Behavioral weight loss interventions: do they work in primary care?  - Harvard Health

Behavioral weight loss interventions: do they work in primary care? – Harvard Health

Multiple supportive relationships in community settings can help people lose weight.

Achieving and maintaining a healthy weight is a major health issue, not just in the United States but in many countries around the world. Governments seek to identify the most effective services to help people lose weight and improve their overall health. A recent systematic review and meta-analysis (a larger review of studies) examined the effectiveness of weight management interventions delivered in primary care settings and included data from the United States, United Kingdom Kingdom and Spain.

Review of Weight Loss Support in Primary Care

The researchers assessed 34 studies with adults who had a body mass index greater than 25 (overweight). They looked at people who received weight loss interventions in primary care settings. Interventions included instruction on weight management behaviors such as calorie restricted diets, increased exercise, use of food diaries and/or behavioral self-management approaches with support from clinic staff to set weight-related goals, solve problems and increase independence. efficiency.

Weight loss interventions were conducted by telephone, Internet, email or face-to-face, and included group and/or individual connections. Research has compared these types of interventions to no weight loss treatment, minimal intervention (use of print or electronic weight loss education), or attention control instructions to resist cravings or behaviors, but without focusing specifically on weight loss behavior.

Programs delivered in primary care produced significant weight loss

The interventions were delivered by various health professionals (nurses, dietitians and general practitioners) and non-medical practitioners such as health coaches. Interventions lasted from one session (with patients following the program unassisted for three months) to multiple sessions over three years, with a median of 12 months.

The results showed that the mean difference between the intervention and comparison groups (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 surgery at one year.

It is important to note that since this was a systematic review of 34 trials with a wide range of interventions, the authors were unable to specifically identify which interventions produced the results.

Even a small weight loss has an impact on health

The authors noted that although a greater weight loss of 5 pounds in the intervention group may seem small, research has shown that a weight loss of 2-5% is associated with health benefits, including lower systolic blood pressure as well as reduced triglyceride and glucose levels. , which can impact heart health.

Do personal recordings and support have an impact on weight loss?

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

Although the study did not determine program costs, it is likely that interventions performed by nonmedical personnel, with supervision and support from primary health care professionals, would be less expensive. A combination of practitioners may be more effective, since physicians and GPs probably won’t have the time to do 12 consultations to support a weight management program.

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 various settings, including universities, primary care, and the community. Compared to controls, participants in behavior-based interventions had greater average weight loss between 12 and 18 months and less weight regain.

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

What’s the takeaway?

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

What can you do?

  • Ask your PCP if their practice or clinic offers programs to support weight management.
  • Contact your health insurance and find out what programs they have in their system to help reduce risk factors and manage weight. Ask if they are free or discounted as part of your plan.
  • Check your area to see if there are community programs such as the YMCA, a school program, or a senior center that focuses on wellness and weight management.

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