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High intensity lifestyle intervention

HiLI subjects achieve substantial weightloss regardless status

Weight loss efficacy was most pronounced in those who had severe obesity (BMI ≥40) and the average weight loss in these patients was 22% compared to 19%, 17%, and 14% for class II obesity, class I obesity, and overweight patients, respectively

Subjects who underwent a programme of high intensity lifestyle intervention (HILI) - including weekly group coaching to achieve reduced calorie intake, increased fruit/vegetable intake, and physical activity ≥2,000kcal/wk - achieved substantial weight loss regardless of duration of programme participation, risk profile and comorbid status. The researchers - from HMR Weight Management Services Boston, MA, Med Data Analytics, Milltown and Merck & Co., Kenilworth, New Jersey, USA – concluded that the HMR programme could be an effective strategy to prevent costly diabetes and cardiovascular events, particularly in high-risk patients.

The study, ‘High intensity lifestyle intervention and long-term impact on weight and clinical outcomes’, published in PlosONE, assessed the effectiveness of clinic-based HILI on weight loss and associated clinical outcomes by duration of programme participation and comorbid conditions and included 500 patients who voluntarily enrolled in one of 43 HMR clinic-based weight management programmes in locations across the US.

The HMR programme is divided into two phases, including Phase 1 (weight-loss) and Phase 2 (weight-maintenance):

  • Phase 1 is designed to allow patients to achieve desired weight loss safely as soon as possible with the assistance of a structured diet, and weekly 75 to 90-minute face-to-face group coaching sessions. Two diet options were offered in clinic-based programmes for weight loss (Decision-Free and Healthy Solutions. These options vary in terms of calorie level and the potential need for medical supervision.
  • Phase 2 allows participants continue to attend weekly 60-minute coaching sessions, where they learn even more strategies to manage their weight as they face ‘real world’ eating challenges such as socialising, dining out or traveling. Participants are coached in maintaining PA (≥ 2,000 kcal/week) and in making healthier eating choices (lean proteins, whole grains, V/F), with optional/strategic use of PCFs to help with additional weight loss or maintaining weight loss.

Outcomes

Of the 500 subjects in the study, 67% were female, mean age 54.1 years, mean weight 243.5lbs (range 144.0–545.0) and mean BMI38.8 (range 25.4–85.0), including 37% with severe obesity (BMI≥ 40). Comorbid conditions reported were: diabetes or pre-diabetes (50%), high or moderate risk for dyslipidaemia (60%) and hypertension or pre-hypertension (86%). Not surprisingly, subjects who had longer duration of participation in the programme had higher baseline weight, BMI and tended to have a greater proportion of severe obesity and diabetes.

The outcomes showed patients achieved substantial weight loss regardless of duration of participation or diet option and on average lost 47.7lbs (18.9%) of initial body weight (IBW). The mean percent of IBW loss was 16.4%, 19.3%, 20.7% for ≤6 months (n=165), 7–12 months (n= 40), 13–24 months (n=195), respectively. Substantial reduction in IBW was achieved by six months of programme participation for both Decision Free and Healthy Solutions diet options, and for both programs longer duration of participation was associated with greater percent weight loss. However, patients participating in the Decision Free programme tended to have higher baseline weight/BMI and greater percent of weight loss.

Severe obesity

Weight loss efficacy was most pronounced in those who had severe obesity (BMI ≥40) and the average weight loss in these patients was 22% compared to 19%, 17%, and 14% for class II obesity, class I obesity, and overweight patients, respectively, although this could be due to these subjects This observation could be due to the higher IBW of severely obese patients and a higher proportion of high BMI patients having longer participation in the programme. Patients with diabetes and hypertension tended to achieve slightly greater % change in IBW loss, compared to those without (19.5% vs. 18.7% and 19.4% vs. 17.5%, respectively).

Among 192 (38%), 235 (46%), and 67 (15%) patients who reported taking oral anti-dyslipidemia, anti-hypertensive, and anti-diabetic medications at baseline, 43 (22%), 79 (33%), and 27 (40%) reported no longer taking the medication at follow up. Compared to those who continued to take medication, greater weight loss was observed in those who reported having discontinued medication: 25% vs. 17% in those stopped vs continuing anti-dyslipidemia; 22% vs. 17% in those who stopped vs. continuing anti-hypertensive; 23% vs. 18% in those who stopped vs. continuing oral anti-diabetic medication.

At baseline, only 22% of patients reported eating a low-fat diet compared to 94% at follow-up and only 28% of patients reported consuming V/F ≥6–7 days per week vs. 87% eating that amount at follow-up. Improvement in dietary behaviours appeared to be associated with more weight loss compared to maintaining good dietary behaviours (51.2lbs. vs. 40.1lbs. (p=0.00), respectively).

Using a simulation model, the researchers estimated that weight loss achieved through participation in the HMR clinic programmes could result in 22 diabetes events, 30 CVD events and US$1,992,370 in health care costs avoided over five years. Among 120 patients with diabetes, 22 CVD events and US$1,022,196 could be avoided over 5 years. Of the 186 patients with severe obesity, six diabetes events, 17 CVD events and US$958,958 could be avoided over five years.

“We found that the patients were able to achieve clinically significant weight loss ranging between 15–17% within six months of programme participation,” the authors noted. “There is a trend of greater weight reduction in those who had longer participation in the programme for up to 24 months.”

The authors emphasised that data from this study underscores the importance enabling patient access to the full continuum of care of evidence-based obesity preventive and treatment modalities. In addition, HILI and behavioural treatments are the foundation and complemented by other adjunct interventions such as pharmacotherapy and/or bariatric surgery/device, when appropriate, they added.

“Our results show encouraging success in the implementation of a clinic-based HILI programme which resulted in weight loss efficacy that surpasses the weight loss goals as outlined in obesity treatment guidelines. The weight loss achieved in this study was associated with reduction in self-reported medication utilisation and projected avoidance of incident cases of diabetes and CVD events,” the authors concluded. “Taken together, clinic-based programmes such as those provided by HMR are a viable option for health care organisations seeking to optimise the delivery of care in their patient population who are overweight or obese to avoid costly chronic diseases through a life-long healthy life style.”

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