Skip to main content
SpringerLink
Log in

Primary Care Interventions for Obesity: Review of the Evidence

  • Psychological Issues (V Drapeau and V Ivezaj, Section Editors)
  • Published:
Current Obesity Reports Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 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.

  2. 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.

  3. 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.

    Article  Google Scholar 

  4. 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.

    Article  Google Scholar 

  5. 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.

    PubMed  Google Scholar 

  6. United States Congress. Patient protection and affordable care act (PPACA), section 2713. 2010.

  7. Centers for Medicare & Medicaid Services. Decision memo for intensive behavioral therapy for obesity (CAG-00423N). 2011.

  8. 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.

    Article  Google Scholar 

  9. 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.

    Article  CAS  Google Scholar 

  10. • 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.

    Article  Google Scholar 

  11. Rui P, Okeyode T. National Ambulatory Medical Care Survey: 2015 State and National Summary Tables.

  12. •• 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.

    Article  Google Scholar 

  13. 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.

    Article  CAS  Google Scholar 

  14. 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.

    Article  Google Scholar 

  15. Heymsfield SB, Wadden TA. Mechanisms, pathophysiology, and management of obesity. N Engl J Med. 2017;376(3):254–66.

    Article  CAS  Google Scholar 

  16. 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.

    Article  CAS  Google Scholar 

  17. 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.

    Article  CAS  Google Scholar 

  18. 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.

    Article  Google Scholar 

  19. 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.

    Article  Google Scholar 

  20. • 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).

    Article  CAS  Google Scholar 

  21. 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.

    Article  Google Scholar 

  22. 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.

    Article  Google Scholar 

  23. 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.

    Article  Google Scholar 

  24. 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.

    Article  Google Scholar 

  25. 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.

    Article  CAS  Google Scholar 

  26. 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.

    Article  Google Scholar 

  27. 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.

    Article  CAS  Google Scholar 

  28. 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.

  29. • 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.

    Article  Google Scholar 

  30. 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.

    Article  Google Scholar 

  31. 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.

    Article  Google Scholar 

  32. 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.

  33. 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.

    Article  Google Scholar 

  34. Miller WR, Rollnick S. Motivational interviewing: helping people change. Guilford press; 2012.

  35. Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Health Promot. 1997;12(1):38–48.

    Article  CAS  Google Scholar 

  36. 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.

    Article  CAS  Google Scholar 

  37. 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.

    Article  CAS  Google Scholar 

  38. 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.

    Article  Google Scholar 

  39. 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.

    Article  CAS  Google Scholar 

  40. 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.

    Article  CAS  Google Scholar 

  41. 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.

    Article  Google Scholar 

  42. 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.

    Article  Google Scholar 

  43. 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.

    Article  Google Scholar 

  44. 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.

    Article  Google Scholar 

  45. Kushner R. What do we need to do to get primary care ready to treat obesity? Obesity. 2018 Apr;26(4):631–2.

    Article  Google Scholar 

  46. Rutledge T, Groesz L, Linke S, Woods G, Herbst K. Behavioural weight management for the primary careprovider. Obes Rev. 2011;12(5):e290–7.

    Article  CAS  Google Scholar 

  47. 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.

    Article  Google Scholar 

  48. 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.

    Article  Google Scholar 

  49. 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.

    Article  CAS  Google Scholar 

  50. 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.

    Article  Google Scholar 

  51. Wadden TA, Didie E. What’s in a name? Patients' preferred terms for describing obesity. Obes Res. 2003;11(9):1140–6.

    Article  Google Scholar 

  52. 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.

    Article  Google Scholar 

  53. 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.

  54. 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.

    Article  Google Scholar 

  55. 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.

    Google Scholar 

  56. 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.

    Article  CAS  Google Scholar 

  57. 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.

    Article  Google Scholar 

  58. 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.

    Article  CAS  Google Scholar 

  59. 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.

    Article  CAS  Google Scholar 

  60. 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.

    Article  CAS  Google Scholar 

  61. 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.

    Article  Google Scholar 

  62. 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.

    Article  CAS  Google Scholar 

  63. 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.

    Article  CAS  Google Scholar 

  64. 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.

Download references

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

  1. Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, 3535 Market Street, Suite 3025, Philadelphia, PA, 19104, USA

    Jena Shaw Tronieri, Thomas A. Wadden & Ariana M. Chao

  2. Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA, USA

    Ariana M. Chao

  3. Kaiser Permanente, Metabolic-Surgical Weight Management, 2045 Franklin Street, 3rd Floor, Denver, CO, 80205, USA

    Adam Gilden Tsai

  4. University of Colorado School of Medicine, Aurora, CO, USA

    Adam Gilden Tsai

Authors
  1. Jena Shaw Tronieri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thomas A. Wadden
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ariana M. Chao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Adam Gilden Tsai
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jena Shaw Tronieri.

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

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

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

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13679-019-00341-5

Keywords

Search

Navigation