Abstract

Background:

As the prevalence of obesity and MASH continues to grow, novel treatment options are needed to prevent progression as there are currently no medications approved to treat MASH. Weight loss has been shown to be an effective treatment with a 5% weight loss reversing steatosis and a 10% weight loss reversing liver fibrosis. Clinical trials using lifestyle-based weight loss interventions in MASH have been shown to achieve >5% total body weight loss (TBWL) in 30% of patients and >10% TBWL in 10% of patients. It is unclear if the standard of care hepatology practice is sufficient to achieve these recommendations in the clinical setting or if a more dedicated intervention is needed.

Methods:

In 2018, our department developed the Weight Intervention in Liver Disease (WILD) clinical pathway, an intensive weight loss program embedded into our hepatology clinic. The program was supervised by a hepatologist board certified in obesity medicine and executed by three advanced practice providers (APP) with obesity certification.

WILD provided lifestyle interventions for those with (1) MASLD (2) body mass index (BMI) >27 with comorbidity or >30 with or without comorbidity and (3) the willingness to participate. The patients were seen monthly to evaluate progress with nutrition, exercise, behavioral modifications, and weight loss medications.

A retrospective chart review was completed to compare percent weight changes of WILD patients managed by APPs to those receiving standard of care in the APP hepatology practice. Patients were included if they had either participated in the WILD program for at least 6 months with a minimum of 2 visits or if they had achieved 10% body weight loss goal prior to the 6-month mark. Using electronic medical records, data collected included demographics, starting weight, maximum achieved weight loss and final recorded weight in the program.

Results:

Between October 2018 and May 2023, 72 patients participated in the WILD pathway and met criteria for the study. This was compared to 30 patients who received standard of care from October 2018 to June 2021.

Of the 72 patients seen in the WILD pathway, 56 patients (77.8%) achieved weight loss with a median TBWL of 7.42%. Only 12 patients (40%) in the standard of care cohort achieved weight loss with a median TBWL of 2.95%.

Of the 56 patients that lost weight in the WILD pathway, a total of 30 patients (53.6%) lost ≥ 5-10% with 16 (28.5%) losing ≥ 10%. In the standard of care cohort, only 4 patients (0.14%) lost ≥ 5% TBWL and no patients with ≥ 10% TBWL.

Conclusion:

A dedicated, intensive APP-directed weight intervention pathway embedded within a standard hepatology practice was more successful in helping patients achieve meaningful weight loss than standard hepatology APP-based care and published clinical trials for MASH. This data supports the development of APP driven weight loss interventions in GI and hepatology specialties to most effectively manage the massive clinical burden of MASH.