Feasibility and indicative results from a 12-month low-energy liquid diet treatment and maintenance programme for severe obesity
Open accessAbstract
BACKGROUND: There is no established primary care solution for the rapidly increasing numbers of severely obese people with body mass index (BMI) > 40 kg/m(2). AIM: This programme aimed to generate weight losses of ≥15 kg at 12 months, within routine primary care. DESIGN AND SETTING: Feasibility study in primary care. METHOD: Patients with a BMI ≥40 kg/m(2) commenced a micronutrient-replete 810-833 kcal/day low-energy liquid diet (LELD), delivered in primary care, for a planned 12 weeks or 20 kg weight loss (whichever was the sooner), with structured food reintroduction and then weight-loss maintenance, with optional orlistat to 12 months. RESULT: Of 91 patients (74 females) entering the programme (baseline: weight 131 kg, BMI 48 kg/m(2), age 46 years), 58/91(64%) completed the LELD stage, with a mean duration of 14.4 weeks (standard deviation [SD] = 6.0 weeks), and a mean weight loss of 16.9 kg (SD = 6.0 kg). Four patients commenced weight-loss maintenance omitting the food-reintroduction stage. Of the remaining 54, 37(68%) started and completed food reintroduction over a mean duration of 9.3 weeks (SD = 5.7 weeks), with a further mean weight loss of 2.1 kg (SD = 3.7 kg), before starting a long-term low-fat-diet weight-loss maintenance plan. A total of 44/91 (48%) received orlistat at some stage. At 12 months, weight was recorded for 68/91 (75%) patients, with a mean loss of 12.4 kg (SD = 11.4 kg). Of these, 30 (33% of all 91 patients starting the programme) had a documented maintained weight loss of ≥15 kg at 12 months, six (7%) had a 10-15 kg loss, and 11 (12%) had a 5-10 kg loss. The indicative cost of providing this entire programme for wider implementation would be £861 per patient entered, or £2611 per documented 15 kg loss achieved. CONCLUSION: A care package within routine primary care for severe obesity, including LELD, food reintroduction, and weight-loss maintenance, was well accepted and achieved a 12-month-maintained weight loss of ≥15 kg for one-third of all patients entering the programme.
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For participants who ceased to engage and did not attend their 12 month trial appointment, data from GP records within a window of plus or minus 3 months of the scheduled follow-up date were used if available, as pre-specified in the protocol.
“For participants who ceased to engage and did not attend their 12 month trial appointment, data from GP records (within a window of plus or minus 3 months of the scheduled follow-up date) were used if available, as pre-specified in the protocol.11”
From Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial (2018) · cites this paper as [11]
The Outcome evaluations for analysis section says 12-month weights were taken within ±90 days of 365 days from baseline, and that weights for patients lost to follow-up were obtained opportunistically from health-professional measurements outside the study. It does not specify GP records, a missed trial appointment, or that this approach was pre-specified in a protocol. (LLM, conf=0.85)
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- Authors
- Lean, M., Brosnahan, N., McLoone, P., McCombie, L., Higgs, A. B., Ross, H., Mackenzie, M., Grieve, E., Finer, N., Reckless, J., Haslam, D., Sloan, B., & Morrison, D.
- Affiliations
- Royal United Hospital (GB)
- ORCID
- Venue
- British Journal of General Practice
- Published
- 2013-02
- Volume
- 63
- Issue
- 607
- Pages
- e115-e124
- ISSN
- 0960-1643 (ISSN-L)
- 1478-5242
- PMC
- PMC3553637
- OpenAlex
- W2160489098
- Semantic Scholar
- 756c1467377df5b7f842bd2845852a784f83c191
- Cited by
- 87
- References
- 41
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 5 · 2023: 9 · 2022: 3 · 2021: 9 · 2020: 10 · 2019: 7 · 2018: 8 · 2017: 7 · 2016: 8 · 2015: 5 · 2014: 7 · 2013: 4
- FWCI
- 5.89
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of General Practice (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Pharmacology and Obesity Treatment
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- obesity, weight loss, weight loss maintenance, food reintroduction, orlistat, feasibility, cost analysis
- MeSH terms
- Orlistat, Adult, Diet, Reducing, Feasibility Studies, Feeding Behavior, Feeding Methods, Female, Humans, Lactones, Male, Middle Aged, Obesity, Morbid, Patient Compliance, Patient Education as Topic, Weight Loss, Treatment Outcome, Patient Satisfaction, Micronutrients, Anti-Obesity Agents, Young Adult
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