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

PURPOSE: 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.