Evaluation and Treatment of Obesity in Primary Care
This chapter reviews the results of randomized trials of the treatment of obesity in primary care. The results are described in the context of the recent decision by CMS (Center for Medicare and Medicaid Services) to reimburse primary care providers for a schedule of visits that meets criteria for high-intensity obesity treatment, as is recommended by the US Preventive Services Task Force. We found that trials in which counseling was provided by PCPs themselves or other office staff typically led to modest weight loss (1–3 kg), likely a result of low-to-moderate-intensity intervention. Trials that provided multimodality treatment, combining counseling with pharmacotherapy or meal replacements, more often achieved clinically significant weight loss (≥5 % of starting weight). Remotely delivered interventions (telephone and web-based) yielded modest weight loss in two studies involving low-income populations, but produced higher weight losses in two trials involving more socioeconomically diverse populations. In the single trial that most closely approximated the schedule of visits currently reimbursed by CMS, dietitians as counselors achieved more than twice the weight loss achieved by PCPs (with patients using meal replacements in both groups). Further study is needed to determine how best to deliver high-intensity counseling to obese patients in primary care settings, including economic analyses to determine the most efficient ways to offer treatment.
KeywordsPlacebo Obesity Depression Carbohydrate Income
Preparation of this article was supported, in part, by grant K24-DK065018 from the National Institute of Diabetes Digestive and Kidney Disease, grant U01-HL087072 from the National Heart, Lung, and Blood Institute, and grant 10SDG2610292 from the American Heart Association.
Thomas Wadden serves on advisory boards for Novo Nordisk and Orexigen Therapeutics, each of which is developing weight loss medications. None of the other authors has any potential conflicts of interest to disclose.
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