Primary Care-Based Weight Loss Interventions Effectiveness

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The Growing Need for Effective Weight Loss Solutions

Attaining and maintaining a healthy weight is a major health issue, not only in the United States but in many countries throughout the world. Governments are looking to identify the most effective services to support people to lose weight and improve overall health. A recent systematic review and meta-analysis examined the effectiveness of weight management interventions delivered in primary care settings, and included data from the United States, the United Kingdom, and Spain.

Examining Weight Loss Support in Primary Care

Researchers evaluated 34 studies with adults who had a body mass index greater than 25 (overweight). They looked at people who received weight loss interventions within primary care settings. The interventions included instruction on weight management behaviors such as low-calorie diets, increased exercise, use of food diaries, and/or behavioral self-management approaches with support by clinic staff to set weight-related goals, solve problems, and increase self-efficacy.

Weight loss interventions were conducted by telephone, the internet, email, or face-to-face, and included group-based and/or individual connections. The research compared these types of interventions to no weight loss treatment, minimal intervention (use of printed or electronic education about weight loss), or instruction in attention control to resist urges or behaviors, but not focusing specifically on weight loss behavior.

The Impact of Primary Care-Delivered Weight Loss Programs

The interventions were delivered by a variety of medical professionals (nurses, dietitians, and general practitioners) and nonmedical practitioners such as health coaches. The interventions lasted between one session (with patients following the program unassisted for three months) and several sessions over three years, with a median of 12 months.

Results showed that the mean difference between the intervention and comparison (no specific weight loss intervention) groups at one year was a weight loss of 5.1 pounds, and at two years it was 4 pounds for those that received weight loss interventions in primary care. There was also a mean difference in waist circumference of -2.5 cm, in favor of the intervention at one year.

The Health Benefits of Even Small Weight Loss

The authors noted that although a 5-pound greater weight loss in the intervention group may seem small, research has shown that a 2% to 5% weight loss is associated with health benefits, including lower systolic blood pressure along with reduced triglyceride and glucose levels, which may impact cardiac health.

Personal Check-ins and Support Lead to More Weight Loss

The study suggests that personal contacts between patients and providers played a critical role in the findings. More contacts led to more weight loss. Programs that include at least 12 face-to-face or telephone consultations should be developed. Interventions delivered by nonmedical personnel with primary care health professionals' support may be less expensive than those delivered by physicians and general practitioners.

The study did not examine the costs of the programs, but it suggests that a combination of practitioners may be the most effective solution. Physicians and general practitioners are unlikely to have the time for 12 consultations to support a weight management program.

Cost-Effective Interventions and a Combination of Practitioners

Although the study did not determine the costs of the programs, it is likely that interventions delivered by nonmedical personnel, with supervision and support from primary care health professionals, would be less expensive. It may be that a combination of practitioners would be most effective, since physicians and general practitioners most likely will not have the time for 12 consultations to support a weight management program.

Supporting Evidence from Previous Research

A study prepared for the US Preventive Services Task Force and published in 2018 found similar results. This review reported a reduction of 5.3 pounds in participants who received weight management interventions in a variety of settings, including universities, primary care, and the community. Compared with controls, participants in behavior-based interventions had greater mean weight loss at 12 to 18 months and less weight regain.

In the two largest trials (of the 124 identified), there was a decreased probability of developing type 2 diabetes compared with those who did not receive the weight management interventions. There was an absolute risk reduction of approximately 14.5% in both trials over three to nine years, meaning those who received weight loss management intervention had a 14.5% reduced chance of developing diabetes compared to a control group.

Community-Based Interventions

Community-based behavioral interventions for weight loss have been supported by previous research. A study conducted in 2018 for the US Preventive Services Task Force found similar results, reporting a weight loss reduction of 5.3 pounds in participants who received weight management interventions in various settings, including primary care, universities, and the community. Compared to control groups, individuals who received behavior-based interventions had greater mean weight loss at 12 to 18 months and less weight regain.

In the two largest trials among the 124 identified, participants who received weight management interventions had a reduced probability of developing type 2 diabetes, with an absolute risk reduction of approximately 14.5% in both trials over three to nine years, compared to those who did not receive such interventions.

Key Takeaways and Practical Advice

Weight management interventions delivered in primary care settings are an effective way to deliver services. Primary care practices offer good reach into the community, and oftentimes are the first point of contact for people to the healthcare system. With our growing obesity epidemic, every effort should be considered to connect with patients struggling with their weight and offer viable, effective interventions.

To make the most of the available resources, individuals seeking weight management support can take the following steps:

  1. Consult your primary care provider (PCP): Ask if their practice or clinic offers programs to support weight management.
  2. Contact your health insurance provider: Inquire about programs they have in their system to help reduce risk factors and manage weight. Ask if they are free or discounted as part of your plan.
  3. Explore community-based programs: Check in your area for programs such as the YMCA, a school-based program, or a senior center focused on wellness and weight management.

The bottom line is that weight management interventions provided in primary care settings are an effective means of delivering services. Primary care practices offer excellent community outreach and are often the first point of contact for people entering the healthcare system. Given our growing obesity epidemic, every effort should be made to reach out to patients struggling with their weight and offer effective interventions.

You can ask your PCP if their practice or clinic offers programs to support weight management. You can also check with your health insurance provider to see if they have programs in place to help reduce risk factors and manage weight, and whether these programs are free or discounted under your plan. Additionally, you can look into community-based programs, such as those offered by the YMCA, school-based programs, or senior centers focused on wellness and weight management, in your area.

References:

  1. "Effectiveness of weight management interventions in primary care: a systematic review and network meta-analysis" - This systematic review and meta-analysis investigates the effectiveness of various weight management interventions in primary care settings. The study includes data from the United States, the United Kingdom, and Spain. Link to the study
  2. "Behavioral Weight Loss Interventions to Prevent Obesity-Related Morbidity and Mortality in Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force" - This 2018 study prepared for the US Preventive Services Task Force provides an overview of weight management interventions in various settings, including primary care, universities, and communities, and examines their impact on weight loss and health outcomes. Link to the study
  3. "Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial" - This trial explores the effectiveness of primary care-led weight management interventions for achieving remission of type 2 diabetes. The study provides insights into the potential health benefits of weight loss interventions within primary care settings. Link to the study

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