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Cited by 143Pharmacology and Obesity TreatmentObesity and Health PracticesObesity, Physical Activity, Diet

Nonsurgical Weight Loss for Extreme Obesity in Primary Care Settings: Results of the Louisiana Obese Subjects Study

Ryan, Donna H.·2010·Archives of Internal Medicine
DOI 10.1001/archinternmed.2009.508
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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.

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  • Long-term weight loss in the enhanced lifestyle counseling group and in the brief lifestyle counseling group was greater than weight loss observed in other primary care trials, with the exception of a study involving extremely obese patients treated with intensive group lifestyle modification and weight-loss medications.

    “Long-term weight loss in the group that received enhanced lifestyle counseling (as well as in the group that received brief lifestyle counseling without enhancement) was greater than weight loss observed in other primary care trials,5–7,30,31 with the exception of a study involving extremely obese patients who were treated with intensive group lifestyle modification and weight-loss medications.32”

    From A Two-Year Randomized Trial of Obesity Treatment in Primary Care Practice (2011) · cites this paper as [32]

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Authors
Ryan, D. H.
Affiliations
Pennington Biomedical Research Center (US)
Corresponding author
Ryan, Donna H.
ORCID
Ryan, Donna H.
Venue
Archives of Internal Medicine
Publisher
American Medical Association (AMA)
Published
2010-01-25
Volume
170
Issue
2
Pages
146
ISSN
0003-9926 (ISSN-L)
DOI
10.1001/archinternmed.2009.508
OpenAlex
W2130977708
Cited by
143
References
36
Citations by year
2026: 1 · 2025: 3 · 2024: 1 · 2023: 5 · 2022: 5 · 2021: 3 · 2020: 10 · 2019: 8 · 2018: 9 · 2017: 10 · 2016: 9 · 2015: 12 · 2014: 18 · 2013: 17 · 2012: 9
FWCI
11.56
Type
journal article
Language
en
Open access
closed
Locations
  • Archives of Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Civil War Book Review (submittedVersion)
Topics
  • Health Sciences › Medicine › Pharmacology › Pharmacology and Obesity Treatment
  • Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
Keywords
morbid obesity, behavioral counseling, liquid diet, sibutramine, orlistat, diethylpropion, pharmacotherapy, body mass index, usual care comparison
MeSH terms
Diet, Reducing, Female, Humans, Male, Middle Aged, Obesity, Morbid, Primary Health Care, Weight Loss, Anti-Obesity Agents

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