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Sharif FV, Yousefi N, Sharif Z. Economic Evaluations of Anti-obesity Interventions in Obese Adults: An Umbrella Review. Obes Surg 2024; 34:1834-1845. [PMID: 38438668 DOI: 10.1007/s11695-024-07104-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 02/12/2024] [Accepted: 02/15/2024] [Indexed: 03/06/2024]
Abstract
This umbrella review amalgamates the outcomes of economic evaluations pertaining to bariatric surgeries, pharmacotherapy, and gastric balloon for adult obesity treatment. Six databases were systematically searched. The inclusion criteria were established following the Patient/population Intervention Comparison and Outcomes (PICO) statement. Fifteen reviews met all the inclusion criteria. Eight studies focused on surgical interventions, four on pharmacotherapy, and three on both interventions. No systematic review of the economic evaluation of gastric balloons was identified. The majority of reviews advocated bariatric surgery as a cost-effective approach; however, there was discordance in the interpretation of pharmacological cost-effectiveness. Most of the economic evaluations were conducted from the payer and the healthcare system perspectives. We propose that future economic evaluations assessing weight loss interventions in adults adopt a societal perspective and longer-term time horizons.
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Affiliation(s)
| | - Nazila Yousefi
- Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Sharif
- School of Pharmacy, Alborz University of Medical Sciences, Karaj, Iran.
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Hoch JS, Kohatsu ND, Fleuret J, Backman DR. Cost-Effectiveness Analysis of a Community-Based Telewellness Weight Loss Program. AJPM FOCUS 2024; 3:100182. [PMID: 38304023 PMCID: PMC10832372 DOI: 10.1016/j.focus.2024.100182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Introduction The purpose of this study was to perform a cost-effectiveness analysis of the Koa Family Program, a community-based telewellness weight reduction intervention for overweight and obese women aged 21-45 years with low income. The Koa Family Program resulted in an approximately 8-pound weight loss as demonstrated in an RCT published previously. Methods Estimates for the cost-effectiveness were derived from the prospective 25-week RCT including 70 women (25 kg/m2≤BMI<40 kg/m2). The analysis was from a program-funder perspective. Base case costs, as well as low and high scenario costs, were estimated from the services provided to intervention participants. The incremental costs were compared with the incremental effectiveness, with weight loss being the outcome of interest. Costs were in 2021 U.S. dollars. Cost-effectiveness was assessed using the incremental cost-effectiveness ratio and the incremental net benefit. The statistical uncertainty was characterized using an incremental net benefit by willingness-to-pay plot and a cost-effectiveness acceptability curve. Results The base case average cost per participant was $564.39. The low and high scenario average costs per participant were $407.34 and $726.22, respectively. Over the 25-week study timeframe, participants lost an average 7.7 pounds, yielding a base case incremental cost-effectiveness ratio of approximately $73 per extra pound lost. The probability that the Koa Family Program is cost-effective is 90%, assuming a willingness-to-pay of $115 for a 1-pound reduction, and is 95%, assuming a willingness-to-pay of $140. Conclusions The Koa Family Program provides good value with cost-effectiveness in line with other weight-loss interventions. This is a striking finding given that the Koa Family Program serves a more vulnerable population than is typically engaged in weight loss research studies.
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Affiliation(s)
- Jeffrey S. Hoch
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, California
- Center for Healthcare Policy and Research, University of California, Davis, California
| | - Neal D. Kohatsu
- Center for Healthcare Policy and Research, University of California, Davis, California
| | - Julia Fleuret
- Center for Healthcare Policy and Research, University of California, Davis, California
| | - Desiree R. Backman
- Center for Healthcare Policy and Research, University of California, Davis, California
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Ladapo JA, Orstad SL, Wylie-Rosett J, Tseng CH, Chung UYR, Patel NR, Shu SB, Goldstein NJ, Wali S, Jay M. Cost-effectiveness of goal-directed and outcome-based financial incentives for weight loss in low-income populations: the FIReWoRk randomized clinical trial. Int J Obes (Lond) 2024; 48:231-239. [PMID: 37919433 DOI: 10.1038/s41366-023-01404-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/14/2023] [Accepted: 10/20/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND The Financial Incentives for Weight Reduction (FIReWoRk) clinical trial showed that financial incentive weight-loss strategies designed using behavioral economics were more effective than provision of weight-management resources only. We now evaluate cost-effectiveness. METHODS Cost-effectiveness analysis of a multisite randomized trial enrolling 668 participants with obesity living in low-income neighborhoods. Participants were randomized to (1) goal-directed incentives (targeting behavioral goals), (2) outcome-based incentives (targeting weight-loss), and (3) resources only, which were provided to all participants and included a 1-year commercial weight-loss program membership, wearable activity monitor, food journal, and digital scale. We assessed program costs, time costs, quality of life, weight, and incremental cost-effectiveness in dollars-per-kilogram lost. RESULTS Mean program costs at 12 months, based on weight loss program attendance, physical activity participation, food diary use, self-monitoring of weight, and incentive payments was $1271 in the goal-directed group, $1194 in the outcome-based group, and $834 in the resources-only group (difference, $437 [95% CI, 398 to 462] and $360 [95% CI, 341-363] for goal-directed or outcome-based vs resources-only, respectively; difference, $77 [95% CI, 58-130] for goal-directed vs outcome-based group). Quality of life did not differ significantly between the groups, but weight loss was substantially greater in the incentive groups (difference, 2.34 kg [95% CI, 0.53-4.14] and 1.79 kg [95% CI, -0.14 to 3.72] for goal-directed or outcome-based vs resources only, respectively; difference, 0.54 kg [95% CI, -1.29 to 2.38] for goal-directed vs outcome-based). Cost-effectiveness of incentive strategies based on program costs was $189/kg lost in the goal-directed group (95% CI, $124/kg to $383/kg) and $186/kg lost in the outcome-based group (95% CI, $113/kg to $530/kg). CONCLUSIONS Goal-directed and outcome-based financial incentives were cost-effective strategies for helping low-income individuals with obesity lose weight. Their incremental cost per kilogram lost were comparable to other weight loss interventions.
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Affiliation(s)
- Joseph A Ladapo
- Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA.
| | - Stephanie L Orstad
- Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, NY, USA
| | - Judith Wylie-Rosett
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Chi-Hong Tseng
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Un Young Rebecca Chung
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Nikhil R Patel
- Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, NY, USA
| | - Suzanne B Shu
- Cornell Dyson School of Applied Economics and Management, Ithaca, NY, USA
| | | | - Soma Wali
- Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA, USA
| | - Melanie Jay
- Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, NY, USA
- Veterans Affairs, New York Harbor, New York, NY, USA
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Xue Y, Zou H, Ruan Z, Chen X, Lai Y, Yao D, Ung COL, Hu H. Pharmacoeconomic evaluation of anti-obesity drugs for chronic weight management: a systematic review of literature. Front Endocrinol (Lausanne) 2023; 14:1254398. [PMID: 38027186 PMCID: PMC10658190 DOI: 10.3389/fendo.2023.1254398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Pharmacological therapy is recommended as a second-line alternative to reverse obesity. Currently, five anti-obesity drugs (AODs) have been approved by the U.S. Food and Drug Administration (FDA) for chronic weight management. The aim of this paper is to investigate the pharmacoeconomic evaluation of AODs through a systematic review with a special focus on methodological considerations. Methods We searched the general and specific databases to identify the primary pharmacoeconomic evaluation of AODs. Results A total of 18 full-text articles and three conference abstracts were included in this review. Most of the economic assessments were still about Orlistat. And the observations we could make were consistent with the previous systematic review. A few studies were on the combined therapies (i.e. PHEN/TPM ER and NB ER) compared to different comparators, which could hardly lead to a generalized summary of the cost-effectiveness. Most recently, pharmacoeconomic evidence on the newest GLP 1 RA approved for the indication of obesity or obesity with at least one comorbidity emerged gradually. Modelling-based cost-utility analysis is the major type of assessment method. In the modelling studies, a manageable number of the key health states and the state transitions were structured to capture the disease progression. In particular, the principal structure of the decision model adopted in the three studies on the newly approved drug was nearly the same, which enables more in-depth comparisons and generalizations of the findings. Conclusion This study provided an up-to-date overview of the strengths and areas for improvement in the methodological design of the pharmacoeconomic evaluation of the licensed drugs for chronic weight management. Future modelling evaluations would benefit from a better understanding of the long-term weight loss effects of the current therapeutic options and the weight rebound process after the discontinuation of treatment. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022302648, identifier CRD42022302648.
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Affiliation(s)
- Yan Xue
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, Macao SAR, China
| | - Huimin Zou
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, Macao SAR, China
| | - Zhen Ruan
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, Macao SAR, China
| | - Xianwen Chen
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, Macao SAR, China
| | - Yunfeng Lai
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Dongning Yao
- School of Pharmacy, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Carolina Oi Lam Ung
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, Macao SAR, China
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macao, Macao SAR, China
| | - Hao Hu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, Macao SAR, China
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macao, Macao SAR, China
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Primeaux SD, Dubin R, Greenway FL. Orlistat mouth rinse: Using the tongue to deliver antiobesity medication in a double-blind randomized crossover pilot trial. Diabetes Obes Metab 2023; 25:2236-2242. [PMID: 37132340 PMCID: PMC10330229 DOI: 10.1111/dom.15101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/11/2023] [Accepted: 04/15/2023] [Indexed: 05/04/2023]
Abstract
AIM To investigate the effects of an orlistat mouth rinse on the intake of a high-fat meal. METHODS A double-blind, balanced order, crossover study was conducted in participants (n = 10, body mass index 25-30 kg/m2 ) assigned to receive placebo or orlistat (24 mg/mL) prior to a high-fat meal. Participants were divided into low- or high-fat consumers based on calories consumed from fat following placebo administration. RESULTS The orlistat mouth rinse decreased total and fat calories consumed during the high-fat meal in high-fat consumers, and did not alter calories consumed in low-fat consumers (P < 0.05). CONCLUSIONS Orlistat decreases long-chain fatty acid (LCFA) absorption by inhibiting lipases that breakdown triglycerides. Orlistat mouth rinse decreased fat intake in high-fat consumers, suggesting that orlistat inhibited the detection of LCFAs from the high-fat test meal. Lingual delivery of orlistat is predicted to eliminate the risk of oil incontinence and promote weight loss in individuals who prefer fat.
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Affiliation(s)
- Stefany D Primeaux
- Department of Physiology, LSU Health-NO, New Orleans, Louisiana, USA
- Joint Diabetes, Endocrinology & Metabolism Program, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Robert Dubin
- Florida State University College of Medicine, Venice, Florida, USA
| | - Frank L Greenway
- Clinical Trials Department, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
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Michaud TL, Wilson KE, Katula JA, You W, Estabrooks PA. Cost and cost-effectiveness analysis of a digital diabetes prevention program: results from the PREDICTS trial. Transl Behav Med 2023; 13:501-510. [PMID: 36809348 DOI: 10.1093/tbm/ibad008] [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] [Indexed: 02/23/2023] Open
Abstract
Although technology-assisted diabetes prevention programs (DPPs) have been shown to improve glycemic control and weight loss, information are limited regarding relevant costs and their cost-effectiveness. To describe a retrospective within-trial cost and cost-effectiveness analysis (CEA) to compare a digital-based DPP (d-DPP) with small group education (SGE), over a 1-year study period. The costs were summarized into direct medical costs, direct nonmedical costs (i.e., times that participants spent engaging with the interventions), and indirect costs (i.e., lost work productivity costs). The CEA was measured by the incremental cost-effectiveness ratio (ICER). Sensitivity analysis was performed using nonparametric bootstrap analysis. Over 1 year, the direct medical costs, direct nonmedical costs, and indirect costs per participant were $4,556, $1,595, and $6,942 in the d-DPP group versus $4,177, $1,350, and $9,204 in the SGE group. The CEA results showed cost savings from d-DPP relative to SGE based on a societal perspective. Using a private payer perspective for d-DPP, ICERs were $4,739 and $114 to obtain an additional unit reduction in HbA1c (%) and weight (kg), and were $19,955 for an additional unit gain of quality-adjusted life years (QALYs) compared to SGE, respectively. From a societal perspective, bootstrapping results indicated that d-DPP has a 39% and a 69% probability, at a willingness-to-pay of $50,000/QALY and $100,000/QALY, respectively, of being cost-effective. The d-DPP was cost-effective and offers the prospect of high scalability and sustainability due to its program features and delivery modes, which can be easily translated to other settings.
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Affiliation(s)
- Tzeyu L Michaud
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kathryn E Wilson
- Department of Kinesiology and Health, College of Education & Human Development, Georgia State University, Atlanta, GA, USA
- Center for the Study of Stress, Trauma, and Resilience, College of Education and Human Development, Georgia State University, Atlanta, GA, USA
| | - Jeffrey A Katula
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Wen You
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Paul A Estabrooks
- Department of Health and Kinesiology, College of Health, University of Utah, Salt Lake City, UT, USA
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Napolitano MA, Bailey CP, Mavredes MN, Neighbors CJ, Whiteley JA, Long MW, Hayman LL, Malin SK, DiPietro L. Personalized versus generic digital weight loss interventions delivered on university campuses: a 6-month cost-benefit analysis. Transl Behav Med 2023; 13:358-367. [PMID: 37186191 PMCID: PMC10255761 DOI: 10.1093/tbm/ibac081] [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] [Indexed: 05/17/2023] Open
Abstract
Cost-effectiveness analyses of weight loss programs for university students can inform administrator decision-making. This study quantifies and compares the costs and cost-effectiveness of implementing two digitally-delivered weight loss interventions designed for university populations. Healthy Body Healthy U (HBHU) was a randomized controlled trial comparing TAILORED (personalized) versus TARGETED (generic) weight loss interventions adapted specifically for young adults to a CONTROL intervention. Participants (N = 459; 23.3 ± 4.4 years; mean BMI 31.2 ± 4.4 kg/m2) were recruited from two universities. Implementation costs were examined from a payer (i.e., university) perspective, comparing both the average cost effectiveness ratio (ACER) and the incremental cost effectiveness ratio (ICER) of the two interventions. Cost-effectiveness measures were calculated for changes in body weight, abdominal circumference, HDL cholesterol, systolic and diastolic blood pressure, and HbA1c. The overall 6-month implementation costs were $105.66 per person for the TAILORED intervention and $91.44 per person for the TARGETED intervention. The ACER for weight change was $107.82 for the TAILORED and $179.29 for the TARGETED interventions. The ICER comparing TAILORED with TARGETED for change in body weight was $5.05, and was even lower ($2.28) when including only those with overweight and not obesity. The ICERs for change in abdominal circumference, HDL cholesterol, systolic and diastolic blood pressure, and HbA1c were $3.49, $59.37, $1.57, $2.64, and $47.49, respectively. The TAILORED intervention was generally more cost-effective compared with the TARGETED intervention, particularly among those with overweight. Young adults with obesity may require more resource-intensive precision-based approaches.
