Screening and brief intervention for obesity in primary care: a parallel, two-arm, randomised trial

Aveyard P, Lewis A, Tearne S, et al.
Lancet 2016;388:2492–2500

Background

Guidelines recommendations that physicians screen for and encourage patients to lose weight are not adequately implemented, because physicians do not believe in the effectiveness of their weight-loss consultation [1,2]. However, data show that weight-loss efforts are more likely after receiving advice from a physician, and that usually it is the patients who initiates the relevant discussion [3,4].
In this parallel, two-arm, randomised study, the effectiveness of physicians screening for and opportunistically intervening on obesity was investigated, in 8403 individuals who consulted primary care physicians in England. Enrolled patients were assigned either to the support (active) intervention or to the advice (control) intervention. In the active intervention, the physician offered referral to a weight management group. If the referral was accepted, the physician ensured the patient made an appointment and offered follow-up. In the control intervention, the physician advised the patient that their health would benefit from weight loss. Each intervention lasted 30 seconds.
Out of 8403 screened patients, 32% were obese (BMI at least 30 kg/m2 or at least 25 kg/m2 if of Asian ethnicity), and 83% of obese patients agreed to participate in the study.

Main results

• At baseline, the mean weight was 104.6 kg (SD 15.7) for men and 92.5 kg (15.3) for women, with a mean BMI of 34.9 kg/m² (4.8).
• The weight loss at 12 months, was 2.43 kg (SD 6.49) for the support group and 1.04 kg (5.50) for the advice group, a difference of 1.43 kg (95% CI: 0.89–1.97; P < 0.0001).
• The mean self-reported weight loss at 3 months was 2.91 kg (5.16) for support and 1.18 kg (3.81) for advice, a difference of 1.76 kg (95% CI: 1.35–2.17; P < 0.0001).
• Overall, 81% of the participants found the interventions both appropriate and helpful, and the odds of a patient taking effective action to manage their weight were significantly higher in the support group than in the advice alone group.

Conclusion

A 30 seconds opportunistic intervention by physicians to motivate weight loss in unselected obese patients was highly acceptable to patients, and when combined with supportive systems, led to overall population weight loss. These data suggest that physicians have no reason to doubt the effectiveness of their weight-loss consultation.

Find this article online at The Lancet

References

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2. NICE. Weight management: lifestyle services for overweight or obese adults. Public health guideline [PH53]. London: National Institute for Health and Care Excellence, 2014.
3. Noordman J, Verhaak P, van Dulmen S. Discussing patient’s lifestyle choices in the consulting room: analysis of GP-patient consultations between 1975 and 2008. BMC Fam Pract 2010; 11: 87.
4. Rose SA, Poynter PS, Anderson JW, et al. Physician weight loss advice and patient weight loss behaviour change: a literature review and meta-analysis of survey data. Int J Obes (Lond) 2013; 37: 118–28.