Despite a general belief among physicians that extreme obesity is too difficult to treat, except with bariatric surgery, researchers at the Pennington Biomedical Research Center have learned a substantial proportion of individuals with extreme obesity can lose ten-percent or more of their body weight through medical treatment that does not include surgery. Furthermore, even though those individuals are still obese, they have improvements in risk factors and other health markers.
“This is important, because surgery is not often affordable or reimbursed by insurance,” said leading scientist Dr. Donna Ryan. “In fact, many medical treatments are frequently not reimbursed by insurance if they are for obesity. So this research is needed to show that primary care doctors are capable of helping obese patients lose weight to improve health, even those with extreme obesity. ”
Ryan said losing only five-percent of body weight can reap healthy benefits for the extremely obese, and nearly 61-percent of those in her clinical trial achieved that. More than 40-percent lost ten-percent body weight or more.
Ryan and her team spread out across Louisiana to recruit and train practicing physicians and their office staffs in 8 cities in what she called “intensive medical intervention,” in which physicians used a combination of medication, low-calorie diets and behavior changes. All of the techniques were endorsed by national guidelines for obesity management. Training of physicians and their staffs took about a day and a half.
Funded by the Louisiana Office of Group Benefits, the health insurer for state employees, the research team contacted state employees, seeking participants to screen for and enroll in the trial. Nearly 400 participants enrolled in the two-year trial, called LOSS, using the nearest trained physicians.
About half of the participants received the intensive medical intervention, the other half received what Ryan called “usual care.” Those in the intense intervention group were immediately placed on a low-calorie liquid diet. They gradually moved to a low calorie, highly controlled diet using meal replacements, and received weight loss medication and group behavioral therapy that included lessons in exercise, activity, self-monitoring and recommendations for walking, water exercise and weight training. The group sessions were supervised by office staff.
“We conducted this trial as close to the reality of a typical clinic setting as we could,” Ryan said, “We didn’t want to learn just if these strategies worked, but if they would work in the daily routine of a doctor’s practice.”
Ryan noted that the continual challenge in weight loss is keeping weight off, and that means sticking with a routine. More than 50-percent of the LOSS participants stuck with it for two years or more, keeping much of the weight off, but Ryan said that does leave room for improving weight loss maintenance.