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Brief Primary Care Intervention for Obesity

Aveyard et al report a randomized clinical trial of a brief physician intervention versus control of physician informing patient the benefits of weight loss. The authors found the active intervention was associated with greater meaningful weight loss. This was achieved was similar rates of patient acceptance.

Abstract

Summary

Background Obesity is a common cause of non-communicable disease. Guidelines recommend that physicians screen
and off er brief advice to motivate weight loss through referral to behavioural weight loss programmes. However,
physicians rarely intervene and no trials have been done on the subject. We did this trial to establish whether physician
brief intervention is acceptable and eff ective for reducing bodyweight in patients with obesity.

Methods

In this parallel, two-arm, randomised trial, patients who consulted 137 primary care physicians in England
were screened for obesity. Individuals could be enrolled if they were aged at least 18 years, had a body-mass index of at
least 30 kg/m² (or at least 25 kg/m² if of Asian ethnicity) , and had a raised body fat percentage. At the end of the
consultation, the physician randomly assigned participants (1:1) to one of two 30 s interventions. Randomisation was
done via preprepared randomisation cards labelled with a code representing the allocation, which were placed in opaque
sealed envelopes and given to physicians to open at the time of treatment assignment. In the active intervention, the
physician off ered referral to a weight management group (12 sessions of 1 h each, once per week) and, if the referral was accepted, the physician ensured the patient made an appointment and off ered follow-up. In the control intervention, the physician advised the patient that their health would benefi t from weight loss. The primary outcome was weight change at 12 months in the intention-to-treat population, which was assessed blinded to treatment allocation. We also assessed asked patients’ about their feelings on discussing their weight when they have visited their general practitioner for other reasons. Given the nature of the intervention, we did not anticipate any adverse events in the usual sense, so safety outcomes were not assessed. This trial is registered with the ISRCTN Registry, number ISRCTN26563137.

Findings

Between June 4, 2013, and Dec 23, 2014, we screened 8403 patients, of whom 2728 (32%) were obese. Of these
obese patients, 2256 (83%) agreed to participate and 1882 were eligible, enrolled, and included in the intention-to-treat
analysis, with 940 individuals in the support group and 942 individuals in the advice group. 722 (77%) individuals
assigned to the support intervention agreed to attend the weight management group and 379 (40%) of these individuals
attended, compared with 82 (9%) participants who were allocated the advice intervention. In the entire study population,
mean weight change at 12 months was 2·43 kg with the support intervention and 1·04 kg with the advice intervention,
giving an adjusted diff erence of 1·43 kg (95% CI 0·89–1·97). The reactions of the patients to the general practitioners’
brief interventions did not diff er signifi cantly between the study groups in terms of appropriateness (adjusted odds
ratio 0·89, 95% CI 0·75–1·07, p=0·21) or helpfulness (1·05, 0·89–1·26, p=0·54); overall, four (<1%) patients thought
their intervention was inappropriate and unhelpful and 1530 (81%) patients thought it was appropriate and helpful.

Interpretation

A behaviourally-informed, very brief, physician-delivered opportunistic intervention is acceptable to
patients and an eff ective way to reduce population mean weight.

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