Abstract
Purpose of Review
This review describes the results of randomized controlled trials that have evaluated the efficacy of behavioral interventions for obesity in primary care settings.
Recent Findings
Most studies have found that high-intensity behavioral counseling (providing 12 or more sessions per year, as defined by the US Preventative Services Task Force), when delivered in-person, by phone, or electronically, produced clinically meaningful weight loss (4 to 7 kg). Low- to moderate-intensity behavioral counseling and counseling that did not include behavioral strategies (e.g., motivational interviewing) produced modest losses of 1 to 2 kg. The addition of weight loss medication increased mean losses relative to behavioral treatment alone.
Summary
Consistent with national guidelines, the largest weight losses were achieved with high-intensity counseling, either alone or in combination with obesity pharmacotherapy. Primary care providers can support their patients by inviting them to discuss their weight concerns and referring interested individuals to appropriate interventions.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
American Medical Association. Proceedings of the 2013 annual meeting of the house of delegates: Resolutions 2013 annual meeting. Reference Committee D. https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/public/hod/a13-resolutions_0.pdf. Accessed 10 Jan 2019.
Hales C, Carroll M, Fryar C, Ogden C. Prevalence of obesity among adults and youth: United States, 2015–2016 NCHS data brief, no 288 2017;288.
Curry S, Krist A, Owens D, Barry M, Caughey A, Davidson K, et al. Behavioral weight loss interventions to prevent obesity-related morbidity and mortality in adults: US Preventive Services Task Force recommendation statement. JAMA. 2018;320(11):1163–71.
Mctigue KM, Harris R, Hemphill B, Lux L. Screening for obesity in adults: recommendations from the U.S. Preventive Services Task Force. Ann Intern Med. 2003;139(11):I–57.
Moyer VA, U.S. Preventive Services Task Force. Screening for and management of obesity in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012;157(5):373–8.
United States Congress. Patient protection and affordable care act (PPACA), section 2713. 2010.
Centers for Medicare & Medicaid Services. Decision memo for intensive behavioral therapy for obesity (CAG-00423N). 2011.
Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Obesity Society. J Am Coll Cardiol. 2014;63(25 Pt B):2985–3023.
Apovian CM, Aronne LJ, Bessesen DH, McDonnell ME, Murad MH, Pagotto U, et al. Pharmacological management of obesity: an endocrine society clinical practice guideline. J Clin Endocrinol Metabolism. 2015;100(2):342–62.
• Fitzpatrick SL, Stevens VJ. Adult obesity management in primary care, 2008–2013. Prev Med. 2017;99:128–33 Study showing a decline in the diagnosis and treatment of obesity in primary care between 2008–2009 and 2012–2013.
Rui P, Okeyode T. National Ambulatory Medical Care Survey: 2015 State and National Summary Tables.
•• LeBlanc E, Patnode C, Webber E, Redmond N, Rushkin M, O’Connor E. Behavioral and pharmacotherapy weight loss interventions to prevent obesity-related morbidity and mortality in adults updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2018;320(11):1172–91 Updated systematic review of primary care-relevant studies by the USPSTF.
Wadden TA, Butryn ML, Hong PS, Tsai AG. Behavioral treatment of obesity in patients encountered in primary care settings: a systematic review. JAMA. 2014;312(17):1779–91.
le Blanc ES, O’Connor E, Whitlock EP, Patnode CD, Kapka T. Effectiveness of primary care-relevant treatments for obesity in adults: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med. 2011;155(7):434–47.
Heymsfield SB, Wadden TA. Mechanisms, pathophysiology, and management of obesity. N Engl J Med. 2017;376(3):254–66.
Appel LJ, Clark JM, Yeh H, Wang N, Coughlin JW, Daumit G, et al. Comparative effectiveness of weight-loss interventions in clinical practice. N Engl J Med. 2011;365(21):1959–68.
Wadden TA, Volger S, Sarwer DB, Vetter ML, Tsai AG, Berkowitz RI, et al. A two-year randomized trial of obesity treatment in primary care practice. N Engl J Med. 2011;365(21):1969–79.
Kumanyika SK, Fassbender JE, Sarwer DB, Phipps E, Allison KC, Localio R, et al. One-year results of the think health study of weight management in primary care practices. Obesity. 2012;20(6):1249–57.
Kumanyika SK, Morales KH, Allison KC, Russell Localio A, Sarwer DB, Phipps E, et al. Two-year results of think health! ¡vive Saludable!: a primary care weight-management trial: think health! Primary care trial 2-year results. Obesity. 2018;26(9):1412–21.
• Wadden TA, Walsh OA, Berkowitz RI, Chao AM, Alamuddin N, Gruber KA, et al. Intensive behavioral therapy for obesity combined with liraglutide 3.0 mg: a randomized controlled trial. Obesity. 2019;27(1):75–86 First study to employ primary care providers to deliver a structured behavioral treatment using the visit schedule covered by CMS (21, 15-min individual sessions over 1 year).
