The following obesity research abstracts were presented during the clinical poster session at Overcoming Obesity 2017 in San Antonio.
4 Clinics, 5 Clinicians, 17 Years, 21,080 Patients, 590,186 Pounds Lost: Data Collection and Results Obtained Following ASBP/OMA Treatment Guidelines
Authors: W. Allen Rader, MD, MFOMA; Michelle Freshwater, MD; Mary Hafer, MD; Brad Gilman, MD
Introduction: Evidence based medicine can only be practiced by collecting and sharing evidence. Data collection in obesity medicine is paramount. Sharing the data and comparing weight loss results obtained using different treatment and dietary regimens is equally important. This presentation shares our results in weight loss obtained over a 17 year experience following the treatment guidelines presented by the ASBP now OMA.
Methods: Data collection started January 2000 in the clinics of Idaho Weight Loss. The Electronic records of all patients presenting for weight loss were included. The weight loss results, first month, and at the end of one year treatment were collected in the reports. Results were exported in excel spread sheets allowing for the analysis of data, calculations of average weight loss, total weight loss, maximum weight loss, weight loss results by medicines and dietary intervention, and categorical weight loss results.
Results: 21,080 patients 85% female 15% male are included. Average age was 41. Oldest age 85 and the youngest at beginning of treatment was age 9. Average beginning weight 217 pounds BMI 36.
Conclusion: Overweight and Obesity treatment following ASABP/OMA guidelines is effective and maintainable. Data collection, sharing, and critical analysis is important in improving results of an individual clinic and the weight loss treatment society.
A Prospective Observational Study Assessing the Effect of Appetite Suppressants on Weight Loss
Authors: Macklin E. Guzmán, DHSc, MPH; Edward Zbella, MD, FACOG; Sejal Shah, MD, FAAP; Christina Holub, PhD, MPH; Eva Imperial, MD; Frank Troncale, MD, FACG; Jamie King, ARNP; Jennifer Nguyen, PhD, MPH, CPH; Arshpreet Kaur Mallhi, MPH, BDS
Introduction: There is literature demonstrating a relationship between the use of appetite suppressants and weight loss, but limited research has been done to compare the likelihood of clinically significant weight loss with appetite suppressants. The objective of the study is to compare the effect of appetite suppressants (phendimetrazine & phentermine) on the probability of losing clinically significant weight in a cohort of patients enrolled in a non-surgical weight management program. Clinically significant weight loss is defined as a loss of ≥ 5% of initial body weight, and is associated with improvement in many obesity related health indicators.
Methods: A sample of 418 patients enrolled in a weight management program was analyzed (phentermine=204, phendimetrazine=98, no medication=116). ‘No medication’ group was used as a reference category to compare the effectiveness of both appetite suppressants. Any patients who were prescribed both medications were excluded. Cox proportional hazard model was used to assess the event of interest (5% loss of starting body weight) over 24 weeks.
Results: We found that participants in the phentermine (1 tablet,15-37.5 mg q.d.) group had 58% higher probability of losing clinically significant weight compared to those who were in the ‘no medication’ group, after adjusting for sex, starting BMI, and age (HR = 1.58, p =0.001). A weak and statistically insignificant association was observed between phendimetrazine and clinically significant weight loss. Participants in the phendimetrazine (1-2 tablets , 35 mg t.i.d.) group had 27% higher probability of losing clinically significant weight compared to those who were in the ‘no medication’ group, after adjusting for sex, starting BMI, and age (HR = 1.27, p =0.12).
Conclusion: Our results show that the probability of achieving clinically significant weight loss is greater with phentermine compared to phendimetrazine; however, these results have some limitations due to unadjusted factors, such as medication dose and dosage schedule that may impact patient medication regimen compliance. More research is needed that controls for factors of medication compliance and their impact on obesity-related weight loss outcomes.
Association of Cardiovascular Risk Factors and Weight Status in Children and Adolescents with Obesity
POSTER CONTEST WINNER!
Author: Suzanne Cuda, MD, FAAP, FOMA
Introduction: The epidemic of children and adolescents with obesity (CWO) is strongly associated with an increased risk of early cardiovascular disease and type 2 diabetes (T2DM). Few studies have examined how weight change in CWO influences cardiovascular risk factors. This study follows CWO in treatment with repeated measurements of cardiovascular risk factors.
Methods: Cardiovascular risk factors were assessed in 107 CWO ages 6-18 at durations of treatment between 4-24 months. CWO were managed in an intensive pediatric weight management program utilizing dietary and lifestyle management, medication and counseling. CWO are treated in the context of the family: treatment was aimed at changes for the entire family as well as the school environment. Change in the percent of the body mass index (BMI) greater than the 95th percentile and laboratories were compared at baseline and at ascending treatment intervals to evaluate the association of cardiovascular risk factors with changes in weight status and duration of treatment. Patients were excluded if they did not have repeat laboratories or if they had a diagnosis of T2DM. All patients were included in the analysis, including those who increased their percent BMI. Results were analyzed in 4 age groups: 6-9, 10-12, 13-15, and 16-18 years and in 3 treatment durations: 4-6 months, 7-12 months, and 13-24 months.
