Interventions for body weight reduction in obese patients during short consultations: an open-label randomized controlled trial in the Japanese primary care setting

Abstract

BackgroundFamily physicians should maintain regular contact with obese patients to ensure they effectively reduce their body weight. However, family physicians in Japan have on average only 6 (min) per consultation, and conventional interventions for body weight reduction require a longer consultation or additional manpower. A brief intervention within the limited consultation time available is therefore needed. Here we investigated the effectiveness of a brief weight reduction intervention for obese patients and the related factors for reducing body weight during routine consultations in the primary care setting.MethodWe conducted an open-label randomized controlled trial at a family medicine clinic in Fukushima, Japan from January 2010 to June 2011. Patients aged 30 to 69 years with body mass index ≥25 who were diagnosed with hypertension, dyslipidemia, and/or type 2 diabetes mellitus were randomly assigned to the intervention or control group. At every consultation, body weight in the intervention group was measured by a family physician who provided weight reduction advice in addition to usual care. The primary outcome was body weight change at 1-year follow up. Analysis was done by intention to treat.ResultWe randomly assigned 29 participants to the intervention group and 21 to the control group. Forty participants (80 %) remained in the trial until the 1-year follow up. At follow up, the median body weight change from baseline was not significantly different between the groups (p = 0.68), at −0.8 (interquartile range [IQR] −2.5 to 1.0) kg in the intervention group and 0.2 (IQR −2.4 to 0.8) kg in the control group.ConclusionWe devised an intervention method for physicians to measure body weight and advise on weight reduction during routine consultations. In our setting, this method did not extend the consultation time, but also had no significant additional effects on body weight reduction in moderately obese patients.Trial registrationThis trial is registered with the UMIN Clinical Trial Registry (UMIN000002967).

Effectiveness of weight management interventions for adults delivered in primary care: systematic review and meta-analysis of randomised controlled trials

“… 26 44 50 Four trials could not be included in the meta-analysis as they did not present data in a way that could be synthesised (ie, measures of dispersion). 25 52 53 58 The mean difference was −2.3 kg (95% confidence interval −3.0 to −1.6 kg, I 2 =88%, τ 2 =3.38; P<0.001) in favour of the intervention group ( fig 2 ). We found no evidence of publication bias (see supplementary fig 1).…”

“…Included trials (see supplementary table 1) were individual randomised controlled trials (n=25) 24 25 26 27 28 29 32 33 34 35 38 39 41 44 45 46 47 50 51 52 53 54 55 56 59 or cluster randomised controlled trials (n=9). 23 30 31 36 37 48 49 57 58 Most were conducted in the US (n=14), 29 30 31 32 33 34 35 36 37 45 48 51 54 55 UK (n=7), 27 28 38 41 47 57 58 and Spain (n=4).…”

“…Risk of bias was considered to be low in nine trials, 24 33 34 35 39 41 47 55 56 unclear in 12 trials, 25 27 28 29 32 45 46 50 51 52 54 59 and high in 13 trials 23 26 30 31 36 37 38 44 48 49 53 57 58 ( fig 4 ). No significant (P=0.65) differences were found in subgroup analyses according to level of risk of bias from baseline to 12 months (see supplementary fig 7).…”

A systematic review of inequalities in the uptake of, adherence to, and effectiveness of behavioral weight management interventions in adults

“…Of the 103 included studies (Tables 1 and S1), 90 were trials of WLs, 36–125 and 13 were of WLMs 126–138 . Across the studies, there were a total of 36,805 participants, with the sample size of each study ranging from 30 44 to 2,161 participants 93 .…”

Low carbohydrate diet-based intervention for obstructive sleep apnea and primary hypothyroidism in an obese Japanese man

“…However, primary care physicians can provide only limited weight loss by medical therapy alone. Previous trials, in which primary care physicians offered lifestyle counseling, achieved a weight loss of only 2.5 kg or less after 6–18 months [ 2 , 3 ]. In addition, intensive medical therapy or enhanced weight loss counseling for patients with obesity has been shown to achieve a mean weight loss of 4.3–5.1 kg after 2–3 years [ 1 , 2 , 4 ].…”