Advertisement

Current Hepatology Reports

, Volume 18, Issue 4, pp 444–454 | Cite as

Medical Approach for Weight Loss in Nonalcoholic Fatty Liver Disease

  • Albert DoEmail author
  • Ysabel C. Ilagan-Ying
  • Wajahat Z. Mehal
Fatty Liver Disease (V Ajmera, Section Editor)
  • 22 Downloads
Part of the following topical collections:
  1. Topical Collection on Fatty Liver Disease

Abstract

Purpose of Review

Nonalcoholic fatty liver disease (NAFLD) has reached epidemic proportions due to obesity in the modern world. Although treatments are in development, weight loss remains the most definitive and impactful approach to treating this disease and with it the other multisystemic complications of obesity. In this review, we summarize the current medical therapies for weight loss in NAFLD, including patient evaluation, counseling, and incorporation of medications for obesity.

Recent Findings

Despite need for weight loss as treatment for NAFLD, few achieve successful weight loss. Weight loss medications lead to weight loss of 5 to 10%, the amount expected to improve NAFLD steatosis and fibrosis. Ultimately, a multimodal approach is necessary to achieve successful weight loss.

Summary

Medical management for weight loss in NAFLD requires fibrosis staging and developing a patient-centered approach to assessment of patient weight and behavioral change goals.

Keywords

Steatohepatitis Obesity Pharmacology Weight loss medications Diet Exercise 

Abbreviations

BMI

Body mass index

CP

Child Pugh

EBT

Endoscopic bariatric therapies

FDA

Food and Drug Administration

NAFL

Nonalcoholic fatty liver

NAFLD

Nonalcoholic fatty liver disease

NASH

Nonalcoholic steatohepatitis

Notes

Acknowledgments

This work was funded by the National Institutes of Health (NIH T32 DK007017-41 (AD)).

Author Contributions

All authors (AD, YCI, and WZM) contributed to research, writing, and editing of this manuscript.

