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Enhanced weight-loss counseling yielded encouraging results
Wadden TA. N Engl J Med. 2011;365:1969-1979.
Participants in an enhanced weight-loss intervention program lost more than twice as much weight as those receiving standard care, according to study results.
The trial was conducted because weight-loss interventions implemented by primary care providers may be insufficient.
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There were 390 obese adults from six PCPs involved in the trial, all of whom received quarterly visits from a PCP during a 2-year period. Participants in the usual care arm received education about weight management from their PCP; those in the brief lifestyle counseling arm also received brief monthly sessions with a lifestyle coach who provided information about behavioral weight control; those in the enhanced brief lifestyle counseling arm received the same monthly intervention as those in the brief lifestyle counseling arm plus meal replacements or weight-loss medications, including orlistat (Xenical, Hoffmann-La Roche; Alli, GlaxoSmithKline) or sibutramine (Meridia, Abbott). The choice between meal replacements or pharmacotherapy was made by the participants and PCPs.
Analysis was conducted for mean weight loss. Participants in the usual care arm experienced a mean weight loss of 1.7 ± 0.7 kg vs. 2.9 ± 0.7 kg in the brief lifestyle counseling arm and 4.6 ± 0.7 kg in the enhanced brief lifestyle counseling arm.
Initial weight decreased at least 5% in 21.5% of participants in the first group, 26% of those in the second group and 34.9% of those in the third group.
Enhanced lifestyle counseling was superior to usual care in mean weight loss (P=.003) and initial weight decrease of at least 5% (P=.02).
Further analysis indicated that the benefits of the most intensive intervention remained, even after participants receiving sibutramine were excluded.
No differences in serious adverse event profiles were observed across the intervention groups.
“Enhanced weight-loss counseling helps about [one-third] of obese patients achieve long-term, clinically meaningful weight loss,” the researchers wrote.
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