Efficacy and safety of long‐term low‐calorie diet in severely obese patients non‐eligible for surgery

Abstract

The aim of this study was to describe the long-term efficacy and safety of low-calorie diets (LCDs; providing 900 kcal day(-1) ) in obese patients who have failed to achieve adequate weight loss with standard medical management and are non-eligible for surgical therapeutic options. Charts from a regional hospital-based outpatient bariatric programme were reviewed. Eight patients (75% male, age 60.1 ± 7.8 years) with severe obesity (body mass index 57.1 ± 8.8 kg m(-2) ) and undergoing long-term LCD (33 ± 10 months) were identified. Variables of interest included anthropometric, cardiovascular risk and nutritional parameters, thyroid, renal and liver function, changes in medications, side effects and adverse events. Average weight loss was 44 ± 15 kg (27 ± 13% of initial weight) at 24 months. Long-term management with LCD resulted in substantial and sustained improvements in glucose homeostasis, blood pressure and lipid profile. LCD was well tolerated with minor self-limited side effects. Over the follow-up period, two subjects underwent coronary revascularization and one patient underwent knee replacement surgery - all recovered without complications. These findings suggest that in selected obese patients (non-eligible for surgery), long-term management with LCD may provide an alternative option for substantial and sustainable weight loss with significant improvements in metabolic and cardiovascular health.

Effectiveness and Characterization of Severely Energy-Restricted Diets in People with Class III Obesity: Systematic Review and Meta-Analysis

“…Full texts of these 157 publications were accessed and screened, resulting in 146 publications being excluded (see Figure 1 for details). Eleven publications met our selection criteria [58][59][60][61]64,[68][69][70][71][72][73], of which ten publications-which included 15 comparison arms-were able to be used in our meta-analyses [58][59][60][61]64,[68][69][70][71][72]. One publication [73], which was included in the systematic review, had to be excluded from the meta-analyses as it did not report weight in absolute terms nor provide a final measurement for average weight, from which weight loss could be calculated.…”

“…In four publications (four comparison arms) [64,68,70,71], only participants who had successfully completed a TMR diet program and had lost a targeted amount of weight were selected, resulting in artificially high participant diet completion rates (83 to 100%). Ten publications used non-randomised methods for participant allocation into intervention arms [58][59][60][61]64,[68][69][70][71]73], and in six of these the classification of the intervention status was potentially affected by knowledge of the outcome by the investigators, as the intervention status was unclear at baseline, classified retrospectively, or prior to the point of delivery of the intervention [59,61,64,68,70,71].…”

“…The characteristics of the 11 publications in our systematic review (including the 10 in our meta-analyses) are shown in Table 2. Two publications were conducted in an inpatient setting [58,59], and the remaining nine in an outpatient environment [60,61,64,[68][69][70][71][72][73].…”

“…The meta-analysis of severely energy-restricted diets of 4 weeks' duration contained nine comparison arms from four publications [58,59,61,70], which were publications reporting on prospective case series [58,59] and prospective cohorts [61,70]. The meta-analysis of severely energy-restricted diets ≥6 weeks' duration contained six comparison arms from six publications [60,64,68,69,71], which reported on non-randomised controlled trials [60,71], prospective case series [64,69], a retrospective case series [68] and a randomised controlled trial [72]. Table 2.…”

“…Of the ten publications (with 15 comparison arms) identified for use in our meta-analyses, three publications excluded participants with major psychiatric disorders [60,69,72], three excluded conditions that contraindicate the use of severely energy-restricted diets, namely cardiac, renal and liver failure [60,69,72], and one excluded subjects with irregular life habits, namely addictive behaviors and sleep problems [71]. With respect to obesity-related conditions, four publications included participants with type 2 diabetes mellitus [60,61,68,70], three included participants with hypertension [60,68,72] and one included participants with dyslipidemia [68]. The two remaining publications did not mention exclusion or inclusion criteria; however, they reported that participants had no medical concerns [58,59].…”