Results: Clinically significant weight loss occurred in every age group with the largest decrease in the 16-18 year olds and in patients with longer duration of treatment. Decreases in triglycerides occurred in every age group and duration of treatment except the 10-12 and 13-15 year olds with treatment duration of 7-12 months. HbA1c decreased in every age and treatment duration group except the 16-18 year olds with a duration of 12-24 months of treatment. Non HDL c decreased in every age and duration of treatment group except the 16-18 year old with a duration of 7-12 months.
Conclusion: These findings strongly support the association of weight loss with improvement in cardiovascular risk factors in CWO managed in an intensive pediatric weight management program. The strength of this study is the long duration of treatment, supporting both intensive weight management and prolonged treatment. The prevention or amelioration of cardiovascular disease is the primary objective of treatment of obesity, especially in children. These findings support intensive and prolonged treatment and suggest that more children and adolescents with obesity could benefit from this type of management.
Childhood Obesity Diagnosis and Management after Expert Clinical Guideline Publication
Authors: Kathryn McKenna, MD, MPH; Andrew Coco, MD, MS
Introduction: The prevalence of obesity decreased in children aged 2 to 5 years from 2002 to 2012 while remaining stable in all other age groups. A national consensus guideline on pediatric obesity management was published in late 2007. Obesity is infrequently diagnosed at pediatric prevention visits. Obesity diagnosis increases the likelihood of a management plan in adults.
Methods: Objective: Compare the rate of obesity diagnosis in children age 2 to 18 years by physicians in the United States before and after guideline publication and evaluate whether diagnosis increased the likelihood of a management plan. Design: Cross sectional analysis of the National (Hospital) Ambulatory Medical Care Surveys from 2005-2012 comparing pre-guideline (2005-2008) to post-guideline (2008-2012) periods. Setting: Patient encounters in physician’s offices/hospital clinics. Participants: Preventive visits with children aged 2 to 18 years. Main and Secondary Outcome Measures: Obesity diagnosis in visits with body mass index (BMI) ≥ 95th% of the sex-specific Centers for Disease Control and Prevention growth charts. Rates of weight reduction/exercise/dietary counseling when obesity diagnosed.
Results: Analysis of 2589 visits representing 43.1 (95%CI: 39.1 -47.2) million children. The rate of obesity diagnosis did not change in visits with children aged 6 to 11 years (25.2% vs 34.4%; P=.12) or 12 to 18 years (46.3% vs 36.5%; P=.09) whereas the rate increased (7.6% vs 17.0%; P=.02) in visits with children 2 to 5 years in the post-guideline period. The rate of weight reduction/exercise/dietary counseling in those visits with children aged 2 to 5 years associated with an obesity diagnosis increased (4.4% vs 42.7%; P<.001) in the post-guideline period without changing in other age groups. Conclusion: After a national guideline publication, physicians increased their diagnosis and management of obesity in children aged 2 to 5 years. This increased awareness could have contributed to the lower obesity prevalence in this age group.
Early Dumping Syndrome: Case Series of Uncommon Incidence Following Laparoscopic Sleeve Gastrectomy (LSG)
Authors: Mohamed Elsherif, MD, PhD; Fahad Hanna, PhD; Sama Abdulrazzaq, MD; Isra Mustafa, MD; Wahiba Elhag, MD
Introduction: Dumping syndrome (DS) is a clinical impediment characterized by postprandial discomfort following bariatric-surgery. Data on incidence of DS following LSG is scarce. The purpose of this case series is to demonstrate the observation of DS in Qatari patients following Laparoscopic Sleeve Gastrectomy (LSG).
Methods: Cases from the outpatients’ clinic at the department of bariatric and metabolic surgery- Hamad General Hospital, who had undergone LSG during the year 2016 were followed up for progress and data were analyzed and treatment options were discussed.
Results: Five women under the age of 45 were diagnosed with DS. The first patient experienced fatigue, weakness and syncope. The second patient had a chief complaint of mild dizziness and diarrhea associated with low blood sugar. The third patient had complaints of recurrent hypoglycemia characterized by sweating, tremors, palpitations and dizziness. The fourth patient experienced significant dizziness associated with eating sweat, fatigue and low blood sugar within the first 40 minutes after meal with symptoms being relieved temporarily by sugary food. The fifth patient was presented to the emergency department with severe hypoglycemia, severe hypokalemia, fatigue, nausea, food intolerance and abdominal cramps. The majority of patients had mild-moderate symptoms with only one case presenting with severe symptoms that required hospitalization (5th patient) as blood sugar was very low (36-45 mg%) with very low potassium (2-2.5 mmol). None of the 5 patients had any comorbidity. Of the five patients, the first 4 responded to the diet modification with 2 required adding Acarbose oral tablets to control their symptoms. The fifth patient with severe symptoms had to undergo more intense therapy to control the symptoms, including administration of intravenous fluids, electrolytes correction, Acarbose, Octreotide and symptomatic treatment for abdominal pain and nausea as well as the usual diet modification and nutritional supplement.
Conclusion: DS in post-LSG patients is an uncommon condition that may lead to serious deficiency complications such as hypoglycemic attacks. This is yet another example that highlights the importance of patient education prior to discharge. Patients education should focus on raising the awareness of such potential complications and healthcare providers must have the knowledge and expertise to predict and deal with such ailment. While it is strongly recommended that alternative diets are adopted to help with the recovery of afflicted patients, severe cases of DS may require medication to treat critical cases.
