Intensive Medical Weight Management Research Articles

A222 5 Year Follow-up of Previously Published Cohort Comparing Diabetes Surgery vs. Intensive Medical Weight Management on Diabetes Remission in Patients with Type 2 Diabetes and BMI 30-35; the Role of sRAGE Diabetes Marker as Potential Predictor of Success

A222 5 Year Follow-up of Previously Published Cohort Comparing Diabetes Surgery vs. Intensive Medical Weight Management on Diabetes Remission in Patients with Type 2 Diabetes and BMI 30-35; the Role of sRAGE Diabetes Marker as Potential Predictor of Success

1124 Identifying Predictors of Weight Loss for Patients Enrolled in an Intensive Medical Weight Management Program

INTRODUCTION: Identifying predictors of weight loss are of paramount importance for patients and clinicians involved in obesity management. The aim of this study was to identify predictors of weight loss for patients enrolled in an intensive medical weight management program (IMWMP). METHODS: Our IMWMP involved visits every two to four weeks with medical providers, a recommended low carbohydrate diet with the goal carbohydrates individualized and often fewer than 100 g per day, encouraging physical activity, pharmacotherapy for some patients and surveillance every three months with bioimpedance plethysmography analysis (BIA). A binomial logistic regression was performed to ascertain the effects of gender, number of visits, number of daily steps, waist circumference, starting weight, starting fat mass measured by BIA, body mass index, HgbA1C, carbohydrate intake and pharmacologic medications to identify predictors of 10% weight loss from the time of enrollment to most recent office visit over a three year period. RESULTS: 160 consecutive patients enrolled in our IMWMP who had at least three or more follow-up visits were analyzed. The mean weight at the time of joining IMWMP and most recent office visit were 238.8 lbs and 214.6 lbs, respectively, for a mean weight loss of 24.2 lbs (-10.1%; P = 0.01). Ten or more visits to our IMWMP was identified a predictor of 10% weight loss (P = .012; eB: 9.6 [CI (1.63-55.5)]; see Table 1). Female gender (P = .139; eB: 3.1 [CI (.69-14.0)]) and starting fat mass less than the mean of 106 kg on BIA (P = .054; eB: 6.37 [CI (0.97-41.7)]) showed trends towards significance. Interestingly, a starting weight under the mean of 242 pounds was associated with a reduction in the likelihood of losing 10% body weight (P = .113; eB: 0.213[CI (0.031-1.45)]. Other predictors of 10% weight loss that had a positive estimate of odds ratio (eB) but did not achieve or show trends towards significance included starting waist circumference below mean of 45 inches, daily carbohydrate intake less than 65 grams, daily steps greater than 5000 and use of pharmacologic therapy intended for weight loss. CONCLUSION: 10 or more visits to our IMWMP are identified as a predictor of 10% weight loss. These results provide insights into predictors of weight loss in obesity management. Further studies are needed to establish the current trends and to identify additional modifiable factors.

Evaluating the Efficacy of an Intensive Medical Weight Management Program

Introduction: Gastroenterologists are increasingly involved in obesity management. The aim of this study is to report the percent of patients enrolled in an intensive medical weight management program (IMWMP) who achieved therapeutic goal of 10% weight loss and maintained their decreased body weight. Methods: Our IMWMP involved visits every two to four weeks with medical providers, a recommended low carbohydrate diet with individualized goal carbohydrates often fewer than 100 g per day, encouraging physical activity, pharmacotherapy for some patients and surveillance every three months with bioelectric impedance analyzer. Our IMWMP is divided into two phases: phase 1 to achieve 10% weight loss and phase 2 to achieve each patient's self-desired goal weight with efforts to maintain weight loss in both phases. Starting with the onset of IMWMP in 2015, we retrospectively chart reviewed the first 225 patients enrolled. Patients with fewer than three visits with medical providers were excluded. Any patient with a visit between March to May 2018 was deemed to be an active enrollee. Results: 160 patients met inclusion criteria, of which 78 were active enrollees. The mean weight at the time of joining IMWMP and most recent office visit were 238.8 lbs and 214.6 lbs, respectively, for a mean weight loss of 24.2 lbs (-10.1%) (Image 1). Mean carbohydrate intake was 63.28 grams per day. During the first six months of enrollment, the mean decrease in weight was 14.5 pounds at three months and 21.6 lbs at six months (Image 2). 105 patients met the phase 1 goal and achieved initial weight loss of at least 10%, in a mean duration of 0.52 years (Image 3). Patients who lost at least 10% of their weight were able to maintain their lower body weight for a mean duration of 1.16 years based off their most recent office visit, with 56 active enrollees either maintaining or exceeding 10% weight loss. 36 patients attained initial weight loss of 20% or greater with 23 patients maintaining weight loss greater than 20% at time of their most recent office visit (Image 3). 11 patients reached their phase 2 goals and achieved it in mean duration of 1.20 years. Conclusion: A majority of patients enrolled in an IMWMP attained therapeutic success of at least 10% weight loss with many able to maintain their decreased weights. Given the tremendous personal and societal costs of obesity, including those of associated gastrointestinal disorders, such programs may have the potential to improve morbidity and mortality.1040_A Figure 1. Provides data about patient enrollment and goals achieved by our patients.1040_B Figure 2. Shows the mean weight over time. n represents the number of patients who were enrolled at the particular time.1040_C Figure 3. Shows the percentage of weight change based off the lowest weight and weight at most recent office visit.

