Feasibility and indicative results from a 12 month low-energy-liquid-diet treatment and maintenance programme for severe obesity

Lean, M.E.J. et al. (2013) Feasibility and indicative results from a 12 month low-energy-liquid-diet treatment and maintenance programme for severe obesity. British Journal of General Practice, 63(607), pp. 115-124. (doi: 10.3399/bjgp13X663073)

Abstract

Background: There is no established primary care solution for the rapidly increasing numbers of severely obese people with body mass index (BMI) > 40 kg/m2. Aim: This programme aimed to generate weight losses of ≥15 kg at 12 months, within routine primary care. Design and setting: Feasibility study in primary care. Method: Patients with a BMI ≥40 kg/m2 commenced a micronutrient-replete 810–833 kcal/day low-energy liquid diet (LELD), delivered in primary care, for a planned 12 weeks or 20 kg weight loss (whichever was the sooner), with structured food reintroduction and then weight-loss maintenance, with optional orlistat to 12 months. Result: Of 91 patients (74 females) entering the programme (baseline: weight 131 kg, BMI 48 kg/m2, age 46 years), 58/91(64%) completed the LELD stage, with a mean duration of 14.4 weeks (standard deviation [SD] = 6.0 weeks), and a mean weight loss of 16.9 kg (SD = 6.0 kg). Four patients commenced weight-loss maintenance omitting the food-reintroduction stage. Of the remaining 54, 37(68%) started and completed food reintroduction over a mean duration of 9.3 weeks (SD = 5.7 weeks), with a further mean weight loss of 2.1 kg (SD = 3.7 kg), before starting a long-term low-fat-diet weight-loss maintenance plan. A total of 44/91 (48%) received orlistat at some stage. At 12 months, weight was recorded for 68/91 (75%) patients, with a mean loss of 12.4 kg (SD = 11.4 kg). Of these, 30 (33% of all 91 patients starting the programme) had a documented maintained weight loss of ≥15 kg at 12 months, six (7%) had a 10–15 kg loss, and 11 (12%) had a 5–10 kg loss. The indicative cost of providing this entire programme for wider implementation would be £861 per patient entered, or £2611 per documented 15 kg loss achieved. Conclusion: A care package within routine primary care for severe obesity, including LELD, food reintroduction, and weight-loss maintenance, was well accepted and achieved a 12-month-maintained weight loss of ≥15 kg for one-third of all patients entering the programme.

• Item Type: Articles
• Keywords: Primary health care; morbid obesity; Low Energy Liquid Diet; acceptability; health economics; orlistat
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McLoone, Mr Philip and Morrison, Dr David and Grieve, Dr Eleanor and Lean, Professor Michael and Mackenzie, Professor Mhairi
• Authors: Lean, M.E.J., Brosnahan, N., McLoone, P., McCombie, L., Bell Higgs, A., Ross, H., Mackenzie, M., Grieve, E., Finer, N., Reckless, J., Haslam, D., Sloan, B., and Morrison, D.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Social Scientists working in Health and Wellbeing; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing; College of Social Sciences > School of Social and Political Sciences > Urban Studies
• Journal Name: British Journal of General Practice
• Publisher: Royal College of General Practitioners
• ISSN: 0960-1643
• ISSN (Online): 1478-5242