Obese Primary Care Patients Research Articles

A structured approach to dietary modification in adult obese patients in primary care

<h3></h3> Ожирение представляет собой социально значимую мультидисциплинарную проблему, сформировавшуюся за непродолжительный период времени. Современные подходы к лечению больных с ожирением базируются на первоочередной необходимости коррекции питания и пищевого поведения вне зависимости от степени ожирения. Однако доступность специализированной диетологической помощи населению в Российской Федерации крайне низкая. Актуальной задачей является обеспечение доступности населения к получению квалифицированной первичной врачебной медико-санитарной помощи по профилю «диетология». С этой целью разработан структурированный подход к проведению консультаций (выполнению трудовых действий) по коррекции питания у взрослых пациентов с избыточной массой тела и ожирением в амбулаторной практике.

Psychometric properties of the Patient Assessment of Chronic Illness Care measure (PACIC-5A) among patients with obesity

BackgroundThe Patient Assessment of Chronic Illness Care (PACIC-5A) was developed to assess the satisfaction with patient-provider interaction based on the Chronic Care Model. The additional 5A approach (assess, advise, agree, assist, arrange) allows to score behavioral counseling. The aim of the study was to assess the psychometric properties of the German adaptation of the PACIC-5A questionnaire in a sample of general practitioners (GP) patients with obesity.MethodsAnalyses were based on data from the study “Five A’s counseling in weight management of obese patients in primary care: a cluster randomized controlled trial (INTERACT)”. Data were collected via standardized questionnaires containing the 26-item version of the PACIC-5A questionnaire. A total of 117 patients with obesity were included in the analyses. Statistical procedures comprised descriptive analyses, the calculation of Cronbach’s alpha, test-retest analyses and factor analyses in order to assess the psychometric properties including reliability and validity of the PACIC-5A.ResultsThe patient’s mean age was 43.4 years and the sample was mostly female (59%). Middle educational level was found for the majority (78%) and the mean Body Mass Index was 38.9 kg/m2. Descriptive analyses revealed a mean PACIC score of 2.33 and 5A sum score of 2.29. Notable floor effects were found. PACIC-5A showed high level of internal consistency (Cronbach’s alphas > 0.9) and exploratory factor analyses resulted in a unidimensional structure.ConclusionThe results of this study provide evidence regarding the psychometric properties of the German version of the PACIC-5A used in a sample of GP patients with obesity and make an important contribution to the reliable and valid assessment of the patient-GP interaction with regard to obesity counseling in primary care.

Weight loss interventions for overweight and obese patients in primary care: A literature review

Primary care is the ideal place to tackle the obesity crisis. This literature review looks at which interventions are suitable for use in general practice

Five A\u2019s counseling in weight management of obese patients in primary care: a cluster-randomized controlled trial (INTERACT)

BackgroundObesity is one of the most prevalent health problems in western societies. However, it seems not effectively managed in the healthcare system at present. Originating from smoking cessation a tool called the 5As for obesity management has been drafted and adapted by the Canadian Obesity Network (CON) to improve weight counseling and provider-patient-interaction. This paper describes the rationale and design of the INTERACT study. The objective of the INTERACT study is to evaluate the effectiveness and intervention costs of a 5As eLearning program for obesity management aimed specifically at general practitioners (GPs).MethodsThe INTERACT study is a cluster randomized controlled trial aimed at implementing and evaluating an online-tutorial for obesity management based on the 5As approach in cooperating primary health care practices. Effectiveness of the 5As intervention will be evaluated by assessing patients and doctors perspectives on obesity management in primary care before and after the training. GPs in the intervention group will get access to the 5As obesity management online-tutorial while GPs in the control group will be assigned to a waiting list. Outcome measures for patients and GPs will be compared between the intervention group (treatment as usual + training of the GP) and the control group (treatment as usual). Hierarchical regression models will be used to analyze effects over time pre- and post-intervention.DiscussionThe 5As present physicians with a simple mnemonic for patient counseling in the primary care context. While the use of the 5As in weight counseling seems to be associated with improved doctor-patient interaction and motivation to lose weight, intervention studies assessing the effectiveness of a short 5A eLearning tutorial for physicians on secondary outcomes, such as weight development, are lacking.Trial registrationThe study has been registered at the German Clinical Trials Register (DRKS00009241; date of registration: 03.02.2016).

