Baseline traits as predictors of success in medical weight management

Abstract

Background: Although there are current treatment plans for individuals who are seeking to lose a significant amount of weight, success rate are highly variable. Barriers to success include lack of attention to development of individualized weight loss plans, issues with lack of readiness to change or confidence to make a change, and pre-existing medical conditions and medications that inhibit weight loss. By understanding and addressing an individual's baseline characteristics there is the potential to create a more successful individualized weight loss program. Aim: To determine the relationship between baseline characteristics and subsequent weight loss in individuals at the University of Minnesota Adult Medical Weight Management clinic (MWM clinic). Materials/Subjects and Methods: Three-hundred fifty intake assessment forms from the MWM clinic were collected over a one and a half year time frame. Assessments were checked for completion based on answers of the Eating Habit (Table 1) and Eating Habit Frequency sections (Table 2), excluding any patient from further analysis if either section was not completed. The questions were split into 6 trait categories including preventive medical eating, disordered eating patterns, food insecurity, hunger disorder, emotional eating, and craving and binging. Later, craving and binging were split into binge eating and craving driven eating to determine the relationship between binging and craving. Data from a total of 219 patients were used for statistical analysis using SAS (version 9.3, SAS Institute Inc., Cary, NC). Results: Mean months of follow-up time for individuals with at least two visits (n = 84) was 4.05 ± 2.93 with significant difference seen between men (3.66 ± 1.95) and women (4.24 ± 3.29) (P = 0.040). Mean weight change per 30 days was -2.62 ± 4.05 (female: -2.13 ± 3.47; male: -3.65 ± 4.99) and the mean percent weight change per 30 days was -0.96 ± 1.46 (female: -0.82 ± 1.40; male: -1.26 ± 1.56). Success of 5% baseline body weight was seen in 42 (50%) and 10% in 23 (27%) of the population. Significant difference was seen between individuals who reported food insecurity compared to those who did not with change in weight per 30 days with individuals reporting food insecurity having a change in weight of -1.2 ± 0.8 pounds and those not reporting food insecurity having a change in weight of -3.5 ± 0.5 (P = 0.017). Percent change in weight per 30 days was seen to be significant between individuals with food insecurity (-0.36 ± 0.3) and those who did not report food insecurity (-1.3 ± 0.2) (P = 0.008). Highest odds ratios were seen in individual reporting food insecurity versus not and those reporting craving and binging versus not. Individuals who did not report food insecurity were 4.1 times more likely to reach 5% success (P = 0.010) and 5.6 times more likely to reach 10% success (P = 0.955). Patients that did not report craving and binging were 2.2 times more likely to reach 5% success (P = 0.306), and 3.7 times more likely to reach 10% success (P = 0.072). Conclusions: Individuals who self-reported food insecurity had significantly less weight loss per 30 days and percent weight change per 30 days compared to those who did not report food insecurity. Disordered eating (87%), craving driven eating (71%), and binge eating (82%) were the most common baseline traits seen in our patients. Women reported emotional eating more frequently than men (women: n = 42 (74%); men: n =14 (52%); P = 0.047). Hunger disorder was only reported in 59% (36 women and 14 men) of our study patients and was not statistically different between men and women. Presence of craving and binging was seen in 77% of females (n = 40) and 61% of males (n = 14) (P = 0.153). In conclusion, hunger driven eating was not as strongly reported in our obese population as some non-hunger related baseline traits including emotional eating and binging and craving driven eating. Food insecurity was negatively related to weight loss success, suggesting that low socioeconomic status remains a major barrier to successful weight loss.