Compliance with Ethical Standards

Conflict of Interest

Albert Do, Ysabel C. Ilagan-Ying, and Wajahat Z. Mehal each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    •• Younossi Z, Anstee QM, Marietti M, Hardy T, Henry L, Eslam M, et al. Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention. Nat Rev Gastroenterol Hepatol. 2018;15(1):11 Global perspective on the epidemiology of NAFLD worldwide with emphasis on growing strain on health-care systems, calling to attention primary care providers, specialists, and health policy makers. PubMedPubMedCentralGoogle Scholar
  2. 2.
    Younossi ZM, Stepanova M, Afendy M, Fang Y, Younossi Y, Mir H, et al. Changes in the prevalence of the most common causes of chronic liver diseases in the United States from 1988 to 2008. Clin Gastroenterol Hepatol. 2011;9(6):524-30. e1.CrossRefGoogle Scholar
  3. 3.
    Wong RJ, Aguilar M, Cheung R, Perumpail RB, Harrison SA, Younossi ZM, et al. Nonalcoholic steatohepatitis is the second leading etiology of liver disease among adults awaiting liver transplantation in the United States. Gastroenterology. 2015;148(3):547–55.CrossRefGoogle Scholar
  4. 4.
    Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease—meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64(1):73–84.PubMedPubMedCentralGoogle Scholar
  5. 5.
    • Lindenmeyer CC, McCullough AJ. The natural history of nonalcoholic fatty liver disease-an evolving view. Clin Liver Dis. 2018;22(1):11–21 Review on the elevated risk of NAFLD patients for cardiovascular, malignancy, and liver-related morbidity and mortality. PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Carias S, Castellanos AL, Vilchez V, Nair R, Dela Cruz AC, Watkins J, et al. Nonalcoholic steatohepatitis is strongly associated with sarcopenic obesity in patients with cirrhosis undergoing liver transplant evaluation. J Gastroenterol Hepatol. 2016;31(3):628–33.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    •• Paul S, Charlton M. Surgical issues in NASH: bariatric surgery and liver transplantation. Curr Hepatol Rep. 2018;17(4):367–76 Recent review on the primary effects of bariatric surgery on changes in liver disease severity in NAFLD and NASH patients, including the primary effects of bariatric surgery on metabolic pathways. CrossRefGoogle Scholar
  8. 8.
    Corey KE, Klebanoff MJ, Tramontano AC, Chung RT, Hur C. Screening for nonalcoholic steatohepatitis in individuals with type 2 diabetes: a cost-effectiveness analysis. Dig Dis Sci. 2016;61(7):2108–17.PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Health Promot. 1997;12(1):38–48.PubMedCrossRefGoogle Scholar
  10. 10.
    Johnson SS, Paiva AL, Cummins CO, Johnson JL, Dyment SJ, Wright JA, et al. Transtheoretical model-based multiple behavior intervention for weight management: effectiveness on a population basis. Prev Med. 2008;46(3):238–46.PubMedCrossRefGoogle Scholar
  11. 11.
    Tuah NA, Amiel C, Qureshi S, Car J, Kaur B, Majeed A. Transtheoretical model for dietary and physical exercise modification in weight loss management for overweight and obese adults. Cochrane Database Syst Rev. 2011;10:CD008066.Google Scholar
  12. 12.
    Angulo P, Kleiner DE, Dam-Larsen S, Adams LA, Bjornsson ES, Charatcharoenwitthaya P, et al. Liver fibrosis, but no other histologic features, is associated with long-term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology. 2015;149(2):389–97 e10.PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Singh S, Allen AM, Wang Z, Prokop LJ, Murad MH, Loomba R. Fibrosis progression in nonalcoholic fatty liver vs nonalcoholic steatohepatitis: a systematic review and meta-analysis of paired-biopsy studies. Clin Gastroenterol Hepatol. 2015;13(4):643-54. e9.CrossRefGoogle Scholar
  14. 14.
    Hardy T, Oakley F, Anstee QM, Day CP. Nonalcoholic fatty liver disease: pathogenesis and disease spectrum. Annual Review of Pathology: Mechanisms of Disease. 2016;11:451–96.CrossRefGoogle Scholar
  15. 15.