Weight loss attempts in a racially diverse sample of primary care patients.

Despite efforts to promote healthy weight, obesity is at epidemic levels among adults in the US. We examined the prevalence of weight loss attempts among a racially diverse sample of overweight and obese primary care patients (n = 274) based on sociodemographic, clinical and psychological factors, and shared decision-making (SDM) about weight loss/management. This observational study was conducted from December 2015 through January 2017. Data were obtained by self-report via survey. Overall, 64% of participants were attempting to lose weight at the time of survey. No significant differences in current weight loss attempts were found based on racial background, sociodemographic characteristics, or clinical factors. Participants who believed they were obese/overweight (OR = 6.70, 95% CI = 2.86, 15.72, p < 0.0001) or who were ready to lose/manage their weight (OR = 4.50, 95% CI = 1.82, 11.09, p = 0.001) had an increased likelihood of attempting to lose weight. The likelihood of attempting to lose weight increased with greater SDM with providers (OR = 1.54, 95% CI = 1.06, 2.22, p = 0.02). Patient perceptions about their weight, their readiness for weight loss/management, and SDM were associated significantly with weight loss attempts.

Effectiveness of a motivational intervention on overweight/obese patients in the primary healthcare: a cluster randomized trial

BackgroundOverweight and obesity are common health problems which increase the risk of developing several serious health conditions. The main difficulty in the management of weight-loss lies in its maintenance, once it is achieved. The aim of this study was to investigate whether a motivational intervention, together with current clinical practice, was more efficient than a traditional intervention, in the treatment of overweight and obesity and whether this intervention reduces cardiovascular risk factors associated with overweight and obesity.MethodsMulti-centre cluster randomized trial with a 24-month follow-up included 864 overweight/obese patients randomly assigned. Motivational intervention group (400 patients), delivered by a nurse trained by an expert psychologist, in 32 sessions, 1 to 12 fortnightly, and 13 to 32, monthly, on top of their standard programmed diet and exercise. The control group (446 patients), received the usual follow-up.ResultsWeight reduction was statistically significant in the second year with a mean reduction of 1.0 Kg in the control group and 2.5 Kg in the intervention group (p = 0. 02). While 18.1% of patients in the control group reduced their weight by more than 5%, this percentage rose to 26.9% in the intervention group, which is statistically significant (p = 0.04). Patients in the motivational intervention group had significantly greater improvements in triglycerides and APOB/APOA1ratio.ConclusionsThe results highlight the importance of the group motivational interview in the treatment of overweight /obese patients in primary care, and in the improvement of their associated cardiovascular risks factors.Trial registrationClinicalTrials.gov Identifier: NCT01006213 October 30, 2009.

Abstract A49: Shared decision-making about weight loss and weight maintenance among a diverse sample of obese primary care patients

