Mean Weight Loss For Patients Research Articles

Service evaluation of a pilot psychology clinic including psychological intervention within a Tier 2 community adult weight management service

Background:Obesity levels in Scotland are amongst the highest in the developing world and psychological co-morbidities are common amongst the obese population. and evidence suggests that psychological approaches, can result in sustained weight loss, improved wellbeing and reduced binge eating. However, there is limited evidence of effective intervention supporting weight outcomes in a general setting.Aim:The aim of this pilot intervention was to determine if the addition of a psychology clinic within a Tier 2 community adult weight management service (CAWMS) supported positive weight management outcomes.Methods:Service evaluation data was gathered at an urban and rural GP practice within Grampian. Patients were referred to the pilot psychology clinic if mild to moderate mental health concerns were highlighted. Eight patients (average age 46 years; mean BMI 46.2) attended between four and eight appointments within the psychology clinic. Progress, goal setting, barriers and relapse prevention were discussed using a motivational interviewing approach. Psycho-education, self-management advice and brief psychological interventions, were offered where appropriate.Results:Mean weight loss for patients who attended the psychology clinic was 7.4kg. Mean HADS anxiety scores did not change, whereas HADS depression scores reduced by 3.5, although not statistically significant (p > 0.001). Qualitative feedback suggests that the majority of patients found the addition of psychological support helpful.Conclusion:The pilot has highlighted the value and importance of a psychology clinic within Tier 2 CAWMS. Feedback from dietitians suggests that the addition of psychological support better informed their understanding of patients concerns. It highlights the need for ‘joined-up’ working within the community weight management service.

Decision Regret up to 4Years After Gastric Bypass and Gastric Banding.

Weight loss surgery (WLS) is neither risk-free nor universally effective. Few studies have examined what proportion of patients regret having undergone WLS. We interviewed patients at two WLS centers before and after WLS about weight loss, quality of life/QOL (Impact of Weight on QOL-lite), and decision regret (modified Brehaut Regret scale, range 0-100). We conducted separate multivariable logistic regression models to examine the association between weight loss and ∆QOL scores and having decision regret (score > 50). Of 205 RYGB patients, only 2.2% (year 1) to 5.1% (year 4, n = 134) reported regret scores > 50 over 4years; 2.0-4.5% did not think they made the right decision; 2.0-4.5% would not undergo WLS again. In contrast, of 188 gastric banding patients (n = 123 at year 4), 8.2-20.3% had regret scores > 50; 5.9-19.5% did not think they made the right decision; 7.1-19.5% would not undergo WLS again. Weight loss and ∆QOL scores were significant correlates of decision regret after banding although weight loss was a stronger correlate with lower model quasi-likelihood under the independence model criterion score. Four years after banding, mean weight loss for patients with regret scores > 50 was 7.4% vs. 21.1% for those with scores < 50; the AOR for regret score > 50 was 0.90 (95% CI 0.87-0.94) for every 1% greater weight loss. Poor sexual function, but not weight loss or other QOL factors, was significantly correlated with decision regret after RYGB. Few patients regret undergoing RYGB but 20% regret undergoing gastric banding with weight loss being a major driver.

Meta-Analysis of Ultrafiltration versus Diuretics Treatment Option for Overload Volume Reduction in Patients with Acute Decompensated Heart Failure.

IntroductionAlthough diuretics are mainly used for the treatment of acute decompensated heart failure (ADHF), inadequate responses and complications have led to the use of extracorporeal ultrafiltration (UF) as an alternative strategy for reducing volume overloads in patients with ADHF.ObjectiveThe aim of our study is to perform meta-analysis of the results obtained from studies on extracorporeal venous ultrafiltration and compare them with those of standard diuretic treatment for overload volume reduction in acute decompensated heart failure.MethodsMEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials databases were systematically searched using a pre‑specified criterion. Pooled estimates of outcomes after 48 h (weight change, serum creatinine level, and all-cause mortality) were computed using random effect models. Pooled weighted mean differences were calculated for weight loss and change in creatinine level, whereas a pooled risk ratio was used for the analysis of binary all-cause mortality outcome.ResultsA total of nine studies, involving 613 patients, met the eligibility criteria. The mean weight loss in patients who underwent UF therapy was 1.78 kg [95% Confidence Interval (CI): −2.65 to −0.91 kg; p < 0.001) more than those who received standard diuretic therapy. The post-intervention creatinine level, however, was not significantly different (mean change = −0.25 mg/dL; 95% CI: −0.56 to 0.06 mg/dL; p = 0.112). The risk of all-cause mortality persisted in patients treated with UF compared with patients treated with standard diuretics (Pooled RR = 1.00; 95% CI: 0.64–1.56; p = 0.993).ConclusionCompared with standard diuretic therapy, UF treatment for overload volume reduction in individuals suffering from ADHF, resulted in significant reduction of body weight within 48 h. However, no significant decrease of serum creatinine level or reduction of all-cause mortality was observed.

