Six-year Follow-Up of Nonpharmacological and Nonsurgical Obesity Treatments

Maja J Ekman,1 Martin Ridderstråle1,2 1Department of Clinical Sciences Malmö, Clinical Obesity Research, Lund University, Skåne University Hospital, Malmö, Sweden; 2Department of Translational Type 2 Diabetes Research, Steno Diabetes Center Copenhagen, Herlev, DenmarkCorrespondence: Martin Ridderstråle, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, Herlev, 2730, Denmark, Tel +46-760 211 646 (direct), Email [email protected]: The prevalence of obesity and its cardiometabolic consequences are increasing worldwide. Scalable and affordable methods to obtain and maintain weight loss and prevent comorbidities such as type 2 diabetes (T2D) are major goals for obesity care. We performed a long-term follow-up study based on self-report after attending different nonpharmacological weight loss treatments at a university center when modern obesity drugs were not yet available.Patients and Methods: A total of 1,130 subjects were invited. Response rate was 67% and treatment and follow-up times were 1.4± 0.04 and 6.1± 0.1 years (mean±SEM), respectively. The treatment groups were: Individual therapy (IT; n=156); Group-based behavioral therapy (GT; n=285); GT initiated by low-calorie diet (LCD-GT; n=136); and bariatric surgery (BS) at any time after attending the center (n=152). A total of 145 subjects had T2D at baseline.Results: 57.8% (95% CI 54.1– 61.5) and 36.4% (32.9– 40.0) of subjects achieved > 5% and > 10% body weight loss, respectively. At follow-up, this translated into 96.7 (92.5– 98.9) and 92.1% (86.6– 95.9) of subjects who went on to BS achieving > 5% and > 10% weight loss compared to 48.1 (43.9– 52.4) and 30.9% (27.1– 34.9) in the non-surgery (NS) subgroups. The LCD-GT subgroup experienced the largest weight loss, but also the greatest weight regain among the NS subgroups; 56.7 (47.9– 65.2) and 41.8% (33.3– 50.6) maintaining a > 5% and > 10% loss of weight at follow-up. Incident T2D was lower (2.6% [0.5– 7.4] vs 9.2% [6.7– 12.2], p=0.02) and remission of T2D was greater (52.8% [35.5– 69.6] vs 9.3% [4.5– 16.4]; p< 0.0001) after BS than after NS, where the lowest T2D incidence and greatest remission were observed in LCD-GT; 5.6% (2.1– 11.7) and 17.9% (6.1– 36.9), respectively.Conclusion: In real-world practice, bariatric surgery fulfils the promise of academic trials. However, nonsurgical and nonpharmacological treatments can also have a long-term impact on both weight loss and diabetes prevention and remission. This is important because modern obesity drugs and bariatric surgery are not available or affordable for most obese people. Keywords: weight loss, weight maintenance, type 2 diabetes remission, real-world evidence, clinical practice