Advantages Seen With Clinic-Based Weight-Loss Programs

Steven Fox

October 19, 2011

October 19, 2011 (Orlando, Florida) — Clinic-based weight-loss interventions might get better results than some commercial weight-loss programs, according to results from a pilot study of inner-city low-income residents conducted in Denver, Colorado.

The results were presented in a poster session here at Obesity 2011: The Obesity Society 29th Annual Scientific Meeting.

"A lot of weight-loss studies tend to overrecruit ethnic minorities — patients who historically have a high incidence of obesity," presenter Adam Tsai, MD, told Medscape Medical News in an interview. "But people of low socioeconomic status are often underrepresented."

Dr. Tsai, who is an internal medicine physician and weight-loss specialist at Denver Health Medical Center, and assistant professor of medicine at the University of Colorado, and his colleagues conducted their study in an urban hospital setting with a significant proportion of low-income patients.

Rather than compare a single intervention with a control group, they elected to compare the efficacy of 2 active interventions: a popular commercial weight-loss program (in this case, Weight Watchers) and a clinic-based individualized treatment approach.

They recruited 46 obese patients, each with a body mass index above 30 kg/m2. Besides being obese, none of the patients had any other serious or life-threatening conditions.

Patients were randomized into 2 groups. The first group got a voucher to attend the commercial weight-loss program for 17 weeks. The other group got 12 individual counseling sessions with a nurse nutritionist.

"Clinic sessions were 20 to 30 minutes long," Dr. Tsai explained. "The patients assigned to the clinic intervention were also given the option of using meal replacements, with products like Slim Fast or Glucerna, or taking a weight-loss medication, which in this trial was phentermine."

Participants were assessed 4 months later. The primary outcome was weight loss. Secondary outcomes were blood pressure, waist circumference, and health-related quality of life.

"We found that patients in the clinic-based group lost significantly more weight," Dr. Tsai said. More specifically, weight loss in the commercial weight-loss program totaled 0.6 ± 1.0 kg, whereas patients in the clinic-based program lost 4.0 ± 1.2 kg (P = .042).

"I suspected that the weight loss in the clinic arm would be about 3 to 4 kg more than in the patients randomized to the commercial program, and that's what we found," he said. "But the absolute weight losses in both of the groups were less than what I expected — less than what's been seen in other trials."

How does he account for that difference? "I think it's at least partly a function of the population we studied," he said. "This was a poor inner-city population. Virtually all the patients were living in situations where the household income was 200% or less than the [federally defined] poverty level. So most of them were dealing with a lot of other tough problems besides their weight."

Dr. Tsai said there were insignificant differences between the 2 interventions in terms of attrition; 39% dropped out of the commercial weight-loss program and 30% dropped out of the clinic program (P = .54).

The investigators conducted brief qualitative interviews with several of the patients assigned to the commercial program. "They indicated a desire for more structure from the meetings, along with more educational content, rather than hearing individual anecdotes from other people attending the meetings," Dr. Tsai said.

No significant differences were found in secondary outcomes, most likely because of the small sample size, he said.

"We think this small study suggests that a clinic-based approach might be more effective, at least in this low-income population, but we certainly need larger trials to answer that question fully," Dr. Tsai said.

Stephanie Sogg, PhD, a staff psychologist at Massachusetts General Hospital Weight Center, Boston, reviewed the poster presentation and told Medscape Medical News in an interview that "this is a very important study because it demonstrates in a randomized clinical trial that individualized medical treatment for weight loss was superior — at least in this short study — to a very popular commercial program."

She echoed Dr. Tsai's point that many other weight-loss trials fail to include representative samples from low-income groups, "Even though we're only talking about a small cohort here, that's a really important and informative feature of this study," she said.

She also pointed out that because of the small size of the sample, researchers were not able to conduct a meaningful comparison between clinic-based patients who chose meal replacement and those who chose weight-loss drug therapy. "You'd definitely like to see that in future studies," she said. "But I think the positive side of these researchers offering those 2 options is that that really approximates real-world treatment in the clinic setting."

Dr. Sogg said it is also important to note that the clinic group of the trial was administered by nurse nutritionists, rather than physicians. "That would suggest that this kind of program can be a relatively cost-effective option for payers," she said.

The authors and the commentator have disclosed no relevant financial relationships.

Obesity 2011: The Obesity Society 29th Annual Scientific Meeting: Poster 587-PDT. Presented October 5, 2011.

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