Clin Obes
DOI: 10.1111/cob.12337
Physical capacity outcomes in patients with severe obesity after 12 months of physician‐led multidisciplinary team care: A case series from a public hospital clinical obesity service
Evan Atlantis
Kiri Langford
Milan K. Piya
Abstract: Summary Impaired physical capacity is common in people with severe levels of obesity. We aimed to investigate changes in physical capacity outcomes in patients with severe obesity following 12 months of physician‐led multidisciplinary care from a "real world" Australian public hospital setting using a case series study design. We extracted data from medical records for all of the eligible patients referred to our clinical obesity service from 2010 to 2015 (69 of 239). We found significant (P < .05) pre‐test/po… Show more
Search citation statements
Paper Sections
Methods 3
Citation Types
Contrasting
Self Cite 4
Export report
Cited by 10 publications
(104 citation statements)
References 41 publications
(104 reference statements)
"…All patients enrolled were over 18 years of age with a BMI ≥40 kg/m 2 and at least one weight-related medical comorbidity, the most common being T2DM or nonalcoholic fatty liver disease (NAFLD). The components of the metabolic clinic have been previously described in detail by Atlantis et al [26] . In brief, the program offers a multidisciplinary approach involving endocrinologists, a gastroenterologist, dietitian, a psychiatrist, psychologists, physiotherapists and a specialist nurse.…"
Section: Methodsmentioning
confidence: 99%
"…Patients with T2DM who performed at least moderate levels of physical activity have been shown to have reduced all-cause mortality compared to those who performed no or mild levels of physical activity [24, 25] . Physical capacity outcomes have been shown to improve in patients with class 3 obesity enrolled in our multidisciplinary program that included supervised exercise [26] . However, patients with class 3 obesity appear to face more barriers to physical exercise than patients without class 3 obesity, and patients may decline participation in supervised exercise programs [27] .…"
Section: Introductionmentioning
See 1 more Smart Citation
Class 3 Obesity in a Multidisciplinary Metabolic Weight Management Program: The Effect of Preexisting Type 2 Diabetes on 6-Month Weight Loss
Medveczky
Kodsi2,
Skelsey3
Journal of Diabetes Research
Self Cite
Introduction. Class 3 obesity (BMI≥40 kg/m2) is a growing health problem worldwide associated with considerable comorbidity including Type 2 diabetes mellitus (T2DM). The multidisciplinary medical management of obesity can be difficult in T2DM due to potential weight gain from medications including sulphonylureas and insulin. However, newer weight-neutral/losing diabetes medications can aid additional weight loss. The aim of this study was to compare weight loss outcomes of patients with and without T2DM, and in patients with T2DM, to compare diabetes outcomes and change in medications at 6 months. Methods. All patients entering a multidisciplinary weight management metabolic program in a publicly funded hospital clinic in Sydney between March 2018 and March 2019, with BMI≥40 kg/m2 and aged ≥18 years were included. Data was collected from patient clinical and electronic notes at baseline and 6 months. Results. Of the 180 patients who entered the program, 53.3% had T2DM at baseline. There was no difference in percentage weight loss in those with or without T2DM (4.2±4.9% vs. 3.6±4.7%, p=0.35). Additionally, T2DM patients benefited from a 0.47% reduction in HbA1c (p<0.01) and a reduction in the number of medications from baseline to 6 months (1.8±1.0/patient vs. 1.0±1.2/patient, p<0.001). T2DM patients who started on weigh-neutral/losing medications in the program lost more weight than those started on weight-gaining medications (7.7±5.3% vs. 2.4±3.8%, p=0.015). Conclusions. Patients with class 3 obesity had significant weight loss at 6 months in this program. Patients with T2DM at baseline had comparable weight loss at 6 months, a significant improvement in glycaemic control, and a reduction in diabetes medication load. Additionally, patients with T2DM who were started on weight-neutral/losing medications lost significantly more weight than those started on weight-gaining medications, and these medications should be preferentially used in class 3 obesity and comorbid T2DM.
"…Disability is worse for those admitted to hospital with high EOSS than outpatients 39 and thus should be the target of early hospital interventions that focus on rehabilitation and return to function. Specialized clinical obesity services with supervised onsite exercise have been shown to be effective for improving physical capacity and function in patients with severe obesity 48 …"
Section: Discussionmentioning
Usefulness of the Edmonton Obesity Staging System for stratifying the presence and severity of weight‐related health problems in clinical and community settings: A rapid review of observational studies
Sahebolamri
Cheema
Obesity Reviews
This rapid review aimed to examine the usefulness of the Edmonton Obesity Staging System (EOSS) for stratifying the presence and severity of weight-related health problems in clinical and community settings. We searched PubMed, CINAHL and ProQuest for records from 2009 to May 2020. We considered observational studies in participants with overweight or obesity that investigated the risk of any clinical outcome associated with increasing EOSS. We reviewed and appraised 20 observational studies (cohort = 4, case series = 7, cross-sectional = 9) published between 2011 and 2020. Of 12 studies in clinical populations, the EOSS was most consistently associated with an increased risk of postoperative complications following bariatric surgery, especially for EOSS 3-4, and inversely associated with weight loss, treatment time and resolution of hypertension following bariatric surgery and clinical weight management. Of eight studies in community populations, the EOSS most consistently predicted mortality outcomes, especially for EOSS 3, and was associated with polypharmacy, service use and poorer work outcomes. Studies reported diverse EOSS definitions and outcomes, which slightly weakens the overall evidence base. The EOSS should be routinely used for predicting risks and benefits of surgical and nonsurgical weight management, but it should be applied with caution for population health planning.
"…All patients were seen by a physician, dietitian and psychologist. The weight management program has been described in detail previously [ 28 , 29 , 30 , 31 ]. Dietary advice was personalised, which included but was not limited to advice for a 500 Kcal reduced diet, partial meal replacement and/or a low-calorie diet.…"
Clinical Use of the Edmonton Obesity Staging System for the Assessment of Weight Management Outcomes in People with Class 3 Obesity
Grudzinskas
We aimed to assess weight loss and metabolic outcomes by severity of weight-related complications following an intensive non-surgical weight management program (WMP) in an Australian public hospital. A retrospective cohort study of all patients aged ≥18 years with body mass index (BMI) ≥ 40 enrolled in the WMP during March 2018–March 2019 with 12-month follow-up information were stratified using the Edmonton Obesity Staging System (EOSS). Of 178 patients enrolled in the WMP, 112 (62.9%) completed at least 12 months' treatment. Most patients (96.6%) met EOSS-2 (56.7%) or EOSS-3 (39.9%) criteria for analysis. Both groups lost significant weight from baseline to 12 months; EOSS-2: 139.4 ± 31.8 kg vs. 131.8 ± 31.8 kg (p < 0.001) and EOSS-3: 141.4 ± 24.2 kg vs. 129.8 ± 24.3 kg (p < 0.001). After adjusting for baseline age, sex and employment status, mean weight loss was similar but a greater proportion of EOSS-3 achieved >10% weight loss compared to EOSS-2, (40% vs. 15.9%, p = 0.024). Changes in metabolic parameters including HbA1c, BP and lipids did not differ between EOSS-2 and 3. Despite increased clinical severity, adult patients with class 3 obesity achieved clinically meaningful weight loss and similar improvements in metabolic parameters compared to patients with less severe complications after 12 months in an intensive non-surgical WMP.