(P31-015-23) Dietary Strategy To Promote Compliance Produced Significant Weight Loss and Health Improvement in a Person With Severe Obesity

Objectives: Medical management of severe obesity is often ineffective. A barrier may be low motivation to follow a “diet” for the duration needed for sizable weight loss. Considering the weight loss urgency in severe obesity, we propose a different approach. Instead of a nutritionally perfect diet, we prefer a lower calorie diet that considers personal and family history, lifestyle, occupational circumstances, family environment around food selection, cooking practices and most importantly, dietary likes and dislikes. As illustrated below, the diet included some ‘tasty’ or energy-dense options of patient’s choice to promote dietary compliance, leading to weight loss and improvement in obesity-related comorbidities.

Methods: Ms.X (67y, BMI 80 kg/m² , 481lb) sought weight loss treatment. She was nearly immobile, homebound, had pressure wounds on extremities, received medications for Type 2 Diabetes, hypertension, depression, hypothyroidism, hyperlipidemia, recurrent urinary tract infections, intertrigo, and needed oxygen due to asthma. She had attempted weight loss elsewhere, and was refused bariatric surgery till she lost 50 lb. After a medical exam including blood chemistry, extensive interview and counseling, a diet plan was provided. She was recommended a 600 Cal deficit diet of 2400 Cal (30% protein). With weight loss, calorie and protein of the diet were reduced gradually. Notably, at her request, the diet also included high protein cookies, crunchy rice rollers, sugarless cranberry juice, and some of her favorite foods, with a specified amount. She was encouraged to move arms as exercise, since walking was not possible.

Results: Compliance to this program was excellent as indicated by 81lb weight loss in 12 mo, and substantial decrease in anthropometric measurements. HbA1c reduced by 2% points, insulin dose and oxygen need reduced considerably. She had more energy, less lethargy and somnolence and started walking a few steps. She refused to reconsider bariatric surgery and preferred to continue medical management.

Conclusions: For medical management of severe obesity, focusing on sustainability of a diet plan instead of a nutritionally perfect but unappealing one, can achieve significant weight loss and qualitative and quantitative health improvement.

Funding Sources: None