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Affiliation(s)
- Melissa A Napolitano
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Caitlin P Bailey
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Meghan N Mavredes
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Charles J Neighbors
- Department of Population Health, Grossman School of Medicine, New York University, New York, NY, USA
| | - Jessica A Whiteley
- Departmen of Exercise and Health Sciences, College of Nursing and Health Sciences, The University of Massachusetts at Boston, Boston, MA, USA
| | - Michael W Long
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Laura L Hayman
- Department of Nursing, College of Nursing and Health Sciences, The University of Massachusetts at Boston, Boston, MA, USA
| | - Steven K Malin
- Department of Kinesiology and Division of Endocrinology, Metabolism and Nutrition, Rutgers University, New Brunswick, NJ, USA
| | - Loretta DiPietro
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
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Gómez Lumbreras A, Tan MS, Villa-Zapata L, Ilham S, Earl JC, Malone DC. Cost-effectiveness analysis of five anti-obesity medications from a US payer's perspective. Nutr Metab Cardiovasc Dis 2023; 33:1268-1276. [PMID: 37088648 DOI: 10.1016/j.numecd.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/06/2023] [Accepted: 03/21/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND AND AIMS To determine the cost-effectiveness of anti-obesity medications (AOM): tirzepatide, semaglutide, liraglutide, phentermine plus topiramate (PpT), and naltrexone plus bupropion (NpB). METHODS AND RESULTS From a U.S. perspective we developed a Markov model to simulate weight change over a 40-year time horizon using results from clinical studies. According to the body mass index (BMI), cardiovascular diseases, diabetes and mortality risk were the health states considered in the model, being mutually exclusive. Costs of AOM, adverse events, cardiovascular events, and diabetes were included. We applied a 3% per-year discount rate and calculated the incremental cost-effectiveness ratios (ICERs) of cost per quality-adjusted life-year (QALY) gained. Probabilistic sensitivity analyses incorporated uncertainty in input parameters. A deterministic analysis was conducted to determine the robustness of the model. The model included a cohort of 78.2% females with a mean age of 45 years and BMI of 37.1 (SD 4.9) for females and 36.8 (SD 4.9) for males. NpB and PpT were the least costly medications and, all medications differed no more than 0.5 QALYs. Tirzepatide ICER was $355,616 per QALY. Liraglutide and semaglutide options were dominated by PpT. CONCLUSION Compared to other AOM, PpT was lowest cost treatment with nearly identical QALYs with other agents.
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Affiliation(s)
- Ainhoa Gómez Lumbreras
- Department of Pharmacotherapy, College of Pharmacy. University of Utah, Salt Lake City, UT, USA.
| | - Malinda S Tan
- Department of Pharmacotherapy, College of Pharmacy. University of Utah, Salt Lake City, UT, USA.
| | - Lorenzo Villa-Zapata
- Department of Pharmacy Practice, College of Pharmacy. Mercer University, Atlanta, GA, USA.
| | - Sabrina Ilham
- Department of Pharmacotherapy, College of Pharmacy. University of Utah, Salt Lake City, UT, USA.
| | - Jacob C Earl
- Department of Pharmacotherapy, College of Pharmacy. University of Utah, Salt Lake City, UT, USA.
| | - Daniel C Malone
- Department of Pharmacotherapy, College of Pharmacy. University of Utah, Salt Lake City, UT, USA.
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Apolzan JW, LaRose JG, Anton SD, Beyl RA, Greenway FL, Wickham EP, Lanoye A, Harris MN, Martin CK, Bullard T, Foster GD, Cardel MI. A scalable, virtual weight management program tailored for adults with type 2 diabetes: effects on glycemic control. Nutr Diabetes 2023; 13:3. [PMID: 37024467 PMCID: PMC10079927 DOI: 10.1038/s41387-023-00234-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 03/12/2023] [Accepted: 03/27/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND The objective was to test the efficacy of a scalable, virtually delivered, diabetes-tailored weight management program on glycemic control in adults with type 2 diabetes (T2D). METHODS This was a single arm, three-site clinical trial. Participants had baseline HbA1c between 7-11% and BMI between 27-50 kg/m2. Primary outcome was change in HbA1c at 24 weeks. Secondary outcomes were changes in body weight, waist circumference, the Diabetes Distress Scale (DDS), quality of life (IWQOL-L), and hunger (VAS). Generalized linear effects models were used for statistical analysis. RESULTS Participants (n = 136) were 56.8 ± 0.8 y (Mean ± SEM), 36.9 ± 0.5 kg/m2, 80.2% female, 62.2% non-Hispanic white. Baseline HbA1c, weight, and total DDS score were 8.0 ± 0.09%, 101.10 ± 1.47 kg, and 2.35 ± 0.08, respectively. At week 24, HbA1c, body weight, and total DDS decreased by 0.75 ± 0.11%, 5.74 ± 0.50%, 0.33 ± 0.10 units, respectively (all p < 0.001). Also, at week 24, quality of life increased by 9.0 ± 1.2 units and hunger decreased by 14.3 ± 2.4 units, (both p < 0.0001). CONCLUSIONS The scalable, virtually delivered T2D-tailored weight management program had favorable and clinically meaningful effects on glycemic control, body weight, and psychosocial outcomes.
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Affiliation(s)
- John W Apolzan
- Pennington Biomedical Research Center, Baton Rouge, LA, USA.
| | | | | | - Robbie A Beyl
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | | | - Edmond P Wickham
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Autumn Lanoye
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | | | - Corby K Martin
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | | | - Gary D Foster
- WW International, Inc., New York, NY, USA
- Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michelle I Cardel
- WW International, Inc., New York, NY, USA
- Department of Health Outcomes & Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA
- Center for Integrative Cardiovascular and Metabolic Disease, University of Florida, Gainesville, FL, USA
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10
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Mirghani H, Altedlawi Albalawi I. Metabolic surgery versus usual care effects on diabetes remission: a systematic review and meta-analysis. Diabetol Metab Syndr 2023; 15:31. [PMID: 36829204 PMCID: PMC9951503 DOI: 10.1186/s13098-023-01001-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/17/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Bariatric surgery is superior to usual care for diabetes remission. Previous meta-analyses were limited by pooling observational and randomized trials, using various definitions of diabetes remission, and not controlling for various diabetes medications. The current meta-analysis aimed to compare bariatric surgery and usual care regarding the same. METHODS We searched PubMed MEDLINE, Web of Science, SCOPUS, and Cochrane Library for relevant articles from the date of the first inception up to February 2023. The keywords diabetes remission, Bariatric surgery, metabolic surgery, lifestyles, usual care, GLIP-1 agonists, insulin use, gastric banding, biliopancreatic diversion, sleeve gastrectomy, and Roux-en-Y gastric bypass, were used. A datasheet was used to extract the relevant data. RESULTS Diabetes remission (complete and prolonged) was higher among bariatric surgeries compared to usual care, odd ratio, 0.06, 95 CI, 0.02-0.25 and 0.12, 95 CI, 0.02-0.72, respectively. bariatric surgery patients were younger, had higher HbA1c, odd ratio, - 3.13, 95 CI, - 3.71 to 2.54, and 0.25, 95 CI, 0.02-0.48, respectively, insulin use was higher, and glucagon-like peptide agonists use was lower among bariatric surgery patients, odd ratio, 0.49, 95% CI, 0.24-0.97, and 3.06, 95% CI, 1.44-6.53, respectively. CONCLUSION Bariatric surgery was better than usual care in diabetes remission. Bariatric surgery patients were younger, had higher HbA1c, and received more insulin and lower GLP-1 agonists. No differences were evident regarding body mass index and the duration of diabetes. Further trials comparing the new anti-diabetic medications and different forms of bariatric surgery and controlling for the level of exercise and diet are recommended.
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Affiliation(s)
- Hyder Mirghani
- Department of Internal Medicine, Faculty of Medicine, University of Tabuk, PO Box 3378, Tabuk, 51941, Saudi Arabia.
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Clinical Evidence of Low-Carbohydrate Diets against Obesity and Diabetes Mellitus. Metabolites 2023; 13:metabo13020240. [PMID: 36837859 PMCID: PMC9962697 DOI: 10.3390/metabo13020240] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/08/2023] Open
Abstract
The popularity of low-carbohydrate diets (LCDs) in the last few decades has motivated several research studies on their role in a variety of metabolic and non-morbid conditions. The available data of the results of these studies are put under the research perspective of the present literature review of clinical studies in search of the effects of LCDs on Obesity and Diabetes Mellitus. The electronic literature search was performed in the databases PubMed, Cochrane, and Embase. The literature search found seven studies that met the review's inclusion and exclusion criteria out of a total of 2637 studies. The included studies involved randomized controlled trials of at least 12 weeks' duration, in subjects with BMI ≥ 25 kg/m2, with dietary interventions. The results of the study on the effects of LCDs on obesity showed their effectiveness in reducing Body Mass Index and total body fat mass. In addition, LCDs appear to cause drops in blood pressure, low-density lipoprotein (LDL), and triglycerides, and seem to improve high-density lipoprotein (HDL) values. Regarding the effectiveness of LCDs in Diabetes Mellitus, their effect on reducing insulin resistance and fasting blood glucose and HbA1c values are supported. In conclusion, the results suggest the critical role of LCDs to improve the health of people affected by obesity or diabetes.
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Jacobsen E, Boyers D, Manson P, Avenell A. A Systematic Review of the Evidence for Non-surgical Weight Management for Adults with Severe Obesity: What is Cost Effective and What are the Implications for the Design of Health Services? Curr Obes Rep 2022; 11:356-385. [PMID: 36409442 PMCID: PMC9729129 DOI: 10.1007/s13679-022-00483-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE OF REVIEW Severe obesity (BMI ≥ 35 kg/m2) increases premature mortality and reduces quality-of-life. Obesity-related disease (ORD) places substantial burden on health systems. This review summarises the cost-effectiveness evidence for non-surgical weight management programmes (WMPs) for adults with severe obesity. RECENT FINDINGS Whilst evidence shows bariatric surgery is often cost-effective, there is no clear consensus on the cost-effectiveness of non-surgical WMPs. Thirty-two studies were included. Most were short-term evaluations that did not capture the long-term costs and consequences of ORD. Decision models often included only a subset of relevant ORDs, and made varying assumptions about the rate of weight regain over time. A lack of sensitivity analyses limited interpretation of results. Heterogeneity in the definition of WMPs and usual care prevents formal evidence synthesis. We were unable to establish the most cost-effective WMPs. Addressing these limitations may help future studies provide more robust cost-effectiveness evidence for decision makers.
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Affiliation(s)
- Elisabet Jacobsen
- Health Economics Research Unit, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
| | - Dwayne Boyers
- Health Economics Research Unit, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
| | - Paul Manson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Woolford SJ, Resnicow K, Davis MM, Nichols LP, Wasserman RC, Harris D, Gebremariam A, Shone L, Fiks AG, Chang T. Cost-effectiveness of a motivational interviewing obesity intervention versus usual care in pediatric primary care offices. Obesity (Silver Spring) 2022; 30:2265-2274. [PMID: 36321279 PMCID: PMC9828545 DOI: 10.1002/oby.23560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/25/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aimed to assess the incremental cost-effectiveness ratio (ICER) of a 2-year motivational interviewing (MI) intervention versus usual primary care. METHODS A national trial was implemented in the Pediatric Research in Office Settings (PROS) network of the American Academy of Pediatrics to evaluate MI versus usual care for children (2-8 years old; baseline BMI 85th-97th percentiles). Health care use, food costs, provider fees, and training costs were assessed, and sensitivity analyses were conducted. Primary outcome was the ICER, calculated as cost per unit change in BMI percentile for intervention versus usual care. RESULTS At 2 years, 72% of enrolled parent/child dyads were retained; 312 children were included in the analysis. Mean BMI percentile point change was -4.9 and -1.8 for the intervention and control, respectively, yielding an incremental reduction of 3.1 BMI percentile points (95% CI: 1.2-5.0). The intervention cost $1051 per dyad ($658 for training DVD development). Incorporating health care and non-health care costs, the intervention ICER was $363 (range from sensitivity analyses: cost saving, $3159) per BMI percentile point decrease per participant over 2 years. CONCLUSIONS Training pediatricians, nurse practitioners, and registered dietitians to deliver MI-based interventions for childhood obesity in primary care is clinically effective and acceptably cost-effective. Future work should explore this approach in broader dissemination.
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Affiliation(s)
- Susan J. Woolford
- University of MichiganAnn ArborMichiganUSA
- Susan B. Meister Child Health Evaluation and Research CenterAnn ArborMichiganUSA
| | | | - Matthew M. Davis
- Ann & Robert H. Lurie Children's Hospital of ChicagoNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | | | | | | | - Achamyeleh Gebremariam
- University of MichiganAnn ArborMichiganUSA
- Susan B. Meister Child Health Evaluation and Research CenterAnn ArborMichiganUSA
| | - Laura Shone
- American Academy of PediatricsItascaIllinoisUSA
| | | | - Tammy Chang
- University of MichiganAnn ArborMichiganUSA
- Institute for Healthcare Policy and InnovationAnn ArborMichiganUSA
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Bracci EL, Milte R, Keogh JB, Murphy KJ. Developing and Piloting a Novel Ranking System to Assess Popular Dietary Patterns and Healthy Eating Principles. Nutrients 2022; 14:nu14163414. [PMID: 36014923 PMCID: PMC9415867 DOI: 10.3390/nu14163414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/07/2022] [Accepted: 08/13/2022] [Indexed: 11/23/2022] Open
Abstract
A multitude of weight loss diets exist. However, no one diet has been proven to be superior, despite their claims. Resultingly, this creates confusion amongst consumers and conflicting nutrition messages. The aim of the ranking system was to evaluate a range of dietary pattern’s nutrition profile and financial costs, as well as their potential long-term sustainability and associated adverse effects. Nutrition profile is typically the focal point of weight loss diets with less attention focused towards other factors that may affect their suitability. Five popular diets (Keto, Paleo, Intermittent Fasting, Optifast, and 8 Weeks to Wow) and two energy restricted healthy eating principles (Australian Guide to Healthy Eating and the Mediterranean Diet) were compared for diet quality, cost, adverse effects, and support for behaviour change. In general, healthy eating principles scored more favourably compared to popular weight loss diets in all categories. Lower carbohydrate diets tended to score lower for diet quality due to restricting multiple food groups, had more associated adverse effects and did not encourage behaviour change compared to the other weight loss diets. Optifast was the only weight loss diet to receive a negative score for cost. There should be considerations when undertaking a change to dietary patterns beyond nutrition profile. Diets indeed vary in terms of diet quality, and in addition can be costly, incur adverse effects, and disregard behaviour change which is important for sustainable weight loss and maintenance. This ranking system could create a reference point for future comparisons of diets.
