Behavioral interventions for weight loss: do they work in primary care?

The many supportive connections in the community can help people lose weight.

Achieving and maintaining a healthy weight is a major health concern not only in the United States but in many countries around 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 (larger study of studies) examined the effectiveness of weight control interventions delivered in primary care settings and included data from the United States, the United Kingdom, and Spain.

Consideration of weight loss support in primary care

Researchers evaluated 34 studies involving adults who had a body mass index greater than 25 (overweight). They looked at people who received weight loss interventions in primary care. Interventions include instruction in weight management behaviors such as low-calorie diets, increased exercise, use of food diaries, and/or behavioral self-management approaches with support from clinic staff for weight-related goal setting, problem solving, and increasing self-control efficacy.

Weight loss interventions were conducted by telephone, Internet, email, or face-to-face and included group and/or individual connections. The research compared these types of interventions to no weight loss treatment, a minimal intervention (using printed or electronic weight loss training), or attention control instructions to challenge cravings or behaviors but without specifically focusing on the behaviors for weight loss.

Programs delivered in primary care did result in significant weight loss

The interventions were delivered by a variety of medical professionals (nurses, nutritionists and general practitioners) and non-medical professionals such as health coaches. Interventions ranged between one session (with patients following the program unaided for three months) and several sessions over three years, with an average duration of 12 months.

The results showed that the mean difference between the intervention groups and the comparison group (no specific weight loss intervention) at one year was a weight loss of 5.1 pounds, and at two years it was 4 pounds for those who 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.

Importantly, because this was a systematic review of 34 studies with a wide range of interventions, the authors were unable to identify specifically which interventions produced the outcome.

Even a small weight loss affects health

The authors note that although a 5-pound greater weight loss in the intervention group may seem small, research shows that weight loss of 2% to 5% is associated with health benefits, including lower systolic blood pressure along with reduced triglyceride and glucose levels, which can affect heart health.

Do personal check-ins and maintenance affect weight loss?

The study acknowledges that the comparison groups had less person-to-person contact than the intervention groups, and this may have played a critical role in the findings. A greater number of contacts between patients and providers resulted in more weight loss. Research suggests that programs should be designed to include at least 12 contacts (face-to-face, telephone or a combination).

Although the study did not determine the costs of the programs, it is likely that interventions delivered by non-medical staff, with supervision and support from primary care professionals, would be less expensive. It may be that a combination of GPs would be most effective as GPs and GPs are unlikely to have time for 12 consultations to support a weight management programme.

Previous research supports community-based behavioral interventions for weight loss

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 behavioral interventions had greater mean weight loss at 12 to 18 months and less weight regain.

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

What will we take home?

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

What can you do?

  • Ask your PCP if their practice or clinic offers programs to help with weight management.
  • Contact your health insurance and ask about the programs they have in place to help reduce risk factors and manage weight. Ask if they are free or discounted as part of your plan.
  • Check in your area for community-based programs, such as a YMCA, a school program, or a senior center focused on wellness and weight management.

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