Evaluation of a primary care-oriented brief counselling intervention for obesity with and without orlistat.
OBJECTIVE
There is a significant need for an obesity treatment model suitable for the primary care environment. We examined the effectiveness of a brief counselling intervention alone, in combination with orlistat, and drug-alone in a 12-month randomized-clinical trial at a medical school obesity centre.


METHODS
Participants (N = 250) with body mass index (BMI) >or=27 were randomized. Changes in body weight, lipids, blood pressure and serum glucose were examined. Drug adherence and attendance were also evaluated.


RESULTS
Completers analysis was conducted on 136 participants with data at baseline, 6 and 12 months and intention-to-treat analyses (ITT) for the total sample. Amongst completers, participants in the drug only (P = 0.012) and drug + brief counselling (P = 0.001) groups lost more weight (mean +/- SD: -3.8 +/- 5.8 kg and -4.8 +/- 4.4 kg, respectively) than participants in the brief counselling only group at 6 months (-1.7 +/- 3.3 kg), but there were no significant group differences at 12 months. ITT model results were similar to completers at 6 months and remained significant at 12 months, but the weight losses were more modest (<3 kg) for both groups receiving orlistat. For brief counselling alone, participants gained weight (1.7 +/- 4.2 kg). Cardiovascular disease (CVD) parameter changes were negligible.


CONCLUSIONS
Pharmacotherapy alone or combined with brief counselling resulted in modest weight losses that had minimal impact on cardiovascular parameters, but were greater than brief counselling alone. Whilst brief interventions and primary pharmacotherapy have been suggested as viable treatments for implementation in primary care settings, our study suggests that such minimal interventions provide minimal benefits.
Poston
W S C
WS
School of Medicine, University of Missouri-Kansas City, 64110, USA. postonwa@umkc.edu
Haddock
C K
CK
Pinkston
M M
MM
Pace
P
P
Reeves
R S
RS
Karakoc
N
N
Jones
P
P
Foreyt
J P
JP
D000328:Adult; D019440:Anti-Obesity Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000209:etiology; D003376:Counseling / Q000379:methods*; D006801:Humans; D007783:Lactones / Q000627:therapeutic use*; D008019:Life Style; D008875:Middle Aged; D009765:Obesity / Q000188:drug therapy / Q000628:therapy*; D000077403:Orlistat; D010349:Patient Compliance; D010352:Patient Dropouts; D011320:Primary Health Care / Q000379:methods*; D012307:Risk Factors; D016896:Treatment Outcome; D015431:Weight Loss / Q000502:physiology
D019440:Anti-Obesity Agents; D007783:Lactones; D000077403:Orlistat