Endocrine Abstracts

Background: Obesity (BMI ≤ 30 kg/m²) is a chronic and relapsing disease, associated with numerous co-morbidities. Lifestyle intervention is the cornerstone of treatment of obesity, and is considered effective when weight loss of ≤ 5% is achieved. Here, we describe changes in physiological, psychological and behavioral health outcomes in response to a multidisciplinary combined lifestyle intervention (CLI).MethodsIn this longitudinal study we evaluated 97 adult subjects with obesity (74 women; mean age: 42 years; mean BMI: 40.1 kg/m²). The 1.5 year CLI comprised physical activity, cognitive behavioral therapy and dietary advise tailored to promote a healthy normocaloric diet. We measured changes in physiological health (anthropometrics, metabolic and immune parameters), and used questionnaires to assess psychological health (HADS, SCL-90, PSS, FNAES, RSE), quality of life (IWQoL-Lite), eating behavior (DEBQ, EDE-Q, FCQ-T) and physical activity (IPAQ). In a subset of participants, DEXA-scans (n=37) were also performed to assess body composition. Linear regressions were used to investigate the association between weight loss and changes in physiological and psychological health outcomes, corrected for sex and age.

Results: After 1.5 years, there was a mean 5.1% weight loss (P<.001) along with a 6.1% decrease in waist circumference (P<.001). Total fat mass (-9.8%) and abdominal fat (-13.9%) decreased (both P<.001), while fat free mass did not. Fasting insulin, HOMA-IR, HbA1c, triglycerides and LDL-C decreased significantly (all P<.01), and HDL-C increased (P<.05). Levels of the immune parameters IL1ra, VEGF, sIL2R, sMR decreased (all P<0.05). Moreover, HADS scores (P<.01) and SCL-90 total score (P<.05) decreased, indicating lower psychological symptomatology. IWQoL-Lite scores were increased at 1.5 years (P<.001), indicating higher quality of life. Changes in DEBQ, EDE-Q and FCQT scores showed decreases in problematic eating behaviors (P<.05) while physical activity increased significantly (P<.05). Metabolic improvements correlated with the amount of weight loss (P<.05), except for LDL (P>.05). However, changes in most immune parameters, parameters of psychological health, and eating behavior did not correlate with the amount of weight loss, except for changes in IL1ra (P>.001), IWQoL, PSS (both P<.05) and EDE-Q total score (P<.01).

Conclsion: We show that the value of a multidisciplinary treatment approach for patients with severe obesity is not only limited to successful weight loss and improvements of body composition itself, but also includes the wide range of improvements in metabolic parameters, immunological, psychological, psychosocial, dietary, and behavioural improvements that may occur independently of weight loss.