Characterization of Changes in Clinical and Metabolic Parameters for Patients in an Intensive Medical Weight Management Program

Introduction: Obesity is linked to multiple comorbid conditions such as hypertension, hyperlipidemia, diabetes mellitus and cardiovascular disease; digestive disorders associated with obesity include gastroesophageal reflux disease symptoms, erosive esophagitis, Barrett's esophagus, cholelithiasis, nonalcoholic fatty liver disease (NAFLD), cirrhosis, precancerous colon polyps and cancers. The aim of this study is to report changes in clinical and metabolic parameters for patients who underwent an intensive medical weight management program (IMWMP). Methods: Our IMWMP involved visits every two to four weeks with medical providers, a low carbohydrate diet with individualized goal carbohydrates often fewer than 100 g per day, encouraging physical activity, pharmacotherapy for some patients and surveillance every three months with bioelectrical impedance analyzer (BIA). The goal of IMWMP was to help patients lose 10% or more weight. We retrospectively chart reviewed the first 225 patients enrolled in our IMWMP starting in 2015; only patients who had three or more visits with medical providers were included. Analyzed clinical and metabolic parameters included blood pressure, pulse, hemoglobin A1C (HgbA1C), liver chemistries AST and ALT, lipids and CRP (Table 1). BIA data is reported only on patients who had at least two BIA studies and included body weight, body mass index, skeletal muscle mass, visceral adipose tissue and others (Table 2). All comparisons are between baseline and most recent values. Results: 160 patients met inclusion criteria, of which 78 were active enrollees. The mean weight at the time of joining IMWMP and most recent office visit were 238.8 lbs and 214.6 lbs, respectively, for a mean weight loss of 24.2 lbs (-10.13%). Changes in blood pressure, pulse and HgbA1C were minimal (Table 1). AST and ALT decreased by mean of 24.18% and 28.89%, respectively (Table 1). On average, triglycerides decreased by 17.3% and HDL increased by 16.26%. BIA analysis is reported on 125 patients; it showed a mean decrease in fat mass of 12.42%, decrease in visceral adipose tissue of 16.88% and decrease in skeletal muscle mass of 5.14% (Table 2). Conclusion: Our IMWMP led to improvements in many clinical and metabolic parameters. Decrease in liver chemistries with associated weight loss highlights the importance of weight loss in managing NAFLD. Patients in weight loss programs are prone to sarcopenia and our use of BIA in providing dietary recommendations minimized the loss of skeletal muscle mass.1041_A Figure 1. compares mean clinical and metabolic parameters between baseline and after intervention.1041_B Figure 2. compares mean bioelectric impedance analyzer data between baseline and after intervention.

A125 - Long-Term Follow-Up of Pilot Randomized Trial Comparing Bariatric Surgery Vs. Intensive Medical Weight Management on Diabetes Remission In Patients With Type 2 Diabetes And Bmi 30-35; The Role of Srage Diabetes Biomarker As Predictor of Success

A125 - Long-Term Follow-Up of Pilot Randomized Trial Comparing Bariatric Surgery Vs. Intensive Medical Weight Management on Diabetes Remission In Patients With Type 2 Diabetes And Bmi 30-35; The Role of Srage Diabetes Biomarker As Predictor of Success

The impact of a managed care obesity intervention on clinical outcomes and costs: A prospective observational study

ObjectiveTo evaluate the impact of a managed care obesity intervention that requires enrollment in an intensive medical weight management program, a commercial weight loss program, or a commercial pedometer-based walking program to maintain enhanced benefits.Design and MethodsProspective observational study involving 1,138 adults with BMI ≥32 kg/m2 with one or more comorbidities or BMI ≥35 kg/m2 enrolled in a commercial, independent practice association-model health maintenance organization. Body mass index, blood pressure, lipids, HbA1c or fasting glucose, and per-member per-month costs were assessed one year before and one year after program implementation.ResultsProgram uptake (90%) and one year adherence (79%) were excellent. Enrollees in all three programs exhibited improved clinical outcomes and reduced rates of increase in direct medical costs compared to members who did not enroll in any program.ConclusionsA managed care obesity intervention that offered financial incentives for participation and a variety of programs was associated with excellent program uptake and adherence, improvements in cardiovascular risk factors, and a lower rate of increase in direct medical costs over one year.