Weight Loss in Underserved Patients

Posted by Carla Rothaus

In the trial by Katzmarzyk et al., how did the intensive intervention compare to usual care with respect to weight loss?

The prevalence of obesity is higher among Black and Hispanic adults than among White and Asian adults, and the prevalence is highest among adults in some demographic groups with low income and limited education. Katzmarzyk et al. recently reported the results of a trial that assessed whether patients who received a high-intensity lifestyle intervention, tailored to the health-literacy level of the population, would have greater weight loss than patients who received usual care. Read the NEJM Original Article here.

Clinical Pearls

Q: What is considered the centerpiece of an effective weight loss program?

A: The 2013 guideline of the American College of Cardiology, the American Heart Association Task Force on Practice Guidelines, and the Obesity Society states that an intensive lifestyle intervention is the centerpiece of effective weight loss. However, primary care practitioners have been slow to adopt this approach. Concomitantly, the prevalence of obesity has increased in the population, while the number of patients with obesity who receive weight counseling from their primary care practitioners has declined substantially.

Q: What are some of the obstacles to the delivery of an effective weight loss program in primary care clinics?

A: The sole reliance on primary care practitioners to deliver obesity treatment has limitations, in part because of the limited time available during office visits, a lack of training in behavioral therapy among primary care practitioners, and low reimbursement. Thus, the investigation of different models to promote weight loss in primary care, especially in underserved populations at high risk for obesity, is needed. In the trial by Katzmarzyk et al., the intensive intervention was delivered by health coaches embedded in primary care clinics. At a minimum, coaches had academic degrees related to nutrition, physical activity, and behavioral medicine and underwent an initial 1.5-day training session and yearly retraining.

Morning Report Questions

Q: In the trial by Katzmarzyk et al., how did the intensive intervention compare to usual care with respect to weight loss?

A: As compared with usual care, a high-intensity, lifestyle-based treatment program for obesity delivered with the addition of a health coach resulted in significant weight loss over 24 months in an underserved primary care population. The intensive-lifestyle group had an average weight loss of 5%, and 51% of the patients maintained at least 5% weight loss at 24 months. The incorporation of a health coach into the collaborative care team is a potential model for weight-loss programs in primary care.

Q: Describe some of the findings of subgroup analyses in the trial by Katzmarzyk et al.

A: The percent weight loss in the intensive-lifestyle group tended to be less among Black patients than among patients of other races, and the difference between the two groups across all outcomes was at least 1 percentage point less among Black patients at 24 months. Although previous studies have shown greater weight loss among men than among women, the authors did not identify any differences according to sex. Weight loss among men and women in the intensive-lifestyle group was almost identical.

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