Implementation of a Community-Based Weight Loss Program in a North Carolina Healthcare System

Current strategies for obesity management in primary care leave many patients inadequately treated. We aimed to evaluate a comprehensive primary care clinic-based weight management program’s clinical effectiveness in a community practice setting. This is an 18 month long pre-post intervention study. We collected and analyzed anthropometric data on the patients enrolled in the community-based weight loss program. All participants received targeted lifestyle counseling, and 78% received pharmacotherapy. The primary outcomes were percent weight loss post-intervention and proportion of patients who achieved a total body weight loss of 5% or greater. Our program served 550 patients over 1952 visits from March 2019 through October 2020. Patients attended an average of 3.5 visits (SD 2.7). A total of 209 patients received adequate exposure to the program (attended at least four visits) and achieved a mean total body weight loss of 5.7% (SD 5.8%, range − 22.8% − 13.7%). Of these patients, 53.1% lost > 5% of total weight. We demonstrate that a community-based weight management program delivered by obesity medicine-trained, primary care clinicians effectively produces clinically significant weight loss in a community setting. Our approach represents a promising, scalable model for expanding access to obesity treatment for the general population.

SUN-543 Real World Evidence of Successful Weight Management for the Obese Population: Complete Reversal of Obesity Related Metabolic Co-Morbidities and Weight Loss in Patients Attending a Multidisciplinary Weight Management Clinic in Australia

Over 2.5 billion people worldwide are overweight or obese. Multidisciplinary weight management interventions have evolved to address the complexity of weight loss for those with one or more chronic diseases, and the trend of weight regain. The aim of these interventions is to encourage sustainable lifestyle changes, resulting in weight loss and weight maintenance and improvements in comorbidities. While some prospective clinical trials have demonstrated efficacy, results are often not reported by real life practices. The aim of this study was to evaluate the effectiveness of a Sydney based multidisciplinary weight management clinic with endocrinology, dietetics, exercise physiology, psychology, and bariatric surgical domains. All patients who attended the clinic for weight loss purposes between March 2017 and April 2019 were included (n=220). A retrospective chart review was conducted. Patient data on weight, BMI, waist circumference, body composition measurements, and selected blood test results and co-morbidities were analysed. All patient therapy included endocrinological input for co-morbidity identification and management, lifestyle intervention (dietetic and exercise physiology input) with optional adjunct pharmacotherapy or psychological counselling. Of the 220 cohort, 20 of the patients had sleeve gastrectomy. Patient retention in the clinic after the first consultation was 85% (n=186), a high rate within the weight management community. 59% of patients achieved a minimum of 5% total body weight loss, including 18% who achieved greater than 10% total body weight loss. Additionally, 31% of patients lost enough weight to decrease their BMI class by up to 2 or more classes. Of the gastric sleeve cohort average excess body weight loss was 32kg (21-56kg) enhanced by multidisciplinary care in the lead up to surgery. Across the cohort some patients completely reversed co-morbidities; including dyslipidaemia (n=1), hypertension (n=3), NAFLD (n=1), pre-diabetes (n=8) and type 2 diabetes (n=3), OSA (n=1). These results demonstrate that obesity is a chronic condition that can be successfully managed. We have demonstrated significant durable weight loss and improvement in metabolic co-morbidities with holistic coordinated care. Future directions include translating this model of care into standard practice in Australia and other countries where obesity to date not received the same coordinated approach as other chronic conditions.

Endoscopic Sleeve Gastroplasty for Obesity – First Indian Experience: Case Series and Review of Literature

ABSTRACT Introduction: In India, obesity affects >135 million and leads to nearly 5.8 million deaths per year. Some of the unmet need in the management of obesity can be fulfilled by endoscopic therapies such as endoscopic sleeve gastroplasty (ESG). Methods: In this case series, we report our preliminary experience of ESG in three obese patients. We recorded baseline demographic data, total procedural time, adverse events, and percentage total body weight loss (%TBWL) up to 20 weeks. Results: All three patients were male with a median age of 29 years (range 26–39) with a median body mass index of 34.28 kg/m2 (range 32.60–37.13). A total of four full‑thickness and additional three submucosal sutures were applied in each patient. There were no adverse events. The median total procedural time was 105 min (range 90–150). All patients were discharged within 48 h. The median percentage total body weight loss (%TBWL) at 12 weeks was 12.02 (range 10.85–13.33) and at 16 weeks was 14.23 (range 13.84–14.62). The maximum follow‑up so far is 20 weeks (one patient) with %TBWL of 16.38. Conclusion: In our preliminary experience, we conclude that ESG is safe, effective and requires shorter hospital stay. In short‑term follow‑up, there is adequate weight loss without major adverse events.

Renal Replacement Therapy in Patients with Heart and Kidney Failure

The incidence of chronic kidney disease (CKD) in patients with chronic heart failure (CHF) is high as CKD and CHF share underlying risk factors such as arterial hypertension, diabetes mellitus and atherosclerosis. Cardiac failure leads to renal hypoperfusion and dysfunction and then fluid overload and need for aggressive diuretic therapy. However, development of diuretic resistance represents a significant problem in the management of these patients. The role of Renal Replacement Therapy (RRT) is important for patients who do not response to conservative management of fluid overload facilitating the failing heart to restore function. According to the guidelines, venovenous isolated Ultrafiltration (UF) is indicated for patients with refractory congestion not responding to medical therapy with loop diuretics and infusion of dopamine. A systematic review of randomized controlled trials on the effect of UF vs. IV furosemide for decompensated heart failure showed a benefit of UF on total body weight loss and on readmissions due to heart failure in patients with decompensated heart failure and CKD. Peritoneal dialysis (PD) can provide efficient ultrafiltration and sodium extraction in volume overloaded patients followed by decline of hospitalization days, decrease of body weight and improvement of LVEF in patients with refractory heart failure. The continuous draw of ultrafiltrate is followed by a lesser risk of abrupt hypotension and better preservation of the residual kidney function. This represents a significant advantage of PD over intermittent UF by dialysis. In conclusion, application of UF by dialysis and PD is followed by significant total body weight loss, reduced need for hospital readmissions and better quality of life. PD has a higher probability of preservation of residual kidney function and can be used by patients at home.

Loss of lean body mass within one week as a major determinant for total weight loss at one month after gastrectomy for gastric cancer.

219 Background: Postoperative changes in body weight and composition during first 1 month after gastrectomy remained unclear. Methods: The patients who underwent gastrectomy for gastric cancer between May 2010 and October 2013 were examined. Body weight and composition were evaluated by bioelectrical impedance analyzer within 1 week before surgery (first measurement), at 1 week after surgery (second measurement), and at 1 month after surgery (third measurement). The changes of the early period were defined as the differences until the second measurement, while those of the late period as the differences from the second to the third measurement. Results: Two-hundred forty four patients were selected for this study. Total body weight loss (BWL) within 1 month was -3.4 kg and the rate of body weight at 1 month to the preoperative body weight was 94.1%. BWL was significantly greater in the early period rather than that of the late period (-2.1 kg vs -1.2 kg, p<0.001). In the early period, loss of lean body mass was significantly greater than loss of fat mass (-1.5 kg vs -0.6 kg, p<0.001). The same trend was observed regardless of type of gastrectomy and surgical approach. Conclusions: Loss of lean body mass within 1 week was a major determinant for total body weight loss at 1 month. To maintain lean body mass within 1 week and total body weight at 1 month, future trial should be focused on not the surgical approach but nutritional intervention within 1 week.