Elsevier

Endocrine Practice

Volume 21, Issue 4, April 2015, Pages 330-338
Endocrine Practice

Original Articles
Long-Term, Sustained, Lifestyle-Induced Weight Loss in Severe Obesity: the Get-Real Program

https://doi.org/10.4158/EP14381.ORGet rights and content

ABSTRACT

Objective: To study the long-term effectiveness of a patient-centered, multidisciplinary lifestyle intervention treatment in patients medically eligible for bariatric surgery.

Methods: Using a case-control study design, we compared treatment results for 98 adults (mean body mass index [BMI], 44.2 kg/m2) with the outcomes of 148 controls (mean BMI, 43.0 kg/m2) receiving standard care. The approach included a phased triage for inclusion, followed by 12 lifestyle intervention group sessions alternating with individual visits for behavior, diet, and exercise instructions.

Results: At 2 years, weight loss averaged 15.3 ± 1.4 kg (P<.0010) (12 ± 1% of initial body weight [IBW], P<.001; 21 ± 2% of excess body weight [EBW], P<.001) in an intention-to-treat (ITT) analysis; in completers, weight loss was 18.8 ± 1.5 kg (P<.001) (15 ± 1% IBW, P<.001; 26 ± 3% EBW, P<.001). A total of 42 patients lost ≥10% IBW. Controls remained weight stable (P =.35); 3% lost ≥10% IBW. Patients achieving weight loss that would be considered satisfactory for bariatric surgery included 20% who achieved ≥35% EBW loss, 29% who achieved a BMI <35 kg/m2 (if starting BMI <50 kg/m2) or BMI <40 kg/m2 (if starting BMI ≥50 kg/m2), and 37% who achieved EBW loss ≤50%. These values for completers were 31, 39, and 48%, respectively. In the 55 patients starting the program ≥4 years ago, weight loss maintenance of 12 ± 1% IBW (ITT, 16 ± 1% in completers) was observed.

Conclusion: Substantial nonsurgical weight loss, maintained at 2 to 4 years, is achievable in severely obese patients using comprehensive lifestyle approaches; the efficacy/safety trade-off in obesity treatment is an important consideration in interpreting these results.

Abbreviations: BMI = body mass index EBW = excess body weight HbA1c = glycated hemoglobin IBW = initial body weight LOCFA = last observation carried forward analysis

Section snippets

INTRODUCTION

The prevalence of obesity, currently equaling 35.7% in U.S. adults and predicted to reach 42 to 51% in 2033 (1), progresses twice as rapidly in severe obesity (body mass index [BMI] exceeding 40 kg/m2) as in lesser degrees of obesity (2). However, its treatment is particularly challenging, both regarding quantity and maintenance of weight loss: in severe obesity, behavioral interventions (3–5) merely realize 4.4 to 8.3% loss of initial body weight (IBW) in 2 years and 4.7% in 4 years (6–9),

METHODS

In a case-control study design, we compared weight and health changes in 98 severely obese adults participating in our program to 148 time-concurrent controls receiving standard clinical and diet/weight-loss counseling for hypertension, diabetes, and dyslipidemia in the same clinic.

Patients were medically eligible for bariatric surgery (BMI ≥40 kg/m2 [n = 82] or ≥35 kg/m2 with obesity-related comorbidities [diabetes or impaired fasting glucose, hypertension requiring ≥2 medications,

Baseline Characteristics

Table 1 presents baseline characteristics of the patients starting the actual treatment. By design, patients and controls were not different in age (49 ± 1 and 52 ± 1 years, respectively); females comprised 71 and 68% of patients and controls, respectively.

Eleven percent of patients had well-controlled hypothyroidism, 20% (micro)-albuminuria, 22% clinically documented sleep apnea, 17% cardiovascular disease, 19% musculoskeletal disorders, 19% chronic obstructive pulmonary diseases, and 26%

DISCUSSION

We report the effects of a comprehensive lifestyle intervention on weight and health outcomes in patients normally considered candidates for bariatric surgery. The treatment was carried out by highly trained professionals and included a triage for enrolment in order to optimize response rates. At 2 years, we found that the weight loss of 20 to 48% of patients met criteria used in bariatric surgery to classify results as satisfactory or better (14,18,19). Preliminary analysis suggests that

CONCLUSION

Our results indicate that a comprehensive lifestyle approach can help induce and maintain substantial amounts of weight loss using nonsurgical approaches in severely obese patients in an outpatient treatment setting. The efficacy/safety trade-off characterizing obesity treatment is an important consideration in interpreting these results.

ACKNOWLEDGMENT

We thank Ms. Jolanda Schatorjé-Stroeken, RD, and our physician assistants, Ms. Femke Ewalds, MPA, and Ms. Marcia Huijs-Vissers, RN, MPA, for their contributions and their help in data collection. The initiation of our Treatment Program was partly funded by grants from Novartis, Sanofi-Aventis, Lilly, and NovoNordisk, who had no influence on the content of the program or this paper. The results of this study were presented in abstract form at the European Congress of Obesity, Lyon, France, in

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    DISCLOSURE

    The authors have no multiplicity of interest to disclose.

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