Factors associated with weight loss and health gains in a structured lifestyle modification programme for adults with severe obesity: a prospective cohort study

Front Endocrinol (Lausanne). 2023 Oct 17:14:1257061. doi: 10.3389/fendo.2023.1257061. eCollection 2023.

Abstract

Background: Individual responses to behavioural weight loss interventions can vary significantly, and a better understanding of the factors associated with successful treatment might help to target interventions for those who will benefit the most. We sought to identify demographic and clinical characteristics that predicted intervention "success" (defined as ≥5% weight loss) and other health gains in patients with severe obesity attending a ten-week structured lifestyle modification programme.

Methods: We conducted a prospective cohort study of all 1122 patients (751 (66.9%) female, mean age 47.3 ± 11.9 years, mean body mass index (BMI) 46.7 ± 7.8 kgm-2) referred from our hospital-based obesity clinic, who started the structured lifestyle programme between 2012-2019. We compared routine clinical measures such as weight, fitness, blood pressure, lipids and HbA1c at baseline and follow-up. We also used validated questionnaires to quantify anxiety, depression and health-related quality of life.

Results: Of 1122 patients who started, 877 (78.2%) completed the programme and attended for follow up. Of these, 12.8% lost ≥5% body weight. The amount of weight lost was a strong and consistent predictor of improvements in metabolic, cardiovascular, and mental health, even after adjusting for age, sex, programme attendance and baseline fitness. Older age, male sex, being physically active and having lower anxiety and depression scores at baseline predicted greater weight loss. Younger age, depression and longer wait time to start the intervention were associated with drop-out.

Conclusions: In adults with severe obesity completing a structured lifestyle modification programme, older age and good mental health were associated with programme completion and attaining ≥5% weight loss. The magnitude of weight lost was a strong predictor of improvements in cardiovascular, metabolic and mental health associated with programme completion.

Keywords: anxiety; depression; determinants of response; diet; physical activity; quality of life; severe obesity; structured lifestyle modification.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Diet
  • Exercise
  • Female
  • Humans
  • Life Style*
  • Male
  • Middle Aged
  • Obesity
  • Obesity, Morbid* / therapy
  • Prospective Studies
  • Quality of Life
  • Weight Loss*

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This programme was co-funded between 2013 and 2021 equally by a recurring project grant from the Health and Wellbeing Section of the Health Service Executive (the Irish publicly-funded health service) and by the Saolta University Healthcare Group, Ireland. FF is funded by a Clinical Research Career Development Award from the Saolta University Healthcare Group, and FMF and EM are funded by a CURAM/Science Foundation Ireland Project Grant (ref 13/RC/2073-P2).