results: The WLI group (n = 66) lost an average of 3.3(+/-3.8)% body weight compared to 0.11(+/-3.0)% in the usual care group (n = 21) (P < .0001). Patients who attended the complete WLI (n = 25) lost 4.7(+/- 4.2)% of their body weight. WLI patients attended a greater number of nutrition sessions than the usual care group (12.4 vs 3). Patients in the WLI lost an average of 4.0(+/-4.1) cm from their waist circumference (WC). This data was not available for the usual care group.
Conclusions: The WLI was more effective in inducing weight loss than usual care. Patients who attended the complete WLI program achieved greater weight loss. Although statistically significant, the magnitude of weight change was less than might have been expected and less than the target of 5%-10% for clinical significance. Despite this, the program holds promise and warrants further research with a controlled prospective study. Possible correlates of success such as food record submission as a measure of self-monitoring, attendance, and spousal support could be examined to determine how best to structure the program. Because the goal is sustainable weight loss, the issue of weight maintenance would also need to be addressed.