Effects of sustained weight loss on outcomes associated with obesity comorbidities and healthcare resource utilization

PLoS One. 2021 Nov 3;16(11):e0258545. doi: 10.1371/journal.pone.0258545. eCollection 2021.

Abstract

Objective: Determine the impact of long-term non-surgical weight loss maintenance on clinical relevance for osteoarthritis, cancer, opioid use, and depression/anxiety and healthcare resource utilization.

Methods: A cohort of adults receiving primary care within Geisinger Health System between 2001-2017 was retrospectively studied. Patients with ≥3 weight measurements in the two-year index period and obesity at baseline (BMI ≥30 kg/m2) were categorized: Obesity Maintainers (reference group) maintained weight within +/-3%; Weight Loss Rebounders lost ≥5% body weight in year one, regaining ≥20% of weight loss in year two; Weight Loss Maintainers lost ≥5% body weight in year one, maintaining ≥80% of weight loss. Association with development of osteoarthritis, cancer, opioid use, and depression/anxiety, was assessed; healthcare resource utilization was quantified. Magnitude of weight loss among maintainers was evaluated for impact on health outcomes.

Results: In total, 63,567 patients were analyzed including 67% Obesity Maintainers, 19% Weight Loss Rebounders, and 14% Weight Loss Maintainers; median follow-up was 9.7 years. Time until osteoarthritis onset was delayed for Weight Loss Maintainers compared to Obesity Maintainers (Logrank test p <0.0001). Female Weight Loss Maintainers had a 19% and 24% lower risk of developing any cancer (p = 0.0022) or obesity-related cancer (p = 0.0021), respectively. No significant trends were observed for opioid use. Weight loss Rebounders and Maintainers had increased risk (14% and 25%) of future treatment for anxiety/depression (both <0.0001). Weight loss maintenance of >15% weight loss was associated with the greatest decrease in incident osteoarthritis. Healthcare resource utilization was significantly higher for Weight Loss Rebounders and Maintainers compared to Obesity Maintainers. Increased weight loss among Weight Loss Maintainers trended with lower overall healthcare resource utilization, except for hospitalizations.

Conclusions: In people with obesity, sustained weight loss was associated with greater clinical benefits than regained short-term weight loss and obesity maintenance. Higher weight loss magnitudes were associated with delayed onset of osteoarthritis and led to decreased healthcare utilization.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Body Weight Maintenance / physiology*
  • Cohort Studies
  • Delivery of Health Care
  • Exercise / physiology
  • Female
  • Humans
  • Life Style
  • Male
  • Middle Aged
  • Obesity / epidemiology*
  • Obesity / pathology
  • Obesity / therapy
  • Patient Acceptance of Health Care
  • Weight Gain / physiology*
  • Weight Loss / physiology*

Grants and funding

Abhilasha Ramasamy, Neeraj N. Iyer, B. Gabriel Smolarz, and Neela Kumar are employed by Novo Nordisk, Inc., the study sponsor. Lisa Bailey-Davis, G Craig Wood, Peter Benotti, Adam Cook, James Dove, Jacob Mowery, and Christopher Still are employed by Geisinger Health, which received funding from Novo Nordisk, Inc. for work performed on this study. The funder (Novo Nordisk, Inc,) provided support in the form of salaries for authors [AR, NNI, BGS, NK]. The funder provided support for medical writing provided by Elizabeth Tanner of KJT Group. Inc. The funder was involved in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section.