Cardiometabolic health improved by lifestyle interventions in primary care setting
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A 24-month lifestyle intervention provided in the primary care setting by health coaches improved cardiometabolic risk factors among patients with obesity compared with usual care alone, according to data published in Circulation.
These findings from the PROPEL trial demonstrated the impact of intensive lifestyle intervention in lowering BMI and improving HDL and metabolic syndrome severity among patients with obesity.
PROPEL trial design
“Intensive lifestyle interventions are the first-line approach to promote weight loss and to effectively treat obesity and manage associated health risks,” Christoph Höchsmann, PhD, of the ingestive behavior laboratory at the Pennington Biomedical Research Center in Baton Rouge, Louisiana, and colleagues wrote. “However, only a small proportion of the population has access to intensive lifestyle interventions in academic health centers. Therefore, uptake of similar approaches by primary care, the cornerstone of medical care in the United States, is imperative for a meaningful effect on the global obesity prevalence and for achieving public health goals to reduce health inequities.”
The PROPEL trial randomly allocated 18 clinics to provide intensive lifestyle interventions through health coaches or usual care to 803 adults with obesity (mean age, 49 years; mean BMI, 37 kg/m2; 67% Black; 84% women). Participants in the intervention group underwent a 24-month high-intensity lifestyle-based obesity treatment program in weekly sessions up to month 7 and monthly through 24 months. The usual care group received standard primary care.
“Participants at clinics allocated to the intensive lifestyle intervention group received a comprehensive, high-intensity lifestyle intervention program based on Diabetes Prevention Program, Look AHEAD and CALERIE (Comprehensive Assessment of Long-Term Effects of Reducing Intake of Energy Phase) and consistent with the 2013 American Heart Association/American College of Cardiology/The Obesity Society guidelines,” the researchers wrote. “The regimen was adapted to be literacy and culturally appropriate for a low-income target population.”
Effect of intensive lifestyle intervention
Researchers found that participants in the intervention arm lost more weight in 24 months compared with those who received usual care (mean difference, 4.51%; 95% CI, 5.93 to 3.1; P < .01).
At 12 months, larger reductions in fasting glucose occurred in the intervention group compared with the usual care group (mean difference, 7.1 mg/dL; 95% CI, 12 to 2.1; P < .01); however, there was no difference at 24 months (mean difference, 0.8 mg/dL; 95% CI, 6.2 to 4.6; P = .76).
Increases in HDL were greater in the lifestyle intervention arm compared with the usual care group at 12 and 24 months (mean difference at 24 months, 4.6 mg/dL; 95% CI, 2.9-6.3; P < .01).
At 24 months, the ratio of total cholesterol to HDL in the intervention arm was lower compared with the usual care groups (mean difference, 0.31; 95% CI, 0.47 to 0.14; P < .01), and the intervention group had less metabolic syndrome severity (mean z score difference, 0.21; 95% CI, 0.36 to 0.06; P = .01).
“A major strength of PROPEL is it’s sample, consisting of a racially diverse, low-income population that typically lacks access to effective weight-loss treatment in clinical research or primary care,” the researchers wrote. “The minimal inclusion/exclusion criteria of the trial allow broad generalizability to other underserved populations across the United States. Furthermore, the present results underline the effectiveness of a comprehensive and scalable weight loss and cardiometabolic risk factor treatment model that applies to many primary care settings.”
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