Trial of Prevention and Reduction of Obesity Through Active Living in Clinical Settings: A Randomized Controlled Trial

Study Questions:

How can effective lifestyle strategies for prevention and reduction of obesity be completed in primary care settings?

Methods:

Obese adults were enrolled and randomized to either usual care or a 2-year behavioral intervention. Potential subjects had to be overweight (defined as a body mass index [BMI] between 27 and 39) with abdominal obesity (defined as a waist circumference 102 cm or greater for men and 88 cm or greater for women) and sedentary behaviors. Patients with dyslipidemia, diabetes, and/or hypertension were not excluded. The behavioral intervention included individualized counseling from health educators to promote physical activity, along with a healthy diet. The usual care groups received advice from their physicians on a healthy lifestyle for weight reduction. The primary outcome of interest was change in waist circumference.

Results:

A total of 490 sedentary obese adults were enrolled, 241 to usual care and 249 to the lifestyle intervention, of which 396 subjects (80.8%) completed the trial. A significant main effect was observed for change in waist circumference for those in the intervention group compared with the usual care group (p < 0.001), which was sustained at 24 months (mean [SE], −0.9 [0.4] vs. 0.2 [0.4] cm; p = 0.05). The main effect of changes in waist circumference was observed in men, as opposed to women. In men, the mean (SE) reduction in waist circumference at 24 months was greater with behavioral intervention compared with usual care (−1.6 [0.6] vs. 0.1 [0.6] cm; p = 0.049). In women, the behavioral intervention was associated with differences in waist circumference compared with usual care at 6 and 12 months (p ≤ 0.01), but not at 24 months (p = 0.10).

Conclusions:

The investigators concluded that behavioral intervention performed in primary care settings is associated with modest reductions in waist circumference in men, but not among women.

Perspective:

This study is an excellent example of translation of clinical research to a real-world setting. Given the high prevalence of obesity, further research in the primary care setting is of public health importance. Understanding the gender differences observed in this trial warrants further research.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Diet, Hypertension

Keywords: Overweight, Weight Loss, Health Educators, Counseling, Prevalence, Waist Circumference, Dyslipidemias, Body Mass Index, Cardiology, Motor Activity, Cardiovascular Diseases, Obesity, Sedentary Lifestyle, Diet, Hypertension, Diabetes Mellitus, Primary Health Care


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