Abstract
ObjectiveDetermine the impact of long-term non-surgical weight loss maintenance on clinical relevance for osteoarthritis, cancer, opioid use, and depression/anxiety and healthcare resource utilization.MethodsA cohort of adults receiving primary care within Geisinger Health System between 2001–2017 was retrospectively studied. Patients with ≥3 weight measurements in the two-year index period and obesity at baseline (BMI ≥30 kg/m2) were categorized: Obesity Maintainers (reference group) maintained weight within +/-3%; Weight Loss Rebounders lost ≥5% body weight in year one, regaining ≥20% of weight loss in year two; Weight Loss Maintainers lost ≥5% body weight in year one, maintaining ≥80% of weight loss. Association with development of osteoarthritis, cancer, opioid use, and depression/anxiety, was assessed; healthcare resource utilization was quantified. Magnitude of weight loss among maintainers was evaluated for impact on health outcomes.ResultsIn total, 63,567 patients were analyzed including 67% Obesity Maintainers, 19% Weight Loss Rebounders, and 14% Weight Loss Maintainers; median follow-up was 9.7 years. Time until osteoarthritis onset was delayed for Weight Loss Maintainers compared to Obesity Maintainers (Logrank test p <0.0001). Female Weight Loss Maintainers had a 19% and 24% lower risk of developing any cancer (p = 0.0022) or obesity-related cancer (p = 0.0021), respectively. No significant trends were observed for opioid use. Weight loss Rebounders and Maintainers had increased risk (14% and 25%) of future treatment for anxiety/depression (both <0.0001). Weight loss maintenance of >15% weight loss was associated with the greatest decrease in incident osteoarthritis. Healthcare resource utilization was significantly higher for Weight Loss Rebounders and Maintainers compared to Obesity Maintainers. Increased weight loss among Weight Loss Maintainers trended with lower overall healthcare resource utilization, except for hospitalizations.ConclusionsIn people with obesity, sustained weight loss was associated with greater clinical benefits than regained short-term weight loss and obesity maintenance. Higher weight loss magnitudes were associated with delayed onset of osteoarthritis and led to decreased healthcare utilization.
Highlights
Obesity is a chronic disease that has been associated with a multitude of comorbidities, including cardiovascular disease, diabetes, certain cancers, joint diseases, mental health disorders, and sleeping disorders [1,2,3,4,5,6,7,8,9,10,11] with a negative impact on quality of life [12]
In people with obesity, sustained weight loss was associated with greater clinical benefits than regained short-term weight loss and obesity maintenance
Higher weight loss magnitudes were associated with delayed onset of osteoarthritis and led to decreased healthcare utilization
Summary
Obesity is a chronic disease that has been associated with a multitude of comorbidities, including cardiovascular disease, diabetes, certain cancers, joint diseases, mental health disorders, and sleeping disorders [1,2,3,4,5,6,7,8,9,10,11] with a negative impact on quality of life [12]. Weight loss achieved through caloric restriction or bariatric surgery has many limitations including effects on basal metabolic rate and endocrine regulation, as well as frequent reoperations needed with bariatric surgery [21,22,23,24,25,26] which can make it challenging for many people with obesity to sustain weight loss over time [27, 28]. The aim of this study was to determine the relationship between long-term weight loss maintenance and clinical relevance across a range of comorbidities that can impact the patients with obesity including osteoarthritis, cancer, opioid use, and depression/anxiety. A secondary objective was to examine the relationship between obesity and long-term weight loss maintenance on health care resource utilization
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