Authors: POSTON, W. S. C.¹; HADDOCK, C. K.¹; PINKSTON, M. M.¹; PACE, P.²; REEVES, R. S.²; KARAKOC, N.²; JONES, P.²; FOREYT, J. P.²

Source: Journal of Internal Medicine, Volume 260, Number 4, October 2006 , pp. 388-398(11)

Publisher: Wiley-Blackwell

Abstract:

.  Poston WSC, Haddock CK, Pinkston MM, Pace P, Reeves RS, Karakoc N, Jones P, Foreyt JP (University of Missouri-Kansas City, Kansas City, MO; and Baylor College of Medicine, Houston, TX; USA). Evaluation of a primary care-oriented brief counselling intervention for obesity with and without orlistat. J Intern Med 2006; 260: 388-398. Objective. 

There is a significant need for an obesity treatment model suitable for the primary care environment. We examined the effectiveness of a brief counselling intervention alone, in combination with orlistat, and drug-alone in a 12-month randomized-clinical trial at a medical school obesity centre. Methods. 

Participants (N = 250) with body mass index (BMI) ≥27 were randomized. Changes in body weight, lipids, blood pressure and serum glucose were examined. Drug adherence and attendance were also evaluated. Results. 

Completers analysis was conducted on 136 participants with data at baseline, 6 and 12 months and intention-to-treat analyses (ITT) for the total sample. Amongst completers, participants in the drug only (P = 0.012) and drug + brief counselling (P = 0.001) groups lost more weight (mean ± SD: −3.8 ± 5.8 kg and −4.8 ± 4.4 kg, respectively) than participants in the brief counselling only group at 6 months (−1.7 ± 3.3 kg), but there were no significant group differences at 12 months. ITT model results were similar to completers at 6 months and remained significant at 12 months, but the weight losses were more modest (<3 kg) for both groups receiving orlistat. For brief counselling alone, participants gained weight (1.7 ± 4.2 kg). Cardiovascular disease (CVD) parameter changes were negligible. Conclusions. 

Pharmacotherapy alone or combined with brief counselling resulted in modest weight losses that had minimal impact on cardiovascular parameters, but were greater than brief counselling alone. Whilst brief interventions and primary pharmacotherapy have been suggested as viable treatments for implementation in primary care settings, our study suggests that such minimal interventions provide minimal benefits.

Keywords: behavioural medicine; obesity; primary care; weight loss

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1365-2796.2006.01702.x

Affiliations: 1: School of Medicine, University of Missouri-Kansas City, Kansas City, MO 2: Baylor College of Medicine, Houston, TX; USA

Publication date: 2006-10-01

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