title: Obesity treatment: results after 4 years of a Nutritional and Psycho-Physical Rehabilitation Program in an outpatient setting.
abstract: BACKGROUND
  Obesity is a chronic disease as well as a risk factor for cardiovascular, metabolic and osteoarticular diseases, affecting the psychosocial health and the quality of life. Recent evidence suggests that the adequate treatment of obesity should provide a multidimensional multidisciplinary approach including nutritional therapy, psycho-educational classes and physical reconditioning/motor rehabilitation. The aim of this approach should be to maintain the results over time with a positive impact on the obesity-related cardiovascular and metabolic risk.
  
  
  OBJECTIVE
  To evaluate the effectiveness of a multidisciplinary Nutritional and Psycho-Physical Reconditioning Program (NPPRP) in an outpatient setting.
  
  
  METHODS
  The observational prospective cohort study involved subjects, aged from 18 to 65 years, with a BMI >30 kg/m(2), who were followed up over 48 months. After the first nutritional and psychological examination, patients who refused NPPRP were treated according to standard nutrition procedures (SNT). Patients were followed through monthly medical examinations and then by annual telephonic structured interviews for 4 years. Changes in body weight, eating behavior, physical activity performance, and the occurrence of clinical obesity-related complications were considered as outcome measures.
  
  
  RESULTS
  Of 464 enrolled patients, 161 (34.7%) took part in the follow-up. From the enrollment to the end of follow-up, weight loss was greater in the NPPRP group than in the SNP group (-8.08 ± 10 kg versus -3.0 ± 6 kg). After 4 years eating behavior improved in both groups. The percentage of patients who continued to perform physical activity was higher in the NPPRP group than in the SNT group (61.0 versus 34.1%). The SNT group reported complications more frequently than the NPPRP group: hypertension (19 versus 5.8%), dyslipidemia (19.4 versus 12.7%), and skeletal problems (26.9 versus 17.5%). The main reasons for drop-out from the rehabilitation program were logistic problems (distance or time) in both groups; disappointment was higher in the SNT group than in the NPPRP group (37.8 versus 15.6%).
  
  
  CONCLUSIONS
  A multidimensional multidisciplinary approach including nutritional intervention and psycho-physical rehabilitation, set against a conventional diet therapy, was more effective in the long-term outcome of obesity with regard to weight loss, physical activity, possible eating disorders, and obesity-related complications.
authors.affiliation: Department of Experimental Medicine, Medical Pathophysiology, Food Science and Endocrinology Section, "Sapienza" University of Rome, P.le Aldo Moro, 5, 00185, Rome, Italy, Lorenzomaria.donini@uniroma1.it.
authors.forename: Lorenzo M
authors.initials: LM
authors.lastname: Donini
authors.forename: Massimo
authors.initials: M
authors.lastname: Cuzzolaro
authors.forename: Lucio
authors.initials: L
authors.lastname: Gnessi
authors.forename: Carla
authors.initials: C
authors.lastname: Lubrano
authors.forename: Silvia
authors.initials: S
authors.lastname: Migliaccio
authors.forename: Antonio
authors.initials: A
authors.lastname: Aversa
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pinto
authors.forename: Andrea
authors.initials: A
authors.lastname: Lenzi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001823:Body Composition; D003376:Counseling; D004032:Diet; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D009765:Obesity / Q000523:psychology / Q000628:therapy*; D010045:Outpatients; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D016896:Treatment Outcome; D055815:Young Adult