NEJM Audio Summary - Nov 24, 2011

Excerpted Script

"Comparative Effectiveness of Weight-Loss Interventions in Clinical Practice" by Lawrence Appel from Johns Hopkins University, Baltimore, Maryland. This trial showed that two types of behavioral interventions, one based on remote, call-center support and the other on in-person support, resulted in significant weight loss among obese patients.  At baseline, the mean body-mass index for all participants was 36.6, and the mean weight was 103.8 kg. At 24 months, the mean change in weight from baseline was −0.8 kg in the control group, −4.6 kg in the group receiving remote support only, and −5.1 kg in the group receiving in-person support. The percentage of participants who lost 5% or more of their initial weight was 18.8% in the control group, 38.2% in the group receiving remote support only, and 41.4% in the group receiving in-person support. In two behavioral interventions, one delivered with in-person support and the other delivered remotely, without face-to-face contact between participants and weight-loss coaches, obese patients achieved and sustained clinically significant weight loss over a period of 24 months.
"A Two-Year Randomized Trial of Obesity Treatment in Primary Care Practice" by Thomas Wadden, from the University of Pennsylvania, Philadelphia. This trial compared three weight-loss interventions (usual care, brief lifestyle counseling, and enhanced brief lifestyle counseling) in primary care practice. Of the 390 participants, 86% completed the 2-year trial, at which time, the mean weight loss with usual care, brief lifestyle counseling, and enhanced brief lifestyle counseling was 1.7, 2.9, and 4.6 kg, respectively. Initial weight decreased at least 5% in 21.5%, 26.0%, and 34.9% of the participants in the three groups, respectively. Enhanced lifestyle counseling was superior to usual care on both these measures of success, with no other significant differences among the groups. The benefits of enhanced lifestyle counseling remained even after participants given the weight loss medication, sibutramine were excluded from the analyses. Enhanced weight-loss counseling helps about one third of obese patients achieve long-term, clinically meaningful weight loss. In editorial Susan Yanovski, from National Institute of Health, Bethesda, Maryland, writes that both these studies provide evidence that PCPs can deliver safe and effective weight-loss interventions in primary care settings. Whether patients would be willing to pay for these therapies, or insurers would be willing to reimburse for them, is not known. Some patients will require additional treatments such as medications or bariatric surgery as an adjunct to, but not a replacement for, lifestyle interventions. Continued research on ways to enhance patients' adherence to long-term lifestyle changes should improve the reach and effectiveness of behavioral treatments for obesity in primary care settings. (457 words /214 sec = 128 wpm)