Diets, Doctors and Obesity: Heavier Weight for Primary Care

Wednesday, June 27th, 2012
This post was written by Patricia Donovan

It’s only Wednesday, but it’s already been a weighty week for obesity.

On Tuesday, the U.S. Preventive Services Task Force recommended that primary care doctors screen adult patients for obesity. The task force further suggested that healthcare professionals offer or refer obese persons to a comprehensive weight loss and behavior management program with 12 to 26 sessions in the first year.

But what type of weight loss program is optimal, and what’s the most effective diet to follow? Separate studies appearing in the current issue of the Journal of the American Medical Association (JAMA) offer some guidance for physicians in these areas.

Researchers in the first study, in search of effective but resource-efficient weight loss treatments, compared a standard behavioral weight loss intervention (SBWI) with a stepped-care weight loss intervention (STEP). The JAMA article notes that stepped-treatment approaches customize interventions based on milestone completion and can be more effective while costing less to administer than conventional treatment approaches.

All participants were placed on a low-calorie diet, prescribed increases in physical activity, and attended group counseling sessions ranging from weekly to monthly during an 18-month period. The SBWI group was assigned to a fixed program. Counseling frequency, type, and weight loss strategies could be modified every three months for the STEP group in response to observed weight loss as it related to weight loss goals.

In addition to determining the mean change in weight over 18 months, the study also measured additional outcomes including resting heart rate and blood pressure, waist circumference, body composition, fitness, physical activity, dietary intake and cost of the program.

Researchers concluded that among overweight and obese adults, the use of SBWI resulted in a greater mean weight loss than STEP over 18 months, but that compared with SBWI, STEP resulted in clinically meaningful weight loss that cost less to implement.

But let’s back up a minute to that low-calorie diet both groups followed. The second published study found that not all calories — and low-calorie diets — are created equally. Researchers at the New Balance Foundation Obesity Prevention Center at Boston Children’s Hospital studied the effects of three diets, each of which contained the same number of calories:

  • Low-fat, which is typically recommended by the U.S. government and American Heart Association, aims to reduce overall fat intake.
  • Low-carbohydrate, modeled after the Atkins diet, reduces almost all carbohydrate intake.
  • Low-glycemic, which aims to keep blood sugar levels steady by choosing natural foods and high-quality protein, carbohydrates and fats.

Even though all three diets consisted of the same amount of calories, researchers determined that the low-glycemic diet came out on top: aside from helping to stabilize metabolism even after weight loss, existing research suggests that low-glycemic diets help people feel fuller longer and experience improved sense of well-being, as well as improved mental and physical performance.

You can learn more about this research in Thriving, the Boston Children’s Hospital pediatric health blog.

For Americans identified as overweight or obese and for the healthcare providers assigned to treat them, there are no easy solutions. I leave you with these thoughts from George A. Bray, MD, excerpted from his editorial on these obesity studies that appears in the same JAMA issue:

Obesity is one of the most important and most frustrating health problems that physicians treat, and the studies in this issue of JAMA provide valuable information for clinicians who treat obese patients. It may be possible to have a more individualized approach to weight loss, rather than a one-size-fits-all approach. The most efficient treatment approach incorporates periodic reassessments and adjustment of the weight loss regimen based on a patient’s success at any given time. Although the exact relationship between dietary composition and weight maintenance remains unclear, calorie restriction is more important than diet composition in administering weight loss regimens.

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