A Two-Year Randomized Trial of Obesity Treatment in Primary Care Practice

Abstract

BACKGROUND Calls for primary care providers (PCPs) to offer obese patients behavioral weight-loss counseling have not been accompanied by adequate guidance on how such care could be delivered. This randomized trial compared weight loss during a 2-year period in response to three lifestyle interventions, all delivered by PCPs in collaboration with auxiliary health professionals (lifestyle coaches) in their practices. METHODS We randomly assigned 390 obese adults in six primary care practices to one of three types of intervention: usual care, consisting of quarterly PCP visits that included education about weight management; brief lifestyle counseling, consisting of quarterly PCP visits combined with brief monthly sessions with lifestyle coaches who instructed participants about behavioral weight control; or enhanced brief lifestyle counseling, which provided the same care as described for the previous intervention but included meal replacements or weight-loss medication (orlistat or sibutramine), chosen by the participants in consultation with the PCPs, to potentially increase weight loss. RESULTS Of the 390 participants, 86% completed the 2-year trial, at which time, the mean (±SE) weight loss with usual care, brief lifestyle counseling, and enhanced brief lifestyle counseling was 1.7±0.7, 2.9±0.7, and 4.6±0.7 kg, respectively. Initial weight decreased at least 5% in 21.5%, 26.0%, and 34.9% of the participants in the three groups, respectively. Enhanced lifestyle counseling was superior to usual care on both these measures of success (P = 0.003 and P = 0.02, respectively), with no other significant differences among the groups. The benefits of enhanced lifestyle counseling remained even after participants given sibutramine were excluded from the analyses. There were no significant differences between the intervention groups in the occurrence of serious adverse events. CONCLUSIONS Enhanced weight-loss counseling helps about one third of obese patients achieve long-term, clinically meaningful weight loss. (Funded by the National Heart, Lung, and Blood Institute; POWER-UP ClinicalTrials.gov number, NCT00826774.)

Effects of a Health‐Partner Intervention on Cardiovascular Risk

“…To this effect, various lifestyle and nonpharmacological interventions have been examined in cardiac and noncardiac patient populations and have used cognitive‐behavioral strategies, including motivational interviewing, goal setting, continued support, promotion of clinical self‐knowledge and efficacy, as well as self‐monitoring and management 2, 3, 4. These measures have been delivered by health care providers, computer programs, or online interfaces, predominantly in patients with established CVD or its risk factors 5, 6, 7, 8, 9, 10, 11…”

Access to Primary Care in US Counties Is Associated with Lower Obesity Rates

“…10 Several recent studies support the effectiveness of a primary care-based model for treatment of obesity. 11,12 While it is effective, physicians do not practice weight-loss counseling with appropriate regularity, content, or frequency. 10,[13][14][15][16] Although the content and frequency of weight-loss counseling by physicians is not yet optimal based on the existing evidence, obese people who come in contact with the health care system are more likely to receive weight-loss counseling than those who do not have adequate access to care.…”

Program compliance, weight loss and health profile changes in WHO obesity classes after very low energy dietary intervention

“…As increases in obesity classes are strongly associated with higher health care costs [9], for medical practitioners and other health professionals working in the area of obesity, research data on specific weight loss regimes and private clinic programs [14][15][16][17][18] may assist in counselling obese individuals and potentially lead to significant health care savings.…”

“…The behaviour management components covered the core areas of assertion, stress management, goal setting, self monitoring, portion control, problem solving, cognitive restructuring, relapse prevention, optimistic thinking and self care. These groups were led by physical and health educators (week 1-8, 23-26), a registered psychologist (week 9-12), dietician (week [13][14][15][16][17][18][19][20] or exercise physiologist (week 4-5, 21-22). All groups followed the program manual that was supplied to each participant [17,18].…”

“…Independent and dependent t tests were used, with signi-ficance accepted at p<0.05. Program compliance was defined as low if participants completed only weeks 1-12, medium (completion of weeks [13][14][15][16][17][18][19][20] or high (completion of weeks [21][22][23][24][25][26]. Odds ratios were calculated on each obesity class for participants who lost 15% or more of their initial body mass.…”