Bennett GG, Warner ET, Glasgow RE, Askew S, Goldman J, Ritzwoller DP, et al. Obesity treatment for socioeconomically disadvantaged patients in primary care practice. Arch Intern Med. 2012;172(7):565–74.
Bennett GG, Steinberg D, Askew S, Levine E, Foley P, Batch BC, et al. Effectiveness of an app and provider counseling for obesity treatment in primary care. Am J Prev Med. 2018;55(6):777–86.
Weinstock RS, Trief PM, Cibula D, Morin PC, Delahanty LM. Weight loss success in metabolic syndrome by telephone interventions: results from the SHINE study. J Gen Intern Med. 2013;28(12):1620–8.
Ma J, Yank V, Xiao L, Lavori PW, Wilson SR, Rosas LG, et al. Translating the Diabetes Prevention Program lifestyle intervention for weight loss into primary care: a randomized trial. JAMA Intern Med. 2013;173(2):113–21.
Xiao L, Yank V, Wilson SR, Lavori PW, Ma J. Two-year weight-loss maintenance in primary care-based diabetes prevention program lifestyle interventions. Nutri Diabetes. 2013;3(6):e76.
Tsai AG, Felton S, Wadden TA, Hosokawa PW, Hill JO. A randomized clinical trial of a weight loss maintenance intervention in a primary care population. Obesity. 2015;23(10):2015–21.
Sherrington A, Newham JJ, Bell R, Adamson A, McColl E, Araujo-Soares V. Systematic review and meta-analysis of internet-delivered interventions providing personalized feedback for weight loss in overweight and obese adults. Obes Rev. 2016;17(6):541–51.
Tate D, Nezami B, Valle C. Remotely delivered interventions for obesity. In: Wadden TA, Bray GA, editors. Handbook of obesity treatment. 2nd ed: Guilford Press; 2018. p. 466–79.
• Thomas G, Leahey TM, Wing RR. An automated internet behavioral weight-loss program by physician referral: a randomized controlled trial. Diabetes Care. 2015;38(1):9–15 First study to test a fully automated internet behavioral weight-loss program in primary care.
Pagoto S, Schneider K, Jojic M, DeBiasse M, Mann D. Evidence-based strategies in weight-loss mobile apps. Am J Prev Med 2013. 2013;45(5):576–82.
Laing B, Mangione C, Tseng C, Leng M, Vaisberg E, Mahida M, et al. Effectiveness of a smartphone application for weight loss compared with usual care in overweight primary care patients: a randomized, controlled trial. Ann Intern Med. 2014;161(10):S5–S12.
Christian JG, Bessesen DH, Byers TE, Christian KK, Goldstein MG, Bock BC. Clinic-based support to help overweight patients with type 2 diabetes increase physical activity and lose weight. Am J Health Promot. 2008.
Christian JG, Byers TE, Christian KK, Goldstein MG, Bock BC, Prioreschi B, et al. A computer support program that helps clinicians provide patients with metabolic syndrome tailored counseling to promote weight loss. J Am Diet Assoc. 2011;111(1):75–83.
Miller WR, Rollnick S. Motivational interviewing: helping people change. Guilford press; 2012.
Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Health Promot. 1997;12(1):38–48.
Barnes R, Ivezaj V. A systematic review of motivational interviewing for weight loss among adults in primary care. Obes Rev. 2015;16(4):304–18.
Khera R, Murad MH, Chandar AK, Dulai PS, Wang Z, Prokop LJ, et al. Association of pharmacological treatments for obesity with weight loss and adverse events: a systematic review and meta-analysis. JAMA. 2016;315(22):2424–34.
Stunkard A, Craighead LW, O'Brien R. Controlled trial of behaviour therapy, pharmacotherapy, and their combination in the treatment of obesity. Lancet. 1980;316(8203):1045–7.
Wadden TA, Berkowitz RI, Sarwer DB, Prus-Wisniewski R, Steinberg C. Benefits of lifestyle modification in the pharmacologic treatment of obesity: a randomized trial. Arch Intern Med. 2001;161(2):218–27.
Wadden TA, Berkowitz RI, Womble LG, Sarwer DB, Phelan S, Cato RK, et al. Randomized trial of lifestyle modification and pharmacotherapy for obesity. N Engl J Med. 2005;353(20):2111–20.
Digenio AG, Mancuso JP, Gerber RA, Dvorak RV. Comparison of methods for delivering a lifestyle modification program for obese patients: a randomized trial. Ann Intern Med. 2009;150(4):255–62.
Gloy VL, Briel M, Bhatt DL, Kashyap SR, Schauer PR, Mingrone G, et al. Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials. BMJ. 2013;347(7931):f5934.
Arterburn D, Wellman R, Emiliano A, Smith SR, Odegaard AO, Anau J, et al. Comparative effectiveness and safety of bariatric procedures for weight loss. Ann Intern Med. 2018;169:741–50.
Longitudinal Assessment of Bariatric Surgery (LABS) Consortium. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009;361(5):445–54.
Kushner R. What do we need to do to get primary care ready to treat obesity? Obesity. 2018 Apr;26(4):631–2.
