Treatment of morbid obesity in inner-city women

Objective: To explore the use of the very-low-calorie formula diet (VLCD) i n the indigent population of Newark, NJ, with the goal of achieving 10% wei ght loss within a relatively short period of 10 weeks. Research Methods and Procedures: We accepted 131 morbidly obese indigent wo men into our study program. The study was limited to women only and the ave rage starting weight was 292.3 +/- 5.9 lbs (+/- SE; 50.3 +/- 0.9 body mass index [kg/m(2)]). We used three treatment paradigms: total cost-free progra m for 10 weeks; cost-free, but compliance requirements; and a weekly charge of $25. The results obtained were compared with two control populations: w omen enrolled during the same recruitment period in a comparable suburban V LCD program and a historical control population of suburban women treated f rom 1985 through 1995. Results: In group A (total cost-free), 79% of patients completed the 10-wee k program, but only 18% of patients achieved the goal of 10% weight loss. I n group B when attendance and weight loss requirements were imposed, the dr opout rate accelerated such that only 37% of patients completed the 10-week course, and 16% of the women were successful with their weight loss. In gr oup C, imposing $25/wk financial outlay also accelerated dropouts but had l ittle effect on weight loss success, which was 10% of the starting group. B y comparison, the suburban patients and the historical control group exhibi ted 67% and 76% attendance rates after 10 weeks, and 33% and 55% success ra tes, respectively, in achieving the weight loss goal. Discussion: We conclude that inner-city patients exhibit great interest in weight loss when financial barriers are removed. Successful weight loss was achieved in 10% to 18% of patients using the VLCD approach, approximately one-half of that obtained in affluent suburban women. Imposing financial or compliance restrictions to the inner-city patients served only to enhance dropouts.