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 inappropriate and unhelpful and 1530 (81%) patients thought it was appropriate and helpful.InterpretationA behaviourally-informed, very brief, physician-delivered opportunistic intervention is acceptable to patients and an effective way to reduce population mean weight.FundingThe UK National Prevention Research Initiative.
Highlights
Systematic reviews of data from randomised trials show strong evidence that brief physician intervention is effective for smoking cessation and some evidence that it is effective at reducing problem drinking,[10,11] suggesting that brief opportunistic interventions on behavioural risk factors can be effective
The physician advised the patient that their health would benefit from weight loss. We showed that such brief interventions were highly acceptable, with most patients finding opportunistic intervention appropriate and helpful and very few finding it inappropriate and unhelpful
This study was a parallel, two-arm, randomised trial of a brief intervention for obesity in primary care, which involved the participation of 137 primary care physicians at 57 practices from across the south of England
Summary
No randomised trials have investigated whether advice from physicians leads to weight loss in their patients. Systematic reviews of data from randomised trials show strong evidence that brief physician intervention is effective for smoking cessation and some evidence that it is effective at reducing problem drinking,[10,11] suggesting that brief opportunistic interventions on behavioural risk factors can be effective. Cross-sectional data show that people who are attempting to lose weight are more likely to report having received advice from a physician than are people who aren’t trying to lose weight.[12,13,14] recordings of consultations show that it is the patient, not the doctor, who instigates half of these discussions,[4] which could explain the association; patients motivated to www.thelancet.com Vol 388 November 19, 2016
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