Last month we blogged about a research article that showed that behaviorally-based treatments for obesity are effective whether offered within or outside of a clinical (e.g., doctor's office) setting. But what exactly should a "behaviorally-based treatment" be comprised of? A new study compared weight loss over a 2-year period in response to three lifestyle interventions delivered by primary care providers with other health professionals (i.e., lifestyle coaches):¹

Intervention I - Usual care, consisting of quarterly primary care provider visits that included education about weight management. Specifically, providers spent 5-7 minutes reviewing the patient's weight change and discussing the NHLBI's Aim for a Healthy Weight handouts. They were instructed not to provide specific behavioral strategies for changing eating and activity habits. 

Intervention II - Brief lifestyle counseling, consisting of the quarterly visits combined with brief monthly sessions with lifestyle coaches who instructed participants about behavioral weight control. Specifically, medical assistants (called lifestyle coaches) spent 10-15 minutes each month discussing abbreviated lessons from the Diabetes Prevention Program. Visits included a weigh-in and review of participants' food records, physical activity, and goals. 

Intervention III - Enhanced brief lifestyle counseling, which provided the same care as described for Intervention II but included meal replacements or weight-loss medication, chosen by the participants in consultation with their provider. Participants could choose from Sibutramine (until it was pulled from the market) or Orlistat for medications or Slim-Fast shakes or meal bars to replace one meal and one snack a day. Participants were allowed only one enhancement (medication or meal replacements) at a time but could switch between them with approval from their provider. 

Eight-six percent of the 390 participants completed the 2-year trial and at year 2 weight loss was about 3.7 pounds with Intervention I, 6.4 pounds with Intervention II, and 10 pounds with intervention III. Likewise, about 22%, 26%, and 35% of participants, respectively, lost at least 5% of their initial weight. Interestingly, the benefits of enhanced lifestyle counseling remained even after participants given the weight loss medication were excluded from the analysis.

Study authors concluded that enhanced weight-loss counseling helped about one-third of the obese people achieve long-term, clinically meaningful weight loss. They stated that data from this study supports screening by primary care providers of all adults for obesity, as well as efforts to help patients understand the health consequences of excess weight and the benefits of modest weight loss. By partnering with another health professional for the lifestyle counseling piece, providers could help a significant amount of obese persons achieve meaningful weight loss. The financial and logistical issues related to working with more specialized professionals (e.g., registered dietitians) to provide lifestyle counseling may not be possible for a number of providers but training existing medical personnel to do this may be feasible. Likewise, there may be ways to deliver counseling pieces via the Internet and mobile telephones. 

Mid-January The Cooper Institute is launching a website to help providers and their patients change lifestyle behaviors for weight loss and chronic disease prevention. Based on theoretical models of behavior change, this website will provide tailored information and tools similar to those provided in the lifestyle counseling sessions described above, but via an electronic medium. Go to www.TodayIWill.com now to sign up to be notified as soon as the website it launched. You'll be able to log in as a provider or a public user to get the evidence-based resources you need!

¹Wadden, T. A., Volger, S., & Sarwer, D. B. (2011). A two-year randomized trial of obesity treatment in primary care. N Engl J Med, doi: 10.1056/NEJMoa1109220.