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Affiliation(s)
- Ella L. Bracci
- Clinical and Health Sciences, Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia
- Correspondence:
| | - Rachel Milte
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia
| | - Jennifer B. Keogh
- Clinical and Health Sciences, Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia
| | - Karen J. Murphy
- Clinical and Health Sciences, Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia
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Tate DF, Lutes LD, Bryant M, Truesdale KP, Hatley KE, Griffiths Z, Tang TS, Padgett LD, Pinto AM, Stevens J, Foster GD. Efficacy of a Commercial Weight Management Program Compared With a Do-It-Yourself Approach: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2226561. [PMID: 35972742 PMCID: PMC9382439 DOI: 10.1001/jamanetworkopen.2022.26561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Given the prevalence of obesity, accessible and effective treatment options are needed to manage obesity and its comorbid conditions. Commercial weight management programs are a potential solution to the lack of available treatment, providing greater access at lower cost than clinic-based approaches, but few commercial programs have been rigorously evaluated. OBJECTIVE To compare the differences in weight change between individuals randomly assigned to a commercial weight management program and those randomly assigned to a do-it-yourself (DIY) approach. DESIGN, SETTING, AND PARTICIPANTS This 1-year, randomized clinical trial conducted in the United States, Canada, and United Kingdom between June 19, 2018, and November 30, 2019, enrolled 373 adults aged 18 to 75 years with a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 25 to 45. Assessors were blinded to treatment conditions. INTERVENTIONS A widely available commercial weight management program that included reduced requirements for dietary self-monitoring and recommendations for a variety of DIY approaches to weight loss. MAIN OUTCOMES AND MEASURES The primary outcomes were the difference in weight change between the 2 groups at 3 and 12 months. The a priori hypothesis was that the commercial program would result in greater weight loss than the DIY approach at 3 and 12 months. Analyses were performed on an intention-to-treat basis. RESULTS The study include 373 participants (272 women [72.9%]; mean [SD] BMI, 33.8 [5.2]; 77 [20.6%] aged 18-34 years, 74 [19.8%] aged 35-43 years, 82 [22.0%] aged 44-52 years, and 140 [37.5%] aged 53-75 years). At 12 months, retention rates were 88.8% (166 of 187) for the commercial weight management program group and 95.7% (178 of 186) for the DIY group. At 3 months, participants in the commercial program had a mean (SD) weight loss of -3.8 (4.1) kg vs -1.8 (3.7) kg among those in the DIY group. At 12 months, participants in the commercial program had a mean (SD) weight loss of -4.4 (7.3) kg vs -1.7 (7.3) kg among those in the DIY group. The mean difference between groups was -2.0 kg (97.5% CI, -2.9 to -1.1 kg) at 3 months (P < .001) and -2.6 kg (97.5% CI, -4.3 to -0.8 kg) at 12 months (P < .001). A greater percentage of participants in the commercial program group than participants in the DIY group achieved loss of 5% of body weight at both 3 months (40.7% [72 of 177] vs 18.6% [34 of 183]) and 12 months (42.8% [71 of 166] vs 24.7% [44 of 178]). CONCLUSIONS AND RELEVANCE Adults randomly assigned to a commercial weight management program with reduced requirements for dietary self-monitoring lost more weight and were more likely to achieve weight loss of 5% at 3 and 12 months than adults following a DIY approach. This study contributes data on the efficacy of commercial weight management programs and DIY weight management approaches. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03571893.
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Affiliation(s)
- Deborah F. Tate
- Department of Nutrition, University of North Carolina at Chapel Hill
- Department of Health Behavior, University of North Carolina at Chapel Hill
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Lesley D. Lutes
- Department of Psychology, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Maria Bryant
- Department of Health Sciences, University of York, York, United Kingdom
- The Hull York Medical School, University of York, York, United Kingdom
| | | | - Karen E. Hatley
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | | | - Tricia S. Tang
- Department of Medicine, University of British Columbia, Vancouver Campus, Vancouver, British Columbia, Canada
| | - Louise D. Padgett
- Department of Health Sciences, University of York, York, United Kingdom
| | - Angela M. Pinto
- Department of Psychology, Baruch College/City University of New York, New York
| | - June Stevens
- Department of Nutrition, University of North Carolina at Chapel Hill
- Department of Epidemiology, University of North Carolina at Chapel Hill
| | - Gary D. Foster
- Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- WW, Maidenhead, Berkshire, UK
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16
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Lockard B, Mardock M, Oliver JM, Byrd M, Simbo S, Jagim AR, Kresta J, Baetge CC, Jung YP, Koozehchian MS, Khanna D, Rasmussen C, Kreider RB. Comparison of Two Diet and Exercise Approaches on Weight Loss and Health Outcomes in Obese Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4877. [PMID: 35457744 PMCID: PMC9032860 DOI: 10.3390/ijerph19084877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 04/08/2022] [Accepted: 04/13/2022] [Indexed: 11/16/2022]
Abstract
AIM To compare the efficacy of two popular weight loss approaches on weight loss, body composition, and markers of health in sedentary obese women. METHODS In total, 51 sedentary women (age 34.5 ± 7.7 yrs.; weight 90.0 ± 14.5 kg; BMI 34.0 ± 5.1 kg/m2; 46.5 ± 7.0% fat) were matched and randomized to participate in the Weight Watchers® Momentum™ (WW) or Curves® (CV) Fitness and Weight Management program for 16 weeks. Participants in the WW group (n = 27) were provided a point-based diet program, received weekly progress checks and counseling, and were encouraged to exercise. Participants in the CV group (n = 24) followed a menu-based higher protein/low-fat diet (1200 kcal/d) for 1 week; 1500 kcal/d diet for 3 weeks; and 2000-2500 kcals/d for 2 weeks that was repeated three times (except the last segment) while participating in a supervised circuit-style resistance training program (3 d/wk). A general linear model (GLM) with repeated measures was used to analyze data and are presented as mean changes from baseline (mean [UL, LL]). RESULTS Supervised CV training resulted in greater amounts of vigorous and total physical activity. After 16 weeks, both groups lost weight (WW -6.1 [-7.8, -4.6], CV -4.9 [-6.2, -3.2] kg, p = 0.264). Participants in the CV group observed greater reductions in fat mass (WW -2.9 [-6.7, -0.2], CV -6.4 [-9.2, -3.6] kg, p = 0.081) and increases in lean mass (WW -2.5 [-4.3, -0.7], CV 1.3 [-0.6, 3.2] kg, p = 0.005) resulting in more favorable changes in percent body fat (WW -1.4 [-4.1, 1.2], CV -4.7 [-7.5, -1.8]%, p = 0.098). Both groups observed improvements in peak aerobic capacity and muscular endurance, although bench press lifting volume was greater in the CV group. Those in the CV group experienced a greater increase in HDLc and reduction in the CHL-HDLc ratio and triglycerides. CONCLUSION Both interventions promoted weight loss and improvements in fitness and markers of health. The CV program, which included supervised resistance training and higher protein diet menus, promoted greater fat loss, increases in lean mass, and improvements in percent body fat and blood lipids. TRIAL REGISTRATION clinicaltrials.gov, #NCT04372771, registered retrospectively 1 May 2020.
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Affiliation(s)
- Brittanie Lockard
- School of Nursing and Health Professions, University of the Incarnate Word, San Antonio, TX 78209, USA;
| | - Michelle Mardock
- Exercise & Sport Nutrition Lab, Human Clinical Research Facility, Department of Health and Kinesiology, Texas A & M University, College Station, TX 77843, USA; (M.M.); (J.M.O.); (M.B.); (S.S.); (C.C.B.); (C.R.)
| | - Jonathan M. Oliver
- Exercise & Sport Nutrition Lab, Human Clinical Research Facility, Department of Health and Kinesiology, Texas A & M University, College Station, TX 77843, USA; (M.M.); (J.M.O.); (M.B.); (S.S.); (C.C.B.); (C.R.)
| | - Mike Byrd
- Exercise & Sport Nutrition Lab, Human Clinical Research Facility, Department of Health and Kinesiology, Texas A & M University, College Station, TX 77843, USA; (M.M.); (J.M.O.); (M.B.); (S.S.); (C.C.B.); (C.R.)
- Byrd’s Eye Enterprises, Inc., Forney, TX 75126, USA
| | - Sunday Simbo
- Exercise & Sport Nutrition Lab, Human Clinical Research Facility, Department of Health and Kinesiology, Texas A & M University, College Station, TX 77843, USA; (M.M.); (J.M.O.); (M.B.); (S.S.); (C.C.B.); (C.R.)
- Center for Translational Research in Aging & Longevity, Human Clinical Research Facility, Department of Health & Kinesiology, Texas A&M University, College Station, TX 77843, USA
| | - Andrew R. Jagim
- Department of Sports Medicine, Mayo Clinic Health System, Onalaska, WI 54650, USA;
| | - Julie Kresta
- College of Education and Human Development, Texas A&M University Central-Texas, Killeen, TX 76549, USA;
| | - Claire C. Baetge
- Exercise & Sport Nutrition Lab, Human Clinical Research Facility, Department of Health and Kinesiology, Texas A & M University, College Station, TX 77843, USA; (M.M.); (J.M.O.); (M.B.); (S.S.); (C.C.B.); (C.R.)
| | | | - Majid S. Koozehchian
- Department of Kinesiology, Jacksonville State University, Jacksonville, AL 36265, USA;
| | - Deepesh Khanna
- Department of Foundational Sciences, Nova Southeastern University, Clearwater, FL 33759, USA;
| | - Chris Rasmussen
- Exercise & Sport Nutrition Lab, Human Clinical Research Facility, Department of Health and Kinesiology, Texas A & M University, College Station, TX 77843, USA; (M.M.); (J.M.O.); (M.B.); (S.S.); (C.C.B.); (C.R.)
| | - Richard B. Kreider
- Exercise & Sport Nutrition Lab, Human Clinical Research Facility, Department of Health and Kinesiology, Texas A & M University, College Station, TX 77843, USA; (M.M.); (J.M.O.); (M.B.); (S.S.); (C.C.B.); (C.R.)
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Bracci EL, Milte R, Keogh JB, Murphy KJ. Developing and implementing a new methodology to test the affordability of currently popular weight loss diet meal plans and healthy eating principles. BMC Public Health 2022; 22:23. [PMID: 34991538 PMCID: PMC8734134 DOI: 10.1186/s12889-021-12447-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/15/2021] [Indexed: 11/29/2022] Open
Abstract
Background Weight loss diets continue to rise in popularity; however, the associated costs are seldom reported. Certain weight loss diets may be unaffordable and differ from their traditional nutrition composition to include non-conventional premium products. In contrast, healthy eating principles such as the Australian Guide to Healthy Eating (AGHE) and the Mediterranean Diet (MedDiet) place an emphasis on fresh produce and staple foods but are sometimes thought to be unaffordable. A new methodology was piloted to assess the cost of weight loss diets using seven meal plans. Methods Seven meal plans were analysed to quantify the absolute grams required of all ingredients across seven days and multiplied by the cost of the ingredient per gram to determine the total cost of each ingredient based on unit size and price. The weekly grocery shopping cost was determined through summation of all ingredients and their entire unit size to compare weekly costs. Results Weekly meal plans (absolute grams) cost between $93-193AUD. The AGHE meal plan was the least expensive and 8 Weeks to Wow was the most expensive. Weekly grocery shopping of entire units cost between $345-$625AUD, over $100AUD greater than the spending of an average Australian ($237AUD/week). Conclusions The financial feasibility for long-term sustainment of weight loss diets may be questionable for groups including low-income earners and low socioeconomic status. Further, when dietary patterns are adapted for weight loss, or followed by consumers, deviations from foundational principles tend to occur which may influence overall cost.
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Affiliation(s)
- Ella L Bracci
- Alliance for Research in Exercise, Nutrition and Activity, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, 5001, Australia
| | - Rachel Milte
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, 5042, Australia
| | - Jennifer B Keogh
- Alliance for Research in Exercise, Nutrition and Activity, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, 5001, Australia
| | - Karen J Murphy
- Alliance for Research in Exercise, Nutrition and Activity, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, 5001, Australia.
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Twells LK, Harris Walsh K, Blackmore A, Adey T, Donnan J, Peddle J, Ryan D, Farrell A, Nguyen H, Gao Z, Pace D. Nonsurgical weight loss interventions: A systematic review of systematic reviews and meta-analyses. Obes Rev 2021; 22:e13320. [PMID: 34378849 DOI: 10.1111/obr.13320] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 12/17/2022]
Abstract
Access to bariatric surgery to treat obesity is limited and has long wait times. Many adults are seeking nonsurgical weight loss support. Our study objective was to conduct a systematic review of nonsurgical weight loss interventions. PubMed, EMBASE, CINAHL, PsycInfo, and the CochraneLibrary were searched. Inclusion criteria were adults 18 + with a BMI > 25 enrolled in minimum a 3-month nonsurgical weight loss intervention. Studies were independently extracted and assessed for quality using A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR2). Pooled analyses were extracted, graded for evidence quality, and summarized. A total of 1065 studies were assessed for eligibility; 815 screened and 236 full-texts assessed. Sixty-four meta-analyses met eligibility criteria: 1180 RCTs with 184,605 study participants. Studies were categorized as diets (n = 13), combination therapies (n = 10), alternative (n = 16), technology (n = 10), behavioral (n = 5), physical activity (n = 6), and pharmacotherapy (n = 3). In 80% of studies, significant weight losses were reported ranging from 0.34-8.73 k in favor of the intervention. The most effective nonsurgical weight loss interventions were diets, either low-carbohydrate or low-fat diets, followed for 6 months; combination therapy including meal replacements plus enhanced support; and pharmacotherapy followed for 12 months. Although significant weight losses were reported for other types of interventions such as physical activity and technology, the majority of studies reported weight losses less than 2 kgs.
