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Atlantis E, Kormas N, Piya M, Sahebol-Amri M, Williams K, Huang HCC, Bishay R, Chikani V, Girolamo T, Prodan A, Fahey P. Developing a Decision Aid for Clinical Obesity Services in the Real World: the DACOS Nationwide Pilot Study. Obes Surg 2024; 34:2073-2083. [PMID: 38467898 PMCID: PMC11127827 DOI: 10.1007/s11695-024-07123-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE The purpose of this study is to develop a decision aid tool using "real-world" data within the Australian health system to predict weight loss after bariatric surgery and non-surgical care. MATERIALS AND METHODS We analyzed patient record data (aged 16+years) from initial review between 2015 and 2020 with 6-month (n=219) and 9-/12-month (n=153) follow-ups at eight clinical obesity services. Primary outcome was percentage total weight loss (%TWL) at 6 months and 9/12 months. Predictors were selected by statistical evidence (p<0.20), effect size (±2%), and clinical judgment. Multiple linear regression and bariatric surgery were used to create simple predictive models. Accuracy was measured using percentage of predictions within 5% of the observed value, and sensitivity and specificity for predicting target weight loss of 5% (non-surgical care) and 15% (bariatric surgery). RESULTS Observed %TWL with bariatric surgery vs. non-surgical care was 19% vs. 5% at 6 months and 22% vs. 5% at 9/12 months. Predictors at 6 months with intercept (non-surgical care) of 6% include bariatric surgery (+11%), BMI>60 (-3%), depression (-2%), anxiety (-2%), and eating disorder (-2%). Accuracy, sensitivity, and specificity were 58%, 69%, and 56%. Predictors at 9/12 months with intercept of 5% include bariatric surgery (+15%), type 2 diabetes (+5%), eating disorder (+4%), fatty liver (+2%), atrial fibrillation (-4%), osteoarthritis (-3%), sleep/mental disorders (-2-3%), and ≥10 alcohol drinks/week (-2%). Accuracy, sensitivity, and specificity were 55%, 86%, and 53%. CONCLUSION Clinicians may use DACOS to discuss potential weight loss predictors with patients after surgery or non-surgical care.
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Affiliation(s)
- Evan Atlantis
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, Australia.
| | - Nic Kormas
- Department of Endocrinology, Concord Hospital, Concord, New South Wales, Australia
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden and Campbelltown Hospitals, Campbelltown, New South Wales, Australia
| | - Milan Piya
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden and Campbelltown Hospitals, Campbelltown, New South Wales, Australia
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Mehdi Sahebol-Amri
- Ryde Hospital, Northern Sydney Local Health District, Ryde, New South Wales, Australia
| | - Kathryn Williams
- Department of Endocrinology, Nepean Hospital, Nepean Blue Mountains Local Health District, Kingswood, New South Wales, Australia
- Charles Perkins Centre-Nepean, The University of Sydney, Kingswood, New South Wales, Australia
| | - Hsin-Chia Carol Huang
- Respiratory & Sleep Medicine, Canberra Hospital, Garran, Canberra, Australian Capital Territory, Australia
- Canberra Obesity Management Service, Canberra Health Services, Belconnen, Canberra, Australian Capital Territory, Australia
- College of Health and Medicine, Australian National University, Acton, Australian Capital Territory, Australia
| | - Ramy Bishay
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
- Metabolic & Weight Loss Clinic, University Clinics, Western Sydney University, Blacktown Hospital, Blacktown, New South Wales, Australia
| | - Viral Chikani
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Teresa Girolamo
- Re:You Health, Adelaide Weight Management and Wellness, Adelaide, South Australia, Australia
| | - Ante Prodan
- School of Computer, Data and Mathematical Sciences, Western Sydney University, Sydney, Australia
| | - Paul Fahey
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, Australia
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Barbaro A, Kumar A, Asokan G, Green L, Ibrahim A, Goel R, Harries R, Kanhere H, Prowse P, Trochsler M. Quality of Life After Bariatric and Body Contouring Surgery in the Australian Public Health System. J Surg Res 2023; 285:76-84. [PMID: 36652771 DOI: 10.1016/j.jss.2022.12.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 12/04/2022] [Accepted: 12/25/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION The goals of bariatric surgery are weight loss, improved management of obesity-related diseases, and enhanced health-related quality of life (HRQoL). The aim of this study is to determine HRQoL among postoperative bariatric surgery patients. The aim of this study was to evaluate the utility of bariatric surgery and the role of body contouring surgery (BCS) when considering quality of life in low-volume centres in the Australian public health system. METHODS This cohort study compared patients who underwent bariatric surgery between 2008 and 2018, to those awaiting surgery. An additional analysis was completed for patients who also underwent BCS. Patients completed the Short Form-36 quality of life (SF-36) survey. Linear regression was used to assess the differences in mean scores between cohorts for each of the SF-36 domains. RESULTS A total of 131 postoperative patients were identified, with a follow up rate of 68%. The mean follow up was 5.4 y. The mean scores for all domains of the SF-36 in the postoperative group were higher than the preoperative group (P ≤ 0.0001). A significant difference in scores persisted after controlling for patients' current BMI. When considering patients who underwent BCS (n = 24), there was a further global improvement in HRQoL in physical function (P = 0.0065), role limitation to physical health (P = 0.0026), pain (P = 0.0004), energy (P = 0.0023) and general health perceptions (P = 0.0023). CONCLUSIONS Bariatric surgery followed by BCS may improve HRQoL for the patient when compared to bariatric surgery alone. We advocate for the use of bariatric surgery followed by BCS in low-volume centres in the Australian public health system.