Effectiveness of Anti-Obesity Pharmacotherapies on Short-Term Weight Loss: The Cleveland Clinic Experience
Authors: Khawla F. Ali, MD; Xinge Ji, MA, MS; Alex Milinoivh, BS; Kevin Chagin, MS; Elizabeth R. Pfoh, PhD, MPH; Kelly S. Shibuya; Derrick Cetin, DO; Michael Kattan, PhD; Bartolome Burguera, MD, PhD
Introduction: Weight loss of 3-5% has been shown to improve metabolic parameters and reduce cardiovascular risk factors. With the increase in number of anti-obesity drugs that aid in both weight reduction and improvement in metabolic outcomes, practitioners are in need of comparative weight loss data to guide them through prescribing such agents. In this study, we aimed to examine the effectiveness of the following 6 drugs (both FDA-approved for weight loss and drugs prescribed for off-label use) on short-term weight loss (3 months of therapy): phentermine hydrochloride, phentermine-topiramate, bupropion-naltrexone, liraglutide, exenatide, and locaserin.
Methods: In a retrospective study, we identified adults, 18 years of age or older, with body mass index (BMI) of ≥ 30 kg/m2 or BMI ≥ 27 kg/m2 with established obesity-related comorbidities who were seen at least twice within three months at the Cleveland Clinic between 2006 and 2016. Patients were eligible to be included if they were prescribed at least 3 months of only one of the following agents: phentermine hydrochloride, phentermine-topiramate, bupropion-naltrexone, liraglutide, exenatide, or locaserin, and had documented weight/height at the start of drug therapy and 3 months afterwards. We excluded patients with history of bariatric surgery at baseline. The data was analyzed using means and standard deviations for continuous data, and compared using the Wilcoxon rank sum test.
Results: Our study included 3,627 patients with a mean age of 46 years old, and 84% were female. On average patients had a BMI of 38 kg/m2 at baseline and lost an average of 3.4% of their weight at 3 months. In total, 65.4% of patients (n=2,372) were prescribed phentermine hydrochloride; 11.7% (n=425) were prescribed phentermine-topiramate; 7.1% (n=260) were prescribed bupropion-naltrexone; 3.8% (n=137) were prescribed liraglutide; 2.2% (n=79) were prescribed exenatide; and 9.8% (n=354) were prescribed locaserin. Mean percentages of weight loss, from order of highest to lowest, at 3 months post-therapy initiation, were: phentermine hydrochloride 3.75±5.66%, phentermine-topiramate 3.63±5.7%, liraglutide 2.29±5.37%, exenatide 2.81±4.46%, bupropion-naltrexone 2.66±5.03%, and locaserin 1.84±6.69%.
Conclusion: Meaningful weight loss of at least 3% can be achieved with most anti-obesity pharmacotherapies even in the context of short-term use (3 months of therapy). Prospective, head-to-head trials, investigating the effectiveness of anti-obesity drugs on weight loss and metabolic outcomes are needed to further guide practitioners into prescribing such agents.
Effects of Anti-Obesity Medications Locaserin versus Phentermine on Weight Parameters and Cardiovascular Risk Factors
Authors: Sama Abdulrazzaq Asal, MD; Wahiba Elhage, MD; Mohammed El Sherif, MD; Walid El Ansari, MD; Isra Mustafa, MD
Introduction: Obesity as chronic disease has serious cardio metabolic consequences. Weight loss can result in improvement of obesity-associated comorbidities. Recently,a few medications were approved for chronic weight management withmodest weight loss and reductions in cardio metabolic risks. This study assessed the efficacy, safety, and improvement of comorbidities of anti-obesity medications Locaserin compared with older medication Phentermine.
Methods: This retrospective comparative study (3 month duration)comprised 60 patients with obesity (22% were diabetics, 19% hypertensive and 37% were dyslipidemic). The sample comprised Locaserin(30patients, 27 females) and Phentermine (30patients, 28 females)groups. There were no significant differences between both groups’ baseline characteristics. Patients data included age, weight,BMI, comorbidities(type 2 diabetes, hypertension,dyslipidemia), diabetes lab results (HbA1c, fasting blood sugar),lipid profile (total cholesterol,HDL,LDL, TG), and any side effects mentioned by patients.Data was measured at baseline (before medication) and after 3 months of medication to compare the medications using T- test.
Results: At baseline,mean age, weight and BMI respectively were 43.2 years,94.97 kg,37.35 (Locaserin); and 45.3 years, 98.14 kg, 39.24 (Phentermine).At 3 months, mean ∆weight,∆BMI, and TWL%respectively were 7.05 kg, 2.78and 6.77% (Locaserin); 13.5 kg, 4.47 and 15.13% (Phentermine).Conversely, 7Locaserin patients gained weight (6 gained < 5%,1 gained 20% of baseline weight); and 5Phentermine patients gained weight (4 gained < 5%, 1 gained 7%of baseline weight). As for diabetes, for both groups, HBA1cand fasting blood sugar were slightly but not statistically significantly reduced. In terms of lipid profile(total cholesterol,HDL,LDL, TG), there were non significant minimal or nil decreases among Locaserin patients; but for Phentermine patients,total cholesterol, LDL and TG all significantly decreased, while HDL significantly increased. Two Locaserin patients had side effects (1 blurred vision,1dizziness);whilst 7 Phentermine patients had complaints(2 insomnia, 2 constipation, 2 palpitations and 1 headache). Conclusion: Although both medications exhibited significant weight reductions ,Phentaramin patients lost more weight than Locaserin patients. However both groups did not have significant improvements/ changes in their Diabetes parameters.Phenterminepatients showed a significant improvement in their lipid profile (reduced total cholesterol, LDL and TG; increasedHDL) when compared with Locaserin patients. More Phentaramin than Locaserin patients complained of side effects.
