Willing to go the extra mile: Prospective evaluation of an intensified non-surgical treatment for patients with morbid obesity. Issue 4 (August 2019)

• Record Type: Journal Article
• Authors: Weimann, Arved; Fischer, Martin; Oberänder, Nadine; Prodehl, Guido; Weber, Nadja; Andrä, Manon; Krug, Jürgen; Wallstabe, Ingo; Schiefke, Ingolf; Bischoff, Stephan C.
• Is Part Of: Clinical nutrition. Volume 38:Issue 4(2019)
• Page Start: 1773
• Page End: 1781
• Publication Date: 2019-08
• Subjects: Obesity -- Non-surgical treatment -- Very low-calorie diet -- Gastric balloon -- Multicomponent treatment; EWL Excess weight loss -- HbA1c Hemoglobin A1c -- ITT Intention-to-treat analysis -- RWL Relative weight loss -- PP Per-protocol approach -- QoL Quality of life -- SF-36 Short-Form-36 -- T2DM Type 2 diabetes mellitus -- VLCD Very low-calorie diet -- WHR Waist-to-hip ratio; Critically ill -- Nutrition -- Periodicals; Diet therapy -- Periodicals; Parenteral feeding -- Periodicals; Enteral feeding -- Periodicals; Enteral Nutrition -- Periodicals; Parenteral Nutrition -- Periodicals; Metabolism -- Periodicals; Diétothérapie -- Périodiques; Alimentation parentérale -- Périodiques; Alimentation entérale -- Périodiques; Nutrition -- Périodiques; Diet therapy; Enteral feeding; Nutrition; Parenteral feeding; Electronic journals; Periodicals; Electronic journals; 615.854
• DOI: 10.1016/j.clnu.2018.07.027
• Languages: English
• ISSNs: 0261-5614

Abstract

Summary: Background & aims: Bariatric surgery has been well established and considered the treatment of choice in morbid obesity. However, some patients refuse surgery because long-term effects have not been fully elucidated, quality of life might change and lifelong supplementation with vitamins and trace elements may be required. Our aim was to exhaust non-surgical treatment modalities and to evaluate such an intensified treatment alternative. Methods: A total of 206 patients (mean age = 46 years; BMI = 49 kg/m 2 ) enrolled since 2013 into a non-surgical multimodality obesity treatment program covered by major health insurances were prospectively evaluated over a three year period. The 12-month treatment course comprised 57 h cognitive-behavioral therapy, 53.5 h physical exercise training, and 43.5 h nutritional therapy offered in small groups. Weight loss was induced by a formula-based, very low-calorie diet for 12 weeks in combination with a gastric balloon. The primary outcome was relative weight loss (RWL). Secondary outcome measures were waist-to-hip ratio, blood pressure, antihypertensive drug treatment, anti-diabetic medication, HbA1c, and quality of life. Results: 166 Patients (81%) completed treatment. Mean (±SD) weight loss after 12 months for women and men were 28.8 kg (±14.7) and 33.7 kg (±19.5), respectively, among completers. RWL was 21.9% (±10.0) and excess weight loss (EWL) was 46.9% (±22.2), whereas intention-to-treat analysis revealed a RWL of 20.0% (±10.4) and an EWL of 42.9% (±22.9). Weight loss was accompanied by improved quality of life, lowered HbA1c values, and a significantly reduced need of antihypertensive and diabetes medications over the study period. Three year follow-up data from the first 78 patients (76% follow-up rate) revealed a RWL of 13% (±13.1) and an EWL of 27.2% (±28.8). The majority of patients (51%) maintained a RWL of 10% or more, and 44% had an EWL > 30%. Conclusions: In patients with morbid obesity, an intensified non-surgical multimodality treatment program may achieve significant and sustained weight loss accompanied by improvement of disease markers as well as quality of life for at least three years. Highlights: 166 out of 206 patients completed a 12-months non-surgical weight loss intervention. BMI was reduced from 49 to 38 kg/m 2 with improved comorbidities and QoL. High follow-up rates (>76%) were achieved at 2 and 3 years. A weight loss ≥10% was maintained by half the patients at 3 years. Non-surgical treatment may be offered even in morbidly obese.