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Abstract Details
Factors associated with engagement and adherence to a low-energy diet to promote 10% weight loss in patients with clinically significant non-alcoholic fatty liver disease
BMJ Open Gastroenterol. 2021 Jul;8(1):e000678. doi: 10.1136/bmjgast-2021-000678.
Jadine Scragg12, Kate Hallsworth13, Guy Taylor4, Sophie Cassidy4, Laura Haigh13, Marie Boyle13, Quentin Anstee13, Stuart McPherson13, Leah Avery56
Author information
1Newcastle NIHR Biomedical Research Centre, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.
2Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK.
3Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
4Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
5Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK leah.avery@tees.ac.uk.
6Centre for Rehabilitation, Teesside University School of Health and Life Sciences, Middlesbrough, UK.
Abstract
Objective: Clinical guidelines recommend weight loss to manage non-alcoholic fatty liver disease (NAFLD). However, the majority of patients find weight loss a significant challenge. We identified factors associated with engagement and adherence to a low-energy diet (LED) as a treatment option for NAFLD.
Design: 23 patients with NAFLD enrolled in a LED (~800 kcal/day) were individually interviewed. Transcripts were thematically analysed.
Results: 14/23 patients achieved ≥10% weight loss, 18/23 achieved ≥7% weight loss and 19/23 achieved ≥5% weight loss. Six themes were generated from the data. A desire to achieve rapid weight loss to improve liver health and prevent disease progression was the most salient facilitator to engagement. Early and significant weight loss, accountability to clinicians and regular appointments with personalised feedback were facilitators to engagement and adherence. The desire to receive positive reinforcement from a consultant was a frequently reported facilitator to adherence. Practical and emotional support from friends and family members was critically important outside of the clinical setting. Irregular working patterns preventing attendance at appointments was a barrier to adherence and completion of the intervention.
Conclusions: Engagement and adherence to a LED in patients with NAFLD were encouraged by early and rapid weight loss, personalised feedback and positive reinforcement in the clinical setting combined with ongoing support from friends and family members. Findings support those identified in patients who completed a LED to achieve type 2 diabetes remission and highlight the importance of behaviour change support during the early stages of a LED to promote adherence.