Efficacia del trattamento dimagrante non chirurgico per i pazienti gravemente obesi
Abstract
Purpose: Severe obesity is a worldwide public health problem. We aimed to evaluate the effectiveness of non-surgical treatment on weight, body mass index (BMI), food consumption, and physical activity practice of severely obese outpatients. Methods: Fifty-three severely obese adults were included in the study. Nutritional treatment with a tailored food plan was applied. Patients were followed through nine monthly visits. At statistical analysis, it was observed that some patients were using anti-obesity drugs, thus patients were stratified as follows: nutritional treatment (NT) group (n = 26), those who received only the nutritional intervention; and nutritional treatment plus medicine (NM) group (n = 27), those under NT and anti-obesity drugs. Results: Both groups presented linear reduction on weight and BMI means throughout the follow-up (P < 0.001). NT had lower mean weight values compared to NM in the last three visits (seventh: P = 0.036, eighth: P = 0.020, ninth: P = 0.025). Both interventions promoted clinically significant weight loss with no statistical difference between groups (weight loss %: NT = 7.2 ± 9.0%; NM = 5.9 ± 4.5%; P = 0.491). A qualitative improvement in overall food consumption was observed. NT showed a significant increase in vegetable consumption compared to NM in the sixth visit (P = 0.044). NM had greater adherence to physical activity practice (P < 0.001). Conclusions: The non-surgical treatment program was effective on weight and BMI reduction in severely obese patients with and without anti-obesity drugs, and the food consumption and physical activity practice improved.
Riferimenti bibliografici
-Anderson, J. W.; Konz, E. C.; Frederich, R. C.; Wood, C. L. Long-term weight-loss maintenance: a meta-analysis of US studies. American Journal of Clinical Nutrition. Vol. 74. Num. 5. p. 579-584. 2001.
-Apovian, C. M.; Garvey, W. T.; Ryan, D. H. Challenging obesity: Patient, provider, and expert perspectives on the roles of available and emerging nonsurgical therapies. Obesity (Silver Spring). Vol. 23. Num. Suppl 2. p. S1-S26. 2015.
-Blackburn, G. L.; Wollner, S.; Heymsfield, S. B. Lifestyle interventions for the treatment of class III obesity: A primary target for nutrition medicine in the obesity epidemic. Americal Journal of Clinical Nutrition. Vol. 91. Num. 1. p. 289-292. 2010.
-Burguera, B.; Tur, J. J.; Escudero, A. J.; Alos, M.; Pagan, A.; Cortes, B.; Gonzalez, X. F.; Soriano, J. B. An Intensive Lifestyle Intervention Is an Effective Treatment of Morbid Obesity: The TramomtanaStudy-A Two-Year Randomized Controlled Clinical Trial. International Journal ofEndocrinology. Vol. 2015. p. 12-15. 2015.
-Buzzard, M. 24-hour dietary recall and food record methods. Monographs in Epidemiology and Biostatistics. Vol. 1. Num. 30. p. 50-73. 1998.
-Chang, S. H.; Stoll, C. R. T.; Song, J.; Varela, E.; Eagon, C. J.; Colditz, G. A. Bariatric surgery: an updated systematic review and meta analysis, 2003-2012, JAMA Surgery. Vol. 149. Num. 3. p. 275-287. 2014.
-Curioni, C. C.; Lourenço, P. M. Long-term weight loss after diet and exercise: a systematic review. International Journal of Obesity. Vol. 29. Num. 10. p. 1168-1174. 2005.
-Dalle Grave, R.; Calugi, S.; El Ghoch, M. Lifestyle modification in the management of obesity: Achievements and challenges, Eating and Weight Disorders. Vol. 18. Num. 4. p. 339-349. 2013.
-Di Cesare, M.; and colaborators. Trends in adult body-mass index in 200 countries from 1975 to 2014: A pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet. Vol. 387. Num. 10026. p. 1377-1396. 2016.
-Douketis, J. D.; Macie, C.; Thabane, L.; Williamson, D. F. Systematic review of long-term weight loss studies in obese adults: clinical significance and applicability to clinical practice. International Journal of Obesity. Vol. 29. Num. 10. p. 1153-1167. 2005.
-Franz, M. J.; Vanwormer, J. J.; Crain, A. L.; Boucher, J. L.; Histon, T.; Caplan, W.; Bowman, J. D.; Pronk, N. P. Weight-Loss Outcomes: A Systematic Review and Meta-Analysis of Weight-Loss Clinical Trials with a Minimum 1-Year Follow-Up. Journal of the American Dietetic Association. Vol. 107. Num. 10. p. 1755-1767. 2007.
-Garcia, M. T.; Granado, F. S.; Cardoso, M. A. Alimentação complementar e estado nutricional de crianças menores de dois anos atendidas no Programa Saúde da Família em Acrelândia, Acre, Amazônia Ocidental Brasileira Complementary feeding and nutritionalstatus of 6-24-month-old children in Acrelândia. Cadernos de Saúde Pública. Vol. 27. Num. 2. p. 305-316. 2011.
-Gemming, L.; Jiang, Y.; Swinburn, B.; Utter, J.; Mhurchu, C. N. Under-reporting remains a key limitation of self-reported dietary intake: ananalysis of the 2008/09 New Zealand Adult Nutrition Survey. European Journal of Clinical Nutrition. Vol. 68. Num. 2. p. 259-264. 2014.
