Non-Surgical Interventions for Hospitalized Adults with Class II or Class III Obesity: A Scoping Review

Figures & data

Video abstract

Figure 1 Medline Search.

Figure 2 PRISMA flow chart⁴⁶ showing citation process.

Note: PRISMA figure adapted from Moher D, Liberati A, Tetzlaff J, Altman D. Preferred reporting items for systematic reviews and meta analysis: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.

Table 1 Overview of Eligible Articles

Author	Year	Country	Study Design	Type of Publication	Intervention
Serafim et al^Citation56	2019	Brazil	Evaluation	Journal Article	Nutritional Intervention
Budui, et al^Citation58	2019	Italy	Non-randomised intervention comparative study	Journal Article	Intensive lifestyle intervention
Giordano, et al^Citation55	2017	Italy	Pre and post intervention study	Journal Article	Intensive lifestyle intervention
Pilcher, et al^Citation52	2017	New Zealand	Randomized cross-over trial	Journal Article	Medical Intervention
Danielsen, et al^Citation49	2013	Norway	Clinical Control Trial	Journal Article	Intensive lifestyle intervention
Martins, et al^Citation47	2010	Norway	Non-randomized intervention comparative study	Journal Article	Intensive lifestyle intervention
Øvrebø, et al^Citation48 (Martins, et al study)	2017	Norway	Longitudinal Outcome of	Journal Article	Intensive lifestyle intervention
Mæhlum, et al^Citation53 (Danielsen et al study)	2010	Norway	Clinical controlled trial	Journal Article	Intensive lifestyle intervention
Huerta, et al^Citation51	2009	USA	Pre and post intervention study	Journal Article	Intensive lifestyle intervention
Saldalamacchia, et al^Citation57	2008	Italy	Non-randomized controlled trial	Letter to the Editor	Intensive lifestyle intervention
Maffiuletti, et al^Citation50	2005	France	Longitudinal clinical pre-post intervention study	Journal Article	Intensive lifestyle intervention
Choban, et al^Citation54	1997	USA	Randomized, prospective, double-blind, controlled trial	Journal Article	Medical Intervention

Table 2 Characteristics of Eligible Articles

Author	Sample Size Enrolled	Sample Size Completed (Drop-out)	Mean Age (SD)	Mean BMI (SD)	Inpatient Setting only	Inpatient/ Outpatient Setting	Reason for Admission	Inpatient LOS (Weeks)	Follow up (Years)
Serafim, et al^Citation56	120	0	92% ≤60years	53.7 (0.39)	Yes	No	Obesity treatment	1	0
Budui, et al^Citation58	259	0	48.2 (11.5) 69.3 (3.5)	43.9 (4.2)	Yes	No	Rehabilitation program	3	0
Giordano, et al^Citation55	136	136	52.7 (13.3)	43.2	Yes	No	Rehabilitation program	3	0
Pilcher, et al^Citation52	24	22 (8%)	53.5 (16.1)	50.4	Yes	No	Acute care- Cellulitis (6) Asthma (7) Respiratory Infection (2) Other (7)	0^g	0
Danielsen, et al^Citation49	139	104 (25%)	45.2 (9.5)^a 38.4 (9.8)^b	42.6 (5.2)	No	Yes	Obesity treatment	12	1
Martins, et al^Citation47	94	83 (12%)	42 (9.8)^c 38.4 (10.1)^d	45.4 (5.6)	No	Yes	Obesity treatment	15-17	5
Øvrebø, et al^Citation48 (Martins, et al study)	95	44 (46%)	42 (9.8)^c 38.4 (10.1)^d	45.3 (5.5) 45.5 (5.7)^c	No	Yes	Obesity treatment	15-17	5
Mæhlum, et al^Citation53 (Danielsen et al study)	166	108 (36%)	42.1 (10.6)	45.7 (8.6)	No	Yes	Obesity treatment	16	1
Huerta, et al^Citation51	6	5 (17%)	54.7 (2.6)^a 51.2 (0.9)^b	64.3 (2.1)	Yes	No	Obesity treatment	10	0
Saldalamacchia, et al^Citation57	7	7	49 (9)	-	No	Yes	Obesity treatment	1.3	027^h
Maffiuletti, et al^Citation50	70	64 (9%)	30.9 (7.1)^e 28.5 (7.2)^f	41.3 (4.3)	No	Yes	Obesity treatment	3	1
Choban, et al^Citation54	30	30	52 (19) 52 (15)	36 (5)	Yes	No	Acute Care -Cancer (11) Pancreatic disease (10) Trauma (1) Gastrointestinal issue (5)	2	0

Notes: ^aIntervention; ^bControl/comparator; ^cResidential intermittent program; ^dWeight loss camp; ^eFemale; ^fMale; ^gIntervention 2.5 hours; ^hFollow-up 10 days.

Abbreviations: SD, standard deviation; LOS, length of stay.

Table 3 Profession/Discipline Intervention Delivered by

Authors	Medical Officer	Nurse	Physiotherapist	Exercise Physiologist	Dietitian / Nutritionist	Psychologist	Other
Serafim, et al^Citation56	-	-	-	-	-	-	-
Budui, et al^Citation58	Yes	No	Yes	Yes	Yes	Yes	No
Giordano, et al^Citation55	Yes	No	Yes	Yes	Yes	Yes	No
Pilcher, et al^Citation52	-	-	-	-	-	-	-
Danielsen, et al^Citation49	Yes	Yes	Yes	Yes	Yes	Yes	No
Martins, et al^Citation47	Yes	Yes	Yes	No	Yes	Yes	Yes ^a
Mæhlum, et al^Citation53 (Danielsen et al study)	-	-	-	-	Yes	Yes	No
Huerta, et al^Citation51	Yes	-	-	-	Yes	Yes	No ^b
Saldalamacchia, et al^Citation57	-	-	-	-	-	-	-
Maffiuletti, et al^Citation50	Yes	-	Yes	No	Yes	Yes	No
Choban, et al^Citation54	Yes	Yes	No	No	No	No	Yes ^c
Øvrebø, et al^Citation48(Martins, et al study)	Yes	Yes	Yes	No	Yes	Yes	Yes ^a

Notes: –, Not Reported; ^aSocial Worker and Chef; ^bCalled Staff; ^cPharmacist.

