Nonsurgical weight loss for extreme obesity in primary care settings: results of the Louisiana Obese Subjects Study.
BACKGROUND
Effective primary care practice (PCP) treatments are needed for extreme obesity. The Louisiana Obese Subjects Study (LOSS) tested whether, with brief training, PCPs could effectively implement weight loss for individuals with a body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) of 40 to 60.


METHODS
The LOSS, a 2-year (July 5, 2005, through January 30, 2008) randomized, controlled, "pragmatic clinical trial" trained 7 PCPs and 1 research clinic in obesity management. Primary outcome measure was year-2 percentage change from baseline weight. Volunteers (597) were screened and randomized to intensive medical intervention (IMI) (n = 200) or usual care condition (UCC) (n = 190). The UCC group had instruction in an Internet weight management program. The IMI group recommendations included a 900-kcal liquid diet for 12 weeks or less, group behavioral counseling, structured diet, and choice of pharmacotherapy (sibutramine hydrochloride, orlistat, or diethylpropion hydrochloride) during months 3 to 7 and continued use of medications and maintenance strategies for months 8 to 24.


RESULTS
The mean age of participants was 47 years; 83% were women, and 75% were white. Retention rates were 51% for the IMI group and 46% for the UCC group (P = .30). After 2 years, the results were as follows: (1) among 390 randomized participants, 31% in the IMI group achieved a 5% or more weight loss and 7% achieved a 20% weight loss or more, compared with 9% and 1% of those in the UCC group. (2) The mean +/- SEM baseline observation carried forward analysis showed a weight loss of -4.9% +/- 0.8% in IMI and -0.2 +/- 0.3% in UCC. (3) Last observation carried forward analysis showed a weight loss of -8.3% +/- 0.79% for IMI, whereas UCC was -0.0% +/- 0.4%. (4) A total of 101 IMI completers lost -9.7% +/- 1.3% (-12.7 +/- 1.7 kg), whereas 89 UCC completers lost -0.4% +/- 0.7% (-0.5 +/- 0.9 kg); (P < .001 for all group differences). Many metabolic parameters improved.


CONCLUSIONS
Primary care practices can initiate effective medical management for extreme obesity; future efforts must target improving retention and weight loss maintenance.


BACKGROUND
clinicaltrials.gov Identifier: NCT00115063.
Ryan
Donna H
DH
Pennington Biomedical Research Center of Louisiana State University System, Baton Rouge, LA 70808, USA. ryandh@pbrc.edu
Johnson
William D
WD
Myers
Valerie H
VH
Prather
Tiffany L
TL
McGlone
Meghan M
MM
Rood
Jennifer
J
Brantley
Phillip J
PJ
Bray
George A
GA
Gupta
Alok K
AK
Broussard
Alan P
AP
Barootes
Bryan G
BG
Elkins
Brian L
BL
Gaudin
David E
DE
Savory
Robert L
RL
Brock
Ricky D
RD
Datz
Geralyn
G
Pothakamuri
Srininvasa R
SR
McKnight
G Tipton
GT
Stenlof
Kaj
K
Sjöström
Lars V
LV
D019440:Anti-Obesity Agents / Q000627:therapeutic use*; D004038:Diet, Reducing; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000628:therapy*; D011320:Primary Health Care; D015431:Weight Loss
D019440:Anti-Obesity Agents