    •• Sanyal AJ, Harrison SA, Ratziu V, Abdelmalek MF, Diehl AM, Caldwell S, et al. The natural history of advanced fibrosis due to nonalcoholic steatohepatitis: data from the simtuzumab trials. Hepatology. 2019; Study of the progression of fibrosis in NASH on multiple levels including Ishak fibrosis stage, hepatic collagen content and alpha-smooth muscle actin, NAFLD activity score, and serum markers for fibrosis. Studied the progression to cirrhosis in patients enrolled in two phase 2b, placebo-controlled trials of simtuzumab. Google Scholar
  16. 16.
    McPherson S, Hardy T, Henderson E, Burt AD, Day CP, Anstee QM. Evidence of NAFLD progression from steatosis to fibrosing-steatohepatitis using paired biopsies: implications for prognosis and clinical management. J Hepatol. 2015;62(5):1148–55.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    •• Kleiner DE, Brunt EM, Belt PH, Wilson L, Guy CD, Yeh MM, et al. Diagnostic pattern and disease activity are related to disease progression and regression in nonalcoholic fatty liver disease. Hepatology. In: WILEY-BLACKWELL 111 RIVER ST, HOBOKEN 07030-5774. NJ: USA; 2016. AASLD summary finding that AST, portal inflammation, baseline fibrosis stage, and NAS are predictors of fibrosis progression or regression, and that fibrosis progression in NAFL patients is linked to evolution of NASH. Google Scholar
  18. 18.
    Targher G, Day CP, Bonora E. Risk of cardiovascular disease in patients with nonalcoholic fatty liver disease. N Engl J Med. 2010;363(14):1341–50.PubMedCrossRefGoogle Scholar
  19. 19.
    Söderberg C, Stål P, Askling J, Glaumann H, Lindberg G, Marmur J, et al. Decreased survival of subjects with elevated liver function tests during a 28-year follow-up. Hepatology. 2010;51(2):595–602.CrossRefGoogle Scholar
  20. 20.
    Manne V, Handa P, Kowdley KV. Pathophysiology of nonalcoholic fatty liver disease/nonalcoholic steatohepatitis. Clinics Liver Dis. 2018;22(1):23–37.CrossRefGoogle Scholar
  21. 21.
    •• Chalasani N, Younossi Z, Lavine JE, Charlton M, Cusi K, Rinella M, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018;67(1):328–57 Latest guidelines from the AASLD regarding management of NAFLD patients. CrossRefGoogle Scholar
  22. 22.
    Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L, Torres-Gonzalez A, Gra-Oramas B, Gonzalez-Fabian L, et al. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterology. 2015;149(2):367-78 e5 quiz e14-5.CrossRefGoogle Scholar
  23. 23.
    Whitsett M, Marzio DH, Rossi S. SlimQuick-associated hepatotoxicity resulting in fulminant liver failure and orthotopic liver transplantation. ACG Case Rep J. 2014;1(4):220–2.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    • Greenhalgh S. Soda industry influence on obesity science and policy in China. J Public Health Policy. 2019;40(1):5–16 Excellent review on the soda industry and anti-obesity policy, which is well documented in the US but is now gaining recognition as a global obesity epidemic contributor abroad. PubMedCrossRefPubMedCentralGoogle Scholar
  25. 25.
    Allison DB, Casey DE. Antipsychotic-induced weight gain: a review of the literature. J Clin Psychiatry. 2001.Google Scholar
  26. 26.
    Saunders KH, Igel LI, Shukla AP, Aronne LJ. Drug-induced weight gain: rethinking our choices. J Fam Pract. 2016;65(11):780–8.PubMedGoogle Scholar
  27. 27.
    Giles-Corti B, Macintyre S, Clarkson JP, Pikora T, Donovan RJ. Environmental and lifestyle factors associated with overweight and obesity in Perth. Australia American Journal of Health Promotion. 2003;18(1):93–102.PubMedCrossRefGoogle Scholar
  28. 28.
    Fleischhacker SE, Evenson KR, Rodriguez DA, Ammerman AS. A systematic review of fast food access studies. Obes Rev. 2011;12(5):e460–e71.PubMedCrossRefGoogle Scholar
  29. 29.
    •• Hall KD. Did the food environment cause the obesity epidemic? Obesity. 2018;26(1):11–3 Study from the NIDDKD division of the NIH studying how the changing food environment has shaped the obesity epidemic, supporting sensitivity of healthcare systems to policy-level health factors that affect individual patients struggling with weight. PubMedCrossRefGoogle Scholar
