A New Approach to Keeping The Weight Off

Duke-led study reveals that a low-cost mix of behavior-change strategies can help obese adults control their weight and blood pressure more effectively

Regular medical feedback, self-monitoring and a set of personalized goals can help obese patients in a primary care setting lose weight and keep it off, according to a two-year study. 

While more than 30 percent of Americans are obese, only about a fifth of them receive counseling treatment from their primary care providers to help them lose weight. 

Bennett discusses the study in this video.

A Duke University-led study reveals that the low-cost mix of behavior-change strategies that also included optional group meetings and interactive phone and Web apps can help obese adults control their weight and blood pressure more effectively.

"The study was conducted in the primary care setting. That's important because primary care providers, particularly those who treat high-risk patients, don't have many tools for treating obesity," said lead author Gary Bennett, associate professor of psychology and global health at Duke and director of the university's Obesity Prevention Program (www.bennettlab.org). 

The randomized trial involved 365 obese adults who were receiving treatment for hypertension at three Boston community health centers. Researchers selected participants who have some of the highest obesity rates in the world and have traditionally been the most challenging to treat. 

Nearly 99 percent were low-income racial/ethnic minorities, with 71 percent black, 13 percent Hispanic and 68.5 percent female. The average age of all participants was 54.5; 33 percent did not finish high school. 

The study divided participants into two groups: One group received traditional health care through general physicians at the community health centers plus a self-help booklet; the other received guidance through the model designed by the research team that promoted weight loss and hypertension self-management.

Participants in the intervention program selected goals to change behaviors in 14 areas, divided into three categories: dietary (for example, avoid sugary drinks, fast food, high-calorie snacks); physical activity (walk 10,000 steps a day, get at least 20 minutes of nonstop brisk physical activity most days); and lifestyle (watch no more than two hours of TV a day, take blood pressure medicine properly). 

After 24 months, the intervention group lost an average about 2.2 pounds more than those receiving traditional care. The intervention group also improved blood pressure control and slowed increases in systolic blood pressure, both of which can dramatically lower risk for cardiovascular disease and stroke. 

"Participants lost a modest amount of weight in the first six months, but they kept the weight off over a two-year period. That's important because we believe that stopping weight gain is an important strategy in preventing obesity-associated diseases, including hypertension and diabetes," Bennett said. 

"Our study shows that we can produce modest weight loss among the most high-risk patients using a combination of inexpensive technologies and non-physician clinical staff to deliver weight-loss counseling," he said. 

The findings could prove especially beneficial in helping low-income and some racial minorities, especially blacks, who have the highest risk of obesity and obesity-associated diseases, Bennett said.

The findings also have ramifications for a component of President Obama's health care reform. 

Last fall, the Center for Medicaid and Medicare Services (CMS) announced that the government would begin reimbursing participating physicians for treating obese patients. However, physicians will receive the full reimbursement only if their patients lose at least 3 kg of weight over a year, Bennett said.

Because physicians often don't have extra time to deal with such weight-loss interventions, Bennett and fellow researchers designed their intervention program so it could function outside of routine doctor-patient interactions. 

"It's not clear how much weight patients would have lost if only providers delivered the obesity treatment," Bennett said of the study. "We think our findings highlight the need for the CMS policy to eventually reimburse a broader range of clinical providers and weight-loss treatment strategies." 

The study, "Be Fit, Be Well," was funded in part by grants from the National Heart, Lung and Blood Institute and the National Cancer Institute. The study appears online Monday, March 12, in the Archives of Internal Medicine. Print publication is scheduled for April.