Modest weight loss programs were effective in a “small percentage” of obese kidney transplant candidates — those with a low baseline BMI.
The program primarily encouraged “healthy eating habits and increased energy expenditure” and resulted in an average change in body weight of 3.8%.
“The majority [kidney transplantation] KT program using BMI restrictions [most commonly 35 kg/m2]Only a minority (31%) reported using a formal weight loss program. Roy Hajar, MD “Previously, our program offered only minimal support to potential candidates to achieve BMI limits,” wrote the researchers from the Department of Surgery at Maisonneuve-Rosemont Hospital in Montreal.
To evaluate the impact of a conservative weight management program on this patient population, researchers surveyed 80 patients with kidney disease (BMI ≥ 35 kg/m).2) were offered transplantation. Throughout the program, participants received counseling regarding diet and exercise (e.g., three small meals per day and 10–15 minutes of exercise each morning on a stationary bike or treadmill are recommended) but were not offered drug options. Anthropometric measurements were taken every 3 months. Participants whose BMI decreased to <35 kg/m were considered to have had "successful" weight loss.2.
After a mean follow-up of 24 months, 26.3% had successfully lost weight and 7.5% had experienced significant weight gain (BMI increase of ≥3 kg/m ).2Overall, 31.3% of patients gained weight (mean increase in BMI was 1.9 kg/m2).
The researchers found that women and patients who were initially close to the BMI limit were most likely to achieve weight loss and achieve a BMI below 35 kg/m.2No patient had a baseline BMI >40 kg/m2 We achieved this goal.
A comprehensive nutritional assessment performed on 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 primary treatment option for accessing the KT waiting list may not generate much excitement or hope,” Hajjar and colleagues write, “The study demonstrates its futility with a mean change in weight of 3.8%… As a policy for obese candidates, conservative weight loss will fail for the majority and cannot be the only treatment option.”
Nonetheless, the researchers argued that the success of some patients with the program “should not be overlooked.”
“Since close follow-up may improve patient adherence, additional dietary counseling and follow-up during regular dialysis sessions could ensure adherence and increase motivation,” the researchers wrote.
