Lifestyle Intervention for Weight Loss

According to a recent Gallup poll, 36% of US adults believe that they are overweight, and 26% are actively trying to lose weight. So the next issue of The Medical Letter (February 16, 2015), which will be devoted entirely to Diet, Drugs, and Surgery for Weight Loss, should be helpful in dealing with this common concern. The title is a bit of a misnomer because it fails to mention the section of our article on Lifestyle Intervention (a.k.a. lifestyle modification, behavioral intervention). But our text makes it clear that lifestyle intervention can be a powerful tool in losing weight. Two of the studies that we cite offer impressive evidence for the effectiveness of this approach.

The first study recruited more than 3000 adults (mean age 51) with elevated fasting and post-load glucose concentrations that put them at high risk for type 2 diabetes and randomly assigned them to metformin 850 mg twice daily, placebo, or a lifestyle modification program aimed at a 7% weight loss and 150 minutes of physical activity per week, and followed them for an average of 2.8 years. I think many of us betting on the outcome of that race would have put our money on metformin, but lifestyle intervention took the gold cup by a large margin, reducing the incidence of diabetes (compared to placebo) by 58%, significantly more than the 31% reduction achieved with metformin (WC Knowler et al, N Engl J Med 2002; 346:393).

A second, smaller study compared 2 different types of behavioral intervention. A total of 415 obese patients (mean age 54) with at least one cardiovascular risk factor were recruited from primary care practices, assigned to a support group, and followed for 24 months. One group received traditional counseling in person in individual and group sessions. The second group was counseled remotely through telephone calls, a website, and e-mail. A third group, self-directed, acted as a control. At 24 months, both support groups had lost significantly more weight than the controls (-0.8 kg), but surprisingly the patients receiving remote support were almost as successful (-4.6 kg) as those attending in-person counseling sessions (-5.1 kg). The difference between the 2 types of intervention was not statistically significant (LJ Appel et al. N Engl J Med 2011; 365:1959).

So before we refer our obese patients to our surgical colleagues, it may be worth trying an approach like one of these. For much more on this subject, watch for the next issue of The Medical Letter.

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