Efficacy and Safety of Monotherapy versus Combination Anti-Obesity Medications in Qatar
Authors: Isra Elgenaied, MD; Mohamed Elsherif, MD; Sama Abdulrazzaq, MD; Wahiba Elhag, MD; Walid El Ansari, PhD
Introduction: Management of obesity is a challenge. For positive health impact, medical weight management aims to achieve 5-10% weight reduction. Despite the range of anti-obesity medications, the efficacy and safety of monotherapy versus combination medications is sparse, with particularly limited data from the Eastern Mediterranean Region. This is despite that e.g. ≈70% of the Qatari population is overweight/ obese (receiving anti-obesity medications). We assessed short-term efficacy and safety of monotherapy vs. combination anti-obesity medications.
Methods: Retrospective review of medical charts of 73 overweight/obese Qatari patients attending the Obesity Clinic at Hamad General Hospital, Qatar. Inclusion criteria: age (20-67y); and, BMI> 27 ± comorbidities. Patients were categorized in 4 groups, based on treatment with FDA-approved weight loss agents (Phenteramine, 28 patients; Phenteramine+Topamax, 16 patients; Orlistat, 9 patients; Orlistat+Topamax, 20 patients). We assessed efficacy (weight loss at 3 months of medications) and safety (medications’ side effects) of monotherapy (Phenteramine or Orlistat) versus combination (Phenteramine+Topamax or Orlistat+Topamax).
Results: Sample comprised 76.7% females: mean age, baseline weight and BMI 42.7±10.9y, 100.85±23.62 kg and 38.56±8.02 kg/m² respectively. About 34.2% of the sample was on high protein meal regimen, and 21.9% were physically active.
In terms of efficacy (anthropemtric parameters at 3 months), sample’s mean weight and TWL% were 98.62±22.33kg and 15.86% ±16.23%, respectively. Phentermine+Topamax and Phentermine achieved the highest weight reductions (P = 0.001). About 66.6% of Phentermine+Topamax patients achieved >20% weight loss (mean TWL% = 33.02±16.15%). This was followed by 52.9% of Phentramin patients who achieved >20% weight loss (mean TWL% 23.94±19.14%). A total of 36% of Orlistat+Topamax patients achieved 5-10%, and another 36% achieved <5% weight loss (mean TWL% for whole Orlistat+Topamax sample 8.28%±6.68 kg). Finally 71.4% of Orlistat patients achieved <5% weight reduction (mean TWL% 4.52±4.18%). In terms of safety (side effects at 3 months), ten (62.5%) Phentramin+Topamax patients had side effects: 4 had numbness, 2 drowsiness, 2 constipation, 1 dry mouth, and 1 insomnia. Five (25%) Orlistat+Topamax patients had side effects: 1 had diarrhea, 1 drowsiness, 1 insomnia, 1 constipation, 1 numbness. Five (17.8%) Phentramin patients had side effects: 2 had palpitation, 1 insomnia, 1 dizziness, 1 drowsiness. Orlistat patients complained of no side effects. Conclusion: Overweight/obese patients on anti-obesity medications achieved mean of >10% weight loss at 3 months (15.8%). Phentramin+Topamax and Phentramin patients had highest percentage of weight loss. Phentramin+Topamax had highest side effects (numbness), followed by Orlistat+Topamax with 5 side effects equally distributed among the sample.
Efficacy of Stand Alone Physician Supervised Structured Weight Loss Program vs. In-Office Weight Loss Counseling During Routine Primary Care Visits
Authors: Kyal Sin Htet; Adam Saleem; Phyu Sin Htet; Myo M. Nwe, MD; Sandeep S. Grewal, MD
Introduction: Obesity and its co-morbidities pose a serious threat to human health and increase healthcare costs. Physician supervised structured weight loss programs are available, but beyond the reach of majority of the population due to financial barriers. Some Payers including Medicare have started covering weight loss counseling in physician offices during routine office visits but most health insurance payers still do not cover enrollment into dedicated structured weight loss programs supervised by physicians.
Methods: Aim: The purpose of this research was to evaluate obesity related health outcomes of physician guided structured weight loss program as compared to similar outcomes of weight loss counseling given by primary care physicians to the patients during routine follow-up visits. Method: 60 out of the nearly 600 patients screened were included in this retrospective chart review (RCR) research. The patients were separated into an Experimental and a Control group, with 30 patients in each group. The patients who made up the ‘Experimental group’ were enrolled in freestanding structured weight loss program supervised by a physician. This program guided the patient through every step of their weight loss journey with regular visits dedicated solely for weight loss, use of effective weight loss tools such as the SlimPlate System, video lectures, and medications for obesity management. The ‘Control group’ included patients who received weight loss counseling by their primary care physician during routine primary care follow-up visits at in Internal Medicine clinic. Patients with Body Mass Index (BMI) less than 30 and those who did not receive weight loss counseling during their primary care visits were excluded from the study.