Abstract Background: Obesity and excess body weight are significant clinical and public health issues that disproportionately affect racial and ethnic minorities. Weight control and management are essential to obesity prevention and reduction; racial and ethnic disparities in cancer outcomes are due in part to limited weight control/management through reduced physical activity and unhealthy dietary behaviors. Healthcare providers play an important role in helping patients perform these cancer control behaviors through effective patient-provider communication that facilitates shared decision making. However, limited empirical data are available on the extent to which shared decision making occurs among diverse patients in primary care settings within the context of cancer control behaviors. Objective: The objective of this study was to evaluate perceptions of shared decision making about weight control and management in a racially and geographically diverse sample of primary care patients. Methods: We conducted an observational survey study in a sample of 106 racially and ethnically diverse primary care patients from primary care practices located across the U.S. Shared-decision making (SDM) was measured by self-report using an adapted version of the Shared Decision-Making Scale that measured perceived SDM for weight control/management. Bivariate and multivariate regression analysis was used to identify sociodemographic, clinical, and psychological factors having significant independent associations with SDM. Results: 42% of the sample were from racial/ethnic minority groups and 58% were white. In addition, the majority of participants were married (62%), had at least some college education (62%), were employed (55%), and received medical care in rural primary care practices (97%). With respect to clinical characteristics, 69% were obese, but only 55% believed they were obese or overweight. Scores for SDM ranged from 8 to 32 and the Mean (SD) was 17.1 (7.4); consistent with this, the majority of patients reported that providers were not likely to make clear that a decision needs to be made about their weight management, select a weight management option with their provider, or reach an agreement on how to proceed about their weight management. In the bivariate analyses, SDM scores where significantly higher among patients who had greater readiness to control/manage their weight (t=-2.47, p=0.02), who believed they were overweight/obese (t=-2.41, p=0.02), and were making weight loss efforts (t=-2.56, p=0.01) compared to those who were not making weight loss efforts, patients who did not believe they were obese/overweight, and those who were not ready to control/manage their weight. In the multivariate regression analysis, perceived obesity had a marginally significant positive association with SDM (p=0.08). Conclusions: Patient perceptions of SDM was low in our sample. Greater efforts are needed to enhance SDM about weight management/control between patients and providers, particularly among those who do not believe they are overweight/obese. Citation Format: Melanie S. Jefferson, Lashanta Rice, Kemi Chukwuka, Holly Pierce, Jodie Riley, Chanita Hughes-Halbert. Shared decision-making about weight loss and weight maintenance among a diverse sample of obese primary care patients. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A49.

MON-P203: Degree of Motivation and Perception of Targeted Weight Loss Among Overweightand Obese Patients in Primary Care During a Novel Behavioral Change Consultation

MON-P203: Degree of Motivation and Perception of Targeted Weight Loss Among Overweightand Obese Patients in Primary Care During a Novel Behavioral Change Consultation

Primary Care Patients' Willingness to Participate in Comprehensive Weight Loss Programs: From the WWAMI Region Practice and Research Network.

In the United States, 69% of adults are overweight or obese, as defined by a body mass index (BMI) ≥25 kg/m(2). The US Preventive Services Task Force recommends screening all adult patients for obesity and referring obese patients to intensive, multicomponent behavioral weight loss programs comprising 12 to 26 yearly sessions. The objective of this study is to determine the degree to which overweight and obese primary care patients report willingness to participate in these intensive weight loss programs and to identify the patient factors associated with reported willingness to participate. This 2013 cross-sectional survey was offered to all adult patients seen for an office visit at 1 of 12 primary care clinics in the Washington, Wyoming, Alaska, Montana and Idaho (WWAMI) Region Practice and Research Network (WPRN). Patients self-reported both their health information and their willingness to participate in a comprehensive weight loss program. Respondents were characterized by descriptive statistics. We compared reported rates of willingness to participate by patient factors and assessed which patient factors were independently associated with reported willingness using bivariate analysis and logistic regression, respectively. Of overweight and obese respondents, 63% reported willingness to participate in comprehensive weight loss programs. Age, sex, race/ethnicity, insurance status, BMI, and reason for wanting to lose weight were all significantly and independently associated with reported willingness to participate. Reported willingness to participate in comprehensive weight loss programs suggests that additional resources are needed to understand strategies for disseminating and implementing effective comprehensive weight loss programs.

A Randomized Clinical Trial of a Tailored Lifestyle Intervention for Obese, Sedentary, Primary Care Patients.

