The results of the study have showed the efficacy of MRP for the treatment of obesity in terms of weight loss and body composition. In addition, improvements in blood chemistry were reported at the end of the weeks of hospitalization.
As regards the anthropometric and body composition parameters, the results obtained have revealed a significant statistical improvement of all the parameters investigated: total mass, fat free mass, fat mass, fat mass index, visceral adipose tissue, arm and calf circumferences. The only value that did not undergo a statistically significant variation was the SMI; this data was positive as it reflects the fact that weight loss occurred correctly: weight reduction has mainly affected fat mass, while lean mass was preserved.
Concerning the blood chemistry parameters, there was a statistically significant improvement in the glycaemic profile with a reduction in glycaemic values, glycated haemoglobin, insulin and HOMA index. It also improved the lipid profile with a statistically significant reduction of total cholesterol values, LDL cholesterol and triglycerides. Finally, there was an improvement in the levels of folate, vitamin B12 and calcium.
Lifestyle changes are at the pivot of any obesity treatment program, but these may be difficult to maintain in real life, where personal and social factors can hinder patients' efforts to change. MRP for the treatment of obesity are widely used for the management of obesity and have proven to be more effective than outpatient programs, at least in the short term . Although less frequent, hospitalizations for the treatment of obesity in adults can also lead to important results.
The results of the present study are in agreement with the results of the study by Budui et al, which concluded that 3 weeks of a MRP led to significant clinical and functional improvements, similarly in young and elderly patients suffering from severe obesity . In the long term, these improvements are reflected in a better quality of life, through better management of comorbidities associated with obesity, and a reduction in the state of frailty . Moreover, Capodaglio et al, showed that a 4-week MRP was effective in reducing moderate and severe disabilities of obesity patients with orthopaedic comorbidities and improves functional abilities . However, changes in body weight do not appear to be related to changes in disability test scores. This suggests that other factors besides body weight have an impact on functional improvements .
The improvement in body composition in subjects with obesity of both sexes, was confirmed even by Maffiuletti et al after a 3-week hospitalization, based on similar intervention based on nutritional therapy with calorie restriction and nutritional education, physical activity and psychological counseling . According to Haslacher et al, a 3-week rehabilitation hospitalization leads to a reduction not only in body weight, but also in cardiovascular risk of 30-35% calculated by the Framingham HARD CHD score . The values of c-reactive protein, lipid and carbohydrate metabolism and liver function also improve, so weight loss also reflects a decrease in the inflammatory state linked to obesity .
Secondly, the results obtained in the present study have revealed that average reduction of body weight, BMI and fat mass continued from discharge until T4; a reduction of VAT was detected, but the change was not statistically significant. Moreover, no statistically significant changes in fat free mass and VAT were reported during one year of follow-up. Similarly, the medium-term effects of the 3-weeks recovery were assessed by Maffiuletti et al: 11 months after hospitalization, 75% of patients managed to maintain a body weight lower than baseline. Clinical success at follow-up was associated with higher levels of reported physical activity than in those who regained weight; as a result, subjects who continued to lose weight had greater muscle mass and strength and reduced cardiovascular risk factors (lower total cholesterol and glycemic levels, and higher HDL cholesterol) than the others .
Otherwise, the results obtained by Tadokoro et al, during the follow-up reveal that the BMI remained unchanged three months after discharge, but increases modestly at one year after discharge, regardless of the weight lost during hospitalization . The authors, have investigated the factors involved in weight loss and its maintenance in patients suffering from morbid obesity . The excess weight lost during the weeks of hospitalization is not correlated with its maintenance during the follow-up . The presence of diabetes does not affect the amount of weight lost during hospitalization. However, diabetic patients show less body weight gain after discharge, possibly due to the effects of antidiabetic drugs .
The benefits of rehabilitation hospitalization are expressed not only on a physical level, but also on the mental state of the patient suffering from obesity . Subsequently, in 2 years of follow-up, patients should implement a permanent lifestyle change by improving their diet and fighting a sedentary lifestyle .
The importance of continuous intervention by physicians, dieticians and clinical psychologists was emphasized in a previous work, in which patients who follow biweekly instructions for a year significantly maintained body weight loss, with a slight weight gain of 0.4 kg, unlike those who didn’t follow the directions and registered an increase of 5.1 kg .
Furthermore, successfully achieving a good weight loss goal during the rehabilitation program involves maintaining a lower weight afterwards without increasing the risk of dropping out . Satisfactory weight loss during hospitalization could increase the motivation of patients suffering from obesity .
Some nutritional treatment fails due to patients' poor compliance with the prescribed program. For this reason, constant monitoring and psychological support are necessary.
The strength of this study was given, first of all, by the sample size. Secondly, not only was a comparison of the clinical status of the patients at the beginning and at the end of the treatment carried out, but the subjects were also evaluated during a one-year follow-up.
The main limitation of the study was the absence of a control group. Further investigations will be precisely to compare the group of obese patients who have undergone hospitalization with another group of obese patients followed only on an outpatient basis, in terms of weight loss and adherence in the short and long term to the proposed nutritional treatment.