Low Calorie Liquid Diet Feasibility Study Update
Why is a feasibility study needed for patients with a BMI >40?
The only evidence-based intervention for morbid obesity (BMI>40kg/m2 ) is bariatric surgery. Large observational studies have recently been supported by randomised controlled trial evidence showing major clinical benefits, including reversal of Type 2 diabetes with weight loss >15 kg after laparoscopic banding.1
Very little research on obesity treatments has addressed the management of morbid obesity. Most treatments for obesity have been directed towards achieving >5 kg or >5% weight loss, which will reliably reduce coronary heart disease risk factors.2 Approximately 30% of patients can achieve and maintain >5% weight loss at 12 months using diet and exercise interventions, and this can be increased to about 60-70% of patients if anti-obesity medications are used.3,4 Few of these studies, however, have been conducted in realistic, routine care settings.
The Counterweight Programme is the only fully evaluated evidence-based weight management service for use in routine NHS primary care. It leads to >5% weight loss, maintained for at least 2 years, for 30% of the attending population, with these results being shown to be highly cost effective.5, 6 A 5-10% weight loss is insufficient to deal with the rapid rise in morbid obesity which demands new cost-effective programmes to generate greater weight loss for these patients. Around 25% of patients referred to Counterweight have BMI>40kg/m2.
What is the research aim of the Low Calorie Liquid Diet (LCLD) feasibility study?
The aim is to establish if the LCLD programme is feasible and effective in primary care. To explore whether primary care nurses and dietitians can be trained to a level of confidence and competency to deliver the LCLD programme. This will include gathering both quantitative and qualitative data with patients receiving, and primary care nurses and dietitians delivering, Counterweight LCLDs. Further work will include validation of resources following data analysis.
When and where is the feasibility study being conducted?
Since February 2010 Counterweight has been undertaking a feasibility study across 7 Scottish Health Boards. This study aims to assess the acceptability and practicality of using LCLDs plus orlistat - a licensed anti-obesity medication - to promote significant weight loss ≥15kg for patients with a BMI≥40kg/m2. This amount of weight loss is rarely achieved using medical interventions currently available in primary care.
What does the Counterweight LCLD programme involve?
It is a 12month programme, with an initial LCLD stage lasting for 8-12 weeks to encourage a maximum 20kg weight loss. This will be followed by a structured weight maintenance stage which includes a low fat calorie controlled diet with or without orlistat. These treatments are evidence-based and well-established. Orlistat is licensed and widely used in primary care.
Results to date
So far feedback from patients and practitioners involved with the LCLD feasibility study has been positive, with 65 patients being recruited so far for inclusion in the study. The recruitment stage of the programme is now closed. Results will be made available in due course.
For further information please contact:-
Naomi Brosnahan,
Counterweight Specialist,
naomi.brosnahan@counterweight.org
Tel. 07810570650.
References
1. Dixon JB, O’Brien P, Playfair J et al. Adjustable gastric banding and conventional therapy for type 2 diabetes. A randomised controlled trial. JAMA 2008; 299:316-323
2. Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. NEJM 346: 393-403
3. SIGN (2010). Management of Obesity. No 115.
4. NICE (2006). Obesity: the prevention, identification, assessment and management of overweight and obesity in adults and children.
5. The Counterweight Project Team. Evaluation of the Counterweight Programme for obesity management in primary care: a starting point for continuous improvement. Br J Gen Pract 2008; 58: 548-554
6. The Counterweight Project Team. Long-Term Cost Effectiveness of Weight Management in Primary Care. International Journal of Clinical Practice (2010); 64(6), 775-783.