Poster Presentation ANZOS-OSSANZ-AOCO Joint Annual Scientific Meeting 2017

Efficacy of an intensive lifestyle and medical treatment for severe obesity in the public hospital setting: a case series (#226)

Evan Atlantis 1 2 , Nishant Nundlall 3 4 , Paul Fahey 1 , Nic Kormas 3 5
  1. Western Sydney University, Penrith, NSW, Australia
  2. Medicine, University of Adelaide, Adelaide
  3. Endocrinology, Campbelltown and Camden Hospitals, Campbelltown and Camden, NSW
  4. Department of Endocrinology, St Vincent Hospital, Sydney, NSW
  5. Endocrinology, Concord Hospital, Concord, NSW

Background:

We investigated the efficacy of an intensive multidisciplinary treatment for severe obesity over 12-months, called the Metabolic Rehabilitation Programme (MRP), in a public hospital clinic.

Methods:

We extracted data from medical records for 52 eligible patients (44% men) with a body mass index (BMI) ≥35kg/m2 (27%, 54%, and 19% with a BMI ≥35-39, ≥40-49, and ≥50, respectively) referred to the MRP from 2009-2014. Clinical outcomes were changes in weight, glycosylated haemoglobin (HbA1c%) and systolic blood pressure (SBP) at 3, 6 and 12-months. Predictors tested were: age, gender, exercise sessions, BMI, waist circumference (WC), blood pressure, HbA1c, diabetes history, and medications at baseline; and total exercise sessions. Paired samples t-test, ANOVA, and Pearson’s correlation were used to test within-group mean differences, potential predictors and associations between outcomes, respectively.

Results:

Baseline mean(SD): age 59(11)years; weight 129(31)kg; HbA1c 8.0(1.5%); SBP 135(17)mmHg; WC 134(18); BMI 46.2(8.5)kg/m2; and diabetes duration 11.2(7.4)years. Within-group mean(SD) differences at 3, 6, and 12 months: HbA1c level -0.8(1.0), -0.8(0.9), and -0.9(1.1)%; percent change in weight -4.3(2.9), -6.6(3.5), and -9.0(5.2)%; SBP reading -6.2(13.7) (P=0.052), -6.0(18.7) (P=0.084), and -10.1(12.7)mmHg; (all others P<0.05). Absolute change in weight was predicted by: exercise sessions (-0.4kg per additional session, P=0.038); BMI (-0.51kg per additional BMI unit, P<0.001); and WC (-0.2kg per additional 1cm, P=0.002). Change in SBP was predicted by exercise sessions (-0.1mmHg per additional session, P=0.031); and possibly by gender (-7.8 for females, P=0.052). Percent change in HbA1c was correlated with percent change in weight (r=0.295, P=0.040) at 12-months. No serious adverse events were attributable to the MRP.

Conclusions:

The MRP resulted in clinically meaningful and incremental weight loss and improvements in metabolic control at 3, 6, and 12-months of treatment. Future research on the scalability and incremental cost-effectiveness of intensive multidisciplinary treatment for severe obesity in public hospitals is justified.