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Affiliation(s)
- Laurie K Twells
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Kristin Harris Walsh
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Alicia Blackmore
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Tanis Adey
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Jennifer Donnan
- School of Pharmacy, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Justin Peddle
- School of Pharmacy, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Devonne Ryan
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Alison Farrell
- Health Sciences Library, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Hai Nguyen
- School of Pharmacy, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Zhiwei Gao
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Dave Pace
- Faculty of Medicine-Surgery, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
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Iwamoto SJ, Abushamat LA, Zaman A, Millard AJ, Cornier MA. Obesity Management in Cardiometabolic Disease: State of the Art. Curr Atheroscler Rep 2021; 23:59. [PMID: 34345933 PMCID: PMC8358925 DOI: 10.1007/s11883-021-00953-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW To summarize research from the last 5 years on the effects of weight loss treatments, including lifestyle changes, anti-obesity medications, and bariatric procedures on cardiovascular disease (CVD) risk factors and CVD outcomes in adults. RECENT FINDINGS This narrative review includes and summarizes the contemporary evidence of the effects of these different weight loss approaches individually. A literature search was performed using the key words obesity, weight loss, CVD, cardiometabolic, and risk factors and included key clinical trials from the past 5 years. Obesity management through weight loss is associated with improvements in CVD risk factors, such as improved blood pressure, lipid profiles, and glycemic control, with greater weight loss leading to greater improvements in CVD risk factors. Bariatric surgery is associated with greater weight loss than the other procedures and treatments for obesity, and for this, and possibly for other reasons, it is associated with greater reductions in CVD outcomes and mortality. Obesity is an independent risk factor and modulator of other CVD risk factors, and thus, treatment of obesity should be an integral part of management strategies to reduce CVD risk. Future trials and real-world studies of longer duration are needed to inform providers and patients on how to individualize the approach to modifying risks of cardiometabolic disorders through obesity management.
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Affiliation(s)
- Sean J Iwamoto
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
- Center for Women's Health Research, Department of Medicine, Anschutz Medical Campus, University of Colorado, 12348 E Montview Blvd, C263, Aurora, CO, USA
- Anschutz Health and Wellness Center, University of Colorado School of Medicine, Anschutz Medical Campus, 12348 E Montview Blvd, C263, Aurora, CO, 80045, USA
- Rocky Mountain Regional Veterans Administration, Aurora, CO, USA
| | - Layla A Abushamat
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Adnin Zaman
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
- Anschutz Health and Wellness Center, University of Colorado School of Medicine, Anschutz Medical Campus, 12348 E Montview Blvd, C263, Aurora, CO, 80045, USA
| | - Anthony J Millard
- Anschutz Health and Wellness Center, University of Colorado School of Medicine, Anschutz Medical Campus, 12348 E Montview Blvd, C263, Aurora, CO, 80045, USA
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Marc-Andre Cornier
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA.
- Anschutz Health and Wellness Center, University of Colorado School of Medicine, Anschutz Medical Campus, 12348 E Montview Blvd, C263, Aurora, CO, 80045, USA.
- Rocky Mountain Regional Veterans Administration, Aurora, CO, USA.
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20
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Laudenslager M, Chaudhry ZW, Rajagopal S, Clynes S, Gudzune KA. Commercial Weight Loss Programs in the Management of Obesity: an Update. Curr Obes Rep 2021; 10:90-99. [PMID: 33609270 PMCID: PMC8159888 DOI: 10.1007/s13679-021-00428-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Comprehensive lifestyle programs are cornerstones of obesity management, but clinician referrals may be limited by program availability. Commercial weight loss programs may be an alternative, but clinicians may be unaware of their efficacy and safety. This review describes the evidence for commercial programs, particularly 12-month weight loss, among individuals with obesity. RECENT FINDINGS Several programs are concordant with evidence-based recommendations (i.e., lower-calorie diet, increased physical activity, and behavioral strategies). Among the guideline-concordant programs, National Diabetes Prevention Program, WW, Jenny Craig, Medifast, and OPTIFAST have demonstrated 12-month weight loss efficacy and safety. While other programs show promise, more evidence is needed before clinician referral may be recommended. Clinical practice guidelines support referrals to commercial weight loss programs that have peer-reviewed evidence to support their efficacy and safety. Clinicians should consider the available evidence, patient preference, and cost when considering referrals to these programs for weight management.
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Affiliation(s)
| | | | - Selvi Rajagopal
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sasha Clynes
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kimberly A Gudzune
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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21
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Kuk JL, Dehlehhosseinzadeh M, Kamran E, Wharton S. An analysis of weight loss efforts and expectations in a Canadian Cohort: A retrospective medical chart review. Clin Obes 2021; 11:e12449. [PMID: 33745235 DOI: 10.1111/cob.12449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 02/17/2021] [Accepted: 03/03/2021] [Indexed: 11/30/2022]
Abstract
The weight loss history and weight loss goals were examined in 4108 patients referred to a publicly funded evidence-based clinical weight management program using a retrospective chart review. The majority of patients were white females, aged of 50.1 ± 13.7 years and a BMI of 39.0 ± 7.5 kg/m2 . Pregnancy was the most common reason for weight gain in women (17.7%) and while the reasons in men are more varied (injury, stress and medication: all ~5%). Over 50% of patients cited no specific reason for their weight gain. Self-directed diet and exercise were the most commonly used self-reported weight loss methods. Women were more likely to report using medication and bariatric surgical weight loss methods than men (P < .05), and only 5% of women and 12.8% men report never having tried to lose weight in the past. Patients had an ideal weight loss goal of 28.9% to 34.4%, which was similar to the patient's lowest reported adult weight. Approximately 70% of patients enrolling at the clinic had previously lost at least 4.5 kg (10 lb) one or more times and 16.7% lost weight at least 5 times in their life, but patient weight at enrolment was similar to their highest adult reported weight. Thus, most patients referred to this clinical weight management program have previously attempted self-directed diet and exercise weight loss. Patients were close to their highest adult weight and had very large weight loss goals, similar to what is typically achieved only by surgical intervention, despite having already had several bouts of weight loss.
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Affiliation(s)
- Jennifer L Kuk
- School of Kinesiology and Health Science, York University, Toronto, Canada
| | | | - Elham Kamran
- Weight Management Clinic, The Wharton Medical Clinic, Hamilton, Canada
| | - Sean Wharton
- School of Kinesiology and Health Science, York University, Toronto, Canada
- Weight Management Clinic, The Wharton Medical Clinic, Hamilton, Canada
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22
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Holden SS, Zlatevska N, Parkinson J, Cadario R, Dubelaar C, Lei J, Moore E, Sayarh N, Van Kerckhove A, Werle C. Unpalatable food for thought: Let marketing research guide effective public obesity interventions. Obes Rev 2021; 22:e13141. [PMID: 32902093 DOI: 10.1111/obr.13141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/16/2020] [Accepted: 08/17/2020] [Indexed: 11/28/2022]
Abstract
The prevalence of obesity is growing unabatedly despite the considerable efforts directed at the problem. Although abundant research has contributed to our understanding of the multifactorial causes of obesity, there is less attention to research that is relevant for guiding social marketers, public health professionals and policymakers in delivering public health interventions for countering and/or preventing the problem of obesity. This review offers six points for identifying and developing research relevant for guiding community-wide obesity interventions based on the idea that an applied marketing research perspective offers a better model for identifying effective interventions than more theoretical academic research. Specifically, the research guiding public health and social marketing interventions needs to (1) provide information on ultimate outcomes (weight, health and unintended consequences) more than intermediate outcomes (beliefs, attitudes and behaviour), (2) report on observations collected over the longer term, (3) use natural settings (even at a cost of internal validity), (4) endeavour to overcome observer-effects, (5) report effect sizes (rather than statistical significance) and (6) use moderator analyses to capture variation in how a population responds to interventions.
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Affiliation(s)
- Stephen S Holden
- Macquarie School of Business, Macquarie University, Sydney, New South Wales, Australia
| | - Natalina Zlatevska
- Faculty of Business, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Joy Parkinson
- Griffith Business School, Griffith University, Brisbane, Queensland, Australia
| | - Romain Cadario
- Rotterdam School of Management, Erasmus University, Rotterdam, The Netherlands
| | - Chris Dubelaar
- Department of Marketing, Deakin University, Melbourne, Victoria, Australia
| | - Jing Lei
- Department of Management & Marketing, University of Melbourne, Melbourne, Victoria, Australia
| | - Elizabeth Moore
- Mendoza College of Business, University of Notre Dame, South Bend, Indiana, USA
| | - Nada Sayarh
- Geneva School of Economics & Management, University of Geneva, Geneva, Switzerland
| | | | - Carolina Werle
- Grenoble Ecole de Management, Grenoble, France & IREGE, Université Savoie Mont Blanc, Chambery, France
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23
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Abdalgwad R, Rafey MF, Murphy C, Ioana I, O'Shea PM, Slattery E, Davenport C, O'Keeffe DT, Finucane FM. Changes in alanine aminotransferase in adults with severe and complicated obesity during a milk-based meal replacement programme. Nutr Metab (Lond) 2020; 17:87. [PMID: 33072167 PMCID: PMC7565317 DOI: 10.1186/s12986-020-00512-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 10/08/2020] [Indexed: 12/28/2022] Open
Abstract
Introduction Excess adiposity is associated with fat accumulation within the liver, and non-alcoholic steatohepatitis (NASH) is highly prevalent in bariatric patients. Elevated alanine aminotransferase (ALT) is associated with prevalent NASH. We sought to determine the influence of a milk-based meal replacement weight-loss programme on ALT levels in adults with severe and complicated obesity.
Methods We conducted a retrospective cohort study of patients who completed a 24-week meal replacement programme, comprised of a weight loss phase followed by weight stabilisation and maintenance phases, each 8 weeks long. ALT was quantified using an enzymatic assay with spectrophotometric detection. We examined changes over time in ALT using the non-parametric Wilcoxon singed-rank test and the Friedman test. Results Of 105 patients, 56 were female, mean age was 51.2 ± 11.2 (range 18.0–71.6) years. There was an unanticipated but transient increase in ALT from 28.0 [20.0, 40.5] iu/L at baseline to 40.0 [26.0, 55.0] iu/L after 2 weeks (p < 0.0005), followed by a gradual reduction to 21.0 [17.0, 28.3] iu/L by 24 weeks (p < 0.0005). The overall reductions in ALT were more pronounced in patients who had elevated levels at baseline. Body weight decreased from 144.2 ± 28.0 kg at baseline to 121.6 ± 25.4 kg at 24 weeks (p < 0.0005) and body mass index (BMI) decreased from 50.7 ± 8.1 kg m−2 at baseline to 43.0 ± 7.6 kg m−2 by 24 weeks (p < 0.0005). Conclusion In adults with severe and complicated obesity undergoing a milk-based meal replacement programme, there was an initial unanticipated rise in ALT in the first 2 weeks, followed by a gradual overall reduction by 24 weeks. These findings suggest that rapid weight loss secondary to significant caloric restriction might induce a transient deterioration in hepatic steatosis prior to an ultimate overall improvement.
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Affiliation(s)
- Razk Abdalgwad
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and and HRB Clinical Research Facility, Galway University Hospitals, Galway, Ireland.,HRB Clinical Research Facility, National University of Ireland Galway, Galway, Ireland.,Department of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Mohammed Faraz Rafey
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and and HRB Clinical Research Facility, Galway University Hospitals, Galway, Ireland.,HRB Clinical Research Facility, National University of Ireland Galway, Galway, Ireland.,Department of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Conor Murphy
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and and HRB Clinical Research Facility, Galway University Hospitals, Galway, Ireland.,HRB Clinical Research Facility, National University of Ireland Galway, Galway, Ireland.,Department of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Iulia Ioana
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and and HRB Clinical Research Facility, Galway University Hospitals, Galway, Ireland
| | - Paula Mary O'Shea
- Department of Clinical Biochemistry, Galway University Hospitals, Galway, Ireland
| | - Eoin Slattery
- HRB Clinical Research Facility, National University of Ireland Galway, Galway, Ireland.,Department of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Colin Davenport
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and and HRB Clinical Research Facility, Galway University Hospitals, Galway, Ireland.,HRB Clinical Research Facility, National University of Ireland Galway, Galway, Ireland.,Department of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Derek Timothy O'Keeffe
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and and HRB Clinical Research Facility, Galway University Hospitals, Galway, Ireland.,HRB Clinical Research Facility, National University of Ireland Galway, Galway, Ireland.,Department of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Francis Martin Finucane
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and and HRB Clinical Research Facility, Galway University Hospitals, Galway, Ireland.,HRB Clinical Research Facility, National University of Ireland Galway, Galway, Ireland.,Department of Medicine, National University of Ireland Galway, Galway, Ireland
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24
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Williams DM, Nawaz A, Evans M. Drug Therapy in Obesity: A Review of Current and Emerging Treatments. Diabetes Ther 2020; 11:1199-1216. [PMID: 32297119 PMCID: PMC7261312 DOI: 10.1007/s13300-020-00816-y] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Indexed: 12/25/2022] Open
Abstract
Whilst the prevalence of obesity continues to increase at an alarming rate worldwide, the personal and economic burden of obesity-related complications becomes ever more important. Whilst dietary and lifestyle measures remain the fundamental focus of the patient to counter obesity, more frequently pharmacological and/or surgical interventions are required. Nevertheless, these therapies are often limited by weight loss efficacy, side effects, surgical risks and frequently obesity relapse. Currently, only five drug therapies are approved for the specific treatment of obesity. However, our understanding of the pathophysiology of obesity and of gut hormones has developed precipitously over the last 20-30 years. As a result, there has been a recent movement to create and use analogues that manipulate these gut hormones to support weight loss. In this article we review the efficacy of the currently approved drug therapies and discuss future potential drug mechanisms and early clinical trial results exploring these budding avenues. We discuss the use of glucagon-like peptide-1 (GLP-1) analogues as monotherapy and unimolecular dual or triple agonists that exploit the GLP-1 receptor and/or the gastric inhibitory peptide (GIP) receptor and/or the glucagon receptor. We also explore the use of sodium-glucose co-transporter-2 (SGLT-2) inhibitors, amylin mimetics, leptin analogues, ghrelin antagonists and centrally acting agents to suppress appetite [neuropeptide Y (NPY) antagonists, melanocortin-4 receptor (MC4R) agonists and cannabinoid-1 receptor antagonists]. Whilst further evidence is required to support their clinical use, preclinical and early clinical trial results are encouraging.
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Affiliation(s)
- David M Williams
- Department of Diabetes and Endocrinology, University Hospital Llandough, Cardiff, UK.
| | - Asif Nawaz
- Department of Diabetes and Endocrinology, University Hospital Llandough, Cardiff, UK
| | - Marc Evans
- Department of Diabetes and Endocrinology, University Hospital Llandough, Cardiff, UK
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25
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Gudzune KA, Clark JM. Role of Commercial Weight-Loss Programs in Medical Management of Obesity. Endocrinol Metab Clin North Am 2020; 49:275-287. [PMID: 32418590 DOI: 10.1016/j.ecl.2020.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Rates of obesity counseling are low among physicians because of the lack of time and training in this area. In recognition of this challenge, recent national guidelines encourage physicians to refer patients with obesity to intensive, comprehensive lifestyle programs to lose weight. Some commercial weight-loss programs meet these criteria, and this article reviews the evidence from randomized controlled trials regarding such programs' weight-loss efficacy and safety as well as glycemic outcomes among patients with and without diabetes mellitus. A discussion of how physicians might approach the referral process and continued management of patients participating in these programs is included.
