Abstract 25307: Treating Obesity in Primary Care Practice: A Two-Year Randomized Controlled Trial
Background: Primary care providers (PCPs) are encouraged to screen adults for obesity and to offer lifestyle counseling for weight loss. This study assessed three lifestyle interventions of varying intensities, all provided by PCPs, working with medical assistant (MAs) in their practices.
Method: A total of 311 women and 79 men (mean age=51.5±11.5 yr, BMI=38.5±4.7 kg/m2) were recruited at 6 primary care practices, owned by a university health system. Participants were randomized to: 1) Usual Care, consisting of quarterly PCP visits at which weight management was briefly (5-7 min) reviewed using handouts from NHLBI; 2) Brief Lifestyle Coaching (LC), which included the same PCPs visits, combined with monthly 10-15 min visits with MAs, who presented abbreviated lessons from the Diabetes Prevention Program; or 3) Enhanced LC, which provided the same visits as Brief LC, combined with the use of either meal replacements or weight loss medication (sibutramine or orlistat), selected by participants in consultation with PCPs. The study, sponsored by NHLBI, had 80% power to detect a 2.75 kg difference in weight loss between Usual Care and each of the LC interventions. (Sibutramine was removed from the U.S. market in October 2010 because of its association with CVD events.)
Results: Study retention at Month 24 was approximately 85% in all three groups. At this time, participants in Usual Care, Brief LC, and Enhanced LC lost 1.7±0.7, 2.9±0.7, and 4.6±0.7 kg, respectively. Enhanced LC was superior (p<0.003) to Usual Care, with no other differences between groups. Forty percent of Enhanced LC participants lost ≥5% of weight vs 26% for Usual Care (p<0.027) and 30% for Brief LC (ns). A secondary analysis, eliminating the 44 participants exposed to sibutramine, revealed a 4.3±0.8 kg loss for Enhanced LC, superior to Usual Care (p<0.015).
Conclusions: PCPs, by collaborating with MAs and prescribing meal replacements/medications, helped obese patients in their practices achieve clinically meaningful weight loss. Questions remain whether lifestyle counseling should be offered in primary care or could be provided more efficiently and at lower cost using Internet, smart phone, or call-center platforms.
- © 2011 by American Heart Association, Inc.