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dc.contributor.authorDale, Kelly Sandraen_NZ
dc.date.available2011-01-25T00:23:28Z
dc.date.copyright2007en_NZ
dc.identifierhttp://adt.otago.ac.nz/public/adt-NZDU20080129.122806en_NZ
dc.identifier.citationDale, K. S. (2007). Determining optimal approaches for successful maintenance of weight loss (Thesis, Doctor of Philosophy). University of Otago. Retrieved from http://hdl.handle.net/10523/523en
dc.identifier.urihttp://hdl.handle.net/10523/523
dc.descriptionxiv, 132, [189] leaves :ill., (some col.) ; 30 cm. Includes bibliographical references. University of Otago department: Human Nutrition. "March 2007"
dc.description.abstractObjective: Since short-term weight loss is often achievable in overweight individuals but long-term weight maintenance is generally poor, this thesis examines the effect of the nature of support programmes and macronutrient composition on weight maintenance following weight loss. Research design and methods: A 2x2 multifactorial design was used to compare two support programmes and two diets differing in macronutrient composition on maintenance of weight loss over a 2-year period. Two hundred women who had recently lost at least 5% of initial body weight were randomised into one of two support programmes. One provided intensive expert, health professional support with regular circuit training classes. The other provided brief and frequent 'weigh-ins' and support facilitated by a nurse. Participants were also randomised with regard to recommended diet composition. One eating plan was high in carbohydrate and dietary fibre, emphasising low glycemic index foods. The second eating plan was relatively high in monounsaturated fat and protein and had a low overall glycaemic load. At baseline, 1 and 2-years, weight, waist circumference and blood pressure were measured and body composition was estimated using bioelectrical impedance. Three-day weighed diet records were collected to estimate dietary intake. A fasting blood sample was used to measure glucose, insulin and lipids. Results: At 2-years weight was measured for 87% of participants. On average those randomised to the Expert Support Programme reduced weight by 2.5kg while those on the Nurse Support Programme reduced weight by 3.6kg (difference between support programmes, P=0.976). On the High Carbohydrate Diet average weight loss was 2.4kg compared with a loss of 3.8kg on the High Monounsaturated fat Diet (difference between diets, P=0.419). At follow-up, there were no significant differences between the support programmes with regards to body composition, systolic and diastolic blood pressures, blood lipid levels, glucose, insulin, and predicted insulin sensitivity. From a health system perspective and relative to the Nurse Support Programme, the Expert Support Programme cost $NZ 928, 970 per QALY gained (or $9, 290 per person). At follow-up, there were no significant differences between the dietary prescriptions with regard to body composition, systolic and diastolic blood pressures, triglycerides, HDL-cholesterol, glucose, insulin and predicted insulin sensitivity. However, total and LDL cholesterol were significantly lower on the High Carbohydrate Diet compared with the High Monounsaturated fat Diet (total cholesterol 0.2mmol/l, P=0.044, LDL cholesterol 0.2mmol/l, P=0.042). At follow-up those on the High Monounsaturated fat Diet reported significantly higher intakes of saturated fat (1.5%TE), total fat (5%TE), monounsaturated fat (2.4%), and a significantly lower intake of carbohydrate (-5%TE) than those on the High Carbohydrate Diet. Conclusion: A relatively inexpensive nurse led programme appears to be as effective as a more costly expert health professional led programme in achieving weight maintenance over a 2-year period. This inexpensive and successful weight maintenance programme offers a feasible option for implementation in primary health care in New Zealand. Similarly, both dietary approaches produced comparable beneficial effects in terms of weight loss maintenance. However the High Carbohydrate Diet was associated with lower levels of total and LDL cholesterol, possibly due to a lower intake of saturated fat.en_NZ
dc.format.mimetypeapplication/pdf
dc.languageenen_NZ
dc.publisherUniversity of Otagoen_NZ
dc.rightshttp://www.otago.ac.nz/administration/policies/otago003228.htmlen_NZ
dc.rightsAll items in OUR Archive are provided for private study and research purposes and are protected by copyright with all rights reserved unless otherwise indicated.
dc.rights.urihttp://www.otago.ac.nz/administration/policies/otago003228.html
dc.subjectweight lossen_NZ
dc.subjecthealth aspectsen_NZ
dc.titleDetermining optimal approaches for successful maintenance of weight lossen_NZ
dc.typeThesisen_NZ
thesis.degree.disciplineDepartment of Human Nutritionen_NZ
thesis.degree.nameDoctor of Philosophyen_NZ
thesis.degree.grantorUniversity of Otagoen_NZ
thesis.degree.levelDoctoral Thesesen_NZ
otago.interloanyesen_NZ
otago.openaccessOpen
dc.identifier.voyager1442070
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