ABSTRACT
Objective
Obesity is a major modifiable risk factor for gastrointestinal disease. Although lifestyle modification remains the basis of treatment, these interventions are often ineffective when self‐directed. This study aimed to assess the effect on weight loss when lifestyle modification is paired with a support group model.
Methods
Ninety‐four patients with obesity enrolled in the weight loss program at a community gastroenterology practice and participated in a 6‐month support group. These sessions provided patients with a space to discuss shared experiences and receive education. Total body weight loss was examined by the level of support group attendance.
Results
Patients who demonstrated high levels of support group attendance (≥ 75%) had significantly greater mean absolute (p = 0.0004) and total percentage body weight loss (p < 0.0001) compared to those who attended fewer sessions and overall were significantly more likely to achieve clinically significant total body weight loss (≥ 10%) (p = 0.0008) over the 6‐month period after adjustment for age.
Conclusion
This study demonstrates that lifestyle modification is effective in achieving clinically significant weight loss when patients have consistent engagement, measured here by attendance, in a support group. Regular support group attendance has been validated as an effective tool to maintain lifestyle modification participation and adherence, and it appears equally important in sustaining long‐term weight loss.
Keywords: community, MASLD, support group, weight loss
1. Introduction
Obesity‐related gastrointestinal (GI) disorders, including gastroesophageal reflux disease (GERD) and metabolic dysfunction‐associated steatotic liver disease (MASLD), account for at least 30% of patient visits in gastroenterology clinics [1, 2, 3]. Lifestyle modification, which includes calorie restriction, increased physical activity, and behavioral modification, remains the cornerstone of obesity treatment [4, 5]. Unfortunately, weight regain is a common and frustrating problem that patients face in nearly all interventions studied to date [6]. In particular, previous research has shown that patients' self‐directed efforts are often unsuccessful or short‐lived, both when attempting to lose weight and maintain lifestyle modification participation and adherence [7, 8, 9]. The positive effects of group participation on behavioral modification have been well documented in the literature. Group sessions have been used in lifestyle medicine clinics with success. For example, shared medical appointments are effective in improving diabetes care delivery. Coaching visits facilitate knowledge‐sharing among participants, and group interventions have been applied to treat obesity with success. A systematic review and meta‐analysis of 47 randomized controlled trials demonstrated that group‐based diet and physical activity interventions can produce clinically meaningful weight loss, with effects sustained at 6, 12, and 24 months. Notably, interventions that explicitly targeted weight loss and incorporated structured feedback and peer support were associated with greater effectiveness [10]. The Look AHEAD study by Wadden et al. was performed at a large academic center and showed that patients with frequent counseling and structured behavioral support had improved long‐term weight outcomes, suggesting that continued engagement with providers helps sustain behavioral change [11]. A 2022 systematic review concluded that group interventions can be more effective than individual interventions for long term, clinically relevant weight loss in adults with obesity [12]. Many of these previous studies have taken place in academic primary care settings. However, the impact of a support group has not been well researched in a structured weight management setting specifically within a community‐based gastroenterology clinical practice. The aim of this study was to assess if level of engagement in, measured by attendance of a social support group as part of an intensive weight management program in a community practice setting was associated with clinically significant weight loss.
2. Materials and Methods
2.1. Program Goals
In 2017, the American Gastroenterological Association published practice guidelines entitled “POWER: Practice Guide on Obesity and Weight Management”, which outlined a process for obesity management that gastroenterologists could implement in practice [13]. Based on the four pillars set forth in the practice guidelines, Huron Gastro in Ann Arbor, MI developed a medically‐supervised, clinic‐based weight management program [14, 15]. The main goal of the program was to achieve a total body weight loss of 10% or more, which is associated with improved histological features of MASLD, including resolution of steatohepatitis and improvement of fibrosis and portal hypertension [1, 16, 17, 18].
2.2. Program Description
The structure and multidisciplinary nature of the weight loss program have been described previously [14, 15]. Briefly, patients who participated in the voluntary weight loss program were obese adults (body mass index or BMI ≥ 30 kg/m2) with a diagnosis of MASLD, no history of excessive alcohol consumption (> 21 drinks/week for men and > 14 drinks/week for women over a 2‐year period), or evidence of other causes of chronic liver disease. The diagnosis of MASLD was confirmed by a hepatic steatosis index greater than 36 and/or imaging studies (ultrasound, ultrasound elastography, or computed tomography scan) demonstrating hepatic steatosis.
