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Clinician Article

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



  • Madigan CD
  • Graham HE
  • Sturgiss E
  • Kettle VE
  • Gokal K
  • Biddle G, et al.
BMJ. 2022 May 30;377:e069719. doi: 10.1136/bmj-2021-069719. (Review)
PMID: 35636762
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Disciplines
  • Public Health
    Relevance - 7/7
    Newsworthiness - 6/7
  • Endocrine
    Relevance - 7/7
    Newsworthiness - 3/7
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 6/7
    Newsworthiness - 5/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 6/7
    Newsworthiness - 5/7
  • Special Interest - Obesity -- Physician
    Relevance - 6/7
    Newsworthiness - 3/7

Abstract

OBJECTIVE: To examine the effectiveness of behavioural weight management interventions for adults with obesity delivered in primary care.

DESIGN: Systematic review and meta-analysis of randomised controlled trials.

ELIGIBILITY CRITERIA FOR SELECTION OF STUDIES: Randomised controlled trials of behavioural weight management interventions for adults with a body mass index =25 delivered in primary care compared with no treatment, attention control, or minimal intervention and weight change at =12 months follow-up.

DATA SOURCES: Trials from a previous systematic review were extracted and the search completed using the Cochrane Central Register of Controlled Trials, Medline, PubMed, and PsychINFO from 1 January 2018 to 19 August 2021.

DATA EXTRACTION AND SYNTHESIS: Two reviewers independently identified eligible studies, extracted data, and assessed risk of bias using the Cochrane risk of bias tool. Meta-analyses were conducted with random effects models, and a pooled mean difference for both weight (kg) and waist circumference (cm) were calculated.

MAIN OUTCOME MEASURES: Primary outcome was weight change from baseline to 12 months. Secondary outcome was weight change from baseline to =24 months. Change in waist circumference was assessed at 12 months.

RESULTS: 34 trials were included: 14 were additional, from a previous review. 27 trials (n=8000) were included in the primary outcome of weight change at 12 month follow-up. The mean difference between the intervention and comparator groups at 12 months was -2.3 kg (95% confidence interval -3.0 to -1.6 kg, I2=88%, P<0.001), favouring the intervention group. At =24 months (13 trials, n=5011) the mean difference in weight change was -1.8 kg (-2.8 to -0.8 kg, I2=88%, P<0.001) favouring the intervention. The mean difference in waist circumference (18 trials, n=5288) was -2.5 cm (-3.2 to -1.8 cm, I2=69%, P<0.001) in favour of the intervention at 12 months.

CONCLUSIONS: Behavioural weight management interventions for adults with obesity delivered in primary care are effective for weight loss and could be offered to members of the public.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42021275529.


Clinical Comments

Endocrine

The findings for weight loss and waist circumference are very modest, although the authors did support the clinical benefits of these small changes. The trade off is significant, however, with intense monthly visits and only for the 12 month duration of the study. The monthly visit is not sustainable in clinical practice, nor is it practicable for the patients for the number of visits. Monthly cost for each visit is also a consideration where public health is not available. There is no outcome beyond 12 months, but previous evidence showed that most, if not all, patients returned to their pre-intervention weight once the intense and unsustainable efforts lapsed.

Endocrine

Limited by meta-analyses and different types of interventions. Also, subgroup analyses (especially by country) only included in supplemental materials.

Family Medicine (FM)/General Practice (GP)

Really nice study! To me, the key in here are the 12 visits that many insurance companies aren't going to pay for.

Family Medicine (FM)/General Practice (GP)

Many GPs are fatalistic about the chances of patients losing weight. This review supports the small but significant effectiveness of behavioural interventions conducted within primary care, as long as there are at least 12 contacts with patients.

Public Health

Well reported and conducted systematic review demonstrating the impact of primary care programs for weight loss. Follow-up is relatively short to 12 months. Not clear how the programs differ and the impacts on patient sub-populations.

Special Interest - Obesity -- Physician

This is an issue that primary care doctors see multiple times a day, day in and day out, so the topic is highly relevant. And despite the article's interpretation of their results, the experience we have and others share and which this article reports is pretty disappointing. A net loss at 2 years of 1.8 kg (or about 4 pounds) and a reduction in waist circumference of about an inch in someone who at baseline is 40 pounds overweight with a waist circumference of 40 is simply not enough for patients to want to stick with the program. I am hoping the glutide drugs are game-changers here, because the lifestyle approach simply is not effective enough.

Special Interest - Obesity -- Physician

Translation from research to actual clinical practice is a major limitation.

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