Extremely obese, take heart. You can hope to achieved sustained weight loss, even if modest, through appropriate physician advice, a new study shows. Also doctor intervention proves better than online guides.
Patients with a BMI higher than 40 (calculated as weight in kilograms divided by height in meters squared) are encountered regularly in most primary care practices in the US. Extreme obesity plagues 2.8 percent of men and 6.9 percent of women in the country, and it could cut down life expectancy by nearly a decade. While surgery for obesity is not always an option for the extremely obese, little is known about medical weight management in that population. It was precisely this aspect the Louisiana Obese Subjects Study (LOSS) sought to explore.
AdvertisementA total of 391 participants, most of them women and all of them with a body mass index above 40 (a BMI under 25 is considered healthy), participated in the study. Half were offered an Internet-based healthy lifestyle guide at the Mayo Clinic's Web site, and the other half participated in a comprehensive, doctor-led diet and exercise initiative, which included counseling, a 12-week liquid diet and weight-loss medication.
Of those in the doctor-led program, 31 percent achieved a 5 percent or greater loss, and 7 percent attained a 20 percent weight loss. By comparison, those figures dropped to 9 percent and 1 percent among the participants using the online guide. Some metabolic metrics, like levels of HDL ("good") cholesterol and triglycerides, also improved among participants in the intensive program.
"The study demonstrates that, with brief training, primary care practices can help a subset achieve sustained modest weight loss and prevent weight gain," Donna H. Ryan and others said in the Archives of Internal Medicine.
The study's authors hoped to prove that physician-led intervention could, in fact, work among the morbidly obese. In doing so, they wanted to encourage more funding for non-surgical treatment and better training for physicians in treating extremely overweight patients. Weight-loss drugs, meal replacements and specialized counseling often aren't covered by health insurance, making them expensive deterrents to those facing dangerous weight problems.
Unfortunately, weight changes among the participants in both programs were small, and retention rates -- the number of those who stayed with the study through two years -- hovered around 50 percent. And the weight loss couldn't compare to that of bariatric surgery: One analysis of obesity surgery studies reports long-term weight loss of about 45 to 65 pounds.
That's the kind of significant weight reduction necessary to bring notable health benefits, like reduced blood pressure, healthier cholesterol, lower risk of diabetes and even longer lifespan, points out Katie Drummond, writing on AOL News.
Still one has to start somewhere after all. One has to explore all avenues, and primary care settings could help.