Results: Patients’ average initial weight was 241 lbs. in the Experimental group vs. 222 lbs. in the Control group. Numbers of patient office visits were average 5 and 6 respectively. Average weight loss was 19 lbs. in the Experimental group vs. 4.5 lbs. in the Control group. Average reduction in Blood Pressure was by 10 mmHg in Experimental group and 0 mmHg in the Control group. In conclusion, as compared to weight loss counseling during regular primary care visits, enrollment of patients into a structured weight loss program supervised by physicians yields significantly better weight loss results and significantly larger improvement in other obesity related health outcomes such as blood pressure control in this instance. Therefore Payers should initiate health insurance coverage for freestanding structured physician supervised weight loss programs, as they are more efficient and effective in Obesity Management.
Identifying Challenges in Obesity Management
Authors: Preethi Polavarapu, MD; Phyo T. Htoo, MBBS, MPH; Carla DeJesus, MS, RD, LDN, CDE; Sann Y. Mon, MD, MPH
Introduction: Obesity is one of the leading causes of morbidity and mortality. Physicians have multiple challenges in managing obesity due to the lack of adequate training, dedication, and resources. Our main objective is to identify the physician’s level of comfort, their perceived barriers in the management of obesity at the primary care level, and the potential solutions.
Methods: A cross-sectional survey was conducted during July 2017 among a random sample of physicians (primary care and specialists) and medical residents from the University of Pittsburgh Medical Center, McKeesport Hospital. Interviews were conducted with a paper questionnaire. The survey assessed the current patterns of practice in obesity management along with the challenges faced by physicians in managing obesity and their solutions.
Results: Out of the 50 participants, 19 were physicians, 13 were second-year residents, and the rest were third-year residents. 47% of the physicians stated that 30-60% of their patients were obese (Body Mass Index> 30 kg/m2). About 90% physicians did not prescribe pharmacotherapeutic agents for weight loss management. More than 52% of the physicians acknowledged that the main obstacle is the lack of interest from the patient's end for managing obesity. The rest felt that shortage of time for dedicated patient education and counseling is the major challenge. Most physicians are not aware of meal replacement programs. Over half of the physicians (52%) felt that the continuous medical education regarding obesity management would be a potential solution. Among the residents, the majority is not prescribing medications for weight loss. 70% felt that they did not have dedicated time for patient education and counseling on weight loss. Two-thirds of them felt they needed more training regarding obesity management.
Conclusion: Based on our findings, we conclude that frequent continuous medical education sessions are needed to help reduce the training gap in all aspects of managing obesity, such as counseling sessions, pharmacological therapy, and referral to a board certified obesity specialist.
Improvement in Body Satisfaction among Patients after Participation in a Weight Management Program: A Prospective Observational Study
Authors: Macklin E. Guzmán, DHSc, MPH; Edward Zbella, MD, FACOG; Sejal Shah, MD, FAAP; Christina Holub, PhD, MPH; Eva Imperial, MD; Frank Troncale, MD, FACG; Jamie King, ARNP; Jennifer Nguyen, PhD, MPH, CPH; Arshpreet Kaur Mallhi, MPH,BDS; Casey McBride, MPH(C)
Introduction: Research has consistently found that individuals who are classified as overweight or obese are more likely to experience body image distress. Improved body part satisfaction has been found to be associated with sustained healthy weight loss and maintenance. The objective of this research is to assess the impact of weight loss on body satisfaction among individuals who self-enrolled into a non-surgical medically-supervised weight management program.
Methods: A sample of 109 participants was analyzed to assess the improvement in body part satisfaction rating after week 13. All patients completed a modified version of the Body Part Satisfaction Scale (BPSS) at baseline and after approximately 13 (± 3) weeks in the program. The BPSS gauges an individual’s level of satisfaction with various body parts, ranging from very dissatisfied to very satisfied on a five-point Likert scale. A Wilcoxon Signed Rank Test was performed to assess the average weight loss after 13 weeks, and if any statistically significant changes in mean body part satisfaction rating occurred after 13 weeks.
Results: We found statistically significant higher ranks of body part satisfaction at week 13 compared to baseline. After 13 weeks, patients in the cohort lost an average of 28.27 pounds (p < 0.01), and reported a mean improvement in rank by 1.79 points (p < 0.01) in weight satisfaction, 1.56 points (p < 0.01) in figure satisfaction, 1.46 points (p < 0.01) in waist satisfaction, 1.37 points (p < 0.01) in hip satisfaction, 1.27 points (p < 0.01) in leg satisfaction, 1.25 points (p < 0.01) in thigh satisfaction, 1.2 points (p < 0.01) in belly satisfaction, 1.18 points (p < 0.01) in build satisfaction. Conclusion: These results suggest that patients who participate in a medically-supervised weight management program may experience improvement in body part satisfaction. These conclusions are limited by the self-selection of individuals into the program, the self-report nature of the BPSS, and loss-to-follow up. Future research should assess the long-term impact of a medically-supervised weight management program on body satisfaction and weight loss outcomes.
Insights and Perceptions of Obesity Management in Older People with Obesity: Results of National Study
Authors: Michelle Look, MD; Angela Golden, DNP, FNP-C, FAANP; Ted Kyle, RPh, MBA; Nikhil Dhurandhar, PhD; Boris Stevenin, MD; Madhuri Kothari, PharmD, MBA; Ken Tomaszewski, PhD, MS
Introduction: Continued obesity management challenges remain, especially among older persons who may have greater comorbidities. The ACTION (Awareness, Care, and Treatment In Obesity maNagement) study examined attitudes and behaviors related to obesity management among people with obesity (PwO). As a growing proportion of the population, this research examines results among people aged 65 years and older.
