Long-Term,Sustained, Lifestyle-Induced Weight Loss in Severe Obesity: the Get-Real Program |
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| Institution: | 1. From the Department of Internal Medicine and Endocrinology, VieCuri Medical Center, The Netherlands;2. Health, Fitness and Sport, Hergiswil, Switzerland;3. Mayo Clinic, Endocrine Research Unit, Rochester, Minnesota.;1. Department of Gastrointestinal Surgery, Laboratory of Bariatric and Metabolic Surgery, West China Hospital, Sichuan University, Chengdu, P.R. China;2. Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, P.R. China;3. Gastrointestinal Tract Reconstruction and Metabolic Surgery Association, West China Medical School, West China Hospital, Sichuan University, Chengdu, P.R. China;1. Regional Centre for Applied Molecular Oncology, Masaryk Memorial Cancer Institute, Zluty kopec 7, 65653 Brno, Czech Republic;2. First Department of Pathological Anatomy, Medical Faculty of Masaryk University and St. Anne''s University Hospital, Pekarska 53, 65691 Brno, Czech Republic;3. Department of Pathology, Masaryk Memorial Cancer Institute, Zluty kopec 7, 65653 Brno, Czech Republic;4. Department of Comprehensive Oncology Care, Masaryk Memorial Cancer Institute, Zluty kopec 7, 65653 Brno, Czech Republic;1. From the Division of Otolaryngology-Head & Neck Surgery, University of Connecticut School of Medicine, Farmington, Connecticut;2. Department of Internal Medicine, University of Virginia Health System, Charlottesville, Virginia;3. Department of Otolaryngology-Head & Neck Surgery, Boston University Medical Center, Boston, Massachusetts;4. Section of Endocrinology, Diabetes, and Nutrition, Boston University Medical Center, Boston, Massachusetts;5. Department of General Surgery, Boston University Medical Center, Boston, Massachusetts;6. Department of General Surgery, Stamford Hospital, Stamford, Connecticut. |
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| 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 |
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