An Intensive Lifestyle Intervention Is an Effective Treatment of Morbid Obesity: The TRAMOMTANA Study—A Two-Year Randomized Controlled Clinical Trial

Abstract

Bariatric surgery is currently the most effective therapy to induce weight loss in morbidly obese patients. Objective. This controlled, clinical trial with a two-year intervention was aimed at comparing the efficacy of two nonsurgical approaches versus bariatric surgery, on body weight changes and metabolic parameters in morbidly obese patients. Methods. Patients were randomized to an Intensive Lifestyle Intervention (ILI) (n = 60) or Conventional Obesity Therapy (COT) (n = 46). The ILI group received behavioral therapy and nutritional counseling. The COT group received standard medical treatment. They were compared with a third group, Surgical Obesity Group (SOG) (n = 37). Results. Patients who received ILI had a greater percentage of weight loss than patients receiving COT (−11.3% versus −1.6%; p < 0.0044). Interestingly 31.4% of patients included in the ILI group were no longer morbidly obese after just six months of intervention, increasing to 44.4% after 24 months of intervention. The percentage weight loss in SOG was −29.6% after that same period of time. Conclusions. ILI was associated with significant weight loss when compared to COT, in a group of patients with obesity. An ILI approach could be an alternative therapy to patients with obesity, who are not candidates to undergo bariatric surgery. This trial is registered with EudraCT 2009-013737-24.

Meta-analysis of the influence of lifestyle changes for preoperative weight loss on surgical outcomes

“…Following detailed assessment of the full manuscripts, five studies (2 reviews, 2 with no control groups and 1 with no relevant reported outcomes) were excluded. The remaining 16 publications included four RCTs and 12 cohort studies, of which four 33–35,37 were prospective and eight retrospective. No additional references were identified by reference searching, leaving 16 articles that met the inclusion criteria and provided quantitative data for inclusion in the analysis ( Fig .…”

“…All but one of the studies considered patients undergoing bariatric surgery. The enrolled patients underwent the following types of surgery: laparoscopic Roux‐en‐Y gastric bypass, five studies (2 RCTs and 3 cohort studies); open or laparoscopic Roux‐en‐Y gastric bypass, three studies; open Roux‐en‐Y gastric bypass, four studies; mixed types of gastric banding procedure (vertical banded gastroplasty or laparoscopic adjustable gastric bands), two studies; biliopancreatic diversion, one study; and total knee or hip replacement, one cohort study. The mean age of participants in these trials ranged from 39 to 50 years, and the mean follow‐up time was 6–51 months ( Table S2, supporting information).…”

“…The mean age of participants in these trials ranged from 39 to 50 years, and the mean follow‐up time was 6–51 months ( Table S2, supporting information). In eight studies, dietary modification was combined with an exercise programme.…”

Information and communication technology in obesity

“…To achieve this type of weight loss in clinical practice, patients with obesity should be included in multidisciplinary programs with combined treatment options (diet, physical activity, cognitivebehavioral and pharmacological) [14]. This approach has suboptimal outcomes sometimes because of difficulties in access, costs, lack of staff and resources to improve the follow-up, treatment adherence, and long-term efficacy.…”

Multimodal Lifestyle Intervention: Outlines and Outcomes

“…By comparison with BS group, percentage weight loss grew from 5% for COT group to 38% for IMOM from surgical achievement, that is, percentage of weight loss in IMOM achieved more than one-third of the results of bariatric surgery without complication of surgery. Accordingly, IMOM could be an alternative therapy to patients with obesity, who cannot tolerate bariatric surgery [24].…”