Methods: This study comprised a cross-sectional, US-based, stratified sampling of PwO. Inclusion criteria included: BMI ≥30 kg/m2 based on self-reported height and weight. Adult PwO (n=3,008) completed online surveys: 946 (31%) were aged ≥65 years. The instrument assessed attitudes, experiences and behaviors associated with obesity management. Descriptive statistics among older PwO and comparisons between PwO aged ≥65 years (“older PwO”) and <65 years (“younger PwO”) are presented. Results: Two-thirds (66%) of older PwO reported feeling that “obesity is a disease,” similar to younger PwO (64%). Of PwO (n=2185) who discussed “losing weight” or “being overweight” with a healthcare provider (HCP), a lesser proportion (56%) of older PwO report that they “seek support” from their HCP for weight loss (65% among younger). Similarly, fewer older PwO (50%) report receiving a “formal diagnosis” of obesity, compared with younger PwO (56%). Older PwO report greater weight loss “success” in the past year (13%) compared with younger PwO (9%). As expected, older PwO report greater comorbidity prevalence (variable by condition, as much as twice the prevalence) such as high blood pressure, high cholesterol, and sleep apnea. A greater proportion of older PwO (16%) reported that “a specific medical event” (heart attack, stroke, etc.) had a great influence on their desire to manage weight, compared with younger PwO (12%).
Conclusion: Considering their greater prevalence of comorbidities, older PwO may need more appropriate, attentive obesity management from HCPs. Greater morbidity and experiences with health-related life events may have also made their efforts to manage weight more serious and vigilant, which could be associated with greater self-reported weight-loss success. In conclusion, although similar in many ways, older PwO show important statistical and proportional differences in obesity care and management compared with younger PwO. Older PwO more often report improvement in obesity management than their younger peers and, therefore, should receive at least as much clinician attention as younger PwO do. Efforts at providing HCPs a better understanding of how older PwO perceive and manage their obesity may further improve outcomes in this group.
Is Childhood Obesity a Predisposing Factor for Delayed Motor Development?
Author: Ladoris Latin Warren, MD, MBA, MS
Introduction: Childhood obesity may inauspiciously influence developmental outcomes. The aim of this study was to evaluate the relationship between weight and motor developmental delays in children and adolescents.
Methods: A systematic review was conducted identifying all relevant studies from 2006 – 2016 with comparative data on obesity in infancy through adolescence with decreased motor skills compared with normal weight children. The primary outcome was motor delay in children (3 months -13 years) and adolescents (14-20 years). Secondary outcomes included motor delay in infants with increased birth weight, overweight children, and gender differences. The results were analyzed as standard difference in means with standard error. Statistical analysis was done using random-effects meta-analysis to compare the mean value of the two groups (Comprehensive Meta-Analysis Version 3.3.070 software; Biostat Inc., Englewood, NJ).
Results: Four studies were quantitatively assessed and included for meta-analysis, which involved two prospective studies and two retrospective studies. Among the four studies, 491 were obese children and 1,375 were normal weight children. Delayed motor development in obese children was significantly higher (0.143±0.059; p=0.01) when compared to normal weight children and overweight children (-0.244±0.075; p=0.001).There was a significantly lower number of infants with increased birth weight with delayed motor skills as compared to underweight infants (1.101±0.25; p<0.0001) and a significantly higher number of obese boys with decreased physical ability than obese girls with impaired motor skills when comparing two of the four studies (0.636±0.021; p<0.0001). Conclusion: Children with obesity presented a predisposition to delayed motor development as compared to normal weight children and overweight children.
Joint Efforts Encompassing Various Strategies to Address Adiposity & Nutrition - JEEVAN
Authors: Varalakshmi Niranjan, MD, MBA; Abinaya Niranjan
Introduction: The management of obesity is one of the greatest challenges in a primary care private practice. The U.S. Preventive Services Task Force recommends primary care providers (PCPs) to screen all adults for obesity and to treat affected individuals. However, there is limited research and guidance on how to provide counselling on nutrition, promoting behavioral changes and medication management to patients with obesity.
Methods: A physician-supervised weight loss program was designed to treat patients with a BMI > 27 with comorbidities, and or a BMI > 30 with or without comorbidities. Patients were enrolled on a voluntary basis and their medical insurance was billed for office visits with the PCP. Patients were given 3 consecutive appointments when they enrolled to assure follow-ups. Patients were seen weekly or biweekly.
All patients were given nutritional meal plans and tools to track food including free smartphone apps. Protein bars and shakes were made available for purchase. Patients were also given access to Facebook and Instagram pages with recipes and coaching messages. Patients had monthly body composition analyses done with the ‘In Body 270’ scale. Data was collected retrospectively from chart reviews.
Results: A total of 72 patients were enrolled in the program during the study period from September 2016 to June 2017. Eight patients lost follow-up after 1 or 2 visits. The program had an enrollment of 89% females and 11% males. The average age of the patients enrolled was 58 years. The mean BMI at start was 35.57. The average weight lost per patient was 10.07 lbs. The total weight lost in the program was 638.3 lbs and the most weight lost by a single patient was 74.4 lbs in 7 months. A total of 38% lost more than 5% of their initial body weight. The average number of months to achieve this was 4 and 55% of the patients used weight loss products such as protein shakes and bars at least once during the study period.
