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| |  New Tools and Systems Can Help Primary Care Clinicians Manage Obesity CHICAGO -- January 25, 2010 -- Using combined and intensive treatments and restructuring care to treat obesity like other chronic diseases may help primary care clinicians and patients better address the condition, according to a commentary and 3 articles published in the January 25 issue of Archives of Internal Medicine. Data suggest an extensive gap exists between recommended obesity care and current practice by primary care clinicians, noted Robert F. Kushner, MD, Northwestern University Feinberg School of Medicine, Chicago, Illinois in the commentary. “The reasons for the gap are complex owing to multiple physician, patient, and medical system factors,” he wrote. “Cited barriers include a lack of reimbursement, limited time during office visits, lack of training in counselling, competing demands, low confidence in the ability to treat and change patient behaviors, limited resources, the perception that patients are not motivated, and a paucity of proven and effective interventions to treat obesity.” “In this issue of the Archives, three articles on weight loss for overweight or obese patients have potential implications for primary care practice,” Dr. Kushner wrote. The findings, outlined below, provide information on effective interventions for obesity and its complications in primary care settings. In the first article, James A. Blumenthal, PhD, Duke University Medical Center, Durham, North Carolina, and colleagues studied 144 overweight or obese patients with high blood pressure. For 4 months, 46 were assigned to follow the Dietary Approaches to Stop Hypertension (DASH) diet; 49 followed the diet and added supervised exercise and cognitive-behavioural weight loss therapy; and 49 ate their usual diet. Blood pressure decreased by 16.1/9.9 mmHg among those in the DASH plus weight management group, 11.2/7.5 mmHg among those in the DASH alone group, and 3.4/3.8 mmHg in those following their normal diet. Other measures of blood vessel and heart function -- including mass of the left ventricle -- were also most improved in patients assigned to DASH plus weight management. “The present findings suggest that the DASH diet, particularly when augmented by exercise and weight loss, can offer considerable benefit to patients with high blood pressure, not only through reductions in blood pressure but through favourable modification of biomarkers of disease risk,” the authors concluded. In the second article, William S. Yancy, Jr., MD, Department of Veterans Affairs Medical Center, Duke University Medical Center, Durham, North Carolina, and colleagues examined body weight, metabolic and adverse effects in obese or overweight outpatients aged 18 to 70 years who were randomised to one therapy or the other for 48 weeks. Of the participants, 57 in the low-carb diet group and 65 in the orlistat and low-fat diet group completed the study. Weight loss was similar for both groups (mean 8.5% to 9.5% of body weight), but the low-carb diet resulted in greater reductions to systolic and diastolic blood pressures. High-density lipoprotein cholesterol and triglyceride levels improved similarly in both groups. “The low-carbohydrate ketogenic diet and the orlistat plus low-fat diet were equally effective for weight loss and several cardiovascular disease risk factors, although the low-carbohydrate diet was more effective for lowering blood pressure,” the authors concluded. “Efforts should be made to incorporate similarly intensive weight loss programs into medical practice.” In the third article, Donna H. Ryan, MD, Pennington Biomedical Research Center, Baton Rouge, Louisiana, and colleagues trained 7 primary care physicians and 1 research clinic in obesity management. A group of 200 adults with extreme obesity (body mass index > 40) were randomly assigned to participate in the intervention, which involved a short-term liquid diet, group behavioural counselling, a longer-term maintenance diet, and one of several medications. After 2 years, 51% remained on the program, 31% lost >= 5% of their body weight, and 7% lost >= 20% of their body weight. Comparatively, in the group of 190 control participants assigned to follow their usual diet, 46% remained in the study, 9% lost >=5% of their body weight, and 1% lost >=20% of their body weight after 2 years. “Primary care practices can initiate effective medical management for extreme obesity; future efforts must target improving retention and weight loss maintenance,” the authors concluded.
SOURCE: Archives of Internal Medicine
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