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Counseling Proves Most Effective in Meaningful Weight Loss

Primary care programs using three-pronged approach net high results with or without intervention by doctor…

In a meta-analysis, patients who received counseling achieved a maximum weight loss of about 14lbs compared with a top weight loss of about 4lbs for those who did not participate in these programs. However, there is concern that none of the studies reported the intervention being delivered by primary care doctors. “The current findings suggest that a range of trained interventionists, who deliver counseling in person or by telephone, could be considered for treating overweight or obese patients encountered in primary care settings,” investigators said.

Interventionists in the reviewed studies included registered dietitcians, psychologists, exercise specialists, health counselors, medical assistants, and laypeople, whom all followed a structured protocol to deliver counseling. These interventions included a reduced-calorie diet to induce an energy deficit of about 500kcal/day; 150 minutes or more a week of aerobic exercise such as walking; and behavioral strategies to facilitate adherence to the diet and exercise recommendations.

Researchers evaluated studies of behavioral counseling for overweight or obese patients in primary care setting conducted by doctors or interventionists. They noted that they did not include trials such as the Diabetes Prevention Program or the Look AHEAD studies because the counseling was provided to volunteers recruited outside of primary care in these studies. They also included studies in which patients were counseled for at least 3 months, with at least 6 months of follow-up. None of the over 12 trials evaluated included primary care doctors who delivered counseling on their own.

They noted that interventions that prescribe both reduced energy intake and increased physical activity, along with traditional behavioral therapy produced larger weight loss than interventions without these three components. Thomas Wadden and colleagues concluded that more studies are needed to compare the efficacy and costs of behavioral therapy delivered in primary care settings.

In conclusion, primary care doctors will continue to play a role in the diagnosis of obesity, evaluate it causes, assess and treat comorbidities, and can be trained to provide intensive behavioral counseling like other interventionists. However, there are some experts who believe these interventions may be beneficial if specialists could be responsible for these therapies due to increased demands of doctors in patient care.

Practice Pearls:

  • Interventions that prescribe both reduced energy intake and increased physical activity, along with traditional behavioral therapy produced larger weight loss than interventions without these three components.
  • These studies show the importance of proper counseling of patients in the primary care setting for weight loss.
  • There is opportunity for specialists to focus on weight loss in the primary care setting.

Journal of the American Medical Association: Wadden TA, et al “Behavioral treatment of obesity in patients encountered in primary care settings” JAMA 2014; DOI: 10.1001/jama.2014.14173