In addition to the dietary intervention, the program provided support group meetings for a cohort of up to 12 patients who met weekly for 4 months and then bi‐weekly for the remaining 2 months. These groups were led by a registered dietician and facilitated a community of individuals that worked toward a common goal and provided opportunities to discuss shared experiences. Patients received evidence‐based education on following a high‐fiber, low glycemic index diet, sleep optimization, stress reduction using mindfulness techniques, and body weight exercises. These lessons were taught through hands‐on activities, videos, articles, and other educational materials. To enhance accessibility, the support group meetings were offered via Zoom (Zoom Video Communications, San Jose, CA). A closed WhatsApp (Meta Platforms, Menlo Park, CA) chat group was used for patient communication, addressing inquiries, and monitoring compliance with dietary and exercise modification. The support groups were designed to teach the “why” behind the program recommendations, in addition to providing strategies on how to implement them into daily life, all while receiving social support from other patients participating in the program.
2.3. Data Collection
Ninety‐four participants who were enrolled in the weight loss program and attended a 6‐month long support group with a registered dietician between August 2021 and April 2023 were included in the current study. Attendance and weight were documented at each support group meeting. Support group attendance levels were defined as the percentage of total group meetings attended and defined as low (≤ 49% attendance), medium (50%–74%) and high (≥ 75%). The primary outcomes of the current study were absolute total body weight loss (kg), percentage of total body weight loss calculated by: [(baseline weight‐6 months ending weight)/baseline weight], and clinically significant weight loss defined as ≥ 10% total body weight loss.
2.4. Statistical Analysis
Sociodemographic and clinical characteristics were compared by support group attendance levels. Continuous variables were summarized as medians and interquartile ranges (IQRs) and compared using Wilcoxon rank‐sum tests. Categorical variables were reported as frequencies and percentages and compared using chi‐squared or Fisher's exact tests, as appropriate. Age adjusted mean absolute and total percentage body weight loss was examined by support group attendance levels and tested using one‐way analysis of covariance (ANCOVA) models. A logistic regression model was used to examine differences in clinically significant total body weight loss by support group attendance levels after adjustment for age. Statistical significance was set at p < 0.05. Analyses were completed using SAS 9.0 (Cary, NC).
3. Results
A total of 94 participants were enrolled in the support group–based weight loss intervention and stratified by attendance level: low (n = 17), medium (n = 41), and high (n = 36). The overall cohort had a median age of 54.2 years (IQR: 49.0–62.0) and was predominantly female (74.5%) and non‐Hispanic White (81.9%). Demographic characteristics were generally similar across attendance level groups, although participants in the low‐attendance group tended to be significantly younger (median age: 49.2 years) compared to the high‐attendance group (median age: 55.9 years) (p = 0.03) (Table 1).
TABLE 1.
Baseline characteristics of participants by support group attendance level.
| Baseline characteristics | Overall (n = 94) | Low (n = 17) | Medium (n = 41) | High (n = 36) | p‐value * |
|---|---|---|---|---|---|
| Sociodemographic | |||||
| Age (years) (median, IQR) | 54.2 (49.0,62.0) | 49.2 (39.5, 54.0) | 55.8 (51.2, 62.4) | 55.9 (47.6, 64.4) | 0.03 |
| Gender | 0.5 | ||||
| Male | 24 (25.5%) | 6 (35.3%) | 11 (26.8%) | 7 (19.4%) | |
| Female | 70 (74.5%) | 11 (64.7%) | 30 (73.2%) | 29 (80.7%) | |
| Race/ethnicity (non‐Hispanic White) | 77 (81.9%) | 12 (70.6%) | 33 (80.5%) | 32 (88.9%) | 0.3 |
| Married | 66 (70.2%) | 11 (64.7%) | 32 (75.1%) | 23 (63.9%) | 0.3 |
| Former smoker | 23 (28.7%) | 3 (17.7%) | 14 (34.2%) | 10 (27.8) | 0.4 |
| Current drinker | 48 (51.6%) | 9 (22.0%) | 21 (51.2%) | 18 (51.4%) | 0.9 |
| Comorbidities | |||||
| Type 2 diabetes | 39 (42.9%) | 5 (29.4%) | 17 (43.6%) | 17 (48.6%) | 0.4 |
| Hypertension | 53 (57.6%) | 10 (58.8%) | 23 (57.5%) | 20 (57.1%) | 0.9 |
| Hyperlipidemia | 42 (45.7%) | 5 (29.4%) | 17 (42.5%) | 20 (57.1%) | 0.1 |
| MI/angina | 7 (7.6%) | 1 (5.9%) | 3 (7.5%) | 3 (8.6%) | 0.9 |
| Sleep apnea | 36 (39.1%) | 6 (35.3%) | 15 (37.5%) | 15 (42.9%) | 0.8 |
| Number of comorbidities | 0.7 | ||||
| 0 | 15 (16.3) | 3 (16.7%) | 6 (15.0%) | 6 (17.1%) | |
| 1–3 | 56 (60.9) | 12 (70.6%) | 25 (62.5%) | 19 (54.3%) | |
| 4+ | 21 (22.8) | 2 (11.8%) | 9 (22.5%) | 10 (28.6%) | |
p‐value based chi‐squared, Fisher's exact, or Kruskal‐Wallis tests for categorical variables and F‐statistic from ANOVA for continuous variables.
