Mohseni Mostafa, Kuckuck Susanne, Meeusen Renate E H, Jiskoot Geranne, Lengton Robin, Savas Mesut, Berk Kirsten A C, Van der Valk Eline S, Van der Voorn Bibian, Van den Berg Sjoerd A A, Iyer Anand M, Bussmann Johannes B J, Leenen Pieter J M, Dik Willem A, de Groot Cornelis J, Van den Akker Erica L T, Van Rossum Elisabeth F C
Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Obesity Center CGG, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Int J Endocrinol Metab. 2022 Dec 29;21(1):e129906. doi: 10.5812/ijem-129906. eCollection 2023 Jan.
Obesity is a multifactorial, chronic, progressive disease associated with decreased health-related quality of life, comorbidities, and increased mortality risk. Lifestyle interventions, focusing on dietetics, physical exercise, and behavioral therapy, are a cornerstone of therapy. Despite this very multidisciplinary treatment approach, the definition of treatment success is often based only on a weight loss of ≥ 5%. However, the heterogeneous nature of obesity may necessitate a more comprehensive approach to assessing treatment effects.
Here, we describe changes in physiological, psychological, and behavioral health after a multidisciplinary combined lifestyle intervention (CLI). Additionally, we investigated whether these changes were related to weight loss.
This prospective observational longitudinal study comprised 96 adults with obesity (73 women, 81 Caucasian) participating in a CLI at the Obesity Center CGG, Erasmus University Medical Center, Rotterdam, the Netherlands. The 1.5-year intervention comprised multidisciplinary professional guidance towards a healthy diet, increased physical activity, and included cognitive behavioral therapy. Physiological health outcomes, psychological well-being, eating behavior, and physical activity were assessed after ten weeks and 1.5 years and compared to baseline.
An average of 5.2% weight loss (-6.0 kg) was accompanied by a mean 9.8% decrease in fat mass (-5.9 kg; both P < 0.001) and significant improvements in metabolism, hormonal status, and immune parameters (all P < 0.05). Moreover, we observed decreased psychopathology, increased quality of life, and decreased disordered eating (all P < 0.05). Weight loss correlated with most metabolic changes (all P < 0.05) but not with most psychological/behavioral changes.
Combined lifestyle intervention in patients with obesity was accompanied by significant improvements in body weight and body composition along with cardiometabolic, endocrine, immunological, psychological, and behavioral improvements. Interestingly, most changes in psychological and behavioral health occurred independently of weight loss. Obesity treatment success should be evaluated based on a combination of physical and patient-reported outcomes rather than weight loss alone.
肥胖是一种多因素、慢性、进行性疾病，与健康相关生活质量下降、合并症及死亡风险增加有关。以饮食、体育锻炼和行为疗法为重点的生活方式干预是治疗的基石。尽管采用了这种多学科治疗方法，但治疗成功的定义通常仅基于体重减轻≥5%。然而，肥胖的异质性可能需要一种更全面的方法来评估治疗效果。
在此，我们描述了多学科联合生活方式干预（CLI）后生理、心理和行为健康的变化。此外，我们研究了这些变化是否与体重减轻有关。
这项前瞻性观察性纵向研究纳入了96名肥胖成年人（73名女性，81名白种人），他们在荷兰鹿特丹伊拉斯姆斯大学医学中心肥胖中心CGG参加了CLI。为期1.5年的干预包括针对健康饮食、增加身体活动的多学科专业指导，并包括认知行为疗法。在10周和1.5年后评估生理健康结果、心理健康、饮食行为和身体活动，并与基线进行比较。
平均体重减轻5.2%（-6.0千克），同时脂肪量平均减少9.8%（-5.9千克；两者P<0.001），代谢、激素状态和免疫参数有显著改善（均P<0.05）。此外，我们观察到精神病理学减轻、生活质量提高和饮食紊乱减少（均P<0.05）。体重减轻与大多数代谢变化相关（均P<0.05），但与大多数心理/行为变化无关。
肥胖患者的联合生活方式干预伴随着体重和身体成分的显著改善，以及心脏代谢、内分泌、免疫、心理和行为方面的改善。有趣的是，心理和行为健康的大多数变化独立于体重减轻而发生。肥胖治疗的成功应基于身体和患者报告结果的综合评估，而不仅仅是体重减轻。
