Adding trained interventionists to primary care results in weight loss

1. Primary care visits supplemented by sessions with trained interventionists resulted in greater patient weight loss than primary care visits alone.

2. Frequent telephone calls from interventionists may also be successful as a standalone weight loss treatment program.

Evidence Rating Level: 1 (Excellent)

Study Rundown: The health impacts of obesity are widely recognized by the medical community for some time and include hypertension, type 2 diabetes, and heart disease. While the benefits of a balanced diet and exercise have been known for many years, it is a difficult prescription for many patients to adhere to. In 2011, the Centers for Medicare & Medicaid Services consequently attempted to address this issue by approving intensive behavioral weight loss counseling for obese patients in primary care settings.

This study is a systematic review of behavioral counseling programs delivered by primary care physicians alone or with aid from interventionists (such as medical assistants and dieticians) in addition to programs delivered by such trained interventionists alone. The study found that programs focused specific goals, such as maintaining 150 minutes/week of exercise, provided the greatest weight loss benefit compared to programs that did not specify such goals. Further, programs utilizing trained interventionists independently via telephone or in conjunction with primary care physicians during patient visits, demonstrated greater weight loss than primary care physicians alone. While this study utilized stringent search criteria and only included randomized controlled trials, the small number of studies ultimately included limited its results. Nevertheless, this study provides health care providers and policymakers with insight into the elements of a successful weight loss counseling program.

Click to read the study, published today in JAMA

Relevant Reading: 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults

In-Depth [systematic review]: This systematic review used PubMed, CINAHL, and EMBASE to search for articles from January 1, 1980 until June 30, 2014. Of 3304 abstracts, 12 studies were identified comprised of 3893 patients with BMIs ranging 32.0 – 38.5. Primary care visits every 4 months plus monthly interventionist sessions produced a 22.5% weight loss compared to 10.2% for primary care visits alone (P=.02). One remote-support group (telephone sessions with interventionists) showed 52.7% of patients losing at least 5% of their baseline weight at 6 months compared to 14.7% in the usual primary care group. Overall, the difference in weight loss between treatment and control groups in all 12 studies ranged from -1.5 kg to 4.3 kg.

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