Weight Loss in Nonalcoholic Fatty Liver Disease Patients in an Ambulatory Care Setting Is Largely Unsuccessful but Correlates with Frequency of Clinic Visits

Abstract

Background and AimsNonalcoholic fatty liver disease (NALFD) is a leading cause of liver disease. Weight loss improves clinical features of NAFLD; however, maintenance of weight loss outside of investigational protocols is poor. The goals of this study were to characterize patterns and clinical predictors of long-term weight loss in ambulatory patients with NAFLD.MethodsWe retrospectively reviewed 924 non-cirrhotic patients with NAFLD presenting to a liver clinic from May 1st 2007 to April 30th 2013. Overweight and obese patients were counseled on lifestyle modifications for weight loss as per USPSTF guidelines. The primary outcome was percent weight change between the first and last recorded visits: % weight change = (weightinitial – weightfinal)/(weightinitial). Baseline BMI and percent BMI change were secondary measures. Predictors of weight loss were determined using logistic regression.ResultsThe mean baseline BMI was 33.3±6.6 kg/m2, and the mean follow-up duration was 17.3±17.6 months. Most patients with NAFLD were in either overweight (26.1%) or class I obesity (30.5%) categories at baseline, while the prevalence of underweight and class III obesity was lower (0.2% and 15.4%, respectively). Overall, there was no change in mean weight or BMI during the follow-up period, and only 183 patients (19.8%) lost at least 5% body weight during the follow up period. Independent predictors of weight loss included number of clinic visits and baseline BMI, and patients with higher baseline BMI required more clinic visits to lose weight.ConclusionsWeight loss is largely unsuccessful in NAFLD patients in the ambulatory care setting. Frequent clinical encounters are associated with weight reduction, especially among individuals with high baseline BMI. Future studies are required to define effective weight loss strategies in NAFLD patients.

More Frequent Clinic Visits Are Associated with Improved Outcomes for Children with NAFLD

“…The results of this study are in agreement with adult data showing that clinic visit frequency is a predictor of weight loss in patients with NAFLD [4, 15]. In children, Devore et al recently reported the outcomes of a multidisciplinary clinical program caring for patients with NAFLD at a university hospital [8].…”

“…Currently, the only treatment for NAFLD is lifestyle changes (diet and exercise) that lead to a reduction in body mass index (BMI) [3]. Lifestyle changes are difficult to implement and sustain over time [4]. While behavioral interventions aimed at managing pediatric obesity have been shown to be directly proportional to the amount of time children spend with the treating team, it is not clear whether this is also true for the management of pediatric NAFLD [5].…”

“…In a study of 924 adult patients with NAFLD, it was recently shown that weight loss, while difficult to achieve, is independently associated with the frequency of clinic visits [4]. In addition, Svetkey et al compared two weight loss programs and showed that the more successful program mandated monthly contact between patients and their medical team [7].…”

Exercise Training as Treatment of Nonalcoholic Fatty Liver Disease

“…Diet-and exercise-induced weight loss >5% total body weight improves NAFLD and reverses hepatic necroinflammation and fibrosis [6]. Weight loss, however, is challenging and unsustainable for the majority of patients [7]. Only 50% of patients with NAFLD will achieve histological improvement with weight loss and~77% will regain weight within three years after a lifestyle intervention [7,8].…”

“…Weight loss, however, is challenging and unsustainable for the majority of patients [7]. Only 50% of patients with NAFLD will achieve histological improvement with weight loss and~77% will regain weight within three years after a lifestyle intervention [7,8]. While weight loss has remained fundamental to disease management, the benefits of exercise extend beyond weight loss alone.…”