Effects of an eight-week supervised, structured lifestyle modification programme on anthropometric, metabolic and cardiovascular risk factors in severely obese adults.

Catherine Crowe,Jane Windle,Katriona Kilkelly,Tim O′Brien,Helena Griffin,Caroline Costello,Jenni Jones,Mary Hynes,Paula M O′Shea,Irene Gibson,Katie Cunningham,Claire Kerins,Brian Mcguire,Francis M Finucane

doi:10.1186/s12902-015-0038-x

Abstract

BackgroundLifestyle modification is fundamental to obesity treatment, but few studies have described the effects of structured lifestyle programmes specifically in bariatric patients. We sought to describe changes in anthropometric and metabolic characteristics in a cohort of bariatric patients after participation in a nurse-led, structured lifestyle programme.MethodsWe conducted a retrospective, observational cohort study of adults with a body mass index (BMI) ≥40 kgm−2 (or ≥35 kgm−2 with significant co-morbidity) who were attending a regional bariatric service and who completed a single centre, 8-week, nurse-led multidisciplinary lifestyle modification programme. Weight, height, waist circumference, blood pressure, HbA1c, fasting glucose and lipid profiles as well as functional capacity (Incremental Shuttle Walk Test) and questionnaire-based anxiety and depression scores before and after the programme were compared in per-protocol analyses.ResultsOf 183 bariatric patients enrolled, 150 (81.9 %) completed the programme. Mean age of completers was 47.9 ± 11.2 years. 34.7 % were male. There were statistically significant reductions in weight (129.6 ± 25.9 v 126.9 ± 26.1 kg, p < 0.001), BMI (46.3 ± 8.3 v 44.9 ± 9.0 kgm−2, p < 0.001), waist circumference (133.0 ± 17.1 v 129.3 ± 17.5 cm in women and 143.8 ± 19.0 v 135.1 ± 17.9 cm in men, both p < 0.001) as well as anxiety and depression scores, total- and LDL-cholesterol and triglyceride levels, with an increase in functional capacity (5.9 ± 1.7 v 6.8 ± 2.1 metabolic equivalents of thermogenesis (METS), p < 0.001) in completers at the end of the programme compared to the start. Blood pressure improved, with reductions in systolic and diastolic blood pressure from 135 ± 16.2 to 131.6 ± 17.1 (p = 0.009) and 84.7 ± 10.2 to 81.4 ± 10.9 mmHg (p < 0.001), respectively. The proportion of patients achieving target blood pressure increased from 50.3 to 59.3 % (p = 0.04). The proportion of patients with diabetes achieving HbA1c <53 mmol/mol increased from 28.6 to 42.9 %, p = 0.02.ConclusionsBariatric patients completing an 8 week, nurse-led structured lifestyle programme had improved adiposity, fitness, lipid profiles, psychosocial health, blood pressure and glycaemia. Further assessment of this programme in a pragmatic randomised controlled trial seems warranted.

Highlights

Lifestyle modification is fundamental to obesity treatment, but few studies have described the effects of structured lifestyle programmes in bariatric patients
The study population included bariatric patients ≥18 years old with a body mass index (BMI) ≥40 kg m−2 who were willing to attend a community-based facility where the Changing lifestyle with activity and nutrition (CLANN) programme is delivered for 2 h per week for 8 weeks
We anticipated that blood pressure and lipid profiles might not change to the same extent in “Clann” as in “MyAction”, because we sought to minimise any changes in medications during this programme to the greatest extent possible, whereas in the Croi “MyAction” programme the proportions of patients on antiplatelets, renin-angiotensin related antihypertensives and calcium channel blockers increased by 4.6, 4.9 and 5.6 %, respectively while the proportion on statins increased from 40.3 to 65.1 %

Summary

Introduction

Lifestyle modification is fundamental to obesity treatment, but few studies have described the effects of structured lifestyle programmes in bariatric patients. Consistent with global trends, the prevalence of overweight and obesity has increased steadily in Ireland over the past three decades [1, 2] This is a public health concern because of the associated morbidity and mortality from diseases like type 2 diabetes, for which the population attributable risk from obesity is 50 to 80 % [3, 4]. The population shift in body mass index (BMI) has led to a dramatic rise in the prevalence of severe obesity [6] For these individuals (conventionally defined as those with a BMI ≥40 kg m−2 or ≥35 kg m−2 with comorbidities such as type 2 diabetes), relatively intensive “bariatric” interventions need to be adopted [7]. While bariatric surgical interventions are efficacious and cost effective [11], they are invasive, expensive and unsuitable for a significant proportion of bariatric patients

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