  30. 30.
    • Phelan SM, Burgess DJ, Yeazel MW, Hellerstedt WL, Griffin JM, van Ryn M. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obes Rev. 2015;16(4):319–26 Critical review of empirical evidence regarding obesity stigma to highlight prejudice in medical care , with potential intervention strategies that may reduce the impact of obesity stigma on quality of care. PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Casazza K, Fontaine KR, Astrup A, Birch LL, Brown AW, Bohan Brown MM, et al. Myths, presumptions, and facts about obesity. N Engl J Med. 2013;368(5):446–54.PubMedPubMedCentralCrossRefGoogle Scholar
  32. 32.
    Malnick SD, Knobler H. The medical complications of obesity. Journal of the Association of Physicians. 2006;99(9):565–79.CrossRefGoogle Scholar
  33. 33.
    Puhl R, Brownell KD. Bias, discrimination, and obesity. Obes Res. 2001;9(12):788–805.PubMedCrossRefGoogle Scholar
  34. 34.
    Bagley C, Conklin D, Isherwood R, Pechiulis D, Watson L. Attitudes of nurses toward obesity and obese patients. Perceptual and Motor Skills. 1989;68(3):954.PubMedCrossRefGoogle Scholar
  35. 35.
    Alegria Drury CA, Louis M. Exploring the association between body weight, stigma of obesity, and health care avoidance. J Am Acad Nurse Pract. 2002;14(12):554–61.CrossRefGoogle Scholar
  36. 36.
    Vartanian LR, Novak SA. Internalized societal attitudes moderate the impact of weight stigma on avoidance of exercise. Obesity. 2011;19(4):757–62.PubMedCrossRefGoogle Scholar
  37. 37.
    Vartanian LR, Porter AM. Weight stigma and eating behavior: a review of the literature. Appetite. 2016;102:3–14.PubMedCrossRefGoogle Scholar
  38. 38.
    •• van der Windt DJ, Sud V, Zhang H, Tsung A, Huang H. The effects of physical exercise on fatty liver disease. Gene Expression, The Journal of Liver Research. 2018;18(2):89–101 Review summarizing the evidence for effects of physical exercise specifically in NAFLD and NASH patients. CrossRefGoogle Scholar
  39. 39.
    Thoma C, Day CP, Trenell MI. Lifestyle interventions for the treatment of non-alcoholic fatty liver disease in adults: a systematic review. J Hepatol. 2012;56(1):255–66.PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Dansinger ML, Gleason JA, Griffith JL, Selker HP, Schaefer EJ. Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. Jama. 2005;293(1):43–53.PubMedCrossRefGoogle Scholar
  41. 41.
    Lewis MC, Phillips ML, Slavotinek JP, Kow L, Thompson CH, Toouli J. Change in liver size and fat content after treatment with Optifast® very low calorie diet. Obes Surg. 2006;16(6):697–701.PubMedCrossRefGoogle Scholar
  42. 42.
    Pontzer H, Durazo-Arvizu R, Dugas LR, Plange-Rhule J, Bovet P, Forrester TE, et al. Constrained total energy expenditure and metabolic adaptation to physical activity in adult humans. Curr Biol. 2016;26(3):410–7.PubMedPubMedCentralCrossRefGoogle Scholar
  43. 43.
    • Piercy KL, Troiano RP, Ballard RM, Carlson SA, Fulton JE, Galuska DA, et al. The physical activity guidelines for Americans. Jama. 2018;320(19):2020–8 Summary of key guidelines in the 2018 Physical Activity Guidelines for Americans with specific age and activity goals for physical activity to improve a variety of health outcomes. PubMedCrossRefGoogle Scholar
  44. 44.
    Hallsworth K, Fattakhova G, Hollingsworth KG, Thoma C, Moore S, Taylor R, et al. Resistance exercise reduces liver fat and its mediators in non-alcoholic fatty liver disease independent of weight loss. Gut. 2011;60(9):1278–83.PubMedPubMedCentralCrossRefGoogle Scholar
  45. 45.
    Keating SE, Hackett DA, George J, Johnson NA. Exercise and non-alcoholic fatty liver disease: a systematic review and meta-analysis. J Hepatol. 2012;57(1):157–66.PubMedCrossRefGoogle Scholar
  46. 46.
    Wing RR, Phelan S. Long-term weight loss maintenance. Am J Clin Nutr. 2005;82(1):222S–5S.PubMedCrossRefGoogle Scholar
  47. 47.
    •• Igel LI, Kumar RB, Saunders KH, Aronne LJ. Practical use of pharmacotherapy for obesity. Gastroenterology. 2017;152(7):1765–79 Review of medications that can lead to weight gain, alternatives, and anti-obesity medications. PubMedCrossRefGoogle Scholar
