Nonsurgical Weight Loss for Extreme Obesity in Primary Care Settings

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Abstract
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. Conclusion Primary care practices can initiate effective medical management for extreme obesity; future efforts must target improving retention and weight loss maintenance. Trial Registration clinicaltrials.gov Identifier: NCT00115063