Better tools for Primary Care Providers

November 14th, 2011 by MorganDowney Leave a reply »

The New England Journal of Medicine has just published a study by Thomas Wadden, et al., Three interventions were compared. One group received usual care consisting of quarterly visits with a primary care provider that included education about weight management. The second group received brief lifestyle counseling, consisting of quarterly visits with the primary care provider plus brief monthly session with lifestyle coaches who provided instruction about behavioral weight control. The third group received the same care as the second group but with the addition of meal replacements or weight-loss medications (orlistat or sibutramine before it was taken off the market). 

The percentage of participants who lost more than 5% of their initial weight was 21.5% in the usual-care group, 26% in the brief-lifestyle counseling group and 34.9% in the enhanced-brief counseling group. The change in weight loss at 24 months was -1.7 kg in usual-care group, -2.9kg  in the  brief-lifestyle group, and -4.6kg in the enhanced brief-lifestyle group. The pattern shows significant weight loss at 6 and 12 months with subsequent modest regain. Participants who received enhanced brief-lifestyle intervention saw significant reductions in cardiovascular risk factors. SeeA Two-Year Randomized Trial of Obesity Treatment in Primary Care Practice — NEJM

In a second article, Lawrence J. Appel and colleagues compared in-person support with remote care delivered without face-to-face contact between participants and weight loss coaches.  The percentage of participants who lost more than 5% of their initial weight was 18.8% in the control group, 38.2% in the remote support-only group and 41.4% in the in-person group. The change in weight loss was -0.8kg in the control group, -4.6kg in the remote-only group and -5.1kg in the in-person group, corresponding to -1.1%, -5% and -5.2%. Importantly, most participants sustained the weight loss at 24 months. Comparative Effectiveness of Weight-Loss Interventions in Clinical Practice — NEJM

See the Philadelphia Inquirer story by Don Sapatkin, Studies point to weight loss at the doctor’s office | Philadelphia Inquirer | 11/15/2011

Taken both together and with earlier research on primary care, the picture is that intervention by primary care providers can convey the seriousness of weight loss as well as provide patients with some real weight loss, albeit modest compared with surgery and some of the medications under review by the Food and Drug Administration but more than broad prescriptions to lose weight. Intensity matters as does the use of several, mutually-supporting strategies.