Nonsurgical weight loss for extreme obesity in primary care settings: results of the Louisiana Obese Subjects Study
- PMID: 20101009
- DOI: 10.1001/archinternmed.2009.508
Nonsurgical weight loss for extreme obesity in primary care settings: results of the Louisiana Obese Subjects Study
Abstract
Background: Effective primary care practice (PCP) treatments are needed for extreme obesity. The Louisiana Obese Subjects Study (LOSS) tested whether, with brief training, PCPs could effectively implement weight loss for individuals with a body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) of 40 to 60.
Methods: The LOSS, a 2-year (July 5, 2005, through January 30, 2008) randomized, controlled, "pragmatic clinical trial" trained 7 PCPs and 1 research clinic in obesity management. Primary outcome measure was year-2 percentage change from baseline weight. Volunteers (597) were screened and randomized to intensive medical intervention (IMI) (n = 200) or usual care condition (UCC) (n = 190). The UCC group had instruction in an Internet weight management program. The IMI group recommendations included a 900-kcal liquid diet for 12 weeks or less, group behavioral counseling, structured diet, and choice of pharmacotherapy (sibutramine hydrochloride, orlistat, or diethylpropion hydrochloride) during months 3 to 7 and continued use of medications and maintenance strategies for months 8 to 24.
Results: The mean age of participants was 47 years; 83% were women, and 75% were white. Retention rates were 51% for the IMI group and 46% for the UCC group (P = .30). After 2 years, the results were as follows: (1) among 390 randomized participants, 31% in the IMI group achieved a 5% or more weight loss and 7% achieved a 20% weight loss or more, compared with 9% and 1% of those in the UCC group. (2) The mean +/- SEM baseline observation carried forward analysis showed a weight loss of -4.9% +/- 0.8% in IMI and -0.2 +/- 0.3% in UCC. (3) Last observation carried forward analysis showed a weight loss of -8.3% +/- 0.79% for IMI, whereas UCC was -0.0% +/- 0.4%. (4) A total of 101 IMI completers lost -9.7% +/- 1.3% (-12.7 +/- 1.7 kg), whereas 89 UCC completers lost -0.4% +/- 0.7% (-0.5 +/- 0.9 kg); (P < .001 for all group differences). Many metabolic parameters improved.
Conclusion: Primary care practices can initiate effective medical management for extreme obesity; future efforts must target improving retention and weight loss maintenance.
Trial registration: clinicaltrials.gov Identifier: NCT00115063.
Comment in
-
Tackling obesity: is primary care up to the challenge?Arch Intern Med. 2010 Jan 25;170(2):121-3. doi: 10.1001/archinternmed.2009.479. Arch Intern Med. 2010. PMID: 20101005 No abstract available.
Similar articles
-
X-PERT: weight reduction with orlistat in obese subjects receiving a mildly or moderately reduced-energy diet: early response to treatment predicts weight maintenance.Diabetes Obes Metab. 2005 Nov;7(6):699-708. doi: 10.1111/j.1463-1326.2005.00483.x. Diabetes Obes Metab. 2005. PMID: 16219013 Clinical Trial.
-
Nonrandomized trial of weight loss with orlistat, nutrition education, diet, and exercise in obese patients with CKD: 2-year follow-up.Am J Kidney Dis. 2010 Jan;55(1):69-76. doi: 10.1053/j.ajkd.2009.09.011. Epub 2009 Nov 17. Am J Kidney Dis. 2010. PMID: 19926371 Clinical Trial.
-
Effect of orlistat on weight regain and cardiovascular risk factors following a very-low-energy diet in abdominally obese patients: a 3-year randomized, placebo-controlled study.Diabetes Care. 2007 Jan;30(1):27-32. doi: 10.2337/dc06-0210. Diabetes Care. 2007. PMID: 17192328 Clinical Trial.
-
[Past, present and future of obesity pharmacotherapy].Vnitr Lek. 2010 Oct;56(10):1058-64. Vnitr Lek. 2010. PMID: 21105452 Review. Slovak.
-
Behavioural weight management for the primary careprovider.Obes Rev. 2011 May;12(5):e290-7. doi: 10.1111/j.1467-789X.2010.00818.x. Epub 2011 Feb 23. Obes Rev. 2011. PMID: 21348915 Review.
Cited by
-
Successful Medical Weight Loss in a Community Setting.J Obes Weight Loss Ther. 2015 Feb;5(1):248. doi: 10.4172/2165-7904.1000248. Epub 2015 Feb 27. J Obes Weight Loss Ther. 2015. PMID: 26613067 Free PMC article.
-
Interactive computer-based interventions for weight loss or weight maintenance in overweight or obese people.Cochrane Database Syst Rev. 2012 Aug 15;2012(8):CD007675. doi: 10.1002/14651858.CD007675.pub2. Cochrane Database Syst Rev. 2012. PMID: 22895964 Free PMC article.
-
Long-term weight maintenance after a 17-week weight loss intervention with or without a one-year maintenance program: a randomized controlled trial.J Obes. 2015;2015:651460. doi: 10.1155/2015/651460. Epub 2015 Mar 30. J Obes. 2015. PMID: 25918644 Free PMC article. Clinical Trial.
-
The utility of esophagogastroduodenoscopy and Helicobacter pylori screening in the preoperative assessment of patients undergoing bariatric surgery: A cross-sectional, single-center study in Saudi Arabia.Saudi J Gastroenterol. 2020 Jan-Feb;26(1):32-38. doi: 10.4103/sjg.SJG_165_19. Saudi J Gastroenterol. 2020. PMID: 31898643 Free PMC article.
-
Factors associated with weight loss and health gains in a structured lifestyle modification programme for adults with severe obesity: a prospective cohort study.Front Endocrinol (Lausanne). 2023 Oct 17;14:1257061. doi: 10.3389/fendo.2023.1257061. eCollection 2023. Front Endocrinol (Lausanne). 2023. PMID: 37916153 Free PMC article.
Publication types
MeSH terms
Substances
Associated data
LinkOut - more resources
Full Text Sources
Medical