The aim of the study was to test a tailored lifestyle intervention for helping obese primary care patients achieve weight loss and increase physical activity. We conducted a 24-month randomized clinical trial in Rhode Island. Primary care physicians identified obese, sedentary patients motivated to lose weight and increase their moderate to vigorous physical activity. These patients were randomized to 1 of 2 experimental groups: enhanced intervention (EI) or standard intervention (SI). Both groups received 3 face-to-face weight loss meetings. The enhanced intervention group also received telephone counseling calls, individually tailored print materials, and DVDs focused on diet and physical activity. Active intervention occurred in year 1 with a tapered maintenance phase in year 2. Two hundred eleven obese, sedentary patients were recruited from 24 primary care practices. Participants were 79% women and 16% minorities. They averaged 48.6 years of age, with a mean body mass index (BMI) of 37.8 kg/m(2), and 21.2 minutes/week of moderate to vigorous physical activity. Significantly more EI participants lost 5% of their baseline weight than SI participants (group by visit, P <.001). The difference was significant during active treatment at 6 months (37.2% EI vs 12.9% SI) and 12 months (47.8% vs 11.6%), but was no longer significant during the maintenance phase at 18 months (31.4% vs 26.7%,) or 24 months (33.3% vs 24.6%). The EI group reported significantly more minutes of moderate to vigorous physical activity over time than the SI group (group by visit, P = 0.04). The differences in minutes per week at 6 months was 95.7 for the EI group vs 68.3 minutes for the SI group; at 12 months, it was 126.1 vs 73.7; at 18 months, 103.7 vs 63.7, and at 24 months, 101.3 vs 75.4. Similar trends were found for absolute weight loss and the percentage reaching national guidelines for physical activity. A home-based tailored lifestyle intervention in obese, sedentary primary care patients was effective in promoting weight loss and increasing moderate to vigorous physical activity, with the effects peaking at 12 months but waning at 24 months.

Lipid Profile Patterns of Overweight and Obese Primary Care Patients in Niger Delta Region, South-South Nigeria

Lipid Profile Patterns of Overweight and Obese Primary Care Patients in Niger Delta Region, South-South Nigeria

Physical activity counseling in overweight and obese primary care patients: Outcomes of the VA-STRIDE randomized controlled trial.

The purpose of this 2-arm randomized clinical trial was to evaluate the effectiveness of a 12-month, expert system-based, print-delivered physical activity intervention in a primary care Veteran population in Pittsburgh, Pennsylvania.Participants were not excluded for many health conditions that typically are exclusionary criteria in physical activity trials. The primary outcome measures were physical activity reported using the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire and an accelerometer-based activity assessment at baseline, 6, and 12 months.Of the 232 Veterans enrolled in the study, 208 (89.7%) were retained at the 6-month follow-up and 203 (87.5%) were retained at 12 months. Compared to the attention control, intervention participants had significantly increased odds of meeting the U.S. recommended guideline of ≥ 150 min/week of at least moderate-intensity physical activity at 12 months for the modified CHAMPS (odds ratio [OR] = 2.86; 95% CI: 1.03–7.96; p = 0.04) but not at 6 months (OR = 1.54; 95% CI: 0.56–4.23; p = 0.40). Based on accelerometer data, intervention participants had significantly increased odds of meeting ≥ 150 min/week of moderate-equivalent physical activity at 6 months (OR = 6.26; 95% CI: 1.26–31.22; p = 0.03) and borderline significantly increased odds at 12 months (OR = 4.73; 95% CI: 0.98–22.76; p = 0.053).An expert system physical activity counseling intervention can increase or sustain the proportion of Veterans in primary care meeting current recommendations for moderate-intensity physical activity.Trial Registration Clinical trials.gov identifier: NCT00731094URL: http://www.clinicaltrials.gov/ct2/show/NCT00731094.

Telecoaching plus a portion control plate for weight care management: a randomized trial.

