Attaining and maintaining a healthy weight is a major health issue, not only in the United States but in many countries throughout the world. Governments are looking to identify the most effective services to support people to lose weight and improve overall health. A recent systematic review and meta-analysis (a larger study of studies) examined the effectiveness of weight management interventions delivered in primary care settings, and included data from the United States, the United Kingdom, and Spain.
Looking at weight loss support in primary care
Researchers evaluated 34 studies with adults who had a body mass index greater than 25 (overweight). They looked at people who received weight loss interventions within primary care settings. The interventions included instruction on weight management behaviors such as low-calorie diets, increased exercise, use of food diaries, and/or behavioral self-management approaches with support by clinic staff to set weight-related goals, solve problems, and increase self-efficacy.
Weight loss interventions were conducted by telephone, the internet, email, or face-to-face, and included group-based and/or individual connections. The research compared these types of interventions to no weight loss treatment, minimal intervention (use of printed or electronic education about weight loss), or instruction in attention control to resist urges or behaviors, but not focusing specifically on weight loss behavior.
Programs delivered in primary care did produce meaningful weight loss
The interventions were delivered by a variety of medical professionals (nurses, dietitians, and general practitioners) and nonmedical practitioners such as health coaches. The interventions lasted between one session (with patients following the program unassisted for three months) and several sessions over three years, with a median of 12 months.
Results showed that the mean difference between the intervention and comparison (no specific weight loss intervention) groups at one year was a weight loss of 5.1 pounds, and at two years it was 4 pounds for those that received weight loss interventions in primary care. There was also a mean difference in waist circumference of -2.5 cm, in favor of the intervention at one year.
Importantly, since this was a systematic review of 34 trials with a wide range of interventions, the authors were not able to specifically identify which interventions produced the result.
Even small weight loss impacts health
The authors noted that although a 5-pound greater weight loss in the intervention group may seem small, research has shown that a 2% to 5% weight loss is associated with health benefits, including lower systolic blood pressure along with reduced triglyceride and glucose levels, which may impact cardiac health.
Do personal check-ins and support impact weight loss?
The study recognized that the comparison groups had fewer person-to-person contacts than the intervention groups, and this may have played a critical role in the findings. A greater number of contacts between patients and providers led to more weight loss. The research suggests that programs should be developed to include at least 12 contacts (face-to-face, telephone, or a combination).
Although the study did not determine the costs of the programs, it is likely that interventions delivered by nonmedical personnel, with supervision and support from primary care health professionals, would be less expensive. It may be that a combination of practitioners would be most effective since physicians and general practitioners most likely will not have the time for 12 consultations to support a weight management program.
Prior research supports community-based behavioral interventions for weight loss
A study prepared for the US Preventive Services Task Force and published in 2018 found similar results. This review reported a reduction of 5.3 pounds in participants who received weight management interventions in a variety of settings, including universities, primary care, and the community. Compared with controls, participants in behavior-based interventions had greater mean weight loss at 12 to 18 months and less weight regain.
In the two largest trials (of the 124 identified), there was a decreased probability of developing type 2 diabetes compared with those who did not receive weight management interventions. There was an absolute risk reduction of approximately 14.5% in both trials over three to nine years, meaning those who received weight loss management intervention had a 14.5% reduced chance of developing diabetes compared to a control group.
What’s the takeaway?
Weight management interventions delivered in primary care settings are an effective way to deliver services. Primary care practices offer good reach into the community, and oftentimes are the first point of contact for people to the healthcare system. With our growing obesity epidemic, every effort should be considered to connect with patients struggling with their weight and offer viable, effective interventions.
What can you do?
- Ask your PCP if their practice or clinic offers programs to support weight management.
- Contact your health insurance and inquire about programs they have in their system to help reduce risk factors and manage weight. Ask if they are free or discounted as part of your plan.
- Check-in your area if there are any community-based programs such as the YMCA, a school-based program, or a senior center focused on wellness and weight management.
Bible verses for today’s meditation and inspiration: Matthew E. McLaren
Suppose you find fifty righteous people living there in the city—will you still sweep it away and not spare it for their sakes? (Genesis 18:24) And the Lord replied, “If I find fifty righteous people in Sodom, I will spare the entire city for their sake.” (Genesis 18:26)
And be sure to say, ‘Look, your servant Jacob is right behind us.’” Jacob thought, “I will try to appease him by sending gifts ahead of me. When I see him in person, perhaps he will be friendly to me.” (Genesis 32:20)
to say to you: ‘Please forgive your brothers for the great wrong they did to you—for their sin in treating you so cruelly.’ So we, the servants of the God of your father, beg you to forgive our sin.” When Joseph received the message, he broke down and wept. (Genesis 50:17)
“Forgive my sin, just this once, and plead with the Lord your God to take away this death from me.” (Exodus 10:17)
Pay close attention to him, and obey his instructions. Do not rebel against him, for he is my representative, and he will not forgive your rebellion. (Exodus 23:21)
Moses Intercedes for Israel The next day Moses said to the people, “You have committed a terrible sin, but I will go back up to the Lord on the mountain. Perhaps I will be able to obtain forgiveness for your sin.” (Exodus 32:30) So Moses returned to the Lord and said, “Oh, what a terrible sin these people have committed. They have made gods of gold for themselves. (Exodus 32:31) But now, if you will only forgive their sin—but if not, erase my name from the record you have written!” (Exodus 32:32)
The Lord passed in front of Moses, calling out, “Yahweh! The Lord! The God of compassion and mercy! I am slow to anger and filled with unfailing love and faithfulness. (Exodus 34:6) I lavish unfailing love to a thousand generations. I forgive iniquity, rebellion, and sin. But I do not excuse the guilty. I lay the sins of the parents upon their children and grandchildren; the entire family is affected— even children in the third and fourth generations.” (Exodus 34:7)
And he said, “O Lord, if it is true that I have found favor with you, then please travel with us. Yes, this is a stubborn and rebellious people, but please forgive our iniquity and our sins. Claim us as your own special possession.” (Exodus 34:9)
just as he does with the bull offered as a sin offering for the high priest. Through this process, the priest will purify the people, making them right with the Lord, and they will be forgiven. (Leviticus 4:20) Then he must burn all the goat’s fat on the altar, just as he does with the peace offering. Through this process, the priest will purify the leader from his sin, making him right with the Lord, and he will be forgiven. (Leviticus 4:26)
Then he must remove all the goat’s fat, just as he does with the fat of the peace offering. He will burn the fat on the altar, and it will be a pleasing aroma to the Lord. Through this process, the priest will purify the people, making them right with the Lord, and they will be forgiven. (Leviticus 4:31) Then he must remove all the sheep’s fat, just as he does with the fat of a sheep presented as a peace offering. He will burn the fat on the altar on top of the special gifts presented to the Lord. Through this process, the priest will purify the people from their sin, making them right with the Lord, and they will be forgiven. (Leviticus 4:35)
The priest will then prepare the second bird as a burnt offering, following all the procedures that have been prescribed. Through this process the priest will purify you from your sin, making you right with the Lord, and you will be forgiven. (Leviticus 5:10) Through this process, the priest will purify those who are guilty of any of these sins, making them right with the Lord, and they will be forgiven. The rest of the flour will belong to the priest, just as with the grain offering.” (Leviticus 5:13)
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