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Obesity and Weight Management Interventions

By December 7, 2011Commentary

Two studies published in the New England Journal of Medicine describe the outcomes of trials of weight management interventions in obese patients.  Obesity is a long-standing problem in American health, one whose prevalence appears to be growing and for which there have been few interventions with lasting effects.  (NEJM Article) (NEJM Article)   In the first study, two interventions for over 400 patients were examined.  There was also a control group which attempted to lose weight on its own.  In the first intervention, the patients had remote support by phone, a specific web-site and email.  The second intervention group had the remote support, but also in-person support through group and individual sessions.

Over 24 months, the control group lost an average of about one pound, the first intervention group an average of over ten pounds and the second intervention group, an average of 11 pounds.  The number of patients who lost 5% of more of their starting weight was 19% in the control group, 38% in the first intervention group and 41% in the second intervention cohort.  Both interventions were obviously fairly effective and it is encouraging that the remote-only support patients showed improvement as significant as those with personal support, since remote only is likely much cheaper to offer.  In the second study, about 400 patients received one of three interventions delivered through their primary care physician.  The first group was usual care, basically quarterly doctor visits with some weight management education; a group that got additional lifestyle coach sessions each month during the two-year trial, and a group that also got meal replacements or weight loss drugs.

In this trial, the usual care group lost an average of almost four pounds, the first intervention group, about 6.5 pounds and the other intervention group, ten pounds.  The 5% weight loss percents for the three groups were 21.5%, 26% and 35%.    Again, the interventions appeared to work fairly well.  Two years is not an overly long follow-up period, and it is very common for people who lose weight to regain it over time, so the sustainability of the loss, and what might help patients keep the weight off, should be further studied.  But both trials are encouraging in showing that there are interventions which will help a significant portion of obese patients achieve meaningful weight loss and that those interventions could be driven through patient’s physicians.

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