Submitted to: Journal of Internal Medicine
Publication Type: Peer reviewed journal
Publication Acceptance Date: 10/1/2006
Publication Date: 10/1/2006
Citation: Poston, W.S.C., Haddock, C.K., Pinkston, M.M., Pace, P., Reeves, R.S., Karakoc, N., Jones, P., Foreyt, J.P. 2006. Evaluation of a primary care-oriented brief counselling intervention for obesity with and without orlistat. Journal of Internal Medicine. 260:388-398. Interpretive Summary: This article examines the effectiveness of brief counseling alone, in combination with the weight loss drug orlistat, and orlistat alone in the treatment of obesity in a primary care setting. At 6 months, participants in the drug only and the drug plus brief counseling group lost more weight than participants in the brief counseling only group; but at 12 months there were no significant differences between groups. In addition, at 12 months the weight losses were more modest (<3 kg) for both groups receiving orlistat. Also, a greater proportion of brief counseling only participants dropped out of the study. This study attempts to determine if obesity treatment in the primary care setting can be a viable alternative to long- term lifestyle interventions. The authors suggest that a highly trained obesity management doctor combined with pharmacotherapy may be necessary for success in a primary care setting.
Technical Abstract: There is a significant need for an obesity treatment model suitable for the primary care environment. We examined the effectiveness of a brief counseling intervention alone, in combination with orlistat, and drug-alone in a 12-month randomized-clinical trial at a medical school obesity center. Participants (N = 250) with body mass index (BMI) >or=27 were randomized. Changes in body weight, lipids, blood pressure, and serum glucose were examined. Drug adherence and attendance were also evaluated. 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. Among completers, participants in the drug only (P = 0.012) and drug + brief counseling (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 counseling 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 counseling alone, participants gained weight (1.7 +/- 4.2 kg). Cardiovascular disease (CVD) parameter changes were negligible. 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. While 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.