title: Effects of an eight-week supervised, structured lifestyle modification programme on anthropometric, metabolic and cardiovascular risk factors in severely obese adults.
abstract: BACKGROUND
  Lifestyle modification is fundamental to obesity treatment, but few studies have described the effects of structured lifestyle programmes specifically in bariatric patients. We sought to describe changes in anthropometric and metabolic characteristics in a cohort of bariatric patients after participation in a nurse-led, structured lifestyle programme.
  
  
  METHODS
  We conducted a retrospective, observational cohort study of adults with a body mass index (BMI) ≥ 40 kgm(-2) (or ≥ 35 kgm(-2) with significant co-morbidity) who were attending a regional bariatric service and who completed a single centre, 8-week, nurse-led multidisciplinary lifestyle modification programme. Weight, height, waist circumference, blood pressure, HbA1c, fasting glucose and lipid profiles as well as functional capacity (Incremental Shuttle Walk Test) and questionnaire-based anxiety and depression scores before and after the programme were compared in per-protocol analyses.
  
  
  RESULTS
  Of 183 bariatric patients enrolled, 150 (81.9%) completed the programme. Mean age of completers was 47.9 ± 1.2 years. 34.7% were male. There were statistically significant reductions in weight (129.6 ± 25.9 v 126.9 ± 26.1 kg, p < 0.001), BMI (46.3 ± 8.3 v 44.9 ± 9.0 kgm(-2), p < 0.001), waist circumference (133.0 ± 17.1 v 129.3 ± 17.5 cm in women and 143.8 ± 19.0 v 135.1 ± 17.9 cm in men, both p < 0.001) as well as anxiety and depression scores, total- and LDL-cholesterol and triglyceride levels, with an increase in functional capacity (5.9 ± 1.7 v 6.8 ± 2.1 metabolic equivalents of thermogenesis (METS), p < 0.001) in completers at the end of the programme compared to the start. Blood pressure improved, with reductions in systolic and diastolic blood pressure from 135 ± 16.2 to 131.6 ± 17.1 (p = 0.009) and 84.7 ± 10.2 to 81.4 ± 10.9 mmHg (p < 0.001), respectively. The proportion of patients achieving target blood pressure increased from 50.3 to 59.3% (p = 0.04). The proportion of patients with diabetes achieving HbA1c <53 mmol/mol increased from 28.6 to 42.9%, p = 0.02.
  
  
  CONCLUSIONS
  Bariatric patients completing an 8 week, nurse-led structured lifestyle programme had improved adiposity, fitness, lipid profiles, psychosocial health, blood pressure and glycaemia. Further assessment of this programme in a pragmatic randomised controlled trial seems warranted.
authors.affiliation: Bariatric Medicine Service, Galway Diabetes Research Centre, HRB Clinical Research Facility, Galway University Hospital, Galway, Ireland.
authors.forename: Catherine
authors.initials: C
authors.lastname: Crowe
authors.affiliation: Croi, the West of Ireland Cardiac Foundation, Heart and Stroke Centre, Moyola Lane, Newcastle, Galway, Ireland.
authors.forename: Irene
authors.initials: I
authors.lastname: Gibson
authors.affiliation: Bariatric Medicine Service, Galway Diabetes Research Centre, HRB Clinical Research Facility, Galway University Hospital, Galway, Ireland.|Croi, the West of Ireland Cardiac Foundation, Heart and Stroke Centre, Moyola Lane, Newcastle, Galway, Ireland.
authors.forename: Katie
authors.initials: K
authors.lastname: Cunningham
authors.affiliation: Croi, the West of Ireland Cardiac Foundation, Heart and Stroke Centre, Moyola Lane, Newcastle, Galway, Ireland.
authors.forename: Claire
authors.initials: C
authors.lastname: Kerins
authors.affiliation: Croi, the West of Ireland Cardiac Foundation, Heart and Stroke Centre, Moyola Lane, Newcastle, Galway, Ireland.
authors.forename: Caroline
authors.initials: C
authors.lastname: Costello
authors.affiliation: Croi, the West of Ireland Cardiac Foundation, Heart and Stroke Centre, Moyola Lane, Newcastle, Galway, Ireland.
authors.forename: Jane
authors.initials: J
authors.lastname: Windle
authors.affiliation: Department of Clinical Biochemistry, Galway University Hospitals, Galway, Ireland.
authors.forename: Paula M
authors.initials: PM
authors.lastname: O Shea
authors.affiliation: Bariatric Medicine Service, Galway Diabetes Research Centre, HRB Clinical Research Facility, Galway University Hospital, Galway, Ireland.|School of Psychology, National University of Ireland, Galway, Ireland.
authors.forename: Mary
authors.initials: M
authors.lastname: Hynes
authors.affiliation: School of Psychology, National University of Ireland, Galway, Ireland.
authors.forename: Brian
authors.initials: B
authors.lastname: McGuire
authors.affiliation: Bariatric Medicine Service, Galway Diabetes Research Centre, HRB Clinical Research Facility, Galway University Hospital, Galway, Ireland.
authors.forename: Katriona
authors.initials: K
authors.lastname: Kilkelly
authors.affiliation: Bariatric Medicine Service, Galway Diabetes Research Centre, HRB Clinical Research Facility, Galway University Hospital, Galway, Ireland.
authors.forename: Helena
authors.initials: H
authors.lastname: Griffin
authors.affiliation: Bariatric Medicine Service, Galway Diabetes Research Centre, HRB Clinical Research Facility, Galway University Hospital, Galway, Ireland.|Discipline of Health Promotion, National University of Ireland, Galway, Ireland.
authors.forename: Tim
authors.initials: T
authors.lastname: O Brien
authors.affiliation: Discipline of Health Promotion, National University of Ireland, Galway, Ireland.|National Institute of Preventive Cardiology, Galway, Ireland.
authors.forename: Jenni
authors.initials: J
authors.lastname: Jones
authors.affiliation: Bariatric Medicine Service, Galway Diabetes Research Centre, HRB Clinical Research Facility, Galway University Hospital, Galway, Ireland. francis.finucane@hse.ie.|Discipline of Health Promotion, National University of Ireland, Galway, Ireland. francis.finucane@hse.ie.
authors.forename: Francis M
authors.initials: FM
authors.lastname: Finucane
mesh_terms: D000328:Adult; D001007:Anxiety / Q000150:complications / Q000523:psychology; D001786:Blood Glucose / Q000378:metabolism; D001827:Body Height; D001835:Body Weight; D002318:Cardiovascular Diseases; D008076:Cholesterol, HDL / Q000378:metabolism; D008078:Cholesterol, LDL / Q000378:metabolism; D015331:Cohort Studies; D003863:Depression / Q000150:complications / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000378:metabolism / Q000523:psychology / Q000628:therapy*; D004035:Diet Therapy; D005080:Exercise Test; D005081:Exercise Therapy; D017079:Exercise Tolerance; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000378:metabolism / Q000523:psychology / Q000628:therapy*; D057184:Practice Patterns, Nurses'; D012189:Retrospective Studies; D040242:Risk Reduction Behavior; D016896:Treatment Outcome; D014280:Triglycerides / Q000378:metabolism; D055105:Waist Circumference
chemical_list: D001786:Blood Glucose; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; D014280:Triglycerides; C517652:hemoglobin A1c protein, human