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. 2021 Nov 3;16(11):e0258545.
doi: 10.1371/journal.pone.0258545. eCollection 2021.

Effects of sustained weight loss on outcomes associated with obesity comorbidities and healthcare resource utilization

G Craig Wood  1 , Lisa Bailey-Davis  1 , Peter Benotti  1 , Adam Cook  1 , James Dove  1 , Jacob Mowery  1 , Abhilasha Ramasamy  2 , Neeraj Iyer  2 , B Gabriel Smolarz  2 , Neela Kumar  2 , Christopher D Still  1
Affiliations

Effects of sustained weight loss on outcomes associated with obesity comorbidities and healthcare resource utilization

G Craig Wood et al. PLoS One. .

Abstract

Objective: Determine the impact of long-term non-surgical weight loss maintenance on clinical relevance for osteoarthritis, cancer, opioid use, and depression/anxiety and healthcare resource utilization.

Methods: A cohort of adults receiving primary care within Geisinger Health System between 2001-2017 was retrospectively studied. Patients with ≥3 weight measurements in the two-year index period and obesity at baseline (BMI ≥30 kg/m2) were categorized: Obesity Maintainers (reference group) maintained weight within +/-3%; Weight Loss Rebounders lost ≥5% body weight in year one, regaining ≥20% of weight loss in year two; Weight Loss Maintainers lost ≥5% body weight in year one, maintaining ≥80% of weight loss. Association with development of osteoarthritis, cancer, opioid use, and depression/anxiety, was assessed; healthcare resource utilization was quantified. Magnitude of weight loss among maintainers was evaluated for impact on health outcomes.

Results: In total, 63,567 patients were analyzed including 67% Obesity Maintainers, 19% Weight Loss Rebounders, and 14% Weight Loss Maintainers; median follow-up was 9.7 years. Time until osteoarthritis onset was delayed for Weight Loss Maintainers compared to Obesity Maintainers (Logrank test p <0.0001). Female Weight Loss Maintainers had a 19% and 24% lower risk of developing any cancer (p = 0.0022) or obesity-related cancer (p = 0.0021), respectively. No significant trends were observed for opioid use. Weight loss Rebounders and Maintainers had increased risk (14% and 25%) of future treatment for anxiety/depression (both <0.0001). Weight loss maintenance of >15% weight loss was associated with the greatest decrease in incident osteoarthritis. Healthcare resource utilization was significantly higher for Weight Loss Rebounders and Maintainers compared to Obesity Maintainers. Increased weight loss among Weight Loss Maintainers trended with lower overall healthcare resource utilization, except for hospitalizations.

Conclusions: In people with obesity, sustained weight loss was associated with greater clinical benefits than regained short-term weight loss and obesity maintenance. Higher weight loss magnitudes were associated with delayed onset of osteoarthritis and led to decreased healthcare utilization.

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Conflict of interest statement

I have read the journal’s policy and the authors of this manuscript have the following competing interests: Abhilasha Ramasamy, Neeraj N. Iyer, B. Gabriel Smolarz, and Neela Kumar are employed by Novo Nordisk, Inc., the study sponsor. Lisa Bailey-Davis, G Craig Wood, Peter Benotti, Adam Cook, James Dove, Jacob Mowery, and Christopher Still are employed by Geisinger Health, which received funding from Novo Nordisk, Inc. for work performed on this study. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Overview of study design and timeline.
BMI, body mass index.
Fig 2
Fig 2. Kaplan-Meier curves for time until cancer stratified by sex and OM, WLR, and WLM.
A. All cancer types, female. B. All cancer types, male. C. Obesity-related cancer, female. D. Obesity-related cancer, male. OM, Obesity Maintainers; WLR, Weight Loss Rebounders; WLM, Weight Loss Maintainers.
Fig 3
Fig 3. Kaplan-Meier curves for time until depression/anxiety stratified by OM, WLR, and WLM.
OM, Obesity Maintainers; WLR, Weight Loss Rebounders; WLM, Weight Loss Maintainers.
Fig 4
Fig 4. Kaplan-Meier curves for time until osteoarthritis within the WLM group stratified by the amount of weight loss at the end of the 2+ year index period.
WLM, Weight Loss Maintainers; WL, weight loss.
See this image and copyright information in PMC

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