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Affiliation(s)
- Antonio Barbaro
- Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital Adelaide, Woodville South, Australia
| | - Ajan Kumar
- Plastic and Reconstructive Surgery, The Queen Elizabeth Hospital, Woodville South, Australia
| | - Gayatri Asokan
- Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital Adelaide, Woodville South, Australia
| | - Luke Green
- Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital Adelaide, Woodville South, Australia
| | - Abdullah Ibrahim
- Plastic and Reconstructive Surgery, The Queen Elizabeth Hospital, Woodville South, Australia
| | - Raghav Goel
- Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital Adelaide, Woodville South, Australia
| | - Richard Harries
- Plastic and Reconstructive Surgery, The Queen Elizabeth Hospital, Woodville South, Australia
| | - Harsh Kanhere
- Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital Adelaide, Woodville South, Australia
| | - Phoebe Prowse
- Plastic and Reconstructive Surgery, The Queen Elizabeth Hospital, Woodville South, Australia
| | - Markus Trochsler
- Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital Adelaide, Woodville South, Australia.
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Kodsi R, Chimoriya R, Medveczky D, Grudzinskas K, Atlantis E, Tahrani AA, Kormas N, Piya MK. Clinical Use of the Edmonton Obesity Staging System for the Assessment of Weight Management Outcomes in People with Class 3 Obesity. Nutrients 2022; 14:967. [PMID: 35267942 PMCID: PMC8912843 DOI: 10.3390/nu14050967] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 11/17/2022] Open
Abstract
We aimed to assess weight loss and metabolic outcomes by severity of weight-related complications following an intensive non-surgical weight management program (WMP) in an Australian public hospital. A retrospective cohort study of all patients aged ≥18 years with body mass index (BMI) ≥ 40 enrolled in the WMP during March 2018−March 2019 with 12-month follow-up information were stratified using the Edmonton Obesity Staging System (EOSS). Of 178 patients enrolled in the WMP, 112 (62.9%) completed at least 12 months’ treatment. Most patients (96.6%) met EOSS-2 (56.7%) or EOSS-3 (39.9%) criteria for analysis. Both groups lost significant weight from baseline to 12 months; EOSS-2: 139.4 ± 31.8 kg vs. 131.8 ± 31.8 kg (p < 0.001) and EOSS-3: 141.4 ± 24.2 kg vs. 129.8 ± 24.3 kg (p < 0.001). After adjusting for baseline age, sex and employment status, mean weight loss was similar but a greater proportion of EOSS-3 achieved >10% weight loss compared to EOSS-2, (40% vs. 15.9%, p = 0.024). Changes in metabolic parameters including HbA1c, BP and lipids did not differ between EOSS-2 and 3. Despite increased clinical severity, adult patients with class 3 obesity achieved clinically meaningful weight loss and similar improvements in metabolic parameters compared to patients with less severe complications after 12 months in an intensive non-surgical WMP.