A1C Improvement with Liraglutide Evaluated by Baseline BMI

The LEAD phase 3 clinical trial program demonstrated both improved glycemic control and mean weight loss in patients with type 2 diabetes with 1.2 mg or 1.8 mg liraglutide treatment. It is unclear whether the glycemic response with liraglutide is dependent on patients’ baseline BMI. In this post-hoc pooled analysis of 7 clinical trials (LEAD-1–6 and Lira–DPP-4i, n=5100), the relationship between A1C response and baseline BMI was explored. Data from each treatment arm were modeled across trials, including pooled analyses of liraglutide and placebo, accounting for baseline A1C, country, trial and prior treatment. Across treatment arms, mean BMI at baseline ranged from 29.8 to 33.7 kg/m2. Maximum baseline BMI was 45 kg/m2 (based on inclusion criteria). Models used 26/28-week data for change in A1C from baseline using the intent-to-treat population, last observation carried forward. The slope of baseline BMI vs. change in A1C for pooled liraglutide 1.8 mg data is shown in Figure 1A, and Forest plots describing the impact of baseline BMI on A1C improvement for liraglutide 1.2 mg and 1.8 mg and placebo for pooled and individual trials are shown in Figure 1B: a slight negative correlation was seen with liraglutide 1.8 mg (–0.011 [95%CI: –0.020, –0.002]), but no association was observed with liraglutide 1.2 mg and placebo. The effect with liraglutide 1.8 mg was small: a 10 kg/m2 higher BMI corresponded to a difference in A1C reduction of 0.11%. In conclusion, there was no clinically relevant A1C improvement associated with liraglutide with higher baseline BMI (up to 45 kg/m2).

Effect of milnacipran on body weight in patients with fibromyalgia.

BackgroundThe purpose of this study was to evaluate the effects of milnacipran on body weight in patients with fibromyalgia.MethodsAnalyses were conducted in the following groups: patients from three double-blind, placebo-controlled milnacipran trials (3 months, n = 2096; 6 months, n = 1008); 354 patients receiving milnacipran in placebo-controlled trials and double-blind extension studies (total ≥ 12 months of treatment); and 1227 patients in a long-term (up to 3.25 years) open-label milnacipran study.ResultsIn placebo-controlled trials, 77% of patients were overweight or obese at baseline (body mass index ≥ 25 kg/m2). Mean weight loss was found with milnacipran at 3 months (100 mg/day, −1.14 kg; 200 mg/day, −0.97 kg; placebo, −0.06 kg; P < 0.001) and 6 months (100 mg/day, −1.01 kg; 200 mg/day, −0.71 kg; placebo, −0.04 kg; P < 0.05). Approximately twice as many milnacipran-treated patients had ≥5% weight loss from baseline compared with placebo (3 and 6 months, P < 0.01). In extension studies, mean weight loss in patients receiving ≥12 months of milnacipran was −1.06 kg. In patients receiving ≥3 years of treatment in the open-label study, mean changes at 12, 24, 30, and 36–38 months were −1.16, −0.76, −0.19, and +0.11 kg, respectively. Among milnacipran-treated patients, rates of nausea (the most common adverse event) were lower among patients who lost weight than among those who did not (3 months, P = 0.02).ConclusionThe majority of patients with fibromyalgia in the milnacipran studies were overweight or obese. Milnacipran was associated with mean weight loss at 3 and 6 months (P < 0.05 versus placebo) and at 12 and 24 months of treatment, with mean changes drifting back to baseline at 30 months (−0.19 kg) and 36–38 months (+0.11 kg, no placebo comparison).