Rutledge T, Groesz L, Linke S, Woods G, Herbst K. Behavioural weight management for the primary careprovider. Obes Rev. 2011;12(5):e290–7.
Post RE, Mainous AG, Gregorie SH, Knoll ME, Diaz VA, Saxena SK. The influence of physician acknowledgment of patients’ weight status on patient perceptions of overweight and obesity in the United States. Arch Intern Med. 2011;171(4):316–21.
Aveyard P, Lewis A, Tearne S, Hood K, Christian-Brown A, Adab P, et al. Screening and brief intervention for obesity in primary care: a parallel, two-arm, randomised trial. Lancet. 2016;388(10059):2492–500.
Wadden TA, Anderson DA, Foster GD, Bennett A, Steinberg C, Sarwer DB. Obese women’s perceptions of their physicians’ weight management attitudes and practices. Arch Fam Med. 2000;9(9):854–60.
Volger S, Vetter ML, Dougherty M, Panigrahi E, Egner R, Webb V, et al. Patients’ preferred terms for describing their excess weight: discussing obesity in clinical practice. Obesity. 2012;20(1):147–50.
Wadden TA, Didie E. What’s in a name? Patients' preferred terms for describing obesity. Obes Res. 2003;11(9):1140–6.
Gudzune KA, Doshi RS, Mehta AK, Chaudhry ZW, Jacobs DK, Vakil RM, et al. Efficacy of commercial weight-loss programs: an updated systematic review. Ann Intern Med. 2015;162(7):501–12.
Gudzune KA, Clark JM. Commercial weight-loss programs. In: Wadden TA, Bray GA, editors. Handbook of obesity treatment. 2nd ed: Guilford Press; 2018. p. 480.
Mitchell NS, Dickinson LM, Kempe A, Tsai AG. Determining the effectiveness of Take Off Pounds Sensibly (TOPS), a nationally available nonprofit weight loss program. Obesity. 2011;19(3):568–73.
Fairburn CG. Overcoming binge eating: the proven program to learn why you binge and how you can stop. 2nd ed. New York: The Guilford Press; 2013.
Foster GD, Wadden TA, Vogt RA, Brewer G. What is a reasonable weight loss? Patients’ expectations and evaluations of obesity treatment outcomes. J Consult Clin Psychol. 1997;65(1):79–85.
Wadden TA, Womble LG, Sarwer DB, Berkowitz RI, Clark VL, Foster GD. Great expectations: “I’m losing 25% of my weight no matter what you say”. J Consult Clin Psychol. 2003;71(6):1084–9.
Wing RR, Lang W, Wadden TA, Safford M, Knowler WC, Bertoni AG, et al. Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. Diabetes Care. 2011;34(7):1481–6.
Villareal DT, Chode S, Parimi N, Sinacore DR, Hilton T, Armamento-Villareal R, et al. Weight loss, exercise, or both and physical function in obese older adults. N Engl J Med. 2011;364(13):1218–29.
Rosenbaum M, Hirsch J, Gallagher DA, Leibel RL. Long-term persistence of adaptive thermogenesis in subjects who have maintained a reduced body weight. Am J Clin Nutr. 2008;88(4):906–12.
Fothergill E, Guo J, Howard L, Kerns J, Knuth N, Brychta R, et al. Persistent metabolic adaptation 6 years after “the biggest loser” competition. Obesity. 2016;24(8):1612–9.
Sumithran P, Prendergast LA, Delbridge E, Purcell K, Shulkes A, Kriketos A, et al. Long-term persistence of hormonal adaptations to weight loss. N Engl J Med. 2011;365(17):1597–604.
Wang G, Tomasi D, Volkow N, Wang R, Telang F, Caparelli E, et al. Effect of combined naltrexone and bupropion therapy on the brain’s reactivity to food cues. Int J Obes. 2014;38(5):682–8.
Tronieri JS, Wadden TA, Walsh OA, Berkowitz RI, Alamuddin N, Gruber KA, et al. Effects of liraglutide on appetite, food preoccupation, and food liking: results of a randomized controlled trial. Int J Obes. In press.
Funding
Dr. Tronieri’s effort was supported, in part, by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health (K23DK116935). Dr. Chao was supported by the National Institute of Nursing Research of the National Institutes of Health (K23NR017209).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Jena Shaw Tronieri has received compensation from Novo Nordisk for service as a consultant.
Thomas A. Wadden has received research support from an investigator-initiated award from Novo Nordisk, and he has received compensation for service on advisory boards from Novo Nordisk and WW (Weight Watchers), Inc.
Ariana M. Chao has received research funding from Shire Pharmaceuticals, and she has received compensation for service as a consultant from Shire Pharmaceuticals and WW, Inc.
Adam Gilden Tsai declares that he has no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical Collection on Psychological Issues
Rights and permissions
About this article
Cite this article
Tronieri, J.S., Wadden, T.A., Chao, A.M. et al. Primary Care Interventions for Obesity: Review of the Evidence. Curr Obes Rep 8, 128–136 (2019). https://doi.org/10.1007/s13679-019-00341-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13679-019-00341-5