Findings could allow physicians and staff to more easily help patients reduce cardiovascular risk
Obese adults who received weight loss coaching via phone, Web, and email contact, as well as support from their primary care providers often lost a significant amount of weight—5 percent or more of their starting body weight—and kept it off for two years, reports a research team funded by the National Institutes of Health.
Principal investigator Lawrence J. Appel, M.D., M.P.H., of the Johns Hopkins University School of Medicine, Baltimore, and colleagues will present these findings at the American Heart Association meeting on Nov. 15, 2011, at which time the results will also appear online in the New England Journal of Medicine.
A second, related, study led by Thomas A. Wadden, Ph.D., of the University of Pennsylvania, Philadelphia, found that 25 lifestyle counseling sessions combined with the option to use weight loss medication or meal replacements (such as liquid shakes or meal bars) helped about one-third of obese participants lose a significant amount of weight and keep it off for two years. These results were presented at the American Heart Association meeting and published online in the New England Journal of Medicine on Nov. 14, 2011.
Both studies were part of the $17.5 million Practice-based Opportunities for Weight Reduction, or POWER, trials funded by the NIH's National Heart, Lung, and Blood Institute (NHLBI). These five-year, randomized, controlled clinical trials sought to identify effective weight loss treatments that can be used in primary care practices to help obese patients who have at least one additional risk factor for cardiovascular disease. Results from a third study are pending.
"Losing 5 percent or more of initial body weight in overweight or obese adults has been linked to improved health, including reduced cardiovascular risk factors such as high cholesterol, high blood pressure, and diabetes," said Susan B. Shurin, M.D., acting director of the NHLBI. "Trials like these are critical for empowering health care providers to help reduce obesity and its associated health risks in America."
POWER Hopkins recruited 415 participants from six primary care practices in the Baltimore area and assigned them at random to one of three groups. A control group received weight loss information in printed materials and a website link. A remote intervention group received phone, Web, and email support from trained weight loss coaches without any face-to-face contact. An in-person intervention group had the same phone, Web, and email support plus individual and group sessions with coaches. The intervention groups also received support from their primary care providers at regularly scheduled visits. Participants were obese adults who had at least one cardiovascular risk factor such as high blood pressure, high cholesterol, or diabetes.
Appel and colleagues found that participants in both intervention groups achieved substantial weight loss with or without in-person coaching sessions. Forty-one percent of participants in the in-person group and 38 percent in the remote group lost 5 percent or more of their initial body weight, compared to 19 percent of participants in the control group.
POWER-UP recruited 390 participants from six primary care practices in the Penn Medicine system and assigned them at random to one of three groups. The usual care group received printed educational materials. The brief lifestyle counseling group was offered 25 sessions with an auxiliary health care provider such as a medical assistant. The enhanced brief lifestyle counseling group was also offered 25 coaching sessions and had the additional option to use liquid meal replacements or take weight loss medication. All groups met with their primary care providers four times a year. Participants were obese adults who had at least two metabolic risk factors such as a large waistline and high fasting blood sugar levels.
Wadden and colleagues found that enhanced brief lifestyle counseling was more effective than the usual care group. Values for the brief lifestyle counseling group did not differ significantly from the usual care group. Nearly 35 percent of participants in the enhanced brief lifestyle group lost 5 percent or more of their initial body weight, compared to 21.5 percent of participants in the usual care group.
Despite the lower success rate of the usual care group, the authors report, the numbers suggest that primary care physicians can still help as many as one-fifth of obese patients lose weight by providing educational materials and discussing weight management during regular appointments.
"Primary care providers have few treatment options that have been shown to be effective for patients with obesity," said Barbara Wells, Ph.D., program director of the POWER Trials at the NHLBI. "These studies will help bring proven weight loss interventions to the front lines of clinical practice."
For additional information about the studies or to arrange an interview with an NHLBI spokesperson, please contact the NHLBI Communications Office at (301) 496-4236 or firstname.lastname@example.org. To arrange an interview with Lawrence Appel, contact Stephanie Desmon at the Johns Hopkins School of Medicine at (410) 955-8665. To arrange an interview with Thomas Wadden, contact the University of Pennsylvania news office at (215) 898-8721.
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