title: Feasibility and indicative results from a 12-month low-energy liquid diet treatment and maintenance programme for severe obesity.
abstract: BACKGROUND
  There is no established primary care solution for the rapidly increasing numbers of severely obese people with body mass index (BMI) > 40 kg/m(2).
  
  
  OBJECTIVE
  This programme aimed to generate weight losses of ≥15 kg at 12 months, within routine primary care.
  
  
  METHODS
  Feasibility study in primary care.
  
  
  METHODS
  Patients with a BMI ≥40 kg/m(2) commenced a micronutrient-replete 810-833 kcal/day low-energy liquid diet (LELD), delivered in primary care, for a planned 12 weeks or 20 kg weight loss (whichever was the sooner), with structured food reintroduction and then weight-loss maintenance, with optional orlistat to 12 months.
  
  
  RESULTS
  Of 91 patients (74 females) entering the programme (baseline: weight 131 kg, BMI 48 kg/m(2), age 46 years), 58/91(64%) completed the LELD stage, with a mean duration of 14.4 weeks (standard deviation [SD] = 6.0 weeks), and a mean weight loss of 16.9 kg (SD = 6.0 kg). Four patients commenced weight-loss maintenance omitting the food-reintroduction stage. Of the remaining 54, 37(68%) started and completed food reintroduction over a mean duration of 9.3 weeks (SD = 5.7 weeks), with a further mean weight loss of 2.1 kg (SD = 3.7 kg), before starting a long-term low-fat-diet weight-loss maintenance plan. A total of 44/91 (48%) received orlistat at some stage. At 12 months, weight was recorded for 68/91 (75%) patients, with a mean loss of 12.4 kg (SD = 11.4 kg). Of these, 30 (33% of all 91 patients starting the programme) had a documented maintained weight loss of ≥15 kg at 12 months, six (7%) had a 10-15 kg loss, and 11 (12%) had a 5-10 kg loss. The indicative cost of providing this entire programme for wider implementation would be £861 per patient entered, or £2611 per documented 15 kg loss achieved.
  
  
  CONCLUSIONS
  A care package within routine primary care for severe obesity, including LELD, food reintroduction, and weight-loss maintenance, was well accepted and achieved a 12-month-maintained weight loss of ≥15 kg for one-third of all patients entering the programme.
authors.affiliation: Human Nutrition, School of Medicine, University of Glasgow, Glasgow, UK. Mike.Lean@glasgow.ac.uk
authors.forename: Michael
authors.initials: M
authors.lastname: Lean
authors.forename: Naomi
authors.initials: N
authors.lastname: Brosnahan
authors.forename: Philip
authors.initials: P
authors.lastname: McLoone
authors.forename: Louise
authors.initials: L
authors.lastname: McCombie
authors.forename: Anna Bell
authors.initials: AB
authors.lastname: Higgs
authors.forename: Hazel
authors.initials: H
authors.lastname: Ross
authors.forename: Mhairi
authors.initials: M
authors.lastname: Mackenzie
authors.forename: Eleanor
authors.initials: E
authors.lastname: Grieve
authors.forename: Nick
authors.initials: N
authors.lastname: Finer
authors.forename: John
authors.initials: J
authors.lastname: Reckless
authors.forename: David
authors.initials: D
authors.lastname: Haslam
authors.forename: Billy
authors.initials: B
authors.lastname: Sloan
authors.forename: David
authors.initials: D
authors.lastname: Morrison
mesh_terms: D000328:Adult; D019440:Anti-Obesity Agents / Q000627:therapeutic use; D004038:Diet, Reducing / Q000379:methods*; D005240:Feasibility Studies; D005247:Feeding Behavior; D005248:Feeding Methods; D005260:Female; D006801:Humans; D007783:Lactones / Q000627:therapeutic use; D008297:Male; D018977:Micronutrients / Q000008:administration & dosage; D008875:Middle Aged; D009767:Obesity, Morbid / Q000178:diet therapy*; D000077403:Orlistat; D010349:Patient Compliance; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D016896:Treatment Outcome; D015431:Weight Loss; D055815:Young Adult
chemical_list: D019440:Anti-Obesity Agents; D007783:Lactones; D018977:Micronutrients; D000077403:Orlistat
references.citation: Int J Obes (Lond). 2012 Apr;36(4):614-24
references.pmid: 21673653
references.citation: Diabetes Care. 2007 Jan;30(1):27-32
references.pmid: 17192328
references.citation: Clin Obes. 2011 Feb;1(1):31-40
references.pmid: 25586973
references.citation: Fam Pract. 2012 Apr;29 Suppl 1:i139-i144
references.pmid: 22399544
references.citation: Am J Med. 1999 Feb;106(2):179-84
references.pmid: 10230747
references.citation: N Engl J Med. 2001 May 3;344(18):1343-50
references.pmid: 11333990
references.citation: Int J Obes (Lond). 2012 Jun;36(6):843-54
references.pmid: 21844879
references.citation: J Am Diet Assoc. 2007 Oct;107(10):1755-67
references.pmid: 17904936
references.citation: Int J Obes (Lond). 2013 Aug;37(8):1135-9
references.pmid: 23164699
references.citation: N Engl J Med. 2012 Apr 26;366(17):1567-76
references.pmid: 22449319
references.citation: JAMA. 2008 Jan 23;299(3):316-23
references.pmid: 18212316
references.citation: Nutrition. 2009 Nov-Dec;25(11-12):1129-36
references.pmid: 19592223
references.citation: BMJ. 2011 Nov 03;343:d6500
references.pmid: 22053315
references.citation: BMJ. 2006 Oct 14;333(7572):794-7
references.pmid: 17038738
references.citation: Diabet Med. 1990 Mar-Apr;7(3):228-33
references.pmid: 2139394
references.citation: Diabetes Care. 2004 Jan;27(1):155-61
references.pmid: 14693982
references.citation: Hum Nutr Clin Nutr. 1985;39 Suppl 1:5-41
references.pmid: 4044297
references.citation: Clin Obes. 2011 Feb;1(1):50-52
references.pmid: 25586975
references.citation: Diabet Med. 2012 May;29(5):632-9
references.pmid: 21916973
references.citation: J Am Coll Nutr. 2003 Oct;22(5):331-9
references.pmid: 14559925
references.citation: Eur J Clin Nutr. 2005 Aug;59 Suppl 1:S93-100; discussion S101
references.pmid: 16052202
references.citation: BMJ. 1998 Nov 28;317(7171):1487-9
references.pmid: 9831574
references.citation: Eur J Clin Nutr. 2005 Aug;59 Suppl 1:S31-8; discussion S39
references.pmid: 16052193
references.citation: J Hum Nutr Diet. 2004 Jun;17(3):191-208
references.pmid: 15139891
references.citation: Obes Surg. 2006 Nov;16(11):1488-503
references.pmid: 17132416
references.citation: BMJ. 2011 Jun 01;342:d3017
references.pmid: 21632666
references.citation: Int J Clin Pract. 2010 May;64(6):775-83
references.pmid: 20353431
references.citation: Am J Med. 2009 Mar;122(3):248-256.e5
references.pmid: 19272486
references.citation: Br J Gen Pract. 2008 Aug;58(553):548-54
references.pmid: 18682018