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Affiliation(s)
- Raymond Kodsi
- South Western Sydney Metabolic Rehabilitation and Bariatric Program (SWS MRBP), Camden and Campbelltown Hospitals, Camden, NSW 2570, Australia; (R.K.); (K.G.); (N.K.)
| | - Ritesh Chimoriya
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (R.C.); (D.M.)
| | - David Medveczky
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (R.C.); (D.M.)
| | - Kathy Grudzinskas
- South Western Sydney Metabolic Rehabilitation and Bariatric Program (SWS MRBP), Camden and Campbelltown Hospitals, Camden, NSW 2570, Australia; (R.K.); (K.G.); (N.K.)
| | - Evan Atlantis
- School of Health Sciences, Western Sydney University, Campbelltown, NSW 2560, Australia;
- Discipline of Medicine, Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Nepean, NSW 2747, Australia
| | - Abd A. Tahrani
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, UK;
- Centre for Endocrinology, Diabetes and Metabolism (CEDAM), Birmingham Health Partners, Birmingham B15 2TT, UK
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Trust, Birmingham B15 2TT, UK
| | - Nic Kormas
- South Western Sydney Metabolic Rehabilitation and Bariatric Program (SWS MRBP), Camden and Campbelltown Hospitals, Camden, NSW 2570, Australia; (R.K.); (K.G.); (N.K.)
| | - Milan K. Piya
- South Western Sydney Metabolic Rehabilitation and Bariatric Program (SWS MRBP), Camden and Campbelltown Hospitals, Camden, NSW 2570, Australia; (R.K.); (K.G.); (N.K.)
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (R.C.); (D.M.)
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Bughin F, Bui G, Ayoub B, Blervaque L, Saey D, Avignon A, Brun JF, Molinari N, Pomies P, Mercier J, Gouzi F, Hayot M. Impact of a Mobile Telerehabilitation Solution on Metabolic Health Outcomes and Rehabilitation Adherence in Patients With Obesity: Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e28242. [PMID: 34874887 PMCID: PMC8691412 DOI: 10.2196/28242] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/10/2021] [Accepted: 09/17/2021] [Indexed: 02/06/2023] Open
Abstract
Background Obesity is a major public health issue. Combining exercise training, nutrition, and therapeutic education in metabolic rehabilitation (MR) is recommended for obesity management. However, evidence from randomized controlled studies is lacking. In addition, MR is associated with poor patient adherence. Mobile health devices improve access to MR components. Objective The aim of this study is to compare the changes in body composition, anthropometric parameters, exercise capacity, and quality of life (QOL) within 12 weeks of patients in the telerehabilitation (TR) program to those of usual care patients with obesity. Methods This was a parallel-design randomized controlled study. In total, 50 patients with obesity (BMI>30 kg/m²) were included in a TR group (TRG) or a usual care group (UCG) for 12 weeks. Patients underwent biometric impedance analyses, metabolic exercise tests, actimetry, and QOL and satisfaction questionnaires. The primary outcome was the change in fat mass at 12 weeks from baseline. Secondary outcomes were changes in body weight, metabolic parameters, exercise capacity, QOL, patients’ adhesion, and satisfaction. Results A total of 49 patients completed the study. No significant group × time interaction was found for fat mass (TRG: mean 1.7 kg, SD 2.6 kg; UCG: mean 1.2 kg, SD 2.4 kg; P=.48). Compared with the UCG, TRG patients tended to significantly improve their waist to hip ratios (TRG: −0.01 kg, SD 0.04; UCG: +0.01 kg, SD 0.06; P=.07) and improved QOL physical impact (TRG: +21.8, SD 43.6; UCG: −1.2, SD 15.4; P=.005). Significant time effects were observed for body composition, 6-minute walk test distance, exercise metabolism, sedentary time, and QOL. Adherence (95%) and satisfaction in the TRG were good. Conclusions In adults with obesity, the TR program was not superior to usual care for improving body composition. However, TR was able to deliver full multidisciplinary rehabilitation to patients with obesity and improve some health outcomes. Given the patients’ adherence and satisfaction, pragmatic programs should consider mobile health devices to improve access to MR. Further studies are warranted to further establish the benefits that TR has over usual care. Trial Registration ClinicalTrials.gov NCT03396666; http://clinicaltrials.gov/ct2/show/NCT03396666
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Affiliation(s)
