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Intensive lifestyle therapy for weight loss was successful in a low-income, underserved population
Question clinique
Can an intensive lifestyle intervention help obese patients in underserved settings lose weight?
L’Essentiel
It is possible to help patients in low-income, underserved communities successfully lose weight and keep some of it off for at least 2 years. Most of the participants in this study were women (84%), so it is unclear whether this intervention would be as effective in men. The costs of health coaching and of providing portioned meals create an implementation challenge. 1b-
Référence
Plan de l'etude: Randomized controlled trial (nonblinded)
Financement: Government
Cadre: Outpatient (primary care)
Sommaire
This study randomized 18 primary care clinics that served diverse, low-income populations in Louisiana to implement an intensive lifestyle intervention or usual care for their obese patients. Seven of 9 clinics in each group were federally qualified health centers. They recruited 803 adults, aged 20 to 75 years, with a body mass index between 30 and 50 kg/m^2. Groups were fairly well-balanced at baseline, although there were more women and more Black patients in the clinics assigned to the intensive lifestyle group. The baseline average weight in both groups was 102 kg (224 pounds). The intensive lifestyle intervention consisted of a target of 175 minutes of physical activity per week, portion control, regular coaching sessions, and daily weigh-ins. Portion control was achieved in the first month using prepackaged foods and milkshakes from Nutrisystem and HealthONE, and after that by teaching participants how to prepare appropriately sized, healthful meals. Patients were followed up for 2 years, a strength of this study. At 2 years, 80.1% in the intensive lifestyle group and 87.7% in the usual care group had a body weight measurement available. The average weight loss was 4.5% greater in the intensive lifestyle group, which would correspond to approximately 7 pounds in someone who weighed 150 pounds at baseline, 9 pounds in someone who weighed 200 pounds, and slightly more than 11 pounds in someone starting at 250 pounds. Weight loss was greatest early on, with a 6.86% difference between groups, but was fairly well-maintained over the 2-year study. Change in waist circumference was a mean of 5.1 cm (~ 2 inches) greater in the intensive lifestyle group. Some quality-of-life measures improved more in the intervention group, although biomarkers associated with cardiovascular risk did not. This study was federally funded, although Nutrisystem and HealthONE provided their products at no charge for this study.
Reviewer
Mark H. Ebell, MD, MS
Professor
University of Georgia
Athens, GA
Commentaires
Weight loss
Interesting study - though it seems like most subjects continued to have a BMI > 30 and unchanged risk factors. Suggests that achieving and maintaining a normal BMI is much more complicated than just “eat less and move more”.
Intensive lifestyle and weight loss
This will be of some value in pre-operative management of many arthroplasty patients.
weight loss
How can someone lose weight without spending a lot of money. It is possible.A family doc is situated in a position to find those who might.
Behavioural Medicine works!
Great POEM. Thank you. I don’t believe implementation is an insurmountable obstacle as suggested. With improved virtual care now becoming the norm and improved food delivery services there is no reason this can’t succeed. In fact I have been working on implementing something similar, so this POEM is very timely.
Weight & Lifestyle choice
Choosing/Choice to become OVERWEIGHT is unfortunately a life style choice. Logically reversing the process will Undo the harm.
Using weight loss as a target
We encourage healthy eating and exercise in order to improve health care outcomes. Weight loss as the target is inappropriate and discouraging. We need to shift our focus to other measures that demonstrate the health benefits of healthy behaviours.