Primary Care Tackles Obesity with Good Results

Primary care-based lifestyle interventions achieve significant and durable weight reduction in obese adults, according to a new study.

Researchers at the University of Pennsylvania (Penn, Philadelphia, USA) randomly assigned 390 obese adults in six primary care practices to one of three types of intervention: usual care, consisting of quarterly primary care providers (PCPs) 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 chosen by the participants in consultation with the PCPs, to potentially increase weight loss.

The results showed that of the 390 participants, 86% completed the two-year trial, at which time the mean weight loss with usual care, brief lifestyle counseling, and enhanced brief lifestyle counseling was 1.7, 2.9, and 4.6 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, with no other significant differences among the groups. There were no significant differences between the intervention groups in the occurrence of serious adverse events. The study was published on November 24, 2011, in the New England Journal of Medicine (NEJM).

“The enhanced lifestyle counseling program offers a successful model for treating obesity in primary care practice with the support of regular staff members, primary care providers, and medical assistants,” said lead author Prof. Thomas Wadden, PhD, director of the Penn Center for Weight and Eating Disorders. “This is an important finding, in light of the Centers for Medicare and Medicaid Services' recent proposal to cover the costs of intensive behavioral weight loss counseling provided to seniors in primary care practice by physicians and nurse practitioners.”

A PCP is a physician/medical doctor who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis. The PCP collects information on the present symptoms, prior medical history, and other health details, followed by a physical examination, basic medical testing and interpretation of blood or other patient tests and samples, electrocardiograms, or X-rays.

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