  48. 48.
    Wadden TA, Berkowitz RI, Womble LG, Sarwer DB, Phelan S, Cato RK, et al. Randomized trial of lifestyle modification and pharmacotherapy for obesity. N Engl J Med. 2005;353(20):2111–20.PubMedCrossRefGoogle Scholar
  49. 49.
    •• Do A, Kuszewski EJ, Mehal WZ. Incorporating Weight Loss Medications into Hepatology Practice for Nonalcoholic Steatohepatitis. Hepatology. 2019; Practical considerations for application of weight loss medications into hepatology clinics for NASH patients. Google Scholar
  50. 50.
    • Hagström H, Nasr P, Ekstedt M, Hammar U, Stål P, Hultcrantz R, et al. Fibrosis stage but not NASH predicts mortality and time to development of severe liver disease in biopsy-proven NAFLD. J Hepatol. 2017;67(6):1265–73 Large study of biopsy-proven NAFLD to study if NASH increased the risk of liver-specific morbidity and overall mortality. CrossRefGoogle Scholar
  51. 51.
    Ekstedt M, Hagstrom H, Nasr P, Fredrikson M, Stal P, Kechagias S, et al. Fibrosis stage is the strongest predictor for disease-specific mortality in NAFLD after up to 33 years of follow-up. Hepatology. 2015;61(5):1547–54.CrossRefGoogle Scholar
  52. 52.
    Montano-Loza AJ, Meza-Junco J, Prado CM, Lieffers JR, Baracos VE, Bain VG, et al. Muscle wasting is associated with mortality in patients with cirrhosis. Clin Gastroenterol Hepatol. 2012;10(2):166-73. e1.CrossRefGoogle Scholar
  53. 53.
    Hanai T, Shiraki M, Nishimura K, Ohnishi S, Imai K, Suetsugu A, et al. Sarcopenia impairs prognosis of patients with liver cirrhosis. Nutrition. 2015;31(1):193–9.PubMedCrossRefGoogle Scholar
  54. 54.
    Dasarathy S. Consilience in sarcopenia of cirrhosis. J Cachexia Sarcopenia Muscle. 2012;3(4):225–37.PubMedPubMedCentralCrossRefGoogle Scholar
  55. 55.
    Ziser A, Plevak DJ, Wiesner RH, Rakela J, Offord KP, Brown DL. Morbidity and mortality in cirrhotic patients undergoing anesthesia and surgery. Anesthesiology: The Journal of the American Society of Anesthesiologists. 1999;90(1):42–53.CrossRefGoogle Scholar
  56. 56.
    O’Leary JG, Friedman LS. Predicting surgical risk in patients with cirrhosis: from art to science. Gastroenterology. 2007;132(4):1609–11.PubMedCrossRefGoogle Scholar
  57. 57.
    Mosko JD, Nguyen GC. Increased perioperative mortality following bariatric surgery among patients with cirrhosis. Clin Gastroenterol Hepatol. 2011;9(10):897–901.PubMedCrossRefGoogle Scholar
  58. 58.
    Shimizu H, Phuong V, Maia M, Kroh M, Chand B, Schauer PR, et al. Bariatric surgery in patients with liver cirrhosis. Surg Obes Relat Dis. 2013;9(1):1–6.PubMedCrossRefGoogle Scholar
  59. 59.
    Periyalwar P, Dasarathy S. Malnutrition in cirrhosis: contribution and consequences of sarcopenia on metabolic and clinical responses. Clinics Liver Dis. 2012;16(1):95–131.CrossRefGoogle Scholar
  60. 60.
    Moctezuma-Velázquez C, García-Juárez I, Soto-Solís R, Hernández-Cortés J, Torre A. Nutritional assessment and treatment of patients with liver cirrhosis. Nutrition. 2013;29(11-12):1279–85.PubMedCrossRefGoogle Scholar
  61. 61.
    Nguyen V, Li J, Gan J, Cordero P, Ray S, Solis-Cuevas A, et al. Outcomes following serial intragastric balloon therapy for obesity and nonalcoholic fatty liver disease in a single centre. Canadian J Gastroenterol Hepatol. 2017;2017.Google Scholar
  62. 62.
    •• Dayyeh BKA, Edmundowicz S, Thompson CC. Clinical practice update: expert review on endoscopic bariatric therapies. Gastroenterology. 2017;152(4):716–29 Best practice advice for endoscopic bariatric therapies and their role in part of a structured weight loss program that includes dietary intervention, exercise, and behavior modification throughout weight loss and long-term weight maintenance. PubMedCrossRefGoogle Scholar
  63. 63.
    Mummadi RR, Kasturi KS, Chennareddygari S, Sood GK. Effect of bariatric surgery on nonalcoholic fatty liver disease: systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2008;6(12):1396–402.PubMedCrossRefPubMedCentralGoogle Scholar
