Socioeconomically disadvantaged, obese patients benefit from behavioral intervention

Bennett GG. Arch Intern Med. 2012;doi:10.1001/archinternmed.2012.1.

High-risk, socioeconomically disadvantaged, obese patients experienced modest weight loss and improved BP control after participation in a behavioral intervention designed to address weight loss in resource-constrained settings, new data indicate.

“The socioeconomically disadvantaged patients who seek care at community health centers are particularly affected by the limited availability of obesity treatments,” researchers wrote. “These high-risk patients have disproportionately elevated rates of obesity and obesity-associated health conditions due, in part, to their high levels of adulthood weight gain and prolonged exposure to obesogenic environments.”

As part of the Practice-based Opportunities for Weight Reduction (POWER) trial, researchers randomly assigned 365 obese patients seen at three community health centers in Boston to usual care or the “Be Fit, Be Well” lifestyle intervention promoting weight loss and hypertension self-management for 24 months. The intervention included behavior change goals, self-monitoring of progress via a website or interactive voice response system, 18 telephone counseling calls, 12 optional group support sessions and community resource links.

Of all participants, 71.2% were black; 13.1% were Hispanic; 68.5% were women; 32.9% had less than a high school education; 54.5% had an annual household income less than $25,000; and 54.2% had public health insurance coverage, the researchers said.

Compared with the usual care group, changes in weight and BMI were –1.03 kg (95% CI, –2.03 to –0.03) and –0.38 (95% CI, –0.75 to –0.004), respectively, in the intervention group at 24 months. Additionally, participants in the intervention group experienced larger mean weight losses than those in the usual care group during the study.

Although average systolic BP was lower in the intervention arm vs. the usual care arm, these results were not significantly different. The slope of increasing systolic BP per year, however, was significantly higher in the usual care group. At the study’s conclusion, patients in the intervention group were more likely to achieve BP control than those in the usual care group, according to the researchers.

“As a pragmatic effectiveness trial, our findings are arguably more generalizable to real-world health center settings than are those of highly controlled efficacy trials with larger treatment effects,” the researchers wrote. “More work is necessary to best address the needs of socioeconomically disadvantaged patients who bear the greatest risk and disease burden of obesity.”

Disclosure: The researchers report no relevant financial disclosures.