Weight Loss for Obese Patients With Help From Primary Care

Primary care physicians (PCPs) could help about one-third of obese persons achieve clinically meaningful weight loss by providing enhanced lifestyle counseling. However, combining quarterly PCP visits with brief monthly lifestyle coaching provided by medical assistants does not significantly increase weight loss.

Wadden and associates randomly assigned 390 obese adults to 1 of 3 types of intervention: (1) usual care (quarterly PCP visits that include education about weight management), (2) brief lifestyle counseling (quarterly visits combined with brief monthly sessions with lifestyle coaches), or (3) enhanced brief lifestyle counseling (providing the same care but including meal replacements or weight loss medication). The primary outcome was the change in body weight at month 24 in each of the lifestyle-counseling groups compared with the usual-care group.

At 2 years, the mean 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 3 groups, respectively. Enhanced lifestyle counseling was superior to usual care on both these measures of success.

The authors noted that the treatment model used in their study awaits comparison with community-based approaches and electronically delivered interventions.