  64. 64.
    Mingrone G, Panunzi S, De Gaetano A, Guidone C, Iaconelli A, Leccesi L, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366(17):1577–85.PubMedCrossRefPubMedCentralGoogle Scholar
  65. 65.
    Sjöström L, Lindroos A-K, Peltonen M, Torgerson J, Bouchard C, Carlsson B, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93.PubMedPubMedCentralCrossRefGoogle Scholar
  66. 66.
    Schauer PR, Kashyap SR, Wolski K, Brethauer SA, Kirwan JP, Pothier CE, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366(17):1567–76.PubMedCrossRefPubMedCentralGoogle Scholar
  67. 67.
    Ikramuddin S, Korner J, Lee W-J, Connett JE, Inabnet WB, Billington CJ, et al. Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the Diabetes Surgery Study randomized clinical trial. Jama. 2013;309(21):2240–9.PubMedPubMedCentralCrossRefGoogle Scholar
  68. 68.
    Mathurin P, Hollebecque A, Arnalsteen L, Buob D, Leteurtre E, Caiazzo R, et al. Prospective study of the long-term effects of bariatric surgery on liver injury in patients without advanced disease. Gastroenterology. 2009;137(2):532–40.CrossRefGoogle Scholar
  69. 69.
    Mekary RA, Feskanich D, Hu FB, Willett WC, Field AE. Physical activity in relation to Long-term weight maintenance after intentional weight loss in premenopausal women. Obesity. 2010;18(1):167–74.PubMedCrossRefPubMedCentralGoogle Scholar
  70. 70.
    Miller WC, Koceja D, Hamilton E. A meta-analysis of the past 25 years of weight loss research using diet, exercise or diet plus exercise intervention. Int J Obes. 1997;21(10):941.CrossRefGoogle Scholar
  71. 71.
    Elfhag K, Rössner S. Who succeeds in maintaining weight loss? A conceptual review of factors associated with weight loss maintenance and weight regain. Obes Rev. 2005;6(1):67–85.PubMedCrossRefGoogle Scholar
  72. 72.
    Wing RR, Tate DF, Gorin AA, Raynor HA, Fava JL. A self-regulation program for maintenance of weight loss. N Engl J Med. 2006;355(15):1563–71.PubMedCrossRefGoogle Scholar
  73. 73.
    Thomas JG, Bond DS, Phelan S, Hill JO, Wing RR. Weight-loss maintenance for 10 years in the National Weight Control Registry. Am J Prev Med. 2014;46(1):17–23.PubMedCrossRefGoogle Scholar
  74. 74.
    Harvey-Berino J, Pintauro S, Buzzell P, Gold EC. Effect of internet support on the long-term maintenance of weight loss. Obes Res. 2004;12(2):320–9.PubMedCrossRefGoogle Scholar
  75. 75.
    • Svetkey LP, Stevens VJ, Brantley PJ, Appel LJ, Hollis JF, Loria CM, et al. Comparison of strategies for sustaining weight loss: the weight loss maintenance randomized controlled trial. Jama. 2008;299(10):1139–48 Clinical trial on initial behavioral weight loss programs, finding that monthly brief personal contact provided modest benefit in sustaining weight loss. PubMedCrossRefGoogle Scholar
  76. 76.
    Sumithran P, Prendergast LA, Delbridge E, Purcell K, Shulkes A, Kriketos A, et al. Long-term persistence of hormonal adaptations to weight loss. N Engl J Med. 2011;365(17):1597–604.PubMedCrossRefGoogle Scholar
  77. 77.
    Fothergill E, Guo J, Howard L, Kerns JC, Knuth ND, Brychta R, et al. Persistent metabolic adaptation 6 years after “The Biggest Loser” competition. Obesity. 2016;24(8):1612–9.PubMedCrossRefGoogle Scholar
  78. 78.
    Rosenbaum M, Hirsch J, Gallagher DA, Leibel RL. Long-term persistence of adaptive thermogenesis in subjects who have maintained a reduced body weight. Am J Clin Nutr. 2008;88(4):906–12.PubMedCrossRefGoogle Scholar
  79. 79.
    Franz MJ, VanWormer JJ, Crain AL, Boucher JL, Histon T, Caplan W, et al. Weight-loss outcomes: a systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up. J Am Diet Assoc. 2007;107(10):1755–67.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Albert Do
    • 1
    Email author
  • Ysabel C. Ilagan-Ying
    • 2
  • Wajahat Z. Mehal
    • 1
  1. 1.Section of Digestive Diseases, Department of Internal MedicineYale School of MedicineNew HavenUSA
  2. 2.Yale School of MedicineNew HavenUSA

Personalised recommendations