More intervention, not less, may help obese people lose the most weight

Forget about self-motivation -- people who want to lose weight might do better with more help, not less.

A study finds that obese people lose more weight when they’re part of a primary care-based program that incorporates lifestyle coaching, plus weight loss medication or meal replacement, compared with doctor visits alone. Researchers randomly placed 390 obese men and women into three groups that had the same goal of losing weight via diet and exercise. A “usual care” group took part in quarterly visits to their primary care provider during which they talked about any weight changes as well as weight loss information contained in a handout. Doctors did not discuss detailed strategies for losing weight.

The second group went to the same quarterly visits but also took part in brief monthly lifestyle coaching counseling sessions that included a weigh-in and review of their diet and activity. A third “enhanced” counseling group, in addition to the quarterly visits and coaching, were offered one of two weight loss medications (sibutramine, since taken off the market, or orlistat) or meal replacements.

After two years, those in the enhanced counseling group lost the most weight, about 10.1 pounds on average. Not much difference was noted in weight loss between the group that had brief coaching sessions (about 6.4 pounds on average), and those who just did the quarterly visits (about 3.7 pounds on average). The enhanced group also had the largest percentage of people who achieved a 5% weight loss (34.9%) compared to the brief counseling group (26%) and those who got usual care (21.5%).


The most improvements in waist circumference, HDL (good) cholesterol and triglycerides were seen in the enhanced coaching group, which also had the best attendance record of the three.

A “considerable minority” of obese people could see significant weight loss with this augmented counseling, the authors wrote, probably more than they’d achieve on their own. The only sticking point, they added, is who will pay for it all.

The study was released online today in the New England Journal of Medicine.