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

Abstract

SummaryBackgroundObesity is a common cause of non-communicable disease. Guidelines recommend that physicians screen and offer brief advice to motivate weight loss through referral to behavioural weight loss programmes. However, physicians rarely intervene and no trials have been done on the subject. We did this trial to establish whether physician brief intervention is acceptable and effective for reducing bodyweight in patients with obesity.MethodsIn this parallel, two-arm, randomised trial, patients who consulted 137 primary care physicians in England were screened for obesity. Individuals could be enrolled if they were aged at least 18 years, had a body-mass index of at least 30 kg/m2 (or at least 25 kg/m2 if of Asian ethnicity), and had a raised body fat percentage. At the end of the consultation, the physician randomly assigned participants (1:1) to one of two 30 s interventions. Randomisation was done via preprepared randomisation cards labelled with a code representing the allocation, which were placed in opaque sealed envelopes and given to physicians to open at the time of treatment assignment. In the active intervention, the physician offered referral to a weight management group (12 sessions of 1 h each, once per week) and, 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. The primary outcome was weight change at 12 months in the intention-to-treat population, which was assessed blinded to treatment allocation. We also assessed asked patients' about their feelings on discussing their weight when they have visited their general practitioner for other reasons. Given the nature of the intervention, we did not anticipate any adverse events in the usual sense, so safety outcomes were not assessed. This trial is registered with the ISRCTN Registry, number ISRCTN26563137.FindingsBetween June 4, 2013, and Dec 23, 2014, we screened 8403 patients, of whom 2728 (32%) were obese. Of these obese patients, 2256 (83%) agreed to participate and 1882 were eligible, enrolled, and included in the intention-to-treat analysis, with 940 individuals in the support group and 942 individuals in the advice group. 722 (77%) individuals assigned to the support intervention agreed to attend the weight management group and 379 (40%) of these individuals attended, compared with 82 (9%) participants who were allocated the advice intervention. In the entire study population, mean weight change at 12 months was 2·43 kg with the support intervention and 1·04 kg with the advice intervention, giving an adjusted difference of 1·43 kg (95% CI 0·89–1·97). The reactions of the patients to the general practitioners' brief interventions did not differ significantly between the study groups in terms of appropriateness (adjusted odds ratio 0·89, 95% CI 0·75–1·07, p=0·21) or helpfulness (1·05, 0·89–1·26, p=0·54); overall, four (<1%) patients thought their intervention was inapprop...

Metabolic syndrome and weight management programs in primary care: a comparison of three international healthcare systems

“…Aveyard et al (2016a) found that a brief intervention, where weight was raised as an issue and then a referral to a commercial weight management program was offered, resulted in greater weight loss (mean difference 1.43 kg; 95% CI: 0.89-1.97) than solely raising the issue of weight. This study was important as it was part of routine care where patients were not consulting their GP about their weight, whereas other trials invite patients to take part and only the most motivated respond.…”

“…This study was important as it was part of routine care where patients were not consulting their GP about their weight, whereas other trials invite patients to take part and only the most motivated respond. The patients in the brief intervention trial are likely to be less motivated than other trial participants and they still lost~2.5 kg at 12 months (Aveyard et al 2016b). The model of care for this intervention involves the GP or patient raising weight management and then the GP offering options for referral to a commercial weight management program.…”

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“…The importance of supportive health care delivery with obese patients has been highlighted very recently, particularly with respect to motivation and adherence to primary care interventions. 36 …”

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“…Pharmacists are already involved in providing weight management programs, 9 but there is insufficient evidence to demonstrate their effectiveness, 10 and the contribution they make to tackling obesity warrants further exploration. 11 There is evidence that family physician-led screening and brief motivational advice are effective, 12 and there is no reason why pharmacists working in the community could not also deliver such a structured service, giving priority to overweight patients with conditions exacerbated by obesity (e.g., type 2 diabetes and osteoarthritis). As with smoking cessation progams, pharmacists can effectively deliver lifestyle change interventions, allowing physicians to focus on more complex clinical aspects of obesity.…”