The prevalence of common comorbidities such as type 2 diabetes, hypertension, hyperlipidemia, and sleep apnea did not significantly differ between the groups. However, hyperlipidemia was more frequently reported among participants with high attendance (57.1%) compared to those with low attendance (29.4%), although this was not statistically significant (Table 1).
Importantly, weight loss outcomes varied significantly by support group attendance level. Age adjusted mean absolute total body weight loss was 6.2 kg (± 1.7) in the low‐attendance group, 9.5 kg (± 1.0) in the medium‐attendance group, and 13.9 kg (± 1.1) in the high‐attendance group (F = 8.56, p = 0.0004) (Figure 1). Similarly, corresponding percent total body weight loss was associated with support group attendance level in a stepwise fashion with age adjusted mean percent total body weight loss of 5.7% (± 1.4) in the low group, 8.6% (± 0.9) in the medium group, and 13.4% (± 0.9) in the high group, respectively (F = 12.47, p < 0.0001). In age‐adjusted logistic regression models, support group attendance was strongly associated with achieving clinically significant weight loss (Wald χ 2 = 14.29, p < 0.0008). Specifically, 73.1% of participants in the high‐attendance group achieved clinically significant weight loss (≥ 10%), compared with 38.1% in the medium‐attendance group and 19.2% in the low‐attendance group (Figure 1).
FIGURE 1.
Age‐adjusted mean (± SE) total body weight loss measures by support group attendance level. p‐values based on F‐statistic from ANCOVA models for absolute and percentage total body weight loss and logistic regression model for clinically significant total body weight loss. Errors bars represent standard error.
4. Discussion
Patients who participated in weight loss support groups at a community‐based gastroenterology practice and maintained at least 75% attendance were not only significantly more likely to lose weight overall, after adjustment for age, but also were more likely to achieve greater than 10% total body weight loss over a 6‐month period compared to those with less than 75% attendance. These findings demonstrate a clear dose‐response relationship, underscoring the critical role of consistent participation in structured support as part of a multidisciplinary approach to effective obesity treatment.
The effectiveness of group‐based intervention in achieving behavioral goals has been well‐documented in the literature, including for weight management. Obesity is a chronic condition that requires consistent effort to maintain healthy habits, and one way to do that is by encouraging patients to be active agents in their behavioral change journey and build a community. This can be achieved when patients form empathetic, nonjudgmental relationships with peers experiencing similar challenges in group settings. Senior members often share personal recovery experiences and strategies for managing stressors, contributing to a supportive social network. Structured and frequent participation in support groups can play a role in effective obesity management—a conclusion supported by this study.
These findings are consistent with those of Borek et al., whose systematic review of randomized controlled trials confirmed the efficacy of group‐based weight‐loss interventions, particularly those incorporating goal setting, feedback, and structured peer support [10]. Importantly, this study builds on this evidence by demonstrating similar benefits in a real‐world, community‐based gastroenterology setting. The observed dose‐response relationship in weight loss by session attendance further validates the role of group intensity and sustained engagement as key drivers of success. Unlike many clinical trials where intervention components are inconsistently described, this structured program with consistent facilitation may have helped achieve more uniform and clinically meaningful outcomes.
Obesity‐related disorders are being treated more often by gastroenterologists. While pharmacotherapies are emerging, issues related to cost and access still limit their utility for many patients. Bariatric procedures—such as intragastric balloons, endoscopic and laparoscopic sleeve gastrectomies, and Roux‐en‐Y gastric bypass—are effective but involve risks, high costs, and scalability challenges [19]. Importantly, even these interventions require ongoing lifestyle modification to achieve lasting success.
