INDIVIDUO: Results from a patient-centered lifestyle intervention for obesity surgery candidates - 26/08/16

Doi : 10.1016/j.orcp.2016.08.003

José Camolas ^a,^b,^⁎ , Osvaldo Santos ^c,^d, Pedro Moreira ^e, Isabel do Carmo ^a
^a Hospital Santa Maria/Faculdade de Medicina da Universidade de Lisboa, Portugal
^b Instituto Superior de Ciências da Saúde Egas Moniz, Monte de Caparica, Portugal
^c Instituto de Medicina Preventiva e Saúde Pública da Faculdade de Medicina da Universidade de Lisboa, Portugal
^d Instituto de Saúde Ambiental da Faculdade de Medicina da Universidade de Lisboa, Portugal
^e Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Portugal

^⁎Corresponding author at: Serviço de Endocrinologia, Diabetes e Metabolismo, Hospital Santa Maria, Piso 6, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Friday 26 August 2016
Cet article a été publié dans un numéro de la revue, cliquez ici pour y accéder

Summary

Background

Preoperative nutritional counseling provides an opportunity to ameliorate patients' clinical condition and build-up adequate habits and perception of competence. Study aimed to evaluate: (a) the effect of INDIVIDUO on weight and metabolic control; (b) the impact of INDIVIDUO on psychosocial variables associated with successful weight-control.

Methods

Two-arms randomised controlled single-site study, with six-month duration. Patients were recruited from an Obesity Treatment Unit’s waiting list. For the intervention group (IG), an operating procedure manual was used, nutritionists received training/supervision regarding INDIVIDUO's procedures. Control group (CG) received health literacy-promoting intervention. Intention-to-treat and per-control analysis were used. Outcomes included weight, metabolic control variables (blood pressure, glycemia, insulinemia, triglycerides, cholesterol), measures of eating and physical activity patterns, hedonic hunger, autonomous/controlled regulation, perceived competence for diet (PCS-diet) and quality of life. Primary outcomes were weight and metabolic control. Effect size was estimated by odds ratio and Cohens’d coefficient.

Results

Overall, 94 patients participated (IG:45; CG:49) and 60 completed the study (IG:29; CG:31). Intervention patients lost an excess 9.68% body weight (%EWL), vs. 0.51% for CG. Adjusting for age and baseline BMI, allocation group remained an independent predictor of %EWL (B=8.43, 95%CI: 2.79–14.06). IG had a six-fold higher probability (OR: 6.35, 95%CI: 1.28–31.56) of having adequate/controlled fasting glycemia at final evaluation. PCS-diet at final evaluation was independently predicted by baseline PCS-diet (B=0.31, 95%CI: 0.06–0.64), variation in autonomous regulation (B=0.43, 95%CI: 0.15–0.71) and allocation group (B=0.26, 95%CI: 0.04–1.36).

Conclusions

Results on weight and metabolic control support INDIVIDUO as a valuable clinical tool for obesity surgery candidates counseling. Additionally, intervention associated with perceived competence for weight-control behaviours and autonomous regulation.

Le texte complet de cet article est disponible en PDF.

Keywords : Bariatric surgery preoperative diet, Severe obesity, Patient centered care, Clinical effectiveness