Curbing obesity: Doctors play key role
■ Intensive medical intervention yields results, but physicians face challenges in implementing weight-loss programs due to limited time for visits and inadequate payment for services.
Structured weight-loss plans with regular doctor visits were more effective at helping extremely obese patients lose weight than less-intensive programs, according to a study in the Jan. 25 Archives of Internal Medicine.
In the two-year study, 390 Louisiana adults with a body mass index of 40 or greater were randomly assigned to two groups -- usual care condition and intensive medical intervention.
Physicians instructed the 190 participants in the usual care condition group on how to use a weight management Web site and scheduled two annual visits with them.
The intensive medical intervention of 200 participants involved a multiphase treatment. Physicians first recommended that patients adhere to a low-calorie liquid diet for up to 12 weeks. In the second phase, they recommended a highly structured diet, monthly visits with the doctor, weight-loss medication and group behavioral therapy sessions.
The two programs were implemented at six practices across the state. During the study period through Jan. 30, 2008, researchers measured patients' weight loss and found progress in the medical intervention group comparable to that seen in patients who undergo bariatric surgery.
The study found that 31% of patients in the medical intervention group lost at least 5% of their initial body weight. In the usual care group, only 9% lost at least 5% of their initial body weight.
"Too often ... doctors see it as their duty to tell the patient to lose weight, and it's the patient's responsibility to go out and do that. The study shows if in your practice you put in place a program that helps patients, you can really achieve a lot of good," said Donna Ryan, MD, an author of the study and associate executive director for clinical research at the Pennington Biomedical Research Center in Baton Rouge, La.
Fighting an epidemic
The findings come as obesity continues to plague a nation in which two in three adults are either overweight or obese. And there are signs the epidemic is worsening.
From 1990 to 2005, the obesity rate rose about 50%, said a study in the Dec. 3, 2009, New England Journal of Medicine. A Nov. 20, 2009, report by the Centers for Disease Control and Prevention showed that diabetes is striking hardest in states with the highest rates of obesity and poverty.
The government, physicians and others are beefing up their efforts to combat obesity.
On Jan. 28, first lady Michelle Obama joined Health and Human Services Secretary Kathleen Sebelius and Surgeon General Regina Benjamin, MD, to announce the surgeon general's new grassroots effort to curb obesity. The plan urges Americans to make healthy lifestyle choices, encourages communities to become actively involved in creating healthier environments, and emphasizes the importance of physicians teaching patients about good health.
On Feb. 5, HHS awarded more than $119 million to all 50 states to support efforts to reduce obesity, increase physical activity, improve nutrition and decrease smoking. The grants are part of a new health and wellness initiative, Communities Putting Prevention to Work, which is funded by the federal stimulus package.
The first lady on Feb. 9 announced the Let's Move campaign to raise a healthier generation. The American Medical Association voiced its support for the campaign, saying it has long recognized the public health concern of obesity.
The AMA is "committed to reenergizing our programs and communications this year to focus on children's' needs related to obesity prevention and management," said J. James Rohack, MD, Association president.
As part of its fight against obesity, the AMA offers doctors practical tools, including the AMA Healthier Life Steps program, which helps doctors support patients in changing their diets, physical activity levels and use of alcohol and tobacco.
Delaware internist James Lenhard, MD, said lack of adequate payment for services is one obstacle keeping doctors from implementing programs such as the intensive medical intervention detailed in the Jan. 25 Archives study. The low-calorie diet and weight-loss drugs sibutramine hydrochloride and orlistat used in the study often are not covered by health insurance companies, he said.
Other obstacles in physicians' battle against obesity are limited time for office visits, limited recourses and the perception that patients are not motivated to lose weight, Robert F. Kushner, MD, wrote in a commentary published in same issue of Archives. He said physician training in obesity care and reorganizing health services for people with chronic conditions are needed to engage primary care physicians in obesity care.
"Obesity is underrecognized and undertreated in the primary care setting," wrote Dr. Kushner, clinical director of the Northwestern University Comprehensive Center on Obesity in Illinois.