Electronically captured, patient-reported physical function: an important vital sign in obesity medicine

OBJECTIVES

Impaired physical function (i.e., inability to walk 200 feet, climb a flight of stairs or perform activities of daily living) predicts poor clinical outcomes and adversely impacts medical and surgical weight management. However, routine assessment physical function is seldom performed clinically. The PROMIS Physical Function Short Form 20a (SF-20a) is a validated questionnaire for assessing patient reported physical function, which includes published T-score percentiles adjusted for gender, age and education. However, the effect that increasing levels of obesity has on these percentiles is unclear. We hypothesized that physical function would decline with increasing level of obesity independent of gender, age, education and comorbidity.

MATERIALS AND METHODS

This study included 1,627 consecutive weight management patients [(mean ± SEM), 44.7 ± 0.3 years and 45.1 ± 0.2 kg/m2] that completed the PROMIS SF-20a during their initial consultation. We evaluated the association between obesity level and PROMIS T-score percentiles using multiple linear regression adjusting for gender, age, education and Charlson Comorbidity Index (CCI).

RESULTS

Multiple linear regression T-score percentiles were lower in obesity class 2 (-12.4%tile, p < 0.0001), class 3 (-17.0%tile, p < 0.0001) and super obesity (-25.1%tile, p < 0.0001) compared to class 1 obesity.

CONCLUSION

In patients referred for weight management, patient reported physical function was progressively lower in a dose-dependent fashion with increasing levels of obesity, independent of gender, age, education and CCI.

Initial weight loss goals: have they changed and do they matter?

Objective

Nearly 20 years ago, participants in behavioural weight loss programmes reported goals that greatly exceeded the amount of weight typically produced by these programmes. Whether having unrealistic weight loss goals impacts weight loss or attrition is unclear. The intent of the current study was to revisit current weight loss goals and examine whether goals impact outcomes.

Methods

Adults (N = 308, BMI = 33.7 ± 4.2 kg/m²) participated in a 12‐month behavioural weight management programme and completed questionnaires about their goals.

Results

Participants' weight loss goal was 19.8 ± 7.9% of their body weight, and 90.4% selected a goal ≥10%. Weight goals were not associated with weight loss at 3 (p = 0.75) or 12 months (p = 0.47), or from 3 to 12 months (p = 0.55). Weight loss goals were not related to attrition at 3 (p = 0.91) or 12 months (p = 0.86). Participants believed that weight reduction would positively impact their health and psychosocial functioning.

Conclusion

Weight loss goals have decreased, but still greatly exceed what can be expected by most. Unrealistic goals, however, had no impact on weight loss or attrition. These results question the utility of counseling people with obesity to set more realistic weight loss goals, which is typically practiced in behavioural weight management.

18-month outcomes of a community-based treatment for childhood obesity

BACKGROUND

Few studies have evaluated community-based interventions for childhood obesity and even fewer provide efficacy data 1 year later.

OBJECTIVES

This study assessed changes in relative weight 1 year after a 6-month treatment for childhood obesity.

METHODS

Participants were 155 overweight/obese children/adolescents and their caregivers. The primary outcome was change in child percent over body mass index (BMI) from 6 to 18 months. The primary outcome was also assessed from 0 to 18 months and changes in secondary outcomes (BMI z-score, guardian weight, health-related quality of life [HRQoL]) were examined from 6-18 to 0-18 months.

RESULTS

From 6 to 18 months, there were no significant changes in any outcome. From 0 to 18 months, there were improvements in BMI z-score (P < 0.001), HRQoL (P < 0.001) and guardian weight (P = 0.02).

CONCLUSIONS

Changes in relative weight and HRQoL observed after 6 months persisted 1 year later. The programme produced reductions in BMI z-score and obesity prevalence but not in percent over BMI from 0 to 18 months.