Group therapy in obesity control: results of our 8-year experience

We have analysed group therapy efficacy in weight loss of obese outpatients, non responders to previous hypocaloric treatments. The results we have obtained during the last 8 years have been compared to those reported in literature, to our previous observations and to results obtained in a group of obese outpatients in traditional diet-therapy. The mean weight loss in patients followed for 6 months with group therapy was 5.5% of the initial weight (IW); 48.5% of them lost more than 5% and 13% lost more than 10% of IW. The results obtained in a traditional treated group were a little better: mean weight loss was −6.6%, 61% lost more than 5% and 22% more than 10% of IW. So, in our opinion, group therapy can be usefully applied only in selected patients (i.e. older in age/non-responders to traditional treatments), where it might have a possible role as a more cost-effective treatment.

Laparoscopic Sleeve Gastrectomy is Superior to Endoscopic Intragastric Balloon as a First Stage Procedure for Super-Obese Patients (BMI ≥50)

The treatment of patients with a BMI > or =50 kg/m2 is still controversial. Given the many co-morbidities and oftentimes fragile health of super-obese patients, surgeons experienced in bariatrics often advocate a less invasive first stage operation for these patients. This allows them enough weight loss to support a more major second-stage operation such as a gastric bypass or a biliopancreatic diversion/duodenal switch. Thus, the aim of this study was to compare laparoscopic sleeve gastrectomy (LSG) and the BioEnterics intragastric balloon (BIB) as a first-stage procedure for effective initial weight loss before more definitive surgery. 20 patients (13 males and 7 females) who underwent LSG from May 2001 to December 2002 were compared with 57 patients (33 males and 24 females) obtained as historical controls from two large series who underwent BIB. Patients were evaluated at 6 months in terms of: weight, BMI, percent of excess weight loss (%EWL) and change in BMI. There were no differences between groups for age, weight and BMI. There were no complications for patients under-going the LSG. For patients undergoing BIB, 4 patients (7%) had the balloon removed due to intolerance. The mean weight loss for patients undergoing LSG and BIB at 6 months was 45.5 vs 22.3 kg respectively, and the %EWL was 35 for LSG vs 24 for BIB. BMI decreased respectively from 69 to 53 for the LSG group and from 59 to 51 for the BIB group. Weight loss decreased co-morbidities in 90% of patients after both procedures. Patients undergoing a LSG showed a faster and greater weight loss than those using a BIB at 6 months. Moreover, LSG is a safe procedure, with reproducible results, in contrast to the BIB which was tolerated by 93% of patients. The results indicate that both mean weight loss and %EWL were better in the LSG group, and that BMI decreased substantially more in the LSG group as well. Although the BIB procedure shows efficacy in reducing weight, the LSG group does so faster and to a greater amount, thus suggesting that this may be a superior procedure as a first stage for super-obesity.

Use of TPN in terminally ill cancer patients.

Total parenteral nutrition (TPN) is often used as an adjunct to cancer therapy. However, it is increasingly being used in terminally ill cancer patients without clearly defined reasons. To determine the validity of the use of TPN in terminally ill cancer patients, 26 patients with limited life expectancy due to end-stage cancer were given TPN by their physicians, and the validity of its use was evaluated using the criteria of 1) quality of life, and 2) ultimate outcome. Patients were divided into two groups according to the use of TPN. Group I = TPN as adjunct of medical therapy, n = 15 (eight male, seven female), mean age 32 y. Group II = TPN for in-hospital supportive care, n = 11 (two male, nine female), mean age 56 y. Nutritional status on admission, quality of life (assessed by extent of daily activities, pain, and ability to sustain oral intake), and ultimate treatment outcome were determined. Mean weight loss in patients in Group I was 8.6 kg, 11 patients out of 15 were malnourished; mean weight loss in patients in Group II was 21 kg, and all of the 11 patients belonging to this group were malnourished. Two patients of Group I improved their quality of life, while 6 declined and 7 died; in Group II, 3 improved their quality of life, 4 declined, and 4 died. We conclude that when TPN was given either as an adjunct to in-hospital aggressive therapy for cancer or for in-hospital supportive care, quality of life did not improve in the majority of patients; nor did it influence ultimate outcome. These objective data, thus, raise the question of the validity of the use of TPN in terminally ill cancer patients. However, barring the cost factor, it is recognized that subjective reasons for giving TPN to terminally ill cancer patients persist and include compassionate, ethical, religious, or emotional reasons.