Group-based Intervention Effective for Weight Loss Improves Quality of Life
Key findings
- This prospective study evaluated change in body weight, biochemical parameters and quality of life among 204 individuals who entered a group-based weight loss program at the Massachusetts General Hospital Obesity Medicine Clinic
- During three years of data collection, 70% of participants were adherent to the program (attended nine of 12 weekly sessions)
- Average weight loss was 14 lbs. and the average percent total body weight lost was -5.35% (P=0.0002)
- The group as a whole was metabolically healthy at baseline, but even so there were significant improvements, on average, in total cholesterol (-70.64 mg/dL) and HbA1c (-1.82%)
- The total average score on the IW-QOL-Lite tool for assessing quality of life improved by 5.79% (P=0.005) and significant improvements were also seen on the physical function, self-esteem and sexual life subscales
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It's well established that individual and group interventions can produce similar weight loss. However, recent studies, including a systematic review (published in Obesity Facts), conclude that group interventions for adult obesity are actually more effective than individual interventions.
Accordingly, Abeer Bader, MSc, RD, LDN, CSOWM, registered dietitian and lead clinical nutrition specialist at the Massachusetts General Hospital Weight Center, Fatima Cody Stanford, MD, MPH, MPA, an obesity medicine physician-scientist at the Weight Center, and colleagues developed a group-based program called Healthy Habits for Life (HHL). They have found it effective not just to reduce obesity but also to improve quality of life. Their data appear in Clinical Nutrition ESPEN, a publication of the European Society for Clinical Nutrition and Metabolism (ESPEN).
Study Methods
The study involved 204 patients at the Mass General Weight Center, ages 21–80 years old. Body mass index (BMI) ranged from 29–74 kg/m2 (average, 38 kg/m2).
All participants consulted individually with a registered dietitian, who described the program and enrolled those interested. They underwent indirect calorimetry, which was used to set daily kilocalorie recommendations with the goal of 0.5–2 lb. of weight loss per week. Participants were also instructed on keeping a food record.
The program comprised 12 weekly sessions covering healthy nutrition, etiology of obesity, portions and volumetrics, mindful eating, meal planning and culinary skills, evaluating popular diets, dining out, physical activity and long-term weight management.
Before and after the program, weight, BMI, liver enzymes, lipids, hemoglobin A1C, total glucose and insulin were measured, and quality of life (QOL) was assessed on the IW-QOL-Lite questionnaire. Weight was also measured at each session. At baseline, participants were within normal limits for the biochemical parameters, on average. Approximately 12% were using anti-obesity medications.
Adherence
During three years of data collection, 142 participants (70%) attended nine of the 12 sessions, the prespecified definition of adherence. 97 (48%) completed at least nine sessions and the post-program visit.
Primary Outcomes
Post-program, 83% of participants were using anti-obesity medications. They were excluded from the final analysis to isolate the effects of the behavioral program:
- Average weight loss: 14 lbs.
- Average percent total body weight lost: −5.35% (P=0.0002)
37% of participants lost over 5% of their initial body weight and 18% of participants lost over 10%.
Biochemical Parameters
Even though the group as a whole was metabolically healthy at baseline, there were significant improvements, on average, in total cholesterol (−70.64 mg/dL) and HbA1c (−1.82%).
Quality of Life
Total QOL scores improved by 5.79% on average (P=0.005) and significant improvements were also seen on the physical function, self-esteem and sexual life subscales.
These changes are important because many of the participants joined the program to gain benefits not directly related to health status. Individual patients reported improvements in their relationships with themselves, their body image, their families, their coworkers and the food they eat. Improved self-esteem and self-efficacy may help patients maintain a healthier lifestyle over time.
Suggestions for Devising a Program
Limited resources, including time and qualified interventionists, create a barrier to intensive weight-loss interventions. This short group-based program is more efficient and appears not to be detrimental to patient outcomes.
However, insurers often refuse reimbursement. Housing weight-loss interventions at community centers, as the National Diabetes Prevention Program (DPP) is doing, would improve access and hopefully cost less than care at outpatient clinics. New technologies such as online and telephone conferences, smartphone applications and smart scales could also reduce overhead.
Patients are strongly encouraged to continue visiting the Mass General Weight Center or enroll in other weight management programs after HHL, but there is no formalized process for addressing long-term weight maintenance. One improvement envisioned for HHL is the addition of intermittent post-program visits for at least one year.
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