Diet, exercise may help some transplant candidates lose weight but fail ‘for majority’
A conservative weight loss program was effective for a “small proportion” of kidney transplant candidates with obesity, namely those who had a lower BMI at baseline.
The program — which consisted primarily of encouraging “healthy eating habits and higher energy expenditure” — led to a mean change in body weight of 3.8%.
“Despite the majority of [kidney transplantation] KT programs using a BMI limit [most commonly 35 kg/m2], only a minority (31%) reported the use of a formal weight loss program,” Roy Hajjar, MD, of the department of surgery at Hôpital Maisonneuve-Rosemont in Montréal, and colleagues wrote. “Even in our own program previously, the support provided for potential candidates to attain the BMI limit was negligible.”
To assess the impact of a conservative management weight loss program for this patient population, researchers included 80 patients with kidney disease (BMI of more than 35 kg/m2) who had been referred for transplantation. Throughout the program, participants received counseling on eating habits and exercise (eg, encouraging three small meals a day and 10 to 15 minutes on a stationary bicycle or treadmill each morning), with no pharmacological options offered. Anthropometric measurements were taken every 3 months. Weight loss was considered “successful” for participants who reduced their BMI to less than 35 kg/m2.
After a mean follow-up of 24 months, 26.3% experienced successful weight loss, while 7.5% experienced significant weight gain (BMI increase of more than 3 kg/m2). In total, 31.3% of patients gained weight (average increase in BMI of 1.9 kg/m2).
Researchers found women and patients who were initially closer to the BMI limit were most likely to achieve weight loss resulting in BMI of less than 35 kg/m2; no patients with a baseline BMI of more than 40 kg/m2 reached this target.
Results of a comprehensive nutritional evaluation administered to a subset of 44 patients revealed that 14.6% had previously received nutritional counseling for weight loss.
“Weight loss through diet and exercise, as the main treatment option to accessing the KT waiting list, may not generate an immense amount of excitement or hope,” Hajjar and colleagues wrote. “This study attests to the perceived futility with a mean change in body weight of 3.8% ... As a policy for the obese candidate, conservative weight loss fails for the majority and cannot be the sole treatment option.”
Despite this, the researchers contended it “should not be overlooked” that some patients succeeded in the program.
“Because close follow-up may lead to higher patient adherence, dietary counseling and follow-ups could further be implemented during the more regular dialysis sessions to ensure compliance and increase motivation,” the researchers wrote.