Effectiveness of screening and brief intervention for obesity in primary care: a randomised trial

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Colleges, School and Institutes

Abstract

Background
Obesity is a common cause of non-communicable disease. Guidelines recommend physicians screen and offer brief advice to motivate weight loss through referral to behavioural weight loss programmes. However, physicians rarely intervene and no trials show whether physician brief intervention is acceptable or effective.

Methods
Patients consulting 137 primary care physicians in England were screened. At the end of the consultation, the physician randomised participants to one of two 30-second interventions. In the active intervention, the physician offered referral to a weight management group, if accepted the physician ensured the patient made an appointment, and offered follow-up. In the control intervention, the physician advised the patient their health would benefit from weight loss. Participants rated the appropriateness and helpfulness of the physician intervention. The primary outcome was weight change at 12 months assessed blind to allocation. This trial is registered with ISRCTN Registry, number ISRCTN26563137.

Findings
8403 patients screened; 2728 (32%) were obese. Of these, 83% agreed to participate and 1882 were eligible, and enrolled, and analysed using intention to treat. 722 (76·8%) of 940 participants in the active condition agreed to attend weight management and 379 (40·3%) attended, compared with 82 (8·7%) of the 942 participants in the control group. There were no significant differences by group in patient reaction to the GPs’ brief interventions; 0·2% thought the intervention inappropriate and unhelpful, and 81·3% thought it appropriate and helpful. In the whole population enrolled, mean weight change at 12 months was 2·43kg (active) and 1·04kg (control), the adjusted difference (95% confidence interval) was 1·43kg (0·89 to 1·97). 25·3% (active) and 13·9% (control) lost 5% of baseline weight, an odds ratio 2·11 (1·67 to 2·68).

Interpretation
A behaviourally-informed very brief physician-delivered opportunistic intervention is acceptable to patients and an effective way to reduce population mean weight.

Trial registration
ISRCTN26563137. Registration date: 3rd January 2013.

Details

Original languageEnglish
JournalThe Lancet
Early online date24 Oct 2016
Publication statusE-pub ahead of print - 24 Oct 2016