- François Bughin
- PhyMedExp, Centre Hospitalier Universitaire Montpellier, University of Montpellier, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Montpellier, France
| | - Gaspard Bui
- PhyMedExp, Centre Hospitalier Universitaire Montpellier, University of Montpellier, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Montpellier, France
| | - Bronia Ayoub
- PhyMedExp, Centre Hospitalier Universitaire Montpellier, University of Montpellier, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Montpellier, France
| | - Leo Blervaque
- PhyMedExp, Centre Hospitalier Universitaire Montpellier, University of Montpellier, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Montpellier, France
| | - Didier Saey
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Antoine Avignon
- Institut Desbrest de Santé Publique, University of Montpellier, Institut national de la santé et de la recherche médicale, Montpellier, France.,Endocrinologie-Diabétologie-Nutrition, Centre Hospitalier Universitaire Montpellier, University of Montpellier, Montpellier, France
| | - Jean Frédéric Brun
- PhyMedExp, Centre Hospitalier Universitaire Montpellier, University of Montpellier, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Montpellier, France
| | - Nicolas Molinari
- Institut Montpelliérain Alexander Grothendieck, University of Montpellier, Centre national de la recherche scientifique, Montpellier, France.,Department of Medical Statistics and Epidemiology, Centre Hospitalier Universitaire Montpellier, University of Montpellier, Montpellier, France
| | - Pascal Pomies
- PhyMedExp, Centre Hospitalier Universitaire Montpellier, University of Montpellier, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Montpellier, France
| | - Jacques Mercier
- PhyMedExp, Centre Hospitalier Universitaire Montpellier, University of Montpellier, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Montpellier, France
| | - Fares Gouzi
- PhyMedExp, Centre Hospitalier Universitaire Montpellier, University of Montpellier, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Montpellier, France
| | - Maurice Hayot
- PhyMedExp, Centre Hospitalier Universitaire Montpellier, University of Montpellier, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Montpellier, France
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Piya MK, Chimoriya R, Yu W, Grudzinskas K, Myint KP, Skelsey K, Kormas N, Hay P. Improvement in Eating Disorder Risk and Psychological Health in People with Class 3 Obesity: Effects of a Multidisciplinary Weight Management Program. Nutrients 2021; 13:nu13051425. [PMID: 33922623 PMCID: PMC8146717 DOI: 10.3390/nu13051425] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/01/2021] [Accepted: 04/20/2021] [Indexed: 01/06/2023] Open
Abstract
This study aimed to evaluate the risk of eating disorders, psychological distress, and health-related quality of life (HRQoL) in people with class 3 obesity (body mass index (BMI) ≥ 40 kg/m2), and the effect of multidisciplinary weight management over 12 months. This retrospective cohort study included all adults with class 3 obesity who enrolled in a weight management program from March 2018 to December 2019. Questionnaires included the Eating Disorder Examination Questionnaire Short (EDE-QS), Kessler Psychological Distress Scale (K10), and 36-Item Short Form Survey (SF-36) for HRQoL. Physical and Mental Component Summary scores (PCS and MCS) were derived from the SF-36. Of 169 participants who completed 12 months in the program, 65.7% (n = 111) completed questionnaires at baseline and 12 months, with 6.0 ± 6.8% weight loss over this period. Compared to baseline, there was significant improvement at 12 months in EDE-QS (15.7 ± 6.6 vs. 13.6 ± 6.2, p = 0.002), K10 (25.7 ± 9.7 vs. 21.2 ± 9.4, p < 0.001), PCS (29.4 ± 10.1 vs. 36.1 ± 10.9, p < 0.001), and MCS scores (40.2 ± 12.4 vs. 44.0 ± 13.4, p = 0.001). All, apart from EDE-QS scores, remained significant after adjusting for weight change. This study highlights the importance of multidisciplinary management in people with class 3 obesity to help reduce eating disorder risk and psychological distress, and improve HRQoL, in addition to weight loss.
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Affiliation(s)
- Milan K. Piya
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (R.C.); (K.P.M.); (P.H.)
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden Hospital, Camden, NSW 2570, Australia; (W.Y.); (K.G.); (K.S.); (N.K.)