Conclusion: An insurance-based, physician-supervised weight loss program can be integrated in a private practice model efficiently with minimal investment. This model proves that patients tend to follow up with their PCP more regularly with minimal dropout rates. The trust developed longitudinally with the PCP likely enhances their adherence during the weight loss challenge.
Lifestyle Modification Group for Lymphedema and Obesity Results in Significant Health Outcomes
POSTER CONTEST WINNER!
Authors: Leslyn Keith, OTD; Lorie G. Richards, PhD, OTR/L, FAHA; Carol Rowsemitt, PhD, RN, FNP-C
Introduction: The current rates of obesity are more than reflected in adults with lymphedema, with some clinics showing that over 75% of patients with lymphedema are overweight or obese. This study investigated whether a ketogenic diet promoted by a lifestyle modification group for participants with lymphedema and obesity would improve health outcomes, such as reduced weight and edema, and improved quality of life.
Methods: Twelve participants with lymphedema and obesity, (mean Body Mass Index [BMI] = 38.38 [SD = 7.02]) were enrolled in an occupational therapist-led, 12-session lifestyle modification group with six individual sessions. Retention rate was 83.3%. Participants self-selected into two diet groups: those who implemented the ketogenic diet (KD, n = 6) and those who did not (NKD, n = 4). Data was analyzed with repeated measures ANOVA and Pearson correlation.
Results: Overall, participants demonstrated statistically significant improvement in most outcome measures. Post-intervention mean weight reduced 11.42 lbs (SD = 10.5 lbs, p < .001), or 4.8% of mean baseline weight. Edema volume reduced a mean of 698.9 ml (SD = 642.84, p < .001) and was significantly positively correlated with weight loss. Lymphedema Life Impact Scale (LLIS) scores demonstrated significant improvement in quality of life (M = 12.44, SD = 17.0, p = .002). Individually, the participants who adopted a ketogenic diet achieved a greater mean value than those who did not. Mean weight loss in the KD group was 18.02 lbs (SD = 8.09, p < .001) while the NKD group lost an average of 1.51 lbs (SD = 1.83, p = .415). Reduction in limb volume in the KD group was 1000.58 ml (SD = 554.24, p < .001) and 246.38 ml (SD = 522.2, p = .667) in the NKD group. The KD group demonstrated better reduction of impact of lymphedema on life in LLIS scores (M = 22.61, SD = 13.78, p < .001) compared to the NKD group (M = 2.83, SD = 5.71, p = .305). There was no relationship between attendance at either group or individual sessions and a positive change in outcome measures. Conclusion: While, as a group, the participants improved in all study outcomes, it was primarily the participants employing the ketogenic diet who drove these changes. A lifestyle modification group and individual sessions encouraging the implementation of a ketogenic diet resulted in improved outcomes and may be a viable adjunct to improved clinical outcomes for lymphedema treatment.
Long-term Micronutrient Surveillance after Bariatric Surgery: An Opportunity for Improvement
Authors: Wesley D. Fox, MD; Andrew J. Borgert, PhD; Cary M. Rasmussen, MS; Kara J. Kallies, MS; Paul T. Klas, MD; Shanu N. Kothari, MD
Introduction: Bariatric surgery requires lifelong medical management due to metabolic derangements that occur as sequelae of the procedures. Monitoring of numerous micronutrient parameters are recommended by the American Association of Clinical Endocrinologists, The Obesity Society, and the American Society for Metabolic and Bariatric Surgery. Long-term compliance with recommended surveillance is largely unknown. Our goal was to evaluate our institution’s compliance with recommended laboratory guidelines.
Methods: A retrospective review of all patients who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) from 2001 through 2016 was performed using a prospective bariatric surgery registry and an integrated electronic health record system at a Midwestern multi-specialty health system. Postoperative management by primary care versus the bariatric surgery clinic was determined by the location in which patient weights were recorded. Compliance with recommended laboratory testing was analyzed at 1, 3, and 5 years postoperative.
Results: Overall, 1490 patients were included. Patient follow-up in primary care increased from 8.0% (n=109) at 1 year postoperative to 33.2% (n=359) at 3 years and 43.2% (n=369) at 5 years. At five years post-procedure, 82%, 85%, and 68% of patients followed by primary care did not have a Vitamin D, PTH, and vitamin B12 level, respectively. At five years post-procedure, 81%, 55%, and 48% of patients followed by the bariatric clinic did not have a Vitamin D, PTH, and vitamin B12 level, respectively.
Conclusion: While expert opinions regarding micronutrient surveillance after bariatric surgery exist, most patients did not have the recommended laboratory testing completed. Primary care providers were managing the care for the greatest proportion of patients within three years of their surgical date, yet these patients are at risk for unidentified nutritional derangements. This study identified a gap in long-term post-surgical care for bariatric surgery patients. Reasons for this are varied and may include lack of insurance coverage, inadequate patient follow up, and an unfamiliarity of specialty guidelines. Further studies will be necessary to develop interventions aimed at improving adherence to recommended monitoring in the post-surgical patient.
