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Non-surgical program, primary care practitioners helped morbidly obese patients lose weight
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Primary care practitioners successfully initiated weight loss in morbidly obese adults using intensive medical intervention in a new study.
Results indicated that two-year weight loss among morbidly obese adults, defined as those with a BMI ≥40, was significantly better with a program that implemented therapeutic techniques for treating obesity, including diet, exercise, behavior therapy and pharmacotherapy, compared with usual care.
The LOSS study was conducted from 2005 to 2008. The two-year, randomized, controlled, clinical trial — called a “pragmatic clinical trial” by the researchers — trained seven primary care practices and one research clinic in obesity management. The researchers randomly assigned 597 volunteers to two groups: intensive medical intervention (n=200) or usual care (n=190).
Participants assigned to intensive medical intervention were instructed to follow a 900-kcal liquid diet for at least 12 weeks and undergo group behavioral counseling, a structured diet of 1,200 kcal to 1,600 kcal per day consisting of two portion-controlled meal replacements and one structured meal, selection of pharmacotherapy (sibutramine, orlistat or diethylpropion) from months three to seven, and extended use of medications or maintenance strategies for months eight to 24. Participants assigned to usual care were instructed on weight loss via an internet weight-management program.
After two years, 51% of participants assigned to intensive medical intervention remained on the program and 46% assigned to usual care.
Participants assigned to intensive medical intervention had a mean two-year weight loss of –4.9% compared with –0.2% for participants assigned to usual care.
Among 390 randomized participants, 31% assigned to intensive medical intervention sustained a weight loss of ≥5% of their initial body weight and 7% sustained a loss of ≥20%. In the usual care group, 9% achieved a ≥5% weight loss and 1% achieved ≥20% weight loss.
The last observation carried forward analysis at year two was –8.3% for the intensive medical intervention group and –0% for the usual care group.
“Physicians should not ignore those patients with class-3 obesity who cannot undergo bariatric surgery. Research is needed to guide primary care approaches that are safe, efficacious and cost-effective. The [clinical trial] demonstrates that this research can be done in the real-world setting, mimicking real-life clinical practices.,” the researchers concluded.
Despite current recommendations of guidelines for morbidly obese adults, obesity is undertreated and underrecognized in primary care practices, according to Robert F. Kushner, MD, of Northwestern University Feinberg School of Medicine, Chicago.
“Obesity treatment is often perceived by physicians as a daunting or even futile tasks. There are few other examples in medicine where stigmatization of the patient, feelings of being ill equipped, perceived treatment ineffectiveness, and even reluctance to engage in obesity care prevail as major barriers,” Kushner wrote in an accompanying editorial. “two changes are needed to engage primary care physicians in obesity care: systematic reorganization of office-based processes and functions and physician training in primary care. – by Matthew Brannon
Ryan DH. Arch Intern Med. 2010;170:146-154.
Kushner RF. Arch Intern Med. 2010;170:121-123.