Willing to go the extra mile: Prospective evaluation of an intensified non-surgical treatment for patients with morbid obesity

Background & aims: Bariatric surgery has been well established and considered the treatment of choice in morbid obesity. However, some patients refuse surgery because long-term effects have not been fully elucidated, quality of life might change and lifelong supplementation with vitamins and trace elements may be required. Our aim was to exhaust non-surgical treatment modalities and to evaluate such an intensified treatment alternative. Methods: A total of 206 patients (mean age = 46 years; BMI = 49 kg/m(2)) enrolled since 2013 into a non-surgical multimodality obesity treatment program covered by major health insurances were prospectively evaluated over a three year period. The 12-month treatment course comprised 57 h cognitive-behavioral therapy, 53.5 h physical exercise training, and 43.5 h nutritional therapy offered in small groups. Weight loss was induced by a formula-based, very low-calorie diet for 12 weeks in combination with a gastric balloon. The primary outcome was relative weight loss (RWL). Secondary outcome measures were waist-to-hip ratio, blood pressure, antihypertensive drug treatment, anti-diabetic medication, HbA1 c, and quality of life. Results: 166 Patients (81%) completed treatment. Mean (+/- SD) weight loss after 12 months for women and men were 28.8 kg (+/- 14.7) and 33.7 kg (+/- 19.5), respectively, among completers. RWL was 21.9% (+/- 10.0) and excess weight loss (EWL) was 46.9% (+/- 22.2), whereas intention-to-treat analysis revealed a RWL of 20.0% (+/- 10.4) and an EWL of 42.9% (+/- 22.9). Weight loss was accompanied by improved quality of life, lowered HbAl c values, and a significantly reduced need of antihypertensive and diabetes medications over the study period. Three year follow-up data from the first 78 patients (76% follow-up rate) revealed a RWL of 13% (+/- 13.1) and an EWL of 27.2% (+/- 28.8). The majority of patients (51%) maintained a RWL of 10% or more, and 44% had an EWL > 30%. Conclusions: In patients with morbid obesity, an intensified non-surgical multimodality treatment program may achieve significant and sustained weight loss accompanied by improvement of disease markers as well as quality of life for at least three years. (C) 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.