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia
- Correspondence:
| | - Ritesh Chimoriya
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (R.C.); (K.P.M.); (P.H.)
| | - William Yu
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden Hospital, Camden, NSW 2570, Australia; (W.Y.); (K.G.); (K.S.); (N.K.)
| | - Kathy Grudzinskas
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden Hospital, Camden, NSW 2570, Australia; (W.Y.); (K.G.); (K.S.); (N.K.)
| | - Kyaw Phone Myint
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (R.C.); (K.P.M.); (P.H.)
| | - Kathryn Skelsey
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden Hospital, Camden, NSW 2570, Australia; (W.Y.); (K.G.); (K.S.); (N.K.)
| | - Nic Kormas
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden Hospital, Camden, NSW 2570, Australia; (W.Y.); (K.G.); (K.S.); (N.K.)
| | - Phillipa Hay
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (R.C.); (K.P.M.); (P.H.)
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden Hospital, Camden, NSW 2570, Australia; (W.Y.); (K.G.); (K.S.); (N.K.)
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia
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Atlantis E, Sahebolamri M, Cheema BS, Williams K. Usefulness of the Edmonton Obesity Staging System for stratifying the presence and severity of weight-related health problems in clinical and community settings: A rapid review of observational studies. Obes Rev 2020; 21:e13120. [PMID: 32812345 DOI: 10.1111/obr.13120] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/19/2020] [Accepted: 07/20/2020] [Indexed: 12/12/2022]
Abstract
This rapid review aimed to examine the usefulness of the Edmonton Obesity Staging System (EOSS) for stratifying the presence and severity of weight-related health problems in clinical and community settings. We searched PubMed, CINAHL and ProQuest for records from 2009 to May 2020. We considered observational studies in participants with overweight or obesity that investigated the risk of any clinical outcome associated with increasing EOSS. We reviewed and appraised 20 observational studies (cohort = 4, case series = 7, cross-sectional = 9) published between 2011 and 2020. Of 12 studies in clinical populations, the EOSS was most consistently associated with an increased risk of postoperative complications following bariatric surgery, especially for EOSS 3-4, and inversely associated with weight loss, treatment time and resolution of hypertension following bariatric surgery and clinical weight management. Of eight studies in community populations, the EOSS most consistently predicted mortality outcomes, especially for EOSS 3, and was associated with polypharmacy, service use and poorer work outcomes. Studies reported diverse EOSS definitions and outcomes, which slightly weakens the overall evidence base. The EOSS should be routinely used for predicting risks and benefits of surgical and nonsurgical weight management, but it should be applied with caution for population health planning.
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Affiliation(s)
- Evan Atlantis
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia.,School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Mehdi Sahebolamri
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia.,Department of Endocrinology (Obesity), Nepean Hospital, Nepean Blue Mountains Local Health District, Kingswood, New South Wales, Australia
| | - Birinder S Cheema
- School of Health Sciences and the National Institute of Complementary Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Kathryn Williams
- Department of Endocrinology (Obesity), Nepean Hospital, Nepean Blue Mountains Local Health District, Kingswood, New South Wales, Australia.,Charles Perkins Centre-Nepean, The University of Sydney, Kingswood, New South Wales, Australia
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Medveczky DM, Kodsi R, Skelsey K, Grudzinskas K, Bueno F, Ho V, Kormas N, Piya MK. Class 3 Obesity in a Multidisciplinary Metabolic Weight Management Program: The Effect of Preexisting Type 2 Diabetes on 6-Month Weight Loss. J Diabetes Res 2020; 2020:9327910. [PMID: 32832564 PMCID: PMC7422012 DOI: 10.1155/2020/9327910] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/24/2020] [Accepted: 07/10/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Class 3 obesity (BMI ≥ 40 kg/m2) is a growing health problem worldwide associated with considerable comorbidity including Type 2 diabetes mellitus (T2DM). The multidisciplinary medical management of obesity can be difficult in T2DM due to potential weight gain from medications including sulphonylureas and insulin. However, newer weight-neutral/losing diabetes medications can aid additional weight loss. The aim of this study was to compare weight loss outcomes of patients with and without T2DM, and in patients with T2DM, to compare diabetes outcomes and change in medications at 6 months. METHODS All patients entering a multidisciplinary weight management metabolic program in a publicly funded hospital clinic in Sydney between March 2018 and March 2019, with BMI ≥ 40 kg/m2 and aged ≥18 years were included. Data was collected from patient clinical and electronic notes at baseline and 6 months. RESULTS Of the 180 patients who entered the program, 53.3% had T2DM at baseline. There was no difference in percentage weight loss in those with or without T2DM (4.2 ± 4.9% vs. 3.6 ± 4.7%, p = 0.35). Additionally, T2DM patients benefited from a 0.47% reduction in HbA1c (p < 0.01) and a reduction in the number of medications from baseline to 6 months (1.8 ± 1.0/patient vs. 1.0 ± 1.2/patient, p < 0.001). T2DM patients who started on weigh-neutral/losing medications in the program lost more weight than those started on weight-gaining medications (7.7 ± 5.3% vs. 2.4 ± 3.8%, p = 0.015). CONCLUSIONS Patients with class 3 obesity had significant weight loss at 6 months in this program. Patients with T2DM at baseline had comparable weight loss at 6 months, a significant improvement in glycaemic control, and a reduction in diabetes medication load. Additionally, patients with T2DM who were started on weight-neutral/losing medications lost significantly more weight than those started on weight-gaining medications, and these medications should be preferentially used in class 3 obesity and comorbid T2DM.
