Treating Obesity Like A Chronic Disease Leads To Better Weight-Loss MaintenanceWednesday, March 30, 2016
The nature of chronic diseases is that they are (by definition) rarely (if ever) “cured”, meaning that the best you can generally hope for is “control”, which in some cases may only amount to “stabilisation” or “slowing of progression”.
In the context of obesity, one could perhaps define “control” as achievement AND maintenance of your “best weight”; “stabilisation” could be defined as prevention of further weight gain; “slowing of progression” would be defined as continuing to gain weight but at a slower rate than before.
Now, a paper by Janelle Coughlin and colleagues published in OBESITY, shows (surprise, surprise!) that continued intervention involving personal contact leads to better weight-loss maintenance (at five years) than time-limited self-directed management.
The paper describes the results of the the Weight Loss Maintenance (WLM) Trial, in which participants were essentially randomised to either a personal contact (PC) intervention or a self-directed (SD) group over 30 months with continued follow-up for another 30 months (for a total of 5 years).
Overall, the WLM had 3 phases. Phase 1 was a 6-month weight loss program. In Phase 2, those who lost ≥4 kg were randomized to a 30-month maintenance trial. In Phase 3, PC participants (n = 196, three sites) were re-randomized to no further intervention (PC-Control) or continued intervention (PC-Active) for 30 more months; 218 SD participants were also followed.
In the study overall at 5 years, mean weight change was −3.2 kg in those originally assigned to PC (PC-Combined) and −1.6 kg in SD (this rather modest amount of weight loss maintenance is unfortunately typical for all behavioural weight-management interventions, highlighting the ongoing need for better treatments!).
None of this is surprising.
As with any chronic disease, personal contact interventions by a trained health professional are likely to be superior to patients trying to manage on their own (self-directed).
At some point (the time may well be 30 months), continued regular intervention for everyone will likely provide diminishing returns.
This is evident from the finding in this study that in the PC group, continued intervention after 30 months did not appear to provide a significant additional benefit in terms of weight-loss maintenance.
In fact, one would probably want to vary frequency and intensity of any further intervention for patients who are relapsing (i.e. regaining their weight faster than expected).
This is not unlike patients in a diabetes or hypertension clinic. After an initial phase of a more intense intervention during which patients are titrated to a target blood pressure or HbA1c level, frequency of on-going follow-up should naturally be tailored to how well the patient in managing.
Some individuals will need more attention more often than others – this need will also be expected to vary over time for individual patients.
For many patients with chronic diseases, proper education and development of self-management skills (such as regular self-monitoring of blood pressure or blood sugar levels), may often allow on-going support to be limited to brief encounters largely involving brief assessments and prescription renewals.
As I have said before, long-term management of obesity is no different than managing any other chronic disease.
Tailoring the intensity and rate of follow-up to each patient’s specific needs should be no different in obesity management than in managing someone’s hypertension or diabetes.