Alka M. Kanaya, MD
Is brief lifestyle counseling (BLC), with or without enhanced treatment, better than usual care for weight loss in obese patients? Is enhanced brief lifestyle counseling better than brief lifestyle counseling alone?
Randomized controlled trial (Practice-based Opportunities for Weight Reduction at the University of Pennsylvania [POWER-UP] trial). ClinicalTrials.gov NCT00826774.
3 urban and 3 suburban primary care practices in greater Philadelphia, Pennsylvania, USA.
390 patients ≥ 21 years of age (mean age 52 y, 80% women, mean weight 108 kg) who had a body mass index of 30 to 50 and ≥ 2 of 5 criteria of the metabolic syndrome (blood pressure [BP] ≥ 130/85 mm Hg, triglyceride level ≥ 1.7 mmol/L [150 mg/dL], fasting blood sugar level ≥ 6.1 mmol/L [110 mg/dL], waist circumference > 88 cm in women or > 102 cm in men, and high-density lipoprotein cholesterol level < 1.29 mmol/L [50 mg/dL] in women or < 1.04 mmol/L [40 mg/dL] in men). Exclusion criteria included bariatric surgery, ≥ 5% weight loss in the past 6 months, BP ≥ 160/100 mm Hg, recent cardiovascular disease, medical conditions contraindicating weight loss, medications that affect body weight, substance abuse, severe psychiatric illness that could affect adherence, and pregnancy.
In-person, BLC (10 to 15 min/mo) lifestyle counseling provided by lifestyle coaches and focused on behavioral weight control (BLC, n = 131); BLC plus enhanced treatment (E-BLC, n = 129); or usual care (UC, n = 130). All patients had quarterly visits with their primary care physician (PCP). In the E-BLC group, enhanced treatment comprised 1 of 3 patient choices: meal replacements (Slim-Fast, Unilever); orlistat, 60 mg/meal, optionally increased to 120 mg/meal after 6 months; or sibutramine, 10 mg/d, optionally increased to 15 mg/d after 6 months if BP and pulse levels were acceptable. Patients could switch between enhanced treatment options with physician approval, and when sibutramine was taken off the market in 2010, users were switched to 1 of the other 2 enhanced treatment options.
Weight loss and proportion of patients who lost ≥ 5% of body weight.
86% (intention-to-treat analysis).
At 2 years, the E-BLC group had greater weight loss and more patients with ≥ 5% weight loss than the UC group; BLC did not differ from E-BLC or UC for weight loss or proportion of patients with ≥ 5% weight loss (Table).
Enhanced brief lifestyle counseling was better than usual care for weight loss at 2 years in obese patients; brief lifestyle counseling alone was not.
†Abbreviations defined in Glossary. RBI, NNT, and CI calculated from estimated numbers of events based on event rates and group n's reported in article.
‡Adjusted for baseline weight, age, sex, race or ethnicity, and study site.
Kanaya AM. Enhanced brief lifestyle counseling for obesity was better than usual care for weight loss at 2 years. Ann Intern Med. ;156:JC3–11. doi: 10.7326/0003-4819-156-6-201202210-02011
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Published: Ann Intern Med. 2012;156(6):JC3-11.
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