-Glenny, A. M.; O’meara, S.; Melville, A.; Sheldon, T. A.; Wilson, C. The treatment and prevention of obesity: a systematic review of the literature, International Journal of Obesity and Related Metabolism Disorders. Vol. 21. Num. 9. p. 715-737. 1997.
-Haddock, C.; Poston, W.; Dill, P.; Foreyt, J.; Ericsson, M. Pharmacoterapy for obesity: a quantitative analysis of four decades of published randomized clinical trials, International Journal of Obesity. Vol. 26. Num. 2. p. 262-273. 2002.
-Jensen, M. D.; Ryan, D. H.; Donato, K. A.; Apovian, C. M.; Ard, J. D.; Comuzzie, A. G.; Hu, F. B.; Hubbard, V. S.; Jakicic, J. M.; Kushner, R. F.; Loria, C. M.; Millen, B. E.; Nonas, C. A.; Pi-Sunyer, F. X.; Stevens, J.; Stevens, V. J.; Wadden, T. A.; Wolfe, B. M.; Yanovski, S. Z. Executive summary: Guidelines (2013) for the management of overweight and obesity in adults. Obesity. Vol. 22. Num. S2. p. S5-S39. 2014.
-Laddu, D.; Dow, C.; Hingle, M.; Thomson, C. A review of evidence-based strategies to treat obesity in adults, Nutrition in Clinical Practice. Vol. 26. Num. 5. p. 512-525. 2011.
-Lissner, L. Measuring food intake in studies of obesity. Public Health Nutrition. Vol. 5, Num. 6a. p. 889-892. 2002.
-Mctigue, K.; Larson, J. C.; Valoski, A.; Burke, G.; Kotchen, J.; Lewis, C. E.; Stefanick, M. L.; Van Horn, L.; Kuller, L. Mortality and Cardiac and Vascular Outcomes in Extremely Obese Women. Journal of the American Medical Association. Vol. 296. Num. 1. p. 79–86. 2006.
-Ministério da Saúde. Guia alimentarpara a populacao brasileira: promovendo a Alimentação Saudável. Brasília. 2005.
-National Heart Lung and Blood Institute (NHLBI); National Institutes of Health (NIH). Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. The Evidence Report, NIH Publication Num. 98-4083. Archives of Internal Medicine. Vol. 158. Num. Suppl 2. p. 51S-209S. 1998.
-Padwal, R.; Klarenbach, S.; Wiebe, N.; Hazel, M.; Birch, D.; Karmali, S.; Sharma, A. M.; Manns, B.; Tonelli, M. Bariatric surgery: A systematic review of the clinical and economic evidence. Journal of General Internal Medicine. Vol. 26. Num. 10. p. 1183-1194. 2011.
-Powell, L. H.; Calvin, J. E.; Calvin, J. E. Effective obesity treatments. The American Psychologist. Vol. 62. Num. 3. p. 234-246. 2007.
-Ryan, D. H.; Johnson, W. D.; Myers, V. H.; Prather, T. L.; Mcglone, M.M.; Rood, J.; Brantley, P. J.; Bray, G. A. Nonsurgical Weight Loss for Extreme Obesity in Primary Care Settings. Archives of Internal Medicine. Vol. 170, Num. 2. p. 146-154. 2010.
-Scagliusi, F. B.; Ferriolli, E.; Pfrimer, K.; Laureano, C.; Cunha, C. S.; Gualano, B.; Lourenço, B. H.; Lancha, A. H. Underreporting of Energy Intake in Brazilian Women Varies According to Dietary Assessment: A Cross-Sectional Study Using Doubly Labeled Water. Journal of the American Dietetic Association. Vol. 108. Num. 12. p. 2031-2040. 2008.
-Seagle, H. M.; Strain, G. W.; Makris, A.; Reeves, R. S. Position of the American Dietetic Association: weight management. Journal of the American Dietetic Association. Vol. 109. Num. 2. p. 330-346. 2009.
-Sturm,R. Morbid Obesity Rates Continue to Rise Rapidly in the US. International Journal of Obesity. Vol. 37. Num. 6. p. 889–891. 2013.
-Wharf, S. G.; Fox, T. E.; Fairweather-Tait, S. J.; Cook, J. D. Factors affecting iron stores in infants 4-18 months of age. European Journal of Clinical Nutrition. Vol. 51. Num. 8. p. 504-509. 1997.
-Wing, R.; Lang, W.; Wadden, T.; Safford, M.; Knowler, W.; Bertoni, A.; Hill, J.; Brancati, F.; Peters, A.; Wagenknecht, L. Benefits of Modest Weight Loss in Improving Cardiovascular Risk Factors in Overweight and Obese Individuals With Type 2 Diabetes. Diabetes Care. Vol. 34. Num. 7. p. 1481-1486. 2011.
-World Health Organization (WHO). Diet, nutrition and the prevention of chronic diseases. Geneva. 2003.
-World Health Organization (WHO). Global recommendations on physical activity for health, Geneva. 2010.
-World Health Organization (WHO). Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. Geneva. 1995.
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