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Affiliation(s)
- Kimberly A Gudzune
- Department of Medicine, Johns Hopkins University School of Medicine, 2024 East Monument Street, Room 2-621, Baltimore, MD 21224, USA.
| | - Jeanne M Clark
- Department of Medicine, Johns Hopkins University School of Medicine, 2024 East Monument Street, Room 2-600, Baltimore, MD 21224, USA. https://twitter.com/jmclark_md
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Abstract
Obesity is a chronic, systemic disease defined as a pathologically increased fat mass, which is associated with an increased health risk. A BMI >30 kg/m2 is usually considered as a sign of obesity. Obesity requires a multidisciplinary and multimodal treatment, which varies depending on the phase of disease and the purpose (e.g. weight loss, weight maintenance). The treatment should be based on evidence. The goal of obesity therapy is to reduce the body weight by reducing fat mass in the long term in combination with a change in behavior, which aims to improve obesity-associated risk factors, reduce obesity-related illnesses, reduce the risk of premature mortality, incapacitation and early retirement, and improve quality of life. Non-surgical lifestyle therapy comprises nutrition, exercise, behavior change ("basic therapy") which becomes more effective when combined with initial formula diet. A formula diet as initial therapy is indicated if a relative weight loss more than 10% is intended. A successful and sustained obesity therapy needs a clear structure, a well-trained team of professionals, and the coverage of the costs. Drugs can support obesity therapy, while other drugs can promote weight gain. The multimodal approach is the most effective non-surgical therapy resulting in a relative weight loss of 15-25%. The primary obesity therapy should be with a non-surgical approach, but bariatric surgery may be needed if the problem cannot otherwise be solved. A clear and realistic interface to bariatric surgery needs to be defined. Weight maintenance strategies including and beyond dietetic concepts are usually needed throughout life for long-term stabilization of body weight.
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Affiliation(s)
- Stephan C Bischoff
- University of Hohenheim, Institute of Nutritional Medicine, Stuttgart, Germany.
| | - Anna Schweinlin
- University of Hohenheim, Institute of Nutritional Medicine, Stuttgart, Germany
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27
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Kelly T, Unwin D, Finucane F. Low-Carbohydrate Diets in the Management of Obesity and Type 2 Diabetes: A Review from Clinicians Using the Approach in Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2557. [PMID: 32276484 PMCID: PMC7177487 DOI: 10.3390/ijerph17072557] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 12/14/2022]
Abstract
Low-carbohydrate diets are increasingly used to help patients with obesity and type 2 diabetes. We sought to provide an overview of the evidence for this treatment approach, considering the epidemiology and pathophysiology of obesity and diabetes in terms of carbohydrate excess. We describe the mechanistic basis for the clinical benefits associated with nutritional ketosis and identify areas of practice where the evidence base could be improved. We summarize the key principles which inform our approach to treating patients with low-carbohydrate diets. The scientific controversy relating to these diets is real but is consistent with the known challenges of any dietary interventions and also the limitations of nutritional epidemiology. Secondly, notwithstanding any controversy, international guidelines now recognize the validity and endorse the use of these diets as a therapeutic nutritional approach, in appropriate patients. Thirdly, we have found that early de-prescription of diabetes medications is essential, in particular insulin, sulphonylureas, and sodium-glucose cotransporter (SGLT2) inhibitors. Fourthly, we encourage patients to eat ad libitum to satiety, rather than calorie counting per se. Furthermore, we monitor cardiovascular risk factors frequently, as with all patients with obesity or diabetes, but we do not necessarily consider an increase in low-density lipoprotein (LDL)-cholesterol as an absolute indication to stop these diets, as this is usually related to large LDL particles, which are not associated with increased cardiovascular risk. In the absence of large randomized controlled trials with cardiovascular and other hard endpoints, adopting a low-carbohydrate diet is a legitimate and potentially effective treatment option for patients with diabetes or obesity.
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Affiliation(s)
- Tara Kelly
- HRB Clinical Research Facility, National University of Ireland, H91YR71 Galway, Ireland;
| | | | - Francis Finucane
- HRB Clinical Research Facility, National University of Ireland, H91YR71 Galway, Ireland;
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, H91YR71 Galway, Ireland
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28
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Daumit GL, Janssen EM, Jerome GJ, Dalcin AT, Charleston J, Clark JM, Coughlin JW, Yeh HC, Miller ER, Durkin N, Louis TA, Frick KD, Wang NY, Appel LJ. Cost of behavioral weight loss programs implemented in clinical practice: The POWER trial at Johns Hopkins. Transl Behav Med 2020; 10:103-113. [PMID: 30855082 PMCID: PMC7295697 DOI: 10.1093/tbm/iby120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Obesity presents an important public health problem that affects more than a third of the U.S. adult population and that is associated with increased morbidity, mortality, and costs. Previously, we documented that two primary care-based weight loss interventions were clinically effective. To encourage the implementation of and reimbursement for these interventions, we evaluated their relative cost-effectiveness. We performed a cost analysis of the Practice-based Opportunities for Weight Reduction (POWER) trial, a three-arm trial that enrolled 415 patients with obesity from six primary care practices. Trial participants were randomized to a control arm, an in-person support intervention, or a remote support intervention; in the two intervention arms, behavioral interventions were delivered over 24 months, in two phases. Weight loss was measured at 6, 12, and 24 months. Using timesheets and empirical data, we evaluated the cost of the in-person and remote support interventions from the perspective of a health care system delivering the interventions. A univariate sensitivity analysis was conducted to evaluate uncertainty around model assumptions. All comparisons were tested using independent t-tests. Cost of the in-person intervention was higher at 6 months ($113 per participant per month and $117 per kg lost) than the remote support intervention ($101 per participant per month and $99 per kg lost; p < .001). Costs were also higher for the in-person support intervention at 24 months ($73 per participant per month and $342 per kg lost) than for the remote support intervention ($53 per participant per month and $275 per kg lost; p < .001). In the sensitivity analyses, cost ranged from $274/kg lost to $456/kg lost for the in-person support intervention and from $218/kg to $367/kg lost for the remote support intervention. A primary care weight loss intervention administered remotely was relatively more cost-effective than an in-person intervention. Expanding the scope of reimbursable programs to include other cost-effective interventions could help ensure that a broader range of patients receive the type of support needed.
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Affiliation(s)
- Gail L Daumit
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ellen M Janssen
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gerald J Jerome
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Kinesiology, Towson University, Baltimore, MD, USA
| | - Arlene T Dalcin
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Jeanne Charleston
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeanne M Clark
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Janelle W Coughlin
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hsin-Chieh Yeh
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Edgar R Miller
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Nowella Durkin
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Thomas A Louis
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kevin D Frick
- Johns Hopkins Carey Business School, Baltimore, MD, USA
| | - Nae-Yuh Wang
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lawrence J Appel
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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29
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Radcliff TA, Côté MJ, Whittington MD, Daniels MJ, Bobroff LB, Janicke DM, Perri MG. Cost-Effectiveness of Three Doses of a Behavioral Intervention to Prevent or Delay Type 2 Diabetes in Rural Areas. J Acad Nutr Diet 2020; 120:1163-1171. [PMID: 31899170 DOI: 10.1016/j.jand.2019.10.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 10/28/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Rural Americans have higher prevalence of obesity and type 2 diabetes (T2D) than urban populations and more limited access to behavioral programs to promote healthy lifestyle habits. Descriptive evidence from the Rural Lifestyle Intervention Treatment Effectiveness trial delivered through local cooperative extension service offices in rural areas previously identified that behavioral modification with both nutrition education and coaching resulted in a lower program delivery cost per kilogram of weight loss maintained at 2-years compared with an education-only comparator intervention. OBJECTIVE This analysis extended earlier Rural Lifestyle Intervention Treatment Effectiveness trial research regarding weight loss outcomes to assess whether nutrition education with behavioral coaching delivered through cooperative extension service offices is cost-effective relative to nutrition education only in reducing T2D cases in rural areas. DESIGN A cost-utility analysis was conducted. PARTICIPANTS/SETTING Trial participants (n=317) from June 2008 through June 2014 were adults residing in rural Florida counties with a baseline body mass index between 30 and 45, but otherwise identified as healthy. INTERVENTION Trial participants were randomly assigned to low, moderate, or high doses of behavioral coaching with nutrition education (ie, 16, 32, or 48 sessions over 24 months) or a comparator intervention that included 16 sessions of nutrition education without coaching. Participant glycated hemoglobin level was measured at baseline and the end of the trial to assess T2D status. MAIN OUTCOME MEASURES T2D categories by treatment arm were used to estimate participants' expected annual health care expenditures and expected health-related utility measured as quality adjusted life years (ie, QALYs) over a 5-year time horizon. Discounted incremental costs and QALYs were used to calculate incremental cost-effectiveness ratios for each behavioral coaching intervention dose relative to the education-only comparator. STATISTICAL ANALYSES PERFORMED Using a third-party payer perspective, Markov transition matrices were used to model participant transitions between T2D states. Replications of the individual participant behavior were conducted using Monte Carlo simulation. RESULTS All three doses of the behavioral coaching intervention had lower expected total costs and higher estimated QALYs than the education-only comparator. The moderate dose behavioral coaching intervention was associated with higher estimated QALYs but was costlier than the low dose; the moderate dose was favored over the low dose with willingness to pay thresholds over $107,895/QALY. The low dose behavioral coaching intervention was otherwise favored. CONCLUSIONS Because most rural Americans live in counties with cooperative extension service offices, nutrition education with behavioral coaching programs similar to those delivered through this trial may be effective and efficient in preventing or delaying T2D-associated consequences of obesity for rural adults.
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30
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Manz KC, Waters TM, Clifton HE, Kocak M, Klesges RC, Talcott GW, Krukowski RA. Cost-Effectiveness of a Weight Loss Intervention: An Adaptation of the Look AHEAD Lifestyle Intervention in the US Military. Obesity (Silver Spring) 2020; 28:89-96. [PMID: 31773873 PMCID: PMC6925346 DOI: 10.1002/oby.22681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 08/30/2019] [Indexed: 01/27/2023]
Abstract
OBJECTIVE This study aimed to assess whether a counselor-initiated (CI) adaptation of the Look AHEAD (Action for Health in Diabetes) intensive lifestyle intervention in a military setting was cost-effective relative to a self-paced (SP) adaptation. METHODS A cost-effectiveness analysis from a payer perspective was performed alongside a 2014-2017 randomized behavioral weight loss trial among 248 active-duty military personnel stationed at a US Air Force base in Texas. Incremental cost-effectiveness ratios were calculated for weight loss, reductions in waist circumference, and quality-adjusted life-years (QALYs). RESULTS After 12 months, the CI adaptation cost more per participant compared with the SP adaptation ($1,081 vs. $120) but achieved greater weight loss (1.86 kg vs. 0.06 kg), greater reductions in waist circumference (1.85 cm vs. 0.48 cm), and more QALYs (0.871 vs. 0.856). The incremental cost-effectiveness ratio for the CI adaptation relative to the SP adaptation was $61,268 per additional QALY. At willingness-to-pay thresholds of $50,000 and $100,000 per QALY, the CI adaptation was 45% and 49% likely to be cost-effective, respectively. CONCLUSIONS The CI delivery of the Look AHEAD Intensive Lifestyle Intervention may offer a cost-effective approach to tackle excess weight in the US military.
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Affiliation(s)
- Karina C. Manz
- Department of Health Management and Policy, University of Kentucky College of Public Health, Lexington, KY
| | - Teresa M. Waters
- Department of Health Management and Policy, University of Kentucky College of Public Health, Lexington, KY
| | - Hannah E. Clifton
- Department of Health Management and Policy, University of Kentucky College of Public Health, Lexington, KY
| | - Mehmet Kocak
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Robert C. Klesges
- Department of Public Health Sciences, University of Virginia Medical School, Charlottesville, VA
| | - G. Wayne Talcott
- Department of Public Health Sciences, University of Virginia Medical School, Charlottesville, VA
| | - Rebecca A. Krukowski
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
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Rafey MF, Murphy CF, Abdalgwad R, Kilkelly K, Griffin H, Beatty N, O’Shea PM, Collins C, McGrath R, Hynes M, Davenport C, O’Donnell M, Finucane FM. Effects of a Milk-Based Meal Replacement Program on Weight and Metabolic Characteristics in Adults with Severe Obesity. Diabetes Metab Syndr Obes 2020; 13:197-205. [PMID: 32158243 PMCID: PMC6986176 DOI: 10.2147/dmso.s226327] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 11/15/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Low energy meal replacement regimens can induce short-term weight loss in patients with severe obesity, but usually require specially formulated dietary supplements. We sought to determine the effects of a milk-based meal replacement program on anthropometric and metabolic characteristics in adults with severe obesity. METHODS We conducted a retrospective cohort study of patients attending our hospital-based bariatric medicine service who completed a 24-week program consisting of eight weeks of milk-based meal replacement followed by weight stabilisation and maintenance phases. Patients were seen fortnightly by the bariatric physician, nurse and dietitian. We assessed changes in anthropometric and metabolic outcomes in completers at 0, 8, 16 and 24 weeks. RESULTS Of 105 program completers available for follow-up, 53.3% were female. Mean age was 51.1±11.2 years. Body weight decreased from 144.0±27.6 kg at baseline to 121.1±25.0 kg at 24 weeks (P<0.001), a mean total body weight loss of 15.9±6.0%, with a reduction in body mass index from 50.6±8.0 to 42.6±7.6 kg m-2 (P<0.001). In patients with diabetes, haemoglobin A1c decreased from 66.3±13.0 to 48.3±13.5 mmol/mol (P<0.001) and diabetes medication use decreased significantly. There were significant improvements also in lipid profiles and reductions in antihypertensive medication use. CONCLUSION These preliminary findings suggest that completion of a 24-week milk-based meal replacement program has large effects on important outcomes in adults with severe obesity. However, attrition was high. Prospective assessment of the efficacy, safety, durability and cost-effectiveness of this intervention seems warranted.
