Weight loss after dieting generally is 6-12 kg, most of which occurs during the first 6 months of treatment. Treatment results will be improved if dietary treatment is combined with exercise and behaviour modification. Although many programmes reported in the literature (8) are unimpressive, long-term studies showing excellent results have been described, such as the Finnish programme by Kar-vetti and Hakala demonstrating that a dietary programme for 1 year resulted in sustained weight loss for both men and women during a follow-up period of up to 7 years (49). We also demonstrated sustained weight loss and acceptable adherence with a combined dietary-behavioural modification programme after 10-12 years of monitoring (50).
During recent years it has become obvious that weight loss and weight maintenance after such weight loss represent two different components of the treatment strategy. Numerous programmes have shown considerable weight loss whereas weight maintenance after initial weight loss is rare. Thus the dietary composition during the initial weight loss may be of less importance during a phase when the weight loss is more driven by the energy deficiency than by the dietary composition in itself. As long as adequate protein supplies are available, preventing unnecessary breakdown of lean body mass with an ensuing reduction in basic metabolic rate, the composition of the diet during this phase may not be of major importance. However, when the weight-losing phase is over, generally after 6 months, the composition of the diet with regard to macronutrients may be crucial (51).
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