Although gastroenterologists may lack formal training in weight management, this does not preclude them from contributing effectively to obesity care. Multiple randomized controlled trials have demonstrated the success of structured weight management programs, typically combining dietary interventions with regular physical activity, in improving obesity‐related GI conditions [20, 21]. With the support of multidisciplinary teams and a structured approach, these programs are adaptable and can be implemented across various clinical settings.
This study has several limitations. The small sample size resulted in an uneven distribution across attendance groups, with the majority of patients attending more than 50% of sessions. Thus, the statistical power of the study was limited and there was potential for increased susceptibility to type II errors in the subgroup analyses of comorbidities. Furthermore, the study focused solely on 6‐month outcomes, leaving the long‐term sustainability of weight loss uncertain though this would have the greatest impact on health outcomes. Lastly, the generalizability of these findings is limited by the demographic composition of the study population, which was predominantly non‐Hispanic White, reflecting the local geographic region.
5. Conclusions
This is one of the first studies to demonstrate the importance of increased engagement in support groups to achieve clinically meaningful weight loss in a community gastroenterology clinic weight management program. Further studies of longer duration are needed to ensure reproducibility in a variety of geographic locations and demographics. Studies are ongoing with a larger sample size to corroborate these findings.
Author Contributions
Sangini Tolia: writing original draft, reviewing and editing, and approval of final publication. Sejal Gunaratnam: statistical analysis, writing original draft, reviewing and editing, approval of final publication. Nishant Kumar: statistical analysis, writing original draft, reviewing and editing, approval of final publication. Mallory Evans: data collection, writing original draft, reviewing and editing, and approval of final publication. Caitlin Seibel: statistical analysis and approval of final publication. Aruna V. Sarma: reviewing and editing and approval of final publication. Naresh Gunaratnam: supervision, study design, reviewing and editing, approval of final publication, guarantor.
Funding
The authors have nothing to report.
Consent
Informed consent was obtained from all involved parties.
Conflicts of Interest
The authors declare no conflicts of interest.
Tolia S., Gunaratnam S., Kumar N., et al., “Consistent Support Group Attendance Is Vital for Sustained Total Body Weight Loss in a Community Gastroenterology Clinic,” Obesity Science & Practice(2026): e70157, 10.1002/osp4.70157.
Sangini Tolia and Sejal Gunaratnam were co‐first authors.
References
- 1. Saliares A., Berinstein E., Montagano J. A., Al‐Yaman W. A., and Gunaratnam N. T., “87: Improvement of Non‐Alcoholic Fatty Liver Disease Through a Comprehensive Weight Loss Program in a Community Gastroenterology Practice,” Gastroenterology 162, no. 7 (2022): S‐13, 10.1016/S0016-5085(22)60033-7. [DOI] [Google Scholar]
- 2. Hurt R. T., Kulisek C., Buchanan L. A., and McClave S. A., “The Obesity Epidemic: Challenges, Health Initiatives, and Implications for Gastroenterologists,” Gastroenterology and Hepatology 6, no. 12 (2010): 780–792, PMID: 21301632; PMCID: PMC3033553. [PMC free article] [PubMed] [Google Scholar]
- 3. Imes C. C. and Burke L. E., “The Obesity Epidemic: The USA as a Cautionary Tale for the Rest of the World,” Current Epidemiology Reports 1, no. 2 (2014): 82–88, 10.1007/s40471-014-0012-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4. Bray G. A., Heisel W. E., Afshin A., et al., “The Science of Obesity Management: An Endocrine Society Scientific Statement,” Endocrine Reviews 39, no. 2 (2018): 79–132, 10.1210/er.2017-00253. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5. Ruban A., Stoenchev K., Ashrafian H., and Teare J., “Current Treatments for Obesity,” Clinical Medicine 19, no. 3 (2019): 205–212, 10.7861/clinmedicine.19-3-205. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6. Wadden T. A., Butryn M. L., and Byrne K. J., “Efficacy of Lifestyle Modification for Long‐Term Weight Control,” supplement, Obesity Research 12, no. S12 (2004), 10.1038/oby.2004.282. [DOI] [Google Scholar]