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Affiliation(s)
- Mohammed F Rafey
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
- HRB Clinical Research Facility, National University of Ireland, Galway, Ireland
| | - Conor F Murphy
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
- HRB Clinical Research Facility, National University of Ireland, Galway, Ireland
| | - Razk Abdalgwad
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
- HRB Clinical Research Facility, National University of Ireland, Galway, Ireland
| | - Katriona Kilkelly
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
| | - Helena Griffin
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
| | - Niamh Beatty
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
| | - Paula M O’Shea
- Department of Clinical Biochemistry, Galway University Hospitals, Galway, Ireland
| | - Chris Collins
- HRB Clinical Research Facility, National University of Ireland, Galway, Ireland
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Robert McGrath
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
| | - Mary Hynes
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
| | - Colin Davenport
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
- HRB Clinical Research Facility, National University of Ireland, Galway, Ireland
| | - Martin O’Donnell
- HRB Clinical Research Facility, National University of Ireland, Galway, Ireland
| | - Francis M Finucane
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
- HRB Clinical Research Facility, National University of Ireland, Galway, Ireland
- Correspondence: Francis M Finucane Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospital, Galway, IrelandTel +353 91 542711 Email
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Bourke S, Morton JM, Williams P. Effect of JumpstartMD, a Commercial Low-Calorie Low-Carbohydrate Physician-Supervised Weight Loss Program, on 22,407 Adults. J Obes 2020; 2020:8026016. [PMID: 32318289 PMCID: PMC7157789 DOI: 10.1155/2020/8026016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 09/10/2019] [Accepted: 11/14/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Commercial weight loss programs provide valuable consumer options for those desiring support. Several commercial programs are reported to produce ≥3-fold greater weight loss than self-directed dieting. The effectiveness of JumpstartMD, a commercial pay-as-you-go program that emphasizes a low-to-very-low-carbohydrate real-food diet and optional pharmacologic treatment without prepackaged meals or meal replacement, has not previously been described. METHODS Completer and last observation carried forward (LOCF) of clinic-measured weight loss (kg) in 18,769 female and 3638 male JumpstartMD participants. RESULTS Completers lost (mean ± SE) 8.7 ± 0.04 kg, 9.5 ± 0.04% with 44.5 ± 0.5% achieving ≥10% weight loss at 3 months (mo, N = 14,999 completers); 11.8 ± 0.1 kg, 12.6 ± 0.1% with 66.4 ± 0.6% achieving ≥10% weight loss at 6 mo (N = 11,805); and 11.5 ± 0.2 kg, 12.0 ± 0.2% with 57.6 ± 0.9% achieving ≥10% weight loss at 12 mo (N = 8514). LOCF estimates were -6.5 ± 0.03 kg, -7.2 ± 0.03% with 27.1 ± 0.3% achieving ≥10% weight loss at 3 mo; -7.7 ± 0.04 kg, -8.5 ± 0.04% with 36.3 ± 0.3% achieving ≥10% weight loss at 6 mo; and -7.7 ± 0.1 kg, -8.4 ± 0.1% with 34.6 ± 0.3% achieving ≥10% weight loss after 12 mo. Frequent health coach meetings was a major determinant of weight loss, with women and men attending ≥75% of their weekly appointments losing 8.8 ± 0.04 and 11.9 ± 0.1 kg, respectively, after 3 mo, 13.1 ± 0.1 and 16.5 ± 0.3 kg after 6 mo, and 16.5 ± 0.3 and 19.4 ± 0.8 kg after 12 mo. Phentermine and phendimetrazine had a minor effect in women only at 1 (6.1% greater weight loss than untreated), 2 (4.1%), and 3 mo (1.2%), but treated patients showed longer enrollment than nontreated during the first 3 (females: +0.4 ± 0.01; males: +0.3 ± 0.04 mo), 6 (females: +1.1 ± 0.04; males: +1.0 ± 0.1 mo), and 12 mo (females: +2.7 ± 0.1; males: +2.4 ± 0.2 mo). JumpstartMD produced generally greater weight loss than published reports for other real-food and prepackaged-meal commercial programs and somewhat greater or comparable losses to meal replacement diets. CONCLUSION A one-on-one medically supervised program that emphasized real low-carbohydrate foods produced effective weight loss, particularly in those attending ≥75% of their weekly appointments.
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Affiliation(s)
- Sean Bourke
- JumpstartMD, 350 Lorton Ave, Burlingame, CA 94010, USA
| | - John Magaña Morton
- Department of Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Paul Williams
- Childrens Hospital Oakland Research Institute, Oakland, CA, USA
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Pirotta S, Joham A, Hochberg L, Moran L, Lim S, Hindle A, Brennan L. Strategies to reduce attrition in weight loss interventions: A systematic review and meta-analysis. Obes Rev 2019; 20:1400-1412. [PMID: 31347759 DOI: 10.1111/obr.12914] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 01/02/2023]
Abstract
The primary objective of the study was to identify the effect of intervention strategies on attrition within a weight loss programme among adults aged 18 to 65 years. The secondary objective of the study was to assess the impact of such intervention strategies among female-only weight loss programmes. The literature search was performed in Ovid (CINAHL Plus, MEDLINE, EMBASE, Cochrane [Cochrane Database of Reviews, Cochrane Central Register of Controlled Trials, and Cochrane Methodology Register], and PsycINFO). Studies must have identified weight loss as the main aim and compared the primary weight loss programme alone (control) with the primary weight loss programme coupled with an additional intervention strategy (intervention). Papers must have had a mean participant age between 18 and 65 years and available in English. Fifty-seven trials met the inclusion criteria and were included in the meta-analysis. Strategies that successfully reduced attrition included the incorporation of financial incentives (n = 8), a multicomponent approach (n = 13), and use of self-monitoring technology (n = 4). The majority of studies were of low to moderate methodological quality because of insufficient reporting. A limited number of female-only trials were found (n = 13). Implementation of financial incentives, multicomponent interventions, and self-monitoring technology help reduce attrition among adult weight loss programmes. Further studies are required to identify the impact of intervention strategies on attrition in women.
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Affiliation(s)
- Stephanie Pirotta
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Anju Joham
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Victoria, Australia
| | - Lisa Hochberg
- Faculty of Health Sciences, Australian Catholic University, Fitzroy, Victoria, Australia
| | - Lisa Moran
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Siew Lim
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Annemarie Hindle
- Faculty of Health Sciences, Australian Catholic University, Fitzroy, Victoria, Australia
| | - Leah Brennan
- Faculty of Health Sciences, Australian Catholic University, Fitzroy, Victoria, Australia
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Kuo HH, Wang KT, Lee YH, Lin PL, Liu ME, Lin CY, Liu LYM. Effects of lorcaserin on cardiometabolic risk factors in overweight and obese patients: A systematic review and meta-analysis. J Clin Pharm Ther 2019; 45:35-44. [PMID: 31544267 DOI: 10.1111/jcpt.13047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/31/2019] [Accepted: 08/23/2019] [Indexed: 01/18/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE Lorcaserin is a selective serotonin 2c receptor agonist approved as an anti-obesity agent. The additional cardiometabolic benefits associated with lorcaserin have not been conclusively established. The aim of the systematic review and meta-analysis is to examine the effects of lorcaserin on blood pressure, heart rate and other metabolic parameters in overweight and obese patients from randomized controlled clinical trials (RCTs). METHODS A literature search was conducted on PubMed, EMBASE and Cochrane Central using the search terms 'lorcaserin' and 'randomized controlled trials' without language restrictions. RCTs with a follow-up period of at least 24 weeks were included in the meta-analysis. RESULTS AND DISCUSSION Six studies with 9452 patients in the lorcaserin group and 9392 patients in the placebo group were included. Compared with placebo, lorcaserin not only reduced weight, BMI and waist circumference but also improved SBP, DBP, heart rate, LDL, triglycerides, fasting plasma glucose and HbA1c. Our findings suggest that lorcaserin has trivial though consistent and favourable effects on blood pressure, heart rate and metabolic syndrome. WHAT IS NEW AND CONCLUSION Lorcaserin improved all cardiometabolic parameters modestly in addition to its weight loss effect in overweight and obese patients. More research is needed to determine its long-term cardiovascular benefits.
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Affiliation(s)
- Hsiao-Huai Kuo
- Department of Pharmacy, Hsinchu Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Kuang-Te Wang
- Division of Cardiology, Department of Internal Medicine, Taitung MacKay Memorial Hospital, Taitung, Taiwan
| | - Ying-Hsiang Lee
- Cardiovascular Center, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Po-Lin Lin
- Division of Cardiology, Department of Internal Medicine, Hsinchu Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Ming-En Liu
- Division of Cardiology, Department of Internal Medicine, Hsinchu Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Chien-Yu Lin
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Lawrence Yu-Min Liu
- Division of Cardiology, Department of Internal Medicine, Hsinchu Mackay Memorial Hospital, Hsinchu, Taiwan
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Abstract
PURPOSE OF REVIEW Obesity continues to be a growing concern globally due to association with a number of comorbidities and contributing significantly to increase in health care expenditures. Despite availability of a number of treatment modalities, lifestyle modification with dietary modification and exercise continues to be the foundation. However, the standard model of lifestyle modification is not efficacious or sustainable for many patients leading them to seek alternative approaches. We conducted a comprehensive literature review to present the data regarding efficacy and sustainability of many common dietary approaches. RECENT FINDINGS Building upon previous work, recent randomized controlled trials have compared many popular diets head to head in varying patient populations. Along with the weight changes, studies have investigated the changes in metabolic parameters, inflammatory markers, and cardiac risk factor reduction. Though the studies do not show superiority of one diet compared to the other, the preventive benefits and other favorable metabolic changes of the diets make them worthy of consideration.
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Finkelstein EA, Krishnan A, Doble B. Beyond cost-effectiveness: A five-step framework for appraising the value of health technologies in Asia-Pacific. Int J Health Plann Manage 2019; 35:397-408. [PMID: 31290187 DOI: 10.1002/hpm.2851] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 06/07/2019] [Indexed: 12/31/2022] Open
Abstract
Given resource constraints and the potential for increasingly high-cost, cost-effective medicines to become available, policymakers require strategies that go beyond cost-effectiveness when making resource allocation decisions. This manuscript presents a five-step framework that complements traditional health technology assessment (HTA) guidance documents that policymakers in Asia-Pacific and elsewhere may consider when setting up HTA guidelines and/or evaluating whether or not to subsidize a medicine or other health innovations. The framework recommends that subsidy decisions be based on five criteria: the relative burden of the condition as compared with other conditions (step 1), comparative and cost-effectiveness of the medicine (steps 2 and 3), the short-term impact on the budget (step 4), and other considerations including patient and societal preferences (step 5). Our approach, which is a complement to traditional HTA guidance documents, is not prescriptive but provides an evidence-based framework that HTA agencies in Asia-Pacific can follow as they aim to deliver value-based medicines to their constituents.
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Affiliation(s)
- Eric A Finkelstein
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Anirudh Krishnan
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Brett Doble
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
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Sherman RP, Petersen R, Guarino AJ, Crocker JB. Primary Care-Based Health Coaching Intervention for Weight Loss in Overweight/Obese Adults: A 2-Year Experience. Am J Lifestyle Med 2019; 13:405-413. [PMID: 31285724 PMCID: PMC6600613 DOI: 10.1177/1559827617715218] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 05/19/2017] [Accepted: 05/24/2017] [Indexed: 11/15/2022] Open
Abstract
Background: Obesity is a major contributor to medical comorbidity and places a large economic burden on health care. This study examined the effectiveness of primary care-integrated health coaching for weight loss in overweight/obese patients. Participants/Methods: This observational clinical study with a retrospective comparison analysis was performed at an urban academic primary care practice. A total of 271 individuals with a BMI >25 kg/m2 were recruited and followed for 2 years. A standardized health coaching intervention was used to promote weight loss. The main outcome measures were weight loss as a percentage of initial body weight and proportion of patients with weight loss ≥5% initial body weight, controlling for relevant covariates. An activity-based cost assessment of health coaching for weight loss was also performed. Results: Health coaching was associated with a mean loss of 7.24% initial weight after 12 months (95% CI = 8.68 to 5.90) and 6.77% after 24 months (95% CI = 8.78 to 4.76). Coached patients were more likely to achieve ≥5% of initial weight loss at both 12 and 24 months (P < .001). Health coaching costs were $288.54 per participant over 1 year. Conclusions: Primary care-integrated health coaching was associated with statistically significant weight loss in overweight and obese adults.
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Affiliation(s)
- Ryan P. Sherman
- Medway Public Schools, Medway, Massachusetts
(RPS)
- Azimuth Psychological, Boston, Massachusetts
(RP)
- Fulbright Specialist, Boston, Massachusetts
(AJG)
- the Department of Medicine, Massachusetts General
Hospital, and Harvard Medical School, Boston, Massachusetts (JBC)
| | - Rebecca Petersen
- Medway Public Schools, Medway, Massachusetts
(RPS)
- Azimuth Psychological, Boston, Massachusetts
(RP)
- Fulbright Specialist, Boston, Massachusetts
(AJG)
- the Department of Medicine, Massachusetts General
Hospital, and Harvard Medical School, Boston, Massachusetts (JBC)
| | - Anthony J. Guarino
- Medway Public Schools, Medway, Massachusetts
(RPS)
- Azimuth Psychological, Boston, Massachusetts
(RP)
- Fulbright Specialist, Boston, Massachusetts
(AJG)
- the Department of Medicine, Massachusetts General
Hospital, and Harvard Medical School, Boston, Massachusetts (JBC)
| | - J. Benjamin Crocker
- J. Benjamin Crocker, MD, Harvard Medical
School, 101 Merrimac Street, 10th Floor Boston, MA 02114; e-mail:
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Effectiveness and cost-effectiveness of incentives as a tool for prevention of non-communicable diseases: A systematic review. Soc Sci Med 2019; 232:340-350. [PMID: 31129504 DOI: 10.1016/j.socscimed.2019.05.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/14/2019] [Accepted: 05/16/2019] [Indexed: 01/27/2023]
Abstract
The rising epidemic of non-communicable diseases (NCDs) poses substantial health and economic challenges to both individuals and society. Application of incentive-based strategies based on traditional and behavioural economic theory has emerged as a potential strategy to address rising rates of NCDs. Yet, whether or not incentives truly represent a promising strategy for addressing NCDs has not been systematically addressed nor is it clear whether certain behavioural economic strategies outperform others or simply offering a cash-based incentive for meeting a goal. In this systematic review we aim to determine whether there is an evidence base for any of these strategies. Forty-eight published randomized controlled trials (70 contrasts) evaluating the effectiveness of incentive-based strategies for improvements in NCD risk-factors were reviewed. Our primary conclusion is that there is a lack of compelling evidence that incentives of any form represent a compelling NCD reduction strategy. More evidence for long-term effectiveness and cost-effectiveness is needed to justify third party funding of any incentive based strategy.