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Affiliation(s)
| | - Raymond Kodsi
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden Hospital, NSW, Australia
| | - Kathryn Skelsey
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden Hospital, NSW, Australia
| | - Kathy Grudzinskas
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden Hospital, NSW, Australia
| | - Flavia Bueno
- School of Medicine, Western Sydney University, NSW, Australia
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden Hospital, NSW, Australia
| | - Vincent Ho
- School of Medicine, Western Sydney University, NSW, Australia
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden Hospital, NSW, Australia
| | - Nic Kormas
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden Hospital, NSW, Australia
| | - Milan K. Piya
- School of Medicine, Western Sydney University, NSW, Australia
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden Hospital, NSW, Australia
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Atlantis E, Lin F, Anandabaskaran S, Fahey P, Kormas N. A predictive model for non-completion of an intensive specialist obesity service in a public hospital: a case-control study. BMC Health Serv Res 2019; 19:748. [PMID: 31651309 PMCID: PMC6814104 DOI: 10.1186/s12913-019-4531-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 09/12/2019] [Indexed: 11/10/2022] Open
Abstract
Background Despite the growing evidence base supporting intensive lifestyle and medical treatments for severe obesity, patient engagement in specialist obesity services is difficult to achieve and poorly understood. To address this knowledge gap, we aimed to develop a model for predicting non-completion of a specialist multidisciplinary service for clinically severe obesity, termed the Metabolic Rehabilitation Programme (MRP). Method Using a case-control study design in a public hospital setting, we extracted data from medical records for all eligible patients with a body mass index (BMI) of ≥35 kg/m2 with either type 2 diabetes or fatty liver disease referred to the MRP from 2010 through 2015. Non-completion status (case definition) was coded for patients whom started but dropped-out of the MRP within 12 months. Using multivariable logistic regression, we tested the following baseline predictors hypothesised in previous research: age, gender, BMI, waist circumference, residential distance from the clinic, blood pressure, obstructive sleep apnoea (OSA), current continuous positive airway pressure (CPAP) therapy, current depression/anxiety, diabetes status, and medications. We used receiver operating characteristics and area under the curve to test the performance of models. Results Out of the 219 eligible patient records, 78 (35.6%) non-completion cases were identified. Significant differences between non-completers versus completers were: age (47.1 versus 54.5 years, p < 0.001); residential distance from the clinic (21.8 versus 17.1 km, p = 0.018); obstructive sleep apnoea (OSA) (42.9% versus 56.7%, p = 0.050) and CPAP therapy (11.7% versus 28.4%, p = 0.005). The probability of non-completion could be independently associated with age, residential distance, and either OSA or CPAP. There was no statistically significant difference in performance between the alternate models (69.5% versus 66.4%, p = 0.57). Conclusions Non-completion of intensive specialist obesity management services is most common among younger patients, with fewer complex care needs, and those living further away from the clinic. Clinicians should be aware of these potential risk factors for dropping out early when managing outpatients with severe obesity, whereas policy makers might consider strategies for increasing access to specialist obesity management services.
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Affiliation(s)
- Evan Atlantis
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia. .,School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia.
| | - Fang Lin
- Campbelltown and Camden Hospitals, Campbelltown, New South Wales, Australia
| | - Sulak Anandabaskaran
- Campbelltown and Camden Hospitals, Campbelltown, New South Wales, Australia.,Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Paul Fahey
- School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
| | - Nic Kormas
- Campbelltown and Camden Hospitals, Campbelltown, New South Wales, Australia.,Concord Repatriation General Hospital, Concord, New South Wales, Australia
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