medwireNews: A 30-second conversation about obesity with a primary care physician is well accepted by almost all patients and often leads to referral and successful weight loss, shows a randomized trial.
“Doctors can be concerned about offending their patients by discussing their weight, but evidence from this trial shows that they should be much less worried,” said lead study author Paul Aveyard (University of Oxford, UK) in a press statement.
A total of 932 patients were randomly assigned to receive the offer of a referral to a free weight-loss program, during a routine consultation with their primary care doctor, with the appointment booked before they left the clinic.
Less than 2% of these patients felt this offer was not appropriate or not at all appropriate, with similar proportions regarding it as unhelpful, while 92% felt it to be appropriate or very appropriate – similar to the response rates in the control group of 922 patients who were simply advised to lose weight to benefit their health.
“On average, people consult their doctor five times a year meaning there is huge opportunity to deliver this low cost intervention on a large scale,” said Aveyard.
The study in The Lancet is accompanied by a commentary, in which Boyd Swinburn and Bruce Arroll, from the University of Auckland in New Zealand, express surprise that this is the first trial of its type, “perhaps reflecting the nihilism about weight loss that pervades medical care.”
They highlight the “striking feature” that the patients, who were all obese at baseline (body mass index ≥30 kg/m2 or 25 kg/m2 for Asians), were not pre-assessed for their willingness to tackle weight loss, yet 83% of the potentially eligible patients agreed to participate.
In all, 77% of patients in the referral group accepted a referral and 40% attended at least one appointment. At 12 months the group overall had lost an average of 2.43 kg, with 25% having lost at least 5% of their bodyweight and 12% at least 10%. This was a significant improvement over the 1.04 kg weight loss recorded by the control group, of whom 14% and 6% lost at least 5% and 10%, respectively, of their bodyweight.
The commentators note that this gave a number needed to treat (ie, to be offered a referral) of 8.8 for one patient to achieve at least 5% weight loss, which they say is “very good for a preventive intervention.”
And they stress that the intervention for the “so-called control group” in fact went beyond what is routine in primary care, and thus itself achieved useful results. “Far from being trivial, a 1 kg weight loss or even no weight gain applied at the population level could help to reduce the enormous burden that obesity places on health systems,” they say.
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