Table 4 Key Outcomes of Interest

Author	CVR Factors	Physical Activity	Nutrition	Psychological	Medical ^a	DM 2	Weight	Body Composition	Other
Serafim, et al^Citation56	No	No	No	No	Yes	No	Yes	Yes	Yes ^b
Budui, et al^Citation58	Yes	Yes	Yes	Yes	No	Yes	Yes	Yes	No
Giordano, et al^Citation55	Yes	Yes	Yes	Yes	No	Yes	Yes	Yes	No
Pilcher, et al^Citation52	No	No	No	No	Yes	No	No	No	No
Danielsen, et al^Citation49	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No
Martins, et al^Citation47	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No
Mæhlum, et al^Citation53 (Danielsen et al study)	No	Yes	Yes	Yes	No	No	No	No	No
Huerta, et al^Citation51	No	No	No	No	Yes	Yes	Yes	Yes	Yes ^b
Saldalamacchia, et al^Citation57	No	No	No	No	No	No	Yes	No	No
Maffiuletti, et al^Citation50	Yes	Yes	Yes	No	No	No	Yes	No	No
Choban, et al^Citation54	No	No	Yes	No	No	No	No	No	No
Øvrebø, et al^Citation48 (Martins, et al study)	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No

Notes: ^aMedical – Includes outcome from medical intervention of acute or chronic illness, eg, medication management/titration; ^bReduction in anesthetic/surgical risk.

Moher D , Liberati A , Tetzlaff J , Altman D . Preferred reporting items for systematic reviews and meta analysis: the PRISMA statement. PLoS Med . 2009;6(7):e1000097.19621072

 PubMed Web of Science ®Google Scholar

Serafim MP , Santo MA , Gadducci AV , Scabim VM , Cecconello I , de Cleva R . Very low-calorie diet in candidates for bariatric surgery: change in body composition during rapid weight loss. Clinics (Sao Paulo, Brazil) . 2019;74:e560.

 Web of Science ®Google Scholar

Budui S , Bigolin F , Giordano F , et al. Effects of an intensive inpatient rehabilitation program in elderly patients with obesity. Obes Facts . 2019;12(2):199–210.30928989

 PubMed Web of Science ®Google Scholar

Giordano F , Berteotti M , Budui S , et al. Multidimensional improvements induced by an intensive obesity inpatients rehabilitation programme. Eat Weight Disord . 2017;22:329–338.28455681

 PubMed Web of Science ®Google Scholar

Pilcher J , Richards M , Eastlake L , et al. High Flow or titrated oxygen for obese medical inpatients: a randomised crossover trial. Med J Aust . 2017;27(10):430–434.

 Web of Science ®Google Scholar

Danielsen KK , Svendsen M , Maehlum S , Sundgot-Borgen J . Changes in body composition, cardiovascular disease risk factors, and eating behavior after an intensive lifestyle intervention with high volume of physical activity in severely obese subjects: a prospective clinical controlled trial. J Obes . 2013;2013:325464.23710347

 PubMedGoogle Scholar

Martins C , Strommen M , Stavne OA , Nossum R , Marvik R , Kulseng B . Bariatric surgery versus lifestyle interventions for morbid obesity–changes in body weight, risk factors and comorbidities at 1 year. Obes Surg . 2011;21(7):841–849.20379796

 PubMed Web of Science ®Google Scholar

Ovrebo B , Strommen M , Kulseng B , Martins C . Bariatric surgery versus lifestyle interventions for severe obesity: 5-year changes in body weight, risk factors and comorbidities. Clin Obes . 2017;7(3):183–190.28320081

 PubMed Web of Science ®Google Scholar

Mæhlum S , Danielsen KK , Heggebø LK , Schiøll J . The Hjelp24 NIMI Ringerike obesity clinic: an inpatient programme to address morbid obesity in adults. Br J Sports Med . 2012;46(2):91–94.20460258

 PubMed Web of Science ®Google Scholar

Huerta S , Li Z , Anthony T , Livingston EH . Feasibility of a supervised inpatient low-calorie diet program for massive weight loss prior to RYGB in superobese patients. Obes Surg . 2010;20(2):173–180.19862584

 PubMed Web of Science ®Google Scholar

Saldalamacchia G , Massaro P , Pacioni D , et al. Weight loss in obese type 2 diabetic patients on an intensive therapeutic programme: importance of an initial short hospitalization period. Nutr Metab Cardiovasc Dis . 2008;18(2):e1–2.18029160

 PubMedGoogle Scholar

Maffiuletti NA , Agosti F , Marinone PG , Silvestri G , Lafortuna CL , Sartorio A . Changes in body composition, physical performance and cardiovascular risk factors after a 3-week integrated body weight reduction program and after 1-y follow-up in severely obese men and women. Eur J Clin Nutr . 2005;59:685–694.15770221

 PubMed Web of Science ®Google Scholar

Choban PS , Burge JC , Scales D , Flancbaum L . Hypoenergetic nutrition support in hospitalized obese patients: a simplified method for clinical application. Am J Clin Nutr . 1997;66(3):546–550.9280171

 PubMed Web of Science ®Google Scholar