BackgroundObesity is a leading preventable cause of death and disability and is associated with a lower health-related quality of life. We evaluated the impact of telecoaching conducted by a counselor trained in motivational interviewing paired with a portion control plate for obese patients in a primary care setting.MethodsWe conducted a randomized, clinical trial among patients in a primary care practice in the midwestern United States. Patients were randomized to either usual care or an intervention including telecoaching with a portion control plate. The intervention was provided during a 3-month period with follow-up of all patients through 6 months after randomization. The primary outcomes were weight, body mass index (BMI),waist circumference, and waist to hip ratio measured at baseline, 6, 12, 18, and 24 weeks. Secondary outcomes included measures assessing eating behaviors, self-efficacy, and physical activity at baseline and at 12 and 24 weeks.ResultsA total of 1,101 subjects were pre-screened, and 90 were randomly assigned to telecoaching plus portion control plate (n = 45) or usual care (n = 45). Using last-value carried forward without adjustment for baseline demographics, significant reductions in BMI (estimated treatment effect -0.4 kg/m2, P = .038) and waist to hip ratio (estimated treatment effect -.02, P = .037) at 3 months were observed in the telecoaching plus portion control plate group compared to usual care. These differences were not statistically significant at 6 months. In females, the telecoaching plus portion control plate intervention was associated with significant reductions in weight and BMI at both 3 months (estimated treatment effect -1.6 kg, P = .016 and -0.6 kg/m2, P = .020) and 6 months (estimated treatment effect -2.3 kg, P = .013 and -0.8 kg/m2, P = .025). In males, the telecoaching plus portion control intervention was associated with a significant reduction in waist to hip ratio at 3 months (estimated treatment effect -0.04, P = .017), but failed to show a significant difference in weight and BMI.ConclusionTelecoaching with a portion control plate can produce positive change in body habitus among obese primary care patients; however, changes depend upon sex.Trial registrationClinicalTrials.gov NCT02373878, 13 February 2015. https://clinicaltrials.gov/ct2/show/NCT02373878.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-015-0880-1) contains supplementary material, which is available to authorized users.

Encuesta de satisfacción de un proyecto de mejora de calidad del servicio aragonés de salud

&lt;p&gt; Introducción: Según el informe de 2008 del Sistema Nacional de Salud, existe un 4,7% de los usuarios que opina que el sistema sanitario debería rehacerse por completo y casi un 27%, que es necesario introducir cambios importantes para su mejora.&lt;br /&gt;Hipótesis: El desarrollo de un programa específico de control de peso para pacientes obesos en Atención Primaria mejora la calidad de la actuación percibida por el paciente de Atención Primaria.&lt;br /&gt;Objetivos: Valorar la influencia de un proyecto de mejora de calidad de Atención Primaria en los resultados globales de una encuesta de satisfacción de los usuarios de dicha Zona Básica de Salud.&lt;br /&gt;Material y Métodos: Estudio prospectivo de intervención cuasiexperimental centrado en el tratamiento de la obesidad en Atención Primaria realizado desde Enero de 2012 a Diciembre 2013, en cuya evaluación final se realizó una encuesta autoadministrada de Satisfacción de los usuarios y se comparó con los resultados obtenidos con el mismo cuestionario por el Servicio Aragonés de Salud en dicha Zona Básica de Salud. Para el análisis estadístico de estos datos se empleó el programa informático SPSS.15.&lt;br /&gt;Resultados principales: Se observa un aumento destacable en los apartados “Interés del personal de enfermería”, “Satisfacción de los cuidados sanitarios” (medicina y enfermería) y “Solución dada a problemas”. No hubo aspectos negativos y el 100% de los encuestados expresó una satisfacción general y un 88% destacó el aspecto de la paciencia del profesional hacia los pacientes.&lt;/p&gt;&lt;p&gt;Conclusión: El proyecto de mejora de calidad realizado con pacientes crónicos de la consulta de enfermería de Atención Primaria, ha sido valorado muy satisfactoriamente, llegando a mejorar la puntuación de los resultados globales del Sistema Aragonés de Salud en esta Zona Básica de Salud.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Effectiveness of a Smartphone application and wearable device for weight loss in overweight or obese primary care patients: protocol for a randomised controlled trial.

