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Weight Loss for Sleep Apnea

Obstructive sleep apnea (OSA) is one of the most common respiratory problems in overweight and obese individuals. The poor quality of life, daytime somnolence, fatigue, memory loss, and increased risk for metabolic and cardiac complications makes OSA a significant health problem. Habitual snoring, witnessed apneas, or excessive daytime sleepiness should always prompt further investigation for OSA in anyone with overweight or obesity. While more severe forms of OSA often require continuous positive airway pressure ventilation, milder forms may be amenable to even modest weight loss (higher degrees of weight loss resulting from bariatric surgery virtually cure OSA). The effect of dietary weight loss was now for the first time tested in a randomized controlled trial in a new study just out in the American Journal of Respiratory and Critical Care Medicine. In this study, Henri Tuomilehto and colleagues from the University of Kuopio, Finland, randomized 72 consecutive overweight patients (BMI 28-40) with mild OSA to a very low calorie diet (VLCD=600-800 KCal for 12 weeks) with supervised lifestyle counseling vs. routine lifestyle counseling (general oral and written information about diet and exercise). While the VLCD group lost about 10% of their initial weight, the control group lost around 3%. The VLCD intervention resulted in a 75% reduced risk for OSA at the end of the year-long study. OSA was objectively cured in 63% of patients in the intervention group, but only 35% of patients in the control group. As expected, improvements in the apnea-hypopnea index (AHI) were strongly associated with changes in weight and waist circumference. This study demonstrates that weight loss induced by a hypocaloric diet together with lifestyle counseling is feasible and effective in reducing symptoms in in the majority of subjects with mild OSA and that these outcomes are maintained at 1-year follow-up. Indeed, these findings are very similar to the previous report of marked improvements in OSA in patients achieving an approximately 10% weight loss with sibutramine and lifestyle intervention published by Brendon Yee and colleagues from the University of Sydney in the International Journal of Obesity (2007). Overall it appears that even a moderate 5-10% weight loss can lead to remarkable improvements in OSA – certainly an intervention worth considering prior to investing in an expensive CPAP machine.  AMS Edmonton, Alberta

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Urgent Weight Loss

Obesity is a chronic disease and needs long-term treatment. Weight gain doesn’t happen overnight and obesity treatment is not about how much and how fast you can lose it. Yet, there are situations where rapid and substantial weight loss may be indicated. For example, patients with severe obesity who require urgent diagnostic procedures; patients with severe obesity needing elective surgery; patients with life-threathening medical issues made intractable by obesity; obese patient following acute illness, where recovery and rehabilitation is hampered by excess weight. All of these situations may warrant “urgent” weight loss. The aim is not so much to provide long-term weight management – the aim is to acutely reduce weight to solve an immediate problem and get out of a tough spot. In these situations, and only these, radical weight loss measures may be in order. This is where methods aimed at safe short-term weight loss are indicated. This is where treatments such as very low calorie diets, that may have limited efficacy in producing sustained weight loss, but can provide safe and immediate weight loss, can be helpful. There is a wealth of literature supporting the safety and weight-loss efficacy of low calorie diets such as Optifast. While hardly sustainable in the long term, total meal replacements can provide a rapid and relatively safe strategy to substantially reduce body weight in the short term. I have no doubt that the majority of patient will probably rapidly regain much of the weight lost, unless transitioned into a more sustainable form of obesity treatment – however, in the short term, this approach may help solve an otherwise intractable problem. There are few published studies, let alone randomised trials on this concept. However, I have little doubt that given the dramatic increase in the number of severely obese patients in the health system, this approach will in clinical practice prove a rational and tangible path out of otherwise difficult situations. AMS

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