1. Food-insecure patients were less responsive to intensive lifestyle intervention compared to food-secure patients.
2. Future studies should examine potential causative factors to ensure equitable obesity prevention and treatment.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Food insecurity is defined as the lack of physical, social, or economic access to sufficient quantities of the nutritious foods necessary for sustaining an active, healthy lifestyle. Behavioral weight loss therapies have generally been shown to be effective management for obesity, but it is unknown whether the availability of healthy food choices impacts patient responses to this type of treatment. The trial randomized over 800 patients who received either intensive lifestyle intervention or usual care. While percent weight loss at two years was significantly greater in the intensive-lifestyle treatment group, post hoc analysis revealed that the effect size among those who reported being food-insecure at enrollment was only half those who were food-secure. The study limitation was the use of body weight as the dependent variable rather than body mass index, which is less likely to be affected by confounding variables. The specific psychological or physiological mechanisms behind this disparity remained unclear, but this finding suggested that food insecurity may be a crucial facet for healthcare practitioners to consider when developing tailored weight-loss strategies for patients with obesity.
Relevant Reading: Trends in adiposity and food insecurity among US adults
In-Depth [randomized controlled trial]: The cluster-randomized trial enrolled 803 patients in 18 primary care clinics in Louisiana serving low-income populations. The patients were randomized in a 1:1 ratio to either intensive lifestyle intervention (ILI) or usual care (UC), respectively. Food security status was determined using a six-item instrument in which patients with two or more affirmative responses were categorized as food-insecure. The primary outcome was body weight measured in kilograms. Out of 803 patients, a total of 247 (31%) were food insecure, with 129 patients in the ILI group (29%) and 118 in the UC group (34%). ILI patients in both the food-secure and food-insecure subgroups displayed a similar pattern of dramatic weight loss within six months and gradual rebound over the remainder of the study. However, the mean absolute weight difference between the ILI and UC treatment groups remained significantly lower among those who were food insecure despite this subgroup having numerically greater body weight at baseline. At 24 months, this difference was 2.7 kg (95% confidence interval [CI], 0.7 to 4.8 kg; P = 0.009) in the food-insecure subgroup as compared to 5.2 kg (95% CI, 3.7 to 6.8 kg; P< 0.001) in the food-secure subgroup. Overall, food-insecure patients were less likely to respond to ILI than food-secure patients.
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