- 7. Tsai A. G. and Wadden T. A., “Systematic Review: An Evaluation of Major Commercial Weight Loss Programs in the United States,” Annals of Internal Medicine 142, no. 1 (2005): 56–66, 10.7326/0003-4819-142-1-200501040-00012. [DOI] [PubMed] [Google Scholar]
- 8. Heshka S., Anderson J. W., Atkinson R. L., et al., “Weight Loss With Self‐Help Compared With a Structured Commercial Program: A Randomized Trial,” JAMA 289, no. 14 (2003): 1792–1798, 10.1001/jama.289.14.1792. [DOI] [PubMed] [Google Scholar]
- 9. Moos R. H. and Moos B. S., “Rates and Predictors of Relapse After Natural and Treated Remission From Alcohol Use Disorders,” Addiction 101, no. 2 (2006): 212–222, 10.1111/j.1360-0443.2006.01310.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10. Borek A. J., Abraham C., Greaves C. J., and Tarrant M., “Group‐Based Diet and Physical Activity Weight‐Loss Interventions: A Systematic Review and Meta‐Analysis of Randomised Controlled Trials,” Applied Psychology: Health and Well‐Being 10, no. 1 (2018): 62–86, 10.1111/aphw.12121. [DOI] [PubMed] [Google Scholar]
- 11. Wadden T. A., Neiberg R. H., Wing R. R., et al., “Four‐Year Weight Losses in the Look AHEAD Study: Factors Associated With Long‐Term Success,” Obesity 19, no. 10 (2011): 1987–1998, 10.1038/oby.2011.230. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12. Street S. and Avenell A., “Are Individual or Group Interventions More Effective for Long‐Term Weight Loss in Adults With Obesity? A Systematic Review,” Clinical Obesity 12, no. 5 (2022): e12539, 10.1111/cob.12539. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13. Acosta A., Streett S., Kroh M. D., et al., “White Paper AGA: POWER—Practice Guide on Obesity and Weight Management, Education, and Resources,” Clinical Gastroenterology and Hepatology 15, no. 5 (2017): 631–649.e10, 10.1016/j.cgh.2016.10.023. [DOI] [PubMed] [Google Scholar]
- 14. Hawa F. and Gunaratnam N. T., “Establishing an Effective Weight Loss Program in a Community‐Based Gastroenterology Practice: The Huron Gastro Experience,” Clinical Gastroenterology and Hepatology 17, no. 9 (2019): 1669–1672, 10.1016/j.cgh.2019.02.036. [DOI] [PubMed] [Google Scholar]
- 15. Hawa F., Gladshteyn M., Gunaratnam S. V., et al., “Effective Treatment of Nonalcoholic Fatty Liver Disease Using a Community‐Based Weight Management Program,” Cureus 13, no. 7 (2021): e16709, 10.7759/cureus.16709. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16. Glass L. M., Dickson R. C., Anderson J. C., et al., “Total Body Weight Loss of ≥ 10% Is Associated With Improved Hepatic Fibrosis in Patients With Nonalcoholic Steatohepatitis,” Digestive Diseases and Sciences 60, no. 4 (2015): 1024–1030, 10.1007/s10620-014-3380-3. [DOI] [PubMed] [Google Scholar]
- 17. Younossi Z. M., Corey K. E., and Lim J. K., “AGA Clinical Practice Update on Lifestyle Modification Using Diet and Exercise to Achieve Weight Loss in the Management of Nonalcoholic Fatty Liver Disease: Expert Review,” Gastroenterology 160, no. 3 (2021): 912–918, 10.1053/j.gastro.2020.11.051. [DOI] [PubMed] [Google Scholar]
- 18. Vilar‐Gomez E., Martinez‐Perez Y., Calzadilla‐Bertot L., et al., “Weight Loss Through Lifestyle Modification Significantly Reduces Features of Nonalcoholic Steatohepatitis,” Gastroenterology 149, no. 2 (2015): 367–378.e5, 10.1053/j.gastro.2015.04.005. [DOI] [PubMed] [Google Scholar]
- 19. Elmaleh‐Sachs A., Schwartz J. L., Bramante C. T., Nicklas J. M., Gudzune K. A., and Jay M., “Obesity Management in Adults: A Review,” JAMA 330, no. 20 (2023): 2000, 10.1001/jama.2023.19897. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20. Koutoukidis D. A., Astbury N. M., Tudor K. E., et al., “Association of Weight Loss Interventions With Changes in Biomarkers of Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta‐Analysis,” JAMA Internal Medicine 179, no. 9 (2019): 1262–1271, 10.1001/jamainternmed.2019.2248. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21. Kenneally S., Sier J. H., and Moore J. B., “Efficacy of Dietary and Physical Activity Intervention in Non‐alcoholic Fatty Liver Disease: A Systematic Review,” BMJ Open Gastroenterology 4, no. 1 (2017): e000139, 10.1136/bmjgast-2017-000139. [DOI] [Google Scholar]