Fatores associados à manutenção do peso perdido após tratamento clínico da obesidade

Abstract

Introduction: obesity is a chronic disease, with complex and multiple factors influencing it. Obesity treatments and weight reduction involve several disciplines, and the health benefits are well documented in academia. However, after the initial weight loss, weight maintenance is a challenging process, especially because it involves changes in the physiological mechanisms contributing to weight regain. Many strategies were described for weight loss; however, there is limited academic data on weight maintenance after initial loss. Primary objective: to evaluate which factors are associated with weight maintenance post-initial weight loss, specifically focusing on patients under clinical treatment for obesity. Methods: an analytical cross-sectional study leveraging self-administered questionnaires, available in both physical (public endocrinology health centers) and online (public and private healthcare services) versions, conducted in Brazilian Federal District. The surveys mapped demographic and anthropometric factors, clinical aspects and lifestyle habits. The inclusion criteria were people with current or previous history of obesity (body mass index – BMI ≥ 30kg/m²), with age between 18-65 years old, who have lost at least 10% of their maximum weight. Patients who had undergone bariatric surgery or had conditions that could affect weight changes, such as thyroid disorders, malignancies, and the use of insulin or corticosteroids, were excluded from the study. Weight regain of up to 20% of weight lost after one year was considered “weight maintenance” and above this threshold was considered “weight regain”. The data analysis was conducted through the calculation of the Weight of Evidence (WOE) for categorical variables, univariate logistic regression and subsequent multivariate analysis. Results: 165 patients were included in the study. Among the participants, 27 (16.4%) successfully maintained their weight loss, while 138 (83.6%) exhibited weight regain. In the univariate analysis, the main factors associated with the weight maintenance (p < 0.05) were frequency of consultations per year (6 or more), patient success parameter (reaching normal BMI), reason for not maintaining weight (“nothing stops me”), use of medications on label for obesity treatment, not eating breakfast, consumption of alcoholic beverages (2-3 times per week), daily consumption of food substitutes, frequency of physical exercise (6 or more times per week) and amount of weight loss (19 to 30.5% and 30.5% to 41.9% of maximum weight). Protein foods consumption twice daily was associated with weight regain (p = 0.014). In the multivariate analysis, frequency of consultations 2-3 (p = 0.003), 4-5 (p = 0.001) and 6 or more times a year (p < 0.001), the success metric defined as “feel beautiful and comfortable with your own body” (p = 0.002), having breakfast daily (p = 0.042) and physical exercise frequency 2-3, 4-5 and 6 or more days a week (p < 0.001) were statistically significantly with weight maintenance. Conclusion: according to the study mentioned above, the frequency of consultations, success metric definition, having breakfast daily and physical activity frequency were factors independently associated with weight maintenance. Future research can provide additional insights into the causal effects of the above-mentioned factors and the lost weight maintenance.