Patient predictors of weight loss following a behavioral weight management intervention among US Veterans with severe obesity
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Identification of patient characteristics that are associated with behavioral weight loss success among bariatric surgery candidates could inform selection of optimal bariatric surgery candidates. We examined the associations between psychosocial characteristics and weight loss in a group of Veterans with severe obesity who participated in a behavioral weight loss intervention.
The MAINTAIN trial involved a 16-week weight loss program followed by randomization among participants losing at least 4 kg to a maintenance intervention or usual care. This secondary analysis was performed on Veterans who participated in the 16-week weight loss program and met NIH criteria for bariatric surgery (body mass index [BMI] 35.0–39.9 with at least 1 obesity-related comorbidity or BMI ≥ 40). Unadjusted and adjusted associations between baseline patient characteristics and weight loss during the 16-week induction phase were evaluated with linear regression. Missing weight measurements were multiply imputed, and results combined across ten imputations.
Among the 206 patients who met inclusion criteria, mean initial BMI was 40.8 kg/m2 (SD 6.0), and mean age was 59.2 years (SD 9.4). Approximately 20% of participants were female, 51.5% were Black, and 44.7% were White. Estimated mean 16-week weight loss was 5.16 kg (SD 4.31). In adjusted analyses, greater social support and older age were associated with greater weight loss (p < 0.05). None of the nine psychosocial characteristics we examined were associated with greater weight loss.
Understanding and strengthening the level of social support for bariatric surgery candidates may be important given that it appears to be strongly correlated with behavioral weight loss success.
Level of evidence
Level II, Evidence obtained from well-designed controlled trials without randomization.
ClinicalTrials.gov NCT01357551 http://clinicaltrials.gov/show/NCT01357551.
KeywordsClinical trials Weight loss Severe obesity Bariatric surgery
The authors thank Jamiyla Bolton MS, Jahdai Dawes, Marsha Turner, and Terry Ervin, RN for assistance with recruitment and conducting measurements; Elizabeth Strawbridge, MPH, RD, and Leslie Gaillard, RD, for delivery of the weight loss intervention; and Lesa Powell and Aviel Alkon for programming and database development. Finally, the authors thank all study participants.
Compliance with ethical standards
This study was funded by a grant awarded to Drs. Voils and Yancy by the Department of Veterans Affairs (DVA) Health Services Research & Development Service (IIR 11-040). Effort on this study and manuscript were also made possible by a VA Career Development Award to Dr. Funk (CDA 15-060), an NIH career development award to Dr. McVay (K23 HL127334), and a Research Career Scientist award to Dr. Voils (RCS 14-443). This work was supported by the Center of Innovation for Health Services Research in Primary Care (CIN 13-410) at the Durham VA Medical Center. The views represented in this article represent those of the authors and not those of the DVA or the US Government.
Conflict of interest
Effort on this study and manuscript was made possible by a VA Career Development Award to Dr. Funk, an NIH career development award to Dr. McVay, and a Research Career Scientist award to Dr. Voils. This work was also supported by the Center of Innovation for Health Services Research in Primary Care at the Durham VA Medical Center. The views represented in this article represent those of the authors and not those of the DVA or the US Government. The authors declare no conflicts of interest related to these funding sources.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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