Effective Treatment of Nonalcoholic Fatty Liver Disease Using a Community-Based Weight Management Program (2021)

Introduction Obesity-related gastrointestinal disorders including nonalcoholic fatty liver disease (NAFLD) and gastroesophageal reflux disease (GERD) are more frequent and usually present earlier than type 2 diabetes mellitus (T2DM) and cardiovascular disorders. This provides an opportunity for the gastroenterologist to intervene early with an effective weight-loss therapy. We evaluated the outcomes of a multifaceted, community-based gastroenterologist-supervised weight management program compared with patient-directed weight-loss efforts after physician advice. The program is aimed at achieving a 10% total body weight (TBW) loss at three months, a known determinant for NAFLD regression. Methods This is a retrospective pre- and post-intervention study of NAFLD patients, who participated in a medically supervised weight management program in the period between May 2017 and May 2019. The program is comprised of a very-low-calorie (800 kcal/day) meal replacement diet, a recommended medical fitness program, and weekly behavioral support groups. Patients are followed on monthly basis and slowly transitioned to a whole food plant-based or Mediterranean diet after three months of participation. Patients' weight trends driven by self-directed efforts to lose weight after physician advice were collected based on historical data up to two years prior to program participation. The primary outcome was defined as percentage TBW loss at three months under medical supervision (post-intervention) compared with patient-directed weight-loss efforts (pre-intervention). The secondary outcomes included percentage TBW loss in relation to behavioral support group attendance and improvement in GERD and T2DM disease status after program participation. Linear mixed and linear regression models were used to assess for a statistically significant difference in percentage TBW loss. Statistical significance was defined as p < 0.05. Results A total of 114 NAFLD patients (mean age 55 years, mean BMI 39 kg/m<sup>2</sup>, 77 females, and 37 males) completed at least three months of follow-up and were included in the study. Of those, 89 patients had a documented three-month office visit. At three months, 65% of patients had lost at least 10% of their TBW. Percentage TBW loss under medical supervision was noted to be significantly higher and occurred at a faster rate over three months when compared with patient-directed efforts after physician advice (p < 0.001). Patients who attended the behavioral support groups ≥ 50% of the time had a 3% higher TBW loss at three months compared with patients who attended <50% of the time (p = 0.006). Approximately, 52% of patients with GERD and 38% of patients with T2DM had symptoms improvement and/or medication reduction at their three-month follow-up visit. Conclusion A multifaceted, community-based, gastroenterologist supervised weight management program is effective in achieving a clinically significant TBW loss of at least 10% within three months of participation. This weight loss was greater and occurred at a faster rate when compared with patient-directed efforts. Additionally, improvement in GERD and T2DM disease status was noted in 52% and 38% of patients with these conditions, respectively. Further community-based studies of a larger scale are needed to determine the sustainability of this weight loss over one year.