BackgroundTo evaluate the effectiveness of an experimental intervention based on standard diet recommendations plus free Smartphone application (app) and wearable device for weight loss, compared with the standard diet intervention alone, in primary care patients aged 18 years or older who are overweight or obese.Methods/designMulticentre randomized, controlled clinical trial. Location: Primary health care centres in the city of Tarragona and surrounding areas. Subjects: 70 primary care patients, aged 18 years or older, with body mass index of 25 g/m2 or greater who wish to lose weight. Description of the intervention: 12 months of standard diet recommendations without (n = 35) or with (n = 35) assistance of a free Smartphone app that allows the participant to maintain a record of dietary intake and a bracelet monitor that records physical activity. The outcomes will be weight loss at 12 months (primary outcome), changes in physical activity and cardiometabolic risk factors, frequency of app use, and participant satisfaction after 12 months.DiscussionThe results of our study will offer evidence of the effectiveness of an intervention using one of the most popular free apps and wearable devices in achieving weight loss among patients who are overweight or obese. If these new technologies are proven effective in our population, they could be readily incorporated into primary care interventions promoting healthy weight.The open design and study characteristics make it impossible for the participants and researchers to be blinded to study group assignment. Researchers responsible for data analysis will be blinded to participant allocation.Trial registrationClinical Register: NCT02417623. Registered 26 March 2015.

Multimorbidity and weight loss in obese primary care patients: longitudinal study based on electronic healthcare records

ObjectiveTo analyse the association between cardiovascular and mental comorbidities of obesity and weight loss registered in the electronic primary healthcare records.Design and settingLongitudinal study of a cohort of adult patients...

Recognizing disordered eating in primary care patients with obesity

ObjectiveIn clinical practice, behavioral approaches to obesity treatment focus heavily on diet and exercise recommendations. However, these approaches may not be effective for patients with disordered eating behaviors. Little is known about the prevalence of disordered eating behaviors in primary care patients with obesity or whether they affect difficulty making dietary changes. MethodsWe conducted a telephone interview of 337 primary care patients aged 18–65years with BMI≥35kg/m2 in Greater Boston, 2009–2011 (58% response rate, 69% women). We administered the Three-Factor Eating Questionnaire R-18 (scores 0–100) and the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) (scores 0–100). We measured difficulty making dietary changes using four questions regarding perceived difficulty changing diet (Scores 0–10). Results50% of the patients reported high emotional eating (score>50) and 28% reported high uncontrolled eating (score>50). Women were more likely to report emotional [OR=4.14 (2.90, 5.92)] and uncontrolled eating [OR=2.11 (1.44, 3.08)] than men. African-Americans were less likely than Caucasians to report emotional [OR=0.29 (95% CI: 0.19, 0.44)] and uncontrolled eating [OR=0.11 (0.07, 0.19)]. For every 10-point reduction in QOL score (IWQOL-lite), emotional and uncontrolled eating scores rose significantly by 7.82 and 5.48, respectively. Furthermore, participants who reported emotional and uncontrolled eating reported greater difficulty making dietary changes. SummaryDisordered eating behaviors are prevalent among obese primary care patients and disproportionately affect women, Caucasians, and patients with poor QOL. These eating behaviors may impair patients' ability to make clinically recommended dietary changes. Clinicians should consider screening for disordered eating behaviors and tailoring obesity treatment accordingly.

Factors Affecting Readiness to Change among Literate Obese Patients in Primary Care