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Krishnan A, Finkelstein EA, Levine E, Foley P, Askew S, Steinberg D, Bennett GG. A Digital Behavioral Weight Gain Prevention Intervention in Primary Care Practice: Cost and Cost-Effectiveness Analysis. J Med Internet Res 2019; 21:e12201. [PMID: 31102373 PMCID: PMC6543798 DOI: 10.2196/12201] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 04/03/2019] [Accepted: 04/08/2019] [Indexed: 01/18/2023] Open
Abstract
Background Obesity is one of the largest drivers of health care spending but nearly half of the population with obesity demonstrate suboptimal readiness for weight loss treatment. Black women are disproportionately likely to have both obesity and limited weight loss readiness. However, they have been shown to be receptive to strategies that prevent weight gain. Objective The aim of this study was to evaluate the costs and cost-effectiveness of a digital weight gain prevention intervention (Shape) for black women. Shape consisted of adaptive telephone-based coaching by health system personnel, a tailored skills training curriculum, and patient self-monitoring delivered via a fully automated interactive voice response system. Methods A cost and cost-effectiveness analysis based on a randomized clinical trial of the Shape intervention was conducted from the payer perspective. Costs included those of delivering the program to 91 intervention participants in the trial and were summarized by program elements: self-monitoring, skills training, coaching, and administration. Effectiveness was measured in quality-adjusted life years (QALYs). The primary outcome was the incremental cost per QALY of Shape relative to usual care. Results Shape cost an average of US $758 per participant. The base-case model in which quality of life benefits decay linearly to zero 5 years post intervention cessation, generated an incremental cost-effectiveness ratio (ICER) of US $55,264 per QALY. Probabilistic sensitivity analyses suggest an ICER below US $50,000 per QALY and US $100,000 per QALY in 39% and 98% of simulations, respectively. Results are highly sensitive to durability of benefits, rising to US $165,730 if benefits end 6 months post intervention. Conclusions Results suggest that the Shape intervention is cost-effective based on established benchmarks, indicating that it can be a part of a successful strategy to address the nation’s growing obesity epidemic in low-income at-risk communities.
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Affiliation(s)
- Anirudh Krishnan
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Eric Andrew Finkelstein
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Erica Levine
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States
| | - Perry Foley
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States
| | - Sandy Askew
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States
| | - Dori Steinberg
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States
| | - Gary G Bennett
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States
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van Beurden SB, Smith JR, Lawrence NS, Abraham C, Greaves CJ. Feasibility Randomized Controlled Trial of ImpulsePal: Smartphone App-Based Weight Management Intervention to Reduce Impulsive Eating in Overweight Adults. JMIR Form Res 2019; 3:e11586. [PMID: 31038464 PMCID: PMC6658245 DOI: 10.2196/11586] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 01/03/2019] [Accepted: 01/27/2019] [Indexed: 12/19/2022] Open
Abstract
Background ImpulsePal is a theory-driven (dual-process), evidence-informed, and person-centered smartphone app intervention designed to help people manage impulsive processes that prompt unhealthy eating to facilitate dietary change and weight loss. Objective The aims of this study were to (1) assess the feasibility of trial procedures for evaluation of the ImpulsePal intervention, (2) estimate standard deviations of outcomes, and (3) assess usability of, and satisfaction with, ImpulsePal. Methods We conducted an individually randomized parallel two-arm nonblinded feasibility trial. The eligibility criteria included being aged ≥16 years, having a body mass index of ≥25 kg/m2, and having access to an Android-based device. Weight was measured (as the proposed primary outcome for a full-scale trial) at baseline, 1 month, and 3 months of follow-up. Participants were randomized in a 2:1 allocation ratio to the ImpulsePal intervention or a waiting list control group. A nested action-research study allowed for data-driven refinement of the intervention across 2 cycles of feedback. Results We screened 179 participants for eligibility, and 58 were randomized to the intervention group and 30 to the control group. Data were available for 74 (84%, 74/88) participants at 1 month and 67 (76%, 67/88) participants at 3 months. The intervention group (n=43) lost 1.03 kg (95% CI 0.33 to 1.74) more than controls (n=26) at 1 month and 1.01 kg (95% CI −0.45 to 2.47) more than controls (n=43 and n=24, respectively) at 3 months. Feedback suggested changes to intervention design were required to (1) improve receipt and understanding of instructions and (2) facilitate further engagement with the app and its strategies. Conclusions The evaluation methods and delivery of the ImpulsePal app intervention are feasible, and the trial procedures, measures, and intervention are acceptable and satisfactory to the participants. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 14886370; http://www.isrctn.com/ISRCTN14886370 (Archived by WebCite at http://www.webcitation.org/76WcEpZ51)
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Affiliation(s)
| | - Jane R Smith
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | | | - Charles Abraham
- School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Colin J Greaves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
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Maher M, Rafey MF, Griffin H, Cunningham K, Finucane FM. Utilising a milk-based meal replacement programme in a bariatric patient with poorly controlled type 2 diabetes mellitus. Endocrinol Diabetes Metab Case Rep 2019; 2019:EDM190008. [PMID: 30959473 PMCID: PMC6454224 DOI: 10.1530/edm-19-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 03/18/2019] [Indexed: 11/08/2022] Open
Abstract
A 45-year-old man with poorly controlled type 2 diabetes (T2DM) (HbA1c 87 mmol/mol) despite 100 units of insulin per day and severe obesity (BMI 40.2 kg/m2) was referred for bariatric intervention. He declined bariatric surgery or GLP1 agonist therapy. Initially, his glycaemic control improved with dietary modification and better adherence to insulin therapy, but he gained weight. We started a low-energy liquid diet, with 2.2 L of semi-skimmed milk (equivalent to 1012 kcal) per day for 8 weeks (along with micronutrient, salt and fibre supplementation) followed by 16 weeks of phased reintroduction of a normal diet. His insulin was stopped within a week of starting this programme, and over 6 months, he lost 20.6 kg and his HbA1c normalised. However, 1 year later, despite further weight loss, his HbA1c deteriorated dramatically, requiring introduction of linagliptin and canagliflozin, with good response. Five years after initial presentation, his BMI remains elevated but improved at 35.5 kg/m2 and his glycaemic control is excellent with a HbA1c of 50 mmol/mol and he is off insulin therapy. Whether semi-skimmed milk is a safe, effective substrate for carefully selected patients with severe obesity complicated by T2DM remains to be determined. Such patients would need frequent monitoring by an experienced multidisciplinary team. Learning points: Meal replacement programmes are an emerging therapeutic strategy to allow severely obese type 2 diabetes patients to achieve clinically impactful weight loss. Using semi-skimmed milk as a meal replacement substrate might be less costly than commercially available programmes, but is likely to require intensive multidisciplinary bariatric clinical follow-up. For severely obese adults with poor diabetes control who decline bariatric surgery or GLP1 agonist therapy, a milk-based meal replacement programme may be an option. Milk-based meal replacement in patients with insulin requiring type 2 diabetes causes rapid and profound reductions in insulin requirements, so rigorous monitoring of glucose levels by patients and their clinicians is necessary. In carefully selected and adequately monitored patients, the response to oral antidiabetic medications may help to differentiate between absolute and relative insulin deficiency.
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Affiliation(s)
- Michelle Maher
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
| | - Mohammed Faraz Rafey
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
- HRB Clinical Research Facility, National University of Ireland Galway, Galway, Ireland
| | - Helena Griffin
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
| | - Katie Cunningham
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
| | - Francis M Finucane
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
- HRB Clinical Research Facility, National University of Ireland Galway, Galway, Ireland
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Finkelstein EA, Verghese NR. Incremental cost-effectiveness of evidence-based non-surgical weight loss strategies. Clin Obes 2019; 9:e12294. [PMID: 30677252 DOI: 10.1111/cob.12294] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/13/2018] [Accepted: 12/19/2018] [Indexed: 11/29/2022]
Abstract
Recent medical advancements have led to new modes of treatment for non-surgical weight loss, including several new medications. Our aim was to conduct an incremental cost-effectiveness analysis for all commercially available, evidence-based non-surgical weight loss interventions for people with excess weight. We identified interventions through a systematic review of randomized controlled trials that reported weight loss 12 months from baseline. We then meta-analysed the results, sourced costs and performed an incremental cost-effectiveness analysis from the payer perspective. Cost-effectiveness was presented in terms of cost per kilogram lost and quality-adjusted life years (QALY) gained. We further performed sensitivity analyses on costs and duration of benefits, and a probabilistic sensitivity analysis. Ten interventions were identified for inclusion: six pharmaceutical products (Alli, Xenical, Qsymia, Contrave, Belviq and Saxenda), two lifestyle modification programmes (Weight Watchers Meetings and Online), one food replacement and lifestyle programme (Jenny Craig) and one intragastric balloon system (Orbera). At an incremental cost-effectiveness ratio of $30 071 per additional QALY gained, only Weight Watchers Meetings was cost-effective. Sensitivity analyses revealed that for the medications to become incrementally cost-effective, costs would have to decrease by as much as 91%. Results are highly dependent on duration that benefits are maintained. Despite several newly available interventions, Weight Watchers Meetings is currently the only evidence-based, commercially available, cost-effective option for non-surgical weight loss. Other interventions, specifically medications, are more effective but priced too high to be cost-effective.
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Affiliation(s)
- Eric A Finkelstein
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Global Health Institute, Duke University, Durham, North Carolina
| | - Naina R Verghese
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
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Johnson A, Maiberger M, Donegan S, Kaplan NC, Kinner P. Cost Effectiveness of Two Lifestyle Interventions in the Vermont WISEWOMAN Program. Prev Chronic Dis 2019; 16:E31. [PMID: 30900547 PMCID: PMC6477874 DOI: 10.5888/pcd16.180417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Introduction Low-income women are disproportionately overweight or obese. The Vermont WISEWOMAN (Well Integrated Screening and Evaluation for Women Across the Nation) program, which serves Vermont women whose annual income is less than 250% of the federal poverty level, pays for members to attend 1 of 2 different evidence-based weight loss programs, Weight Watchers or Curves Complete. Purpose and Objectives We evaluated cost effectiveness of the weight-loss programs, conducted from April 2014 through March 2016, to determine which represented the best investment of WISEWOMAN program funds. Intervention Approach Vermont WISEWOMAN members who were overweight or obese during screening and who identified weight loss as a goal were invited to participate in 1 of the 2 programs on the basis of their place of residence and local Weight Watchers or Curves Complete contractual agreements with the Vermont WISEWOMAN program. Evaluation Methods Program costs and benefits were collected for a 2-year period and used to calculate the cost per participant who completed the program and the cost per participant who achieved the weight reduction goal of a 5% or more loss in body weight. Results The cost per participant achieving the weight reduction goal with Curves Complete ($8,613) was approximately 5 times the cost for Weight Watchers ($1,610). Implications for Public Health Weight Watchers, the evidence-based program with the simplest administrative structure, was significantly more cost effective than Curves Complete. Results suggest that overweight or obese low-income women aged 30 to 64 can lose 5% or more of their body weight more cost effectively through Weight Watchers than through Curves Complete.
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Affiliation(s)
- Ali Johnson
- Vermont Department of Health, 108 Cherry St, Burlington, VT 05401.
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Bright D, O'Hare K, Beesley R, Tapp H. Tipping the scales: Provider perspectives on a multi-disciplinary approach to obesity. Exp Biol Med (Maywood) 2019; 244:183-192. [PMID: 30661395 DOI: 10.1177/1535370219825639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPACT STATEMENT Obesity is a major multi-faceted, chronic disease that increases the risk of morbidity and mortality of children and adults particularly impacting high-risk populations and those of lower socioeconomic status. Given provider time constraints, models of care to effectively and efficiently address obesity in primary care are key. Although physician recommendations can exert a powerful influence on behavior, providers often feel powerless to adequately address obesity due to the complexity of physical and behavioral health problems. This mini-review focuses on describing the feasibility and evidence for tackling obesity through provider-led multidisciplinary weight management programs.
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Affiliation(s)
- Dellyse Bright
- Department of Family Medicine, Atrium Health, Charlotte, NC 28207, USA
| | - Katherine O'Hare
- Department of Family Medicine, Atrium Health, Charlotte, NC 28207, USA
| | - Rebecca Beesley
- Department of Family Medicine, Atrium Health, Charlotte, NC 28207, USA
| | - Hazel Tapp
- Department of Family Medicine, Atrium Health, Charlotte, NC 28207, USA
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Avenell A, Robertson C, Skea Z, Jacobsen E, Boyers D, Cooper D, Aceves-Martins M, Retat L, Fraser C, Aveyard P, Stewart F, MacLennan G, Webber L, Corbould E, Xu B, Jaccard A, Boyle B, Duncan E, Shimonovich M, Bruin MD. Bariatric surgery, lifestyle interventions and orlistat for severe obesity: the REBALANCE mixed-methods systematic review and economic evaluation. Health Technol Assess 2018; 22:1-246. [PMID: 30511918 PMCID: PMC6296173 DOI: 10.3310/hta22680] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Adults with severe obesity [body mass index (BMI) of ≥ 35 kg/m2] have an increased risk of comorbidities and psychological, social and economic consequences. OBJECTIVES Systematically review bariatric surgery, weight-management programmes (WMPs) and orlistat pharmacotherapy for adults with severe obesity, and evaluate the feasibility, acceptability, clinical effectiveness and cost-effectiveness of treatment. DATA SOURCES Electronic databases including MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials and the NHS Economic Evaluation Database were searched (last searched in May 2017). REVIEW METHODS Four systematic reviews evaluated clinical effectiveness, cost-effectiveness and qualitative evidence for adults with a BMI of ≥ 35 kg/m2. Data from meta-analyses populated a microsimulation model predicting costs, outcomes and cost-effectiveness of Roux-en-Y gastric bypass (RYGB) surgery and the most effective lifestyle WMPs over a 30-year time horizon from a NHS perspective, compared with current UK population obesity trends. Interventions were cost-effective if the additional cost of achieving a quality-adjusted life-year is < £20,000-30,000. RESULTS A total of 131 randomised controlled trials (RCTs), 26 UK studies, 33 qualitative studies and 46 cost-effectiveness studies were included. From RCTs, RYGB produced the greatest long-term weight change [-20.23 kg, 95% confidence interval (CI) -23.75 to -16.71 kg, at 60 months]. WMPs with very low-calorie diets (VLCDs) produced the greatest weight loss at 12 months compared with no WMPs. Adding a VLCD to a WMP gave an additional mean weight change of -4.41 kg (95% CI -5.93 to -2.88 kg) at 12 months. The intensive Look AHEAD WMP produced mean long-term weight loss of 6% in people with type 2 diabetes mellitus (at a median of 9.6 years). The microsimulation model found that WMPs were generally cost-effective compared with population obesity trends. Long-term WMP weight regain was very uncertain, apart from Look AHEAD. The addition of a VLCD to a WMP was not cost-effective compared with a WMP alone. RYGB was cost-effective compared with no surgery and WMPs, but the model did not replicate long-term cost savings found in previous studies. Qualitative data suggested that participants could be attracted to take part in WMPs through endorsement by their health-care provider or through perceiving innovative activities, with WMPs being delivered to groups. Features improving long-term weight loss included having group support, additional behavioural support, a physical activity programme to attend, a prescribed calorie diet or a calorie deficit. LIMITATIONS Reviewed studies often lacked generalisability to UK settings in terms of participants and resources for implementation, and usually lacked long-term follow-up (particularly for complications for surgery), leading to unrealistic weight regain assumptions. The views of potential and actual users of services were rarely reported to contribute to service design. This study may have failed to identify unpublished UK evaluations. Dual, blinded numerical data extraction was not undertaken. CONCLUSIONS Roux-en-Y gastric bypass was costly to deliver, but it was the most cost-effective intervention. Adding a VLCD to a WMP was not cost-effective compared with a WMP alone. Most WMPs were cost-effective compared with current population obesity trends. FUTURE WORK Improved reporting of WMPs is needed to allow replication, translation and further research. Qualitative research is needed with adults who are potential users of, or who fail to engage with or drop out from, WMPs. RCTs and economic evaluations in UK settings (e.g. Tier 3, commercial programmes or primary care) should evaluate VLCDs with long-term follow-up (≥ 5 years). Decision models should incorporate relevant costs, disease states and evidence-based weight regain assumptions. STUDY REGISTRATION This study is registered as PROSPERO CRD42016040190. FUNDING The National Institute for Health Research Health Technology Assessment programme. The Health Services Research Unit and Health Economics Research Unit are core funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorate.
