A Multi-Disciplinary Approach to Weight Loss in Obese Renal Transplant Candidates: Achieving a Life of Health and Activity

Abstract

Background: Obesity is associated with complications and poor outcomes in renal transplant recipients. It is difficult to justify the allocation of a scarce resource to obese patients. Our program's obese renal transplant candidates (ORTC) are placed on the waiting list for transplantation (status 7) while they undergo mandatory weight loss to BMI<35. To date, little has been reported on the role of a multi-disciplinary approach to weight loss in ORTC. Methods: We performed an IRB-approved, single-center, prospective analysis of ORTC at Albany Medical Center. ORTC were invited to undergo evaluation and treatment for weight loss by a multi-disciplinary team using screening tools, interview, examination, and cardio-respiratory testing. Diet and exercise were prescribed and monitored. Patients with symptoms or signs of depression were referred for counseling. Each patient received education on food selection, preparation, portion control, and eating behaviors. Results: 70 ORTC with a BMI>35 on the renal transplant waiting list were invited to participate in the study; 20 enrolled in the 4-month study. The mean start BMI was 38.4 (35 to 44). 20 of 20 (100%) patients reported at least one barrier to weight loss; mean number of barriers was 3.6 (1 to 7), the most common being previous failed attempts (84%) and unhealthy eating behaviors (74%). 12 of 20 (60%) patients reported symptoms of depression by Patient Health Questionnaire (PHQ-9; score>7) or had signs of depression and were referred for counseling. By Veterans Specific Activity Questionnaire score, 20 of 20 (100%) patients had a daily activity level below predicted capacity; 16 of 20 (80%) patients maintained a daily activity capacity of at least 5 METs by the end of the study. The mean monthly weight loss was 1.5kg. 17 of 20 (85%) of patients lost weight during the study period; 3 of 20 (15%) failed to lose weight during the study; 2 of these 3 patients dropped out of the study. 1 of 20 (5%) patients suffered an exercise injury (a diabetic foot ulcer recurrence). No adverse coronary events occurred during the study; one patient patient's positive stress test led to elective coronary stent placement. Conclusion: Multiple barriers to successful weight loss were identified in our ORTC. The prevalence of untreated/undertreated depression and self-reported unhealthy eating behaviors is high in ORTC. Our study demonstrated the success of a multi-disciplinary approach to weight loss, which focused on the identification and elimination of barriers to successful weight loss using screening tools, diet, exercise, education, and resource referral.