26 Oct Short Interventions By Primary Care Physicians Can Help Patients Lose Weight
MedicalResearch.com Interview with:
Paul Aveyard PhD MRCP FRCGP FFPH
Professor of Behavioural Medicine
Nuffield Department of Primary Care Health Sciences
University of Oxford
Radcliffe Primary Care Building
Radcliffe Observatory Quarter
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We know that opportunistic brief interventions by physicians can be effective, but there is no evidence that they are so for obesity. Physicians worry that broaching this topic will be offensive, time-consuming, and ineffective. We needed a randomised trial to assess whether physicians’ fears were justified, or in fact brief interventions could be as effective for patients who are overweight as they are for smoking or problem drinking and that’s what we did.
MedicalResearch.com: What should readers take away from your report?
Response: The bottom line is that it is possible for physicians to give a short intervention that leads to long-term weight loss and that is welcomed by patients. We tested this in a trial of 137 physicians who gave brief interventions to 1882 patients across England. We aimed to enroll everyone consulting their physician that day and 83% of patients agreed to take part. In one group, physicians advised patients that the most effective way to lose weight is to attend a weight loss programme and encouraged the patient to accept a referral to one. If the patient agreed, they made an appointment for this before leaving the medical practice. In the other group, the physician advised the patient that their health would benefit from weight loss. At one year, the group offered help to lose weight had lost 2.4kg. The group advised to lose weight had lost 1.0kg, a highly significant difference. In both arms, nearly everyone tried to lose weight over the course of a year, but the difference in weight loss arose only because five times as many people did something effective for weight loss, namely they attended the weight loss programme the physician offered. A full 40% of unselected attenders at a primary care practice attended the programme as a result of the doctor’s referral. Those who did attend lost 4.7kg when assessed at one year. Patients rated both interventions positively, with no significant differences between arms. 0.2% thought the intervention inappropriate and unhelpful while 81% thought it appropriate and helpful.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: This study has important implications for practice today as well as future research. Physicians can now feel confident that offering help ‘out of the blue’ to patients who consult them about an unrelated health problem is acceptable, effective, and practical. Providing physicians focus on offering a practical solution and do not start discussing a patient’s weight itself, this should go well. For this to be implemented fully, physicians need access to practical help to offer their patients and need to make the appointment for the patient, much as they would for any other referral.
There are clear implications for further research. We know now that brief interventions are acceptable and effective, but this is rarely enough for treatment programmes to be used widely. We need an active implementation programme. Instead, we need to find active ways of implementing this. Weighing people on arrival in primary care, training physicians to deliver this briefly, removing bureaucratic barriers to referring to weight loss, and energising the whole practice team are probably important elements of the delivery mechanism. We need research to find out how we change systems.
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Screening and brief intervention for obesity in primary care: a parallel, two-arm, randomised trial
Aveyard, Paul et al.
The Lancet , Volume 0 , Issue 0 ,
Published:24 October 2016
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