Effect of weight loss achieved by a lifestyle programme on appetite control in morbid obese patients
Prosjekt
- Prosjektnummer
- 46055600-10
- Ansvarlig person
- Catia Martins
- Institusjon
- NTNU, IKOM
- Prosjektkategori
- Korttidsprosjekt 2013
- Helsekategori
- Metabolic and Endocrine
- Forskningsaktivitet
- 6. Treatment Evaluation
Rapporter
The impact of lifestyle-induced weight loss on appetite in patients with obesity remains controversial. This study aimed to assess the short- and long-term impact of weight loss achieved by diet and exercise, on appetite in patients with obesity. Thirty-five (22 females) adults with severe obesity (BMI: 42.5±5.0 kg/m2) underwent a 2-year WL program focusing on diet and exercise. Body weight (BW), cardiovascular fitness (VO2max), appetite feelings and plasma concentrations of insulin, active ghrelin (AG), glucagon-like peptide 1 (GLP-1), peptide YY (PYY) and cholecystokinin (CCK), in the fasting and postprandial states, were measured at baseline (B), week 4 (W4), 1 and 2-years (and average values for all fasting and postprandial time points computed). BW was significantly reduced and VO2max (ml/kg/min) increased at all time points compared with B (3.5, 8.1 and 8.4 % WL and 7, 11 and 8 % increase at W4, 1 and 2y, respectively). Basal hunger and average hunger and desire to eat were significantly increased at 1 and 2y. Basal fullness was significantly increased at W4 and average ratings reduced at 1y. Average AG and PYY were significantly increased, and insulin reduced, at all time points compared with B. Average GLP-1 was reduced at W4 and CCK increased at 2y. After lifestyle-induced WL, patients with severe obesity will, therefore, have to deal with increased hunger in the long-term. In conclusion, sustained WL at 2y achieved with diet and exercise is associated with increased hunger feelings and ghrelin concentration, but also increased postprandial concentrations of satiety hormones.
It is extremely important that both health professionals working with this patient group and patients with obesity are aware of the fact that sustained weight loss after a multidisciplinary intervention in patients with severe obesity is associated with increased hunger feelings. This shoudl be discussed with the patients and dietary strategies should be development to help them deal with this important side effect of weight loss, so that it does not translate into overeating and relapse.
I have been on maternity leave from May 2015 til May 2016. I am now working on the manuscript and hope to submit it during the next couple of months.I have been on maternity leave from May 2015 til May 2016. I am now working on the manuscript and hope to submit it during the next couple of months.
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Manuscript under preparation
All the lab work is now completed and a manuscript is expected to be submitted in 2016.I have been on maternity leave since May 2015 and on partial sick leave from October 2014-May 2015. For that reason, this project has not evolved as much as desired.
All the lab work is now completed and a manuscript is expected to be submitted in 2016.
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All the plasma samples have been analysed for insulin, PYY, GLP-1, active ghrelin and CCK.
Results will be published in 2016In this project, adult patients with mobid obesity (BMI>40 Kg/m2 or BMI>35kg/m2 with obesity related comorbidities) were treated at Røros Rehabilitering using an intermittent multidiciplinary lifestsyle intervention with a follow up time of 2 years (5 stays at Røros overall). Data on body weigth and composition, markers of subjective appetite (using visual analogue scales) and fasting and postprandial blood samples (for a period of 3h after a standardised breakfast) were collected at four time points: baseline, end of the first stay at Røros Rehabilitering, one and two years follow-up.
Data collection from the last group with two-year follow-up at Røros Rehabilitering happened during Summer 2014.
The folowing data was generated:
6 participants (with 3 evaluation times) x 7 bloodsample timepoints (0 - fasting, 30, 60, 90, 120, 150 and 180 potsprandially)
27 participants (with 4 evaluation times) x 7
2 participants (with 2 evaluation times) x 7
This translates intoa total number of samples of 924.
All the plasma samples have been analysed for insulin, polipeptide YY (PYY), glucagon-like peptide 1 (GLP-1), active ghrelin and cholecistokinin (CCK).
We now need to analyse our results and write a manuscript with our findings. Given that I have been on partial sick leave since October last year and will be on maternity leave from first of May 2015, the publication of the results is likely to take more time than initially planned. However, results are expected to be published during 2016.
We have continued with 1 and 2-years data colection during 2013.
We will have the last group for 2-year data colection in June 2014, analyse the plasma samples generated during August-September and submit a paper during December 2014.
We have asked for an extension (untill end of 2014) to use the money we got from Samarbeidsorganet due to problems with recruitment .Obesity has become a global epidemic with huge public health implications. Although clinical significant weight loss (WL) can be achieved by a combination of diet and behavioral modification, strong metabolic adaptations, with increased hunger and reduced satiety, are activated which increase the risk of weight regain. Røros Rehabilitering Senter (RSSO) offers a “continuous care” WL programme with five intermittent stays over a 2 year period. We have shown that this programme leads to clinical significant weight loss, with improvements in risk factors and comorbidities resolution similar to bariatric surgery at one year. However, weight regain in the long-term is a problem. This project aims to investigate the impact of WL at RRS on compensatory mechanisms at the level of the appetite control system, both in the short-term (after the first stay of three weeks at RRC) and in the long term, after one year. We will look at both fasting and postprandial levels of appetite-related hormones and fasting/postprandial subjective feelings of hunger/fullness. Moreover, we also want to determine if initial compensatory mechanisms after 3 weeks of RRC can predict long-term weight loss outcomes at one year. Finally, we want to determine if cardiovascular fitness (VO2max) modulates the compensatory mechanisms activated by WL, both in the short- and long-term.
At baseline, end of first stay at RRC (3 weeks duration) and one year, body weight and composition, cardiovascular fitness (VO2peak) and the release of appetite-related hormones and subjective feelings of appetite (in fasting and for 180 minutes after a standard breakfast meal) were assessed. This project can bring large practical benefits concerning the design of weight loss programs to minimize weight relapse.
Vitenskapelige artikler
Coutinho SR, Rehfeld JF, Holst JJ, Kulseng B and Martins C
Impact of weight loss achieved through a multidisciplinary intervention on appetite in patients with severe obesity
AJP - Endocrinology and Metabolism, 2018 (accepted for publication)
Deltagere
- Catia Martins Prosjektleder
- Bård Eirik Kulseng Prosjektdeltaker
eRapport er utarbeidet av Sølvi Lerfald og Reidar Thorstensen, Regionalt kompetansesenter for klinisk forskning, Helse Vest RHF, og videreutvikles av de fire RHF-ene i fellesskap, med støtte fra Helse Vest IKT
Alle henvendelser rettes til Helse Midt-Norge RHF - Samarbeidsorganet og FFU