1.
Reducing weight in an internal medicine outpatient clinic using a lifestyle medicine approach: A proof of concept.
Lucini, D, Cesana, G, Vigo, C, Malacarne, M, Pagani, M
European journal of internal medicine. 2015;(9):680-4
Abstract
BACKGROUND Chronic non-communicable diseases represent the major drivers of disease burden, being responsible for the majority of health care cost and deaths. Almost half of premature deaths is due to behaviors amenable to change. Accordingly, addressing behavior might represent a strategic change in the health delivery system. Improving lifestyle requires a specific strategy embedding the active collaboration of individuals with a multilevel team-oriented medical practice. With the present study we sought to assess whether the implementation of cognitive-behavioral strategies, following the principles of lifestyle medicine in an outpatient clinic provides better results in weight reduction as compared to simpler strategies as presently executed in General Practitioners' offices. METHODS This is an observational study on 173 subjects (age 53.1 ± 11.5), comparing three different groups of preventive practice: a personalized lifestyle medicine, combining cognitive behavioral strategies with patient tailored prescription of exercise and nutrition (Group A); a semi-structured approach with generic counseling (Group B); and an unstructured advice (Group C). RESULTS At the end of the intervention period (17-20 months), group A showed an average weight loss of 5.4 ± 5.1 kg, which was significantly (p<0.001)more than observed in group B (2.8 ± 5.1 kg) and group C (1.2 ± 4.8 kg). Likewise BMI and waist were progressively more reduced from A to C. CONCLUSIONS It is possible to implement preventive cognitive-behavioral lifestyle strategies in outpatient internal medicine clinics. This methodology appears more efficacious in inducing weight reduction after more than a year as compared to usual family medicine approaches.
2.
[Effectiveness of cognitive behavioral therapy on weight loss after two years of bariatric surgery in morbidly obese patients].
Abilés, V, Abilés, J, Rodríguez-Ruiz, S, Luna, V, Martín, F, Gándara, N, Fernández-Santaella, MC
Nutricion hospitalaria. 2013;(4):1109-14
Abstract
OBJECTIVE To evaluate the effectiveness of Cognitive Behavioral Therapy (CBT) in the success of postoperative weight loss after 2 years of CB. METHODS A prospective observational study was conducted in consecutive patients with morbid obesity aged between 18 and 59 yrs and enrolled in the bariatric surgery program of the Obesity Surgery Unit of our hospital from June 2007 through June 2010, with two years postoperative follow-up. Participants were divided into two groups according to their participation in Cognitive Behavioral Therapy or not. Over a 3-month period, CBT was applied in 12 2-h sessions. The main dependent variables studied were body weight and height, from which we calculated BMI and percentage of excess weight lost (weight lost x 100)/(initial weight-ideal weight), classifying patients as successful (E ) those with EPP > 50%, and unsuccessful (NE) those with EPP <50%. Participants were also, assessed for general (stress, anxiety, depression and self-esteem) and specific (binge eating and food craving) psychopathology. RESULTS Of the 35 patients with bariatric surgery, 30 responded postoperative evaluations, 16 underwent CBT before CB and 14 underwent surgery without receiving psycho-nutritional therapy, (76% female) with a mean age of 41 ± 9.5 years. The mean baseline BMI was 42 ± 10 and 45% of patients were classified as super obese (BMI: 56 ± 6). Mean excess weight loss (EPP) was 77%. According to the EPP were classified as "successful" (S) (59%) and "unsuccessful" (U) (41%). Of the patients assigned to S, 94% received CBT (15 individuals of 17 total), compared with only 12% who did not receive (2 individuals of the 17 total) with statistically significant differences (p < 0.05). Also, the S patients appeared to be significantly less anxious and stressed and have higher self-esteem (P < 0.05). Regarding specific psychopathology, the food craving guided by hunger, loss of control over food intake and guilt was lower in patients who achieved > 50% of EPP (p < 0.04, p < 0.001, p < 0.001, respectively). It was also noted that these patients were plans to eat less and ate less for positive reinforcement (p < 0.03 and p < 0.000, respectively) than the patient group NE. CONCLUSIONS Patients who achieved successful results in the evolution of weight loss at two years of CB are mostly (94%) who received CBT, presenting lower psychological comorbidity than NE. CBT could positively influence postoperative outcomes.