In-person and remote programs lead to weight loss in primary care

More than a third of obese patients successfully achieved significant weight loss in two different two-year programs led by primary care physicians and funded by the National Heart, Lung and Blood Institute.

The first program compared in-person and remote interventions in a group of 415 obese patients with at least one cardiovascular risk factor. Patients were randomized to remote weight loss support (involving phone calls, a study-specific website and emails) or in-person group and individual sessions in addition to the remote resources. An additional control group engaged in self-directed weight loss. After two years, the control group's mean weight loss was 0.8 kg, compared to 4.6 kg in the remote-only group and 5.1 kg in the in-person support group. Overall, significant weight loss (defined as losing 5% or more from baseline) occurred in 18.8% of the control group, 38.2% of the remote group and 41.4% of the in-person group.

In the second study, 390 obese adults were also randomized to one of two interventions or usual care. Usual care consisted of quarterly visits with the patient's physician. A brief lifestyle counseling group also received monthly sessions with lifestyle coaches, and the “enhanced counseling” group received meal replacements or weight-loss medication in addition to the other resources. After two years, mean weight loss was 1.7 kg in the usual care group, 2.9 kg in the counseling group, and 4.6 kg in the enhanced group. Five percent weight loss was achieved in 21.5%, 26.0% and 34.9% of the patients in the respective trial arms. Because sibutramine, one of the weight-loss medications (the other was orlistat), was removed from the market during the trial, researchers also analyzed the data excluding that drug and found that the enhanced group still did significantly better.

Authors of both studies noted that these were pragmatic effectiveness trials, in which patient compliance was more reflective of actual practice than most study environments. Attendance was low (below half) for the in-person interventions in the second year of both trials. The inconvenience of in-person support may explain why the remote intervention was approximately as successful as the in-person one in the first study, according to an editorial published with the studies online by the New England Journal of Medicine on Nov. 15.

The results should be encouraging to primary care physicians regarding the possibility of successfully helping at least some of their obese patients lose weight, the researchers agreed. However, all noted that implementation of the programs would require either changes in medical reimbursement or patients' willingness to pay for these services. All of the counseling and medications were provided to patients for free in the studies.