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Affiliation(s)
- Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Clare Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Zoë Skea
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Elisabet Jacobsen
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Dwayne Boyers
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - David Cooper
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | | | - Cynthia Fraser
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Fiona Stewart
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | | | | | | | - Bonnie Boyle
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Eilidh Duncan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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McKnight T, Demuth JR, Wilson N, Leider JP, Knudson A. Assessing Effectiveness and Cost-Benefit of the Trinity Hospital Twin City Fit For Life Program for Weight Loss and Diabetes Prevention in a Rural Midwestern Town. Prev Chronic Dis 2018; 15:E98. [PMID: 30073949 PMCID: PMC6093267 DOI: 10.5888/pcd15.170479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction Obesity is a top public health priority in the United States. This article reports on the Fit For Life (FFL) health education program designed to address the determinants of obesity in rural settings and help participants lose weight. Purpose and Objectives We evaluated the implementation of the original FFL program, a replication program, and a diabetes-focused program. Intervention Approach The original FFL program (2006 to 2012) was a 12-week session of classes meeting once weekly. Lecture topics included stress management, nutrition, healthy eating, reading food labels, fitness, disease prevention, and healthy aging. The replication program, conducted in 4 locations from 2012 to 2015, helped determine if the FFL program could be implemented on a larger scale, with outcomes similar to the original program. The longer, more-intensive FFL diabetes prevention program, conducted in 2016 and 2017, sought to reduce the number of rural adults at risk for diabetes. Evaluation Methods We evaluated FFL participation and outcome data from 2009 through first quarter 2017. We calculated rates of course participation and completion and measured changes in several health indicators. We constructed a linear regression model to examine the impact of health behaviors on weight loss and calculated program cost-effectiveness. Results From 2009 to 2017, FFL was delivered to over 1,200 people; 82% of participants completed the program. Completing participants lost an average of 2.7 kg or 3% of their total weight. Overall, 68% of participants said they exercised more per week at the end of the program than at the beginning. Estimated cost per kilogram lost for replication sites was between $73 and $101 for original FFL, in line with other programs. The more resource-intensive diabetes prevention program cost per kilogram lost was $151 to $171. Implications for Public Health Practice Weight loss and lifestyle management are major ways to counteract obesity. Improving program options, especially in rural locales, should be a key policy priority. These programs should be considered for population-based expansion, perhaps by health departments or public–private health care consortiums.
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Affiliation(s)
| | | | - Natalie Wilson
- Ohio University, Voinovich School of Leadership and Public Affairs, Athens, Ohio
| | - Jonathon P Leider
- Johns Hopkins University Bloomberg School of Public Health, Health Policy and Management, 615 N Wolfe St, Baltimore, MD 21205.
| | - Alana Knudson
- National Opinion Research Center, Public Health, Chicago, Illinois
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Bardus M, Hamadeh G, Hayek B, Al Kherfan R. A Self-Directed Mobile Intervention (WaznApp) to Promote Weight Control Among Employees at a Lebanese University: Protocol for a Feasibility Pilot Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e133. [PMID: 29769174 PMCID: PMC5981057 DOI: 10.2196/resprot.9793] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 03/18/2018] [Accepted: 03/31/2018] [Indexed: 01/04/2023] Open
Abstract
Background Overweight and obesity have become major health problems globally with more than 1.9 billion overweight adults. In Lebanon, the prevalence of obesity and overweight is 65.4% combined. Risk factors of obesity and overweight are preventable and can be addressed by modifications in the environment and in an individual’s lifestyle. Mobile technologies are increasingly used in behavioral, self-directed weight management interventions, providing users with additional opportunities to attain weight control (weight loss, weight gain prevention, etc). Mobile apps may allow for the delivery of Just-in-Time Adaptive Interventions (JITAIs), which provide support through skill building, emotional support, and instrumental support, following the participants’ progress. A few commercially available apps offer JITAI features, but no studies have tested their efficacy. Objective The primary objective of this study is to examine the feasibility of a self-directed weight loss intervention, targeting employees of an academic institution, using a virtual coaching app with JITAI features (Lark) and a self-help calorie-counting app (MyFitnessPal). The secondary objective is to estimate the effects of the intervention on main study outcomes. Methods This study is a single-center, parallel, randomized controlled trial with 2 study arms (intervention and control). Participants will be randomly allocated in equal proportions to the intervention (Lark) and control groups (MyFitnessPal). To be eligible for this study, participants must be employed full- or part-time at the university or its medical center, able to read English, have a smartphone, and be interested in controlling their weight. Recruitment strategies entail email invitations, printed posters, and social media postings. We will assess quantitative rates of recruitment, adherence, and retention, self-reported app quality using the user version of the Mobile App Rating Scale. We will also assess changes in weight-related outcomes (absolute weight and waist circumference), behavioral outcomes (physical activity and diet), and cognitive factors (motivation to participate in the trial and to manage weight). Results WaznApp was funded in June 2017, and recruitment started in March 2018. Conclusions This study will provide information as to whether the selected mobile apps offer a feasible solution for promoting weight management in an academic workplace. The results will inform a larger trial whose results might be replicated in similar workplaces in Lebanon and the Middle East and North Africa region, and will be used as a benchmark for further investigations in other settings and similar target groups. Trial Registration ClinicalTrials.gov NCT03321331; https://clinicaltrials.gov/ct2/show/NCT03321331 (Archived by WebCite at http://www.webcitation.org/6ys9NOLo5) Registered Report Identifier RR1-10.2196/9793
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Affiliation(s)
- Marco Bardus
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Ghassan Hamadeh
- Department of Family Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Bouchra Hayek
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Rawan Al Kherfan
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Little P, Stuart B, Hobbs FR, Kelly J, Smith ER, Bradbury KJ, Hughes S, Smith PW, Moore MV, Lean ME, Margetts BM, Byrne CD, Griffin S, Davoudianfar M, Hooper J, Yao G, Zhu S, Raftery J, Yardley L. Randomised controlled trial and economic analysis of an internet-based weight management programme: POWeR+ (Positive Online Weight Reduction). Health Technol Assess 2018; 21:1-62. [PMID: 28122658 DOI: 10.3310/hta21040] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Behavioural counselling with intensive follow-up for obesity is effective, but in resource-constrained primary care settings briefer approaches are needed. OBJECTIVES To estimate the clinical effectiveness and cost-effectiveness of an internet-based behavioural intervention with regular face-to-face or remote support in primary care, compared with brief advice. DESIGN Individually randomised three-arm parallel trial with health economic evaluation and nested qualitative interviews. SETTING Primary care general practices in the UK. PARTICIPANTS Patients with a body mass index of ≥ 30 kg/m2 (or ≥ 28 kg/m2 with risk factors) identified from general practice records, recruited by postal invitation. INTERVENTIONS Positive Online Weight Reduction (POWeR+) is a 24-session, web-based weight management intervention completed over 6 months. Following online registration, the website randomly allocated participants using computer-generated random numbers to (1) the control intervention (n = 279), which had previously been demonstrated to be clinically effective (brief web-based information that minimised pressure to cut down foods, instead encouraging swaps to healthier choices and increasing fruit and vegetables, plus 6-monthly nurse weighing); (2) POWeR+F (n = 269), POWeR+ supplemented by face-to-face nurse support (up to seven contacts); or (3) POWeR+R (n = 270), POWeR+ supplemented by remote nurse support (up to five e-mails or brief telephone calls). MAIN OUTCOME MEASURES The primary outcome was a modelled estimate of average weight reduction over 12 months, assessed blind to group where possible, using multiple imputation for missing data. The secondary outcome was the number of participants maintaining a 5% weight reduction at 12 months. RESULTS A total of 818 eligible individuals were randomised using computer-generated random numbers. Weight change, averaged over 12 months, was documented in 666 out of 818 participants (81%; control, n = 227; POWeR+F, n = 221; POWeR+R, n = 218). The control group maintained nearly 3 kg of weight loss per person (mean weight per person: baseline, 104.4 kg; 6 months, 101.9 kg; 12 months, 101.7 kg). Compared with the control group, the estimated additional weight reduction with POWeR+F was 1.5 kg [95% confidence interval (CI) 0.6 to 2.4 kg; p = 0.001] and with POWeR+R was 1.3 kg (95% CI 0.34 to 2.2 kg; p = 0.007). By 12 months the mean weight loss was not statistically significantly different between groups, but 20.8% of control participants, 29.2% of POWeR+F participants (risk ratio 1.56, 95% CI 0.96 to 2.51; p = 0.070) and 32.4% of POWeR+R participants (risk ratio 1.82, 95% CI 1.31 to 2.74; p = 0.004) maintained a clinically significant 5% weight reduction. The POWeR+R group had fewer individuals who reported doing another activity to help lose weight [control, 47.1% (64/136); POWeR+F, 37.2% (51/137); POWeR+R, 26.7% (40/150)]. The incremental cost to the health service per kilogram weight lost, compared with the control group, was £18 (95% CI -£129 to £195) for POWeR+F and -£25 (95% CI -£268 to £157) for POWeR+R. The probability of being cost-effective at a threshold of £100 per kilogram was 88% and 98% for POWeR+F and POWeR+R, respectively. POWeR+R was dominant compared with the control group. No harms were reported and participants using POWeR+ felt more enabled in managing their weight. The qualitative studies documented that POWeR+ was viewed positively by patients and that health-care professionals generally enjoyed supporting patients using POWeR+. STUDY LIMITATIONS Maintenance of weight loss after 1 year is unknown. FUTURE WORK Identifying strategies for longer-term engagement, impact in community settings and increasing physical activity. CONCLUSION Clinically valuable weight loss (> 5%) is maintained in 20% of individuals using novel written materials with brief follow-up. A web-based behavioural programme and brief support results in greater mean weight loss and 10% more participants maintain valuable weight loss; it achieves greater enablement and fewer participants undertaking other weight-loss activities; and it is likely to be cost-effective. TRIAL REGISTRATION Current Controlled Trials ISRCTN21244703. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 4. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Paul Little
- Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Beth Stuart
- Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Fd Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jo Kelly
- Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Emily R Smith
- Centre for Applications of Health Psychology (CAHP), Faculty of Social and Human Sciences, University of Southampton, Southampton, UK
| | - Katherine J Bradbury
- Centre for Applications of Health Psychology (CAHP), Faculty of Social and Human Sciences, University of Southampton, Southampton, UK
| | - Stephanie Hughes
- Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Peter Wf Smith
- Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, UK
| | - Michael V Moore
- Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Mike Ej Lean
- Human Nutrition, School of Medicine, University of Glasgow, Glasgow, UK
| | - Barrie M Margetts
- Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Christopher D Byrne
- National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Simon Griffin
- Medical Research Council (MRC) Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
| | - Mina Davoudianfar
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Julie Hooper
- Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Guiqing Yao
- Health Economic Analyses Team (HEAT), Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | - Shihua Zhu
- Health Economic Analyses Team (HEAT), Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | - James Raftery
- Health Economic Analyses Team (HEAT), Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | - Lucy Yardley
- Centre for Applications of Health Psychology (CAHP), Faculty of Social and Human Sciences, University of Southampton, Southampton, UK
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An Economic Evaluation of a Weight Loss Intervention Program for People with Serious Mental Illnesses Taking Antipsychotic Medications. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 43:604-15. [PMID: 26149243 DOI: 10.1007/s10488-015-0669-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Individuals with serious mental illnesses suffer from obesity and cardiometabolic diseases at high rates, and antipsychotic medications exacerbate these conditions. While studies have shown weight loss and lifestyle interventions can be effective in this population, few have assessed intervention cost-effectiveness. We present results from a 12-month randomized controlled trial that reduced weight, fasting glucose, and medical hospitalizations in intervention participants. Costs per participant ranged from $4365 to $5687. Costs to reduce weight by one kilogram ranged from $1623 to $2114; costs to reduce fasting glucose by 1 mg/dL ranged from $467 to $608. Medical hospitalization costs were reduced by $137,500.
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50
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Hoang TT, Agopian A, Mitchell LE. Maternal Use of Weight Loss Products and the Risk of Neural Tube Defects in Offspring: A Systematic Literature Review. Birth Defects Res 2017; 110:48-55. [DOI: 10.1002/bdr2.1116] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 07/19/2017] [Accepted: 08/01/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Thanh T. Hoang
- UTHealth School of Public Health, Department of Epidemiology; Human Genetics, and Environmental Sciences; Houston Texas
| | - A.J. Agopian
- UTHealth School of Public Health, Department of Epidemiology; Human Genetics, and Environmental Sciences; Houston Texas
| | - Laura E. Mitchell
- UTHealth School of Public Health, Department of Epidemiology; Human Genetics, and Environmental Sciences; Houston Texas
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