Background: Obesity is a chronic disease which contributes to morbidity and mortality from non-communicable diseases. Urbanization, western lifestyles and demographic transition contribute to this problem in Nigeria. Primary care physicians should be active in early detection, and motivating obese people for life style change. Motivation is an important first step towards any action or behaviour change and clinicians can assess and enhance motivation to change before extensive damage is done to health, relationships, reputation, or self-image. Aims: To determine pattern and predictive factors for readiness to change among literate obese patients in primary care. Methods and Materials: A cross-sectional study was conducted between July and October 2012, among literate obese patients in the outpatient department of an urban hospital. Obese patients were identified by clinical examination, and readiness to change was measured with the University of Rhode Island Change Assessment (URICA) score. Results: Prevalence of obesity was 17.43%. Most of the subjects were married (83.8%), female (76.5%) had tertiary education (64.7%) and from professional cadre (54.4%). Mean age was 43.5±9.2. Majority (69.1%) felt that they were motivated (self- perception) to lose weight, but most (58%) were not confident that they could lose weight (self-efficacy). Based on the URICA score, most (73.5%)of the literate obese patients were contemplators. There were no significant predictors of the stage of change. Conclusion: Obesity is common among literate patients in the outpatient setting. The mean URICA score was 8.68±1.68, and most were in contemplation stage.

Obesity management by general practitioners: the unavoidable necessity.

Nearly 62% of primary care patients are overweight or obese, and obesity is now a National Health Priority Area. Weight management interventions in primary care currently generate little more than 1 kg of weight loss per patient over a 2-year period. Consequently, further strategies are required to improve the effectiveness of weight management in primary care. The National Health and Medical Research Council (NHMRC) have released updated guidelines for the management of overweight and obese patients in primary care. However, there is some disconnect between establishment of guidelines and their implementation in practice. Barriers to GPs using guidelines for the management of obesity include low self-efficacy, perceived insufficient time in consultations and the challenge of raising the topic of a patient's weight. Nonetheless, patients prefer to receive weight management support from GPs rather than other health professionals, suggesting that the demand on GPs to support patients in weight management will continue. GPs cannot afford to side-line obesity management, as obesity is likely to be the most prevalent modifiable risk factor associated with patients' long-term health. Without further strategies to support GPs in their management of patients' weight, obesity will continue to be an expensive and long-term public health issue.

Treatment of binge eating disorder in racially and ethnically diverse obese patients in primary care: Randomized placebo-controlled clinical trial of self-help and medication

The objective was to determine whether treatments with demonstrated efficacy for binge eating disorder (BED) in specialist treatment centers can be delivered effectively in primary care settings to racially/ethnically diverse obese patients with BED. This study compared the effectiveness of self-help cognitive-behavioral therapy (shCBT) and an anti-obesity medication (sibutramine), alone and in combination, and it is only the second placebo-controlled trial of any medication for BED to evaluate longer-term effects after treatment discontinuation. 104 obese patients with BED (73% female, 55% non-white) were randomly assigned to one of four 16-week treatments (balanced 2-by-2 factorial design): sibutramine (N = 26), placebo (N = 27), shCBT + sibutramine (N = 26), or shCBT + placebo (N = 25). Medications were administered in double-blind fashion. Independent assessments were performed monthly throughout treatment, post-treatment, and at 6- and 12-month follow-ups (16 months after randomization). Mixed-models analyses revealed significant time and medication-by-time interaction effects for percent weight loss, with sibutramine but not placebo associated with significant change over time. Percent weight loss differed significantly between sibutramine and placebo by the third month of treatment and at post-treatment. After the medication was discontinued at post-treatment, weight re-gain occurred in sibutramine groups and percent weight loss no longer differed among the four treatments at 6- and 12-month follow-ups. For binge-eating, mixed-models revealed significant time and shCBT-by-time interaction effects: shCBT had significantly lower binge-eating frequency at 6-month follow-up but the treatments did not differ significantly at any other time point. Demographic factors did not significantly predict or moderate clinical outcomes. Our findings suggest that pure self-help CBT and sibutramine did not show long-term effectiveness relative to placebo for treating BED in racially/ethnically diverse obese patients in primary care. Overall, the treatments differed little with respect to binge-eating and associated outcomes. Sibutramine was associated with significantly greater acute weight loss than placebo and the observed weight-regain following discontinuation of medication suggests that anti-obesity medications need to be continued for weight loss maintenance. Demographic factors did not predict/moderate clinical outcomes in this diverse patient group.