Abstract
Introduction: Even with very significant short term weight loss with intensive dietary restriction, subsequent weight regain remains a challenge for most patients. We sought to assess long-term weight change in patients with obesity following completion of a 24-week milk-based meal replacement programme.Methods: We conducted a retrospective cohort study of bariatric patients who completed our milk-based meal replacement programme. This programme started with an 8-week weight loss phase, followed by weight stabilization (8 weeks) and weight maintenance (8 weeks) phases, after which patients were followed up in the bariatric outpatient clinics. A paired sample t-test was used to compare mean differences in weight at the start and the end of the programme and at follow-up. Linear regression was used to identify predictors of weight regain.Results: In total, 78 patients had long term follow-up data at a mean of 34.4 ± 19.8 months after the start of the milk diet and were included in this analysis. Mean body mass index at baseline was 50.5 ± 7.6 kg m−2, 41 (52.6%) were female and the mean age was 51.6 ± 12.0 (range 18.0–71.5) years. Weight decreased from144 ± 26 kg at the start of the milk diet to 121.2 ± 24 kg at completion (P < 0.001), with a non-significant trend upwards in the 1st and 2nd years of follow-up to 129.0 ± 27.7 (P = 0.07 compared to nadir) and 123.4 ± 29.0kg (P = 0.17), respectively. Although regains in the 3rd and 4th follow-up years were substantial to 131.0 ± 22.3 (P < 0.001), and 139.8 ± 35.4 kg (P < 0.001), there was still a moderate net weight loss of 4.7 [9.5, 0.21] and 7.0 [13.9, 0.26] kg (both P = 0.04) between the start and the 3rd and 4th follow-up years, respectively. The amount of weight regain was inversely associated with weight loss at completion of the programme, age, and directly associated with the duration of follow up in months (β = 1.2 [0.46, 1.9] P = 0.002).Conclusion: In patients with severe obesity who completed a milk-based meal replacement programme and lost a large amount of weight, over 4 years of follow-up there was very substantial weight regain. Greater initial weight loss and older age were associated with less subsequent weight regain.
Highlights
Even with very significant short term weight loss with intensive dietary restriction, subsequent weight regain remains a challenge for most patients
A systematic review of 80 randomized clinical trials studying eight different types of non-surgical weight loss intervention reported that short-term (6 months) weight loss varied from 5 to 16%, after an additional 6 months, significant weight regain occurred [11]. In studies such as the SCALE trial, drugs like liraglutide help to maintain and even increase weight loss amongst those who have already achieved more than 5% weight loss with a low calorie diet, but once the drug is stopped, weight regain occurs within weeks [12]
Bariatric surgery is associated with much less weight regain in comparison to lifestyle modification or drug interventions in the longer term [13], with the Swedish Obese Subjects (SOS) study describing maintenance of 18% total body weight loss after 20 years of follow-up after surgery compared to only 1% weight loss with non-surgical weight loss strategies [14]
Summary
Even with very significant short term weight loss with intensive dietary restriction, subsequent weight regain remains a challenge for most patients. A systematic review of 80 randomized clinical trials studying eight different types of non-surgical weight loss intervention reported that short-term (6 months) weight loss varied from 5 to 16%, after an additional 6 months, significant weight regain occurred [11]. In studies such as the SCALE trial, drugs like liraglutide help to maintain and even increase weight loss amongst those who have already achieved more than 5% weight loss with a low calorie diet, but once the drug is stopped, weight regain occurs within weeks [12]. While the literature to date has identified weight regain as a significant problem, the data are somewhat conflicting, with results appearing to depend on the precise intervention utilized in particular
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