Translation of Lectures, Panel Discussion and Tools from Obesity Medicine Association (OMA) to an Intensive Weight Loss Program (IWLP) in a Primary Care Office. Comparison of IWLP and CDC Diabetes Prevention Program (CDC DPP)
Authors: Mahtab Ahmed, MD; Timothy Newman, MD
Introduction: Patients and Primary Care Physicians (PCP) face difficulties in knowledge, motivation, expectation, appropriate setting, and affordability of services for a user friendly effective weight loss and maintenance program in a primary care office. Our poster provides how we translated lectures and tools from OMA to an Intensive Weight Loss Program (IWLP) in a primary care office with 2 nursing staff and one provider. Weight management data from IWLP will be compared with the data from the recently released, CDC-DPP.
Methods: The initial goals of IWLP were a 5 to 10% body weight loss in 3 to 6 months and maintain lost weight. Participants were required to see physician monthly, starting with initial H & P and coaching. After finishing 12 week program, further goals and appointments were individualized according to patient’s need. Patients were advised to keep their daily weight, exercise and food intake log. Weight loss data from 77 adults (49 female, 28 male, 23 to 63 YO) in 7 to 70 week period (Average participation 40 week) is presented. Body weights presented here with initial, lowest and final body weight with corresponding weeks in each individual participants.
Results: Maximum weight loss ranged from 5 to 88 pounds with average weight loss 26.5 pounds, corresponding to 2% to 30% weight loss with average 10.8% weight loss. Final weight loss ranged from +2 to -87 pounds with average weight loss 22 pounds, corresponding to +1% to -30% weight change with average -8.9% weight loss. Only one out of 77 participants regained 2.2 pounds. Seventy six out of 77 participants lost weight and maintained lost weight. 40% of participants (31/77) lost more than 9.9% of body weight and maintained. 70% of participants (54/77) lost more than 4.9% of body weight and maintained. 28% of participants (22/77) lost less than 4.9% and 1.2% (1/77) had weight regain.
IWLP were compared with CDC DPP as follows: Average weeks 40 vs. 208, number adults 77 vs 14,474, # of visits 3 visit/90 days vs. 3 visits/36 days, # of participants achieved >4.9% weight loss 70% in IWLP vs. 35.5% in CDC DPP. Average weight loss was 8.9% in IWLP vs 4.2% in CDC DPP.
Conclusion: This poster demonstrates that a PCP, powered by OMA resources, should be ready to offer individualized program for weight management irrespective of available support staff and equipment. Final weight losses were 8.9% and 4.2% in IWLP and CDC DPP respectively.
Weight Gain is Associated with Elevated Fasting Insulin Levels and Precedes Glucose Elevation
Authors: Nicholas Pennings, DO; Johnny Jaber, OMS4, MPH; Peter Ahiawodzi, PhD, MPH
Introduction: Obesity rates in the US are alarmingly high, with prevalence rates approaching 35% in males, 40% in females. Studies on the relationship between endogenous insulin production, insulin sensitivity, and insulin resistance provide mixed results.
Methods: Cross-sectional study of 3840 participants in the NHANES survey from the 2011-2014. Those <18 years of age, with missing insulin information, intentional weight change, or prior medical history of diabetes/pre-diabetes were all excluded from the study. Measured weights, in pounds, using the 2011-2014 survey cycle was subtracted from self-reported weights 10 years earlier. Fasting insulin was dichotomized into the < 25th percentile (< 5.48µU/mL), and >25th percentile (> 5.48µU/mL). Fasting glucose was categorized into normal (<100mg/dL), pre-diabetic (100-125mg/dL), and diabetic ranges (>125mg/dL). Insulin and glucose groupings were
categorized as the following:
- Group 1: Normal Insulin/Normal Glucose
- Group 2: Elevated Insulin/Normal Glucose
- Group 3: Elevated Insulin/Prediabetes
- Group 4: Elevated Insulin/Diabetes
- Group 5: Normal Insulin/Prediabetes or Diabetes
Results: 10-Year Weight Gain by Group
- Group 1 – 2.4 lbs
- Group 2 – 10.7 lbs
- Group 3 – 11.7 lbs
- Group 4 – 11.8 lbs
- Group 5 – 0.3 lbs
Participants in the first quartile of insulin (Gr 1 & 5) gained on average 1.40 lbs. whereas participants above the first quartile (Gr 2,3 & 4) gained on average 11.12 lbs. Weight change with 1µU/mL increase in insulin were as follows: Groups 1 and 5 had
the highest rate of weight gain at 2.01 & 1.46 lbs/µU insulin. The marginal weight gain in Groups 2, 3, and 4 was smaller and progressively declining at 0.6, 0.46 and 0.16
lbs/µU insulin. Weight change with each unit increase in HOMA-IR were as follows: Group 1, 8.07lbs/unit IR. Groups 2, 3, and 4 progressively declined at 2.65, 1.59 and
0.29 lbs/unit IR respectively.
Conclusion: Understanding the relationship between insulin, insulin resistance and weight change is beneficial in the management of the patient with obesity. There is a significant correlation between elevated fasting insulin levels, insulin resistance and 10-year weight gain. We saw a consistent increase in weight as glycemic stage progressed with the majority of weight gain occurring with elevation of fasting insulin in patients with normoglycemia. For both insulin and insulin resistance, the marginal increase in weight change per unit increase was most pronounce in individuals in the first quartile of insulin levels and declined as glycemic stage progressed.
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