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Primary Care Lifestyle Intervention Effects on Cardiometabolic Risk Factors
Quick Takes
- A primary care weight loss intervention delivered to a diverse, low-income population with obesity is feasible for weight loss.
- An intensive weight loss intervention delivered through health coaches in a primary care setting was associated with improvements in metabolic syndrome severity at 24 months.
- An intensive weight loss intervention was associated with improvements in HDL-C and total cholesterol to HDL-C at 12 and 24 months.
Study Questions:
Is an intensive weight loss lifestyle intervention delivered in primary care settings effective for modifying cardiometabolic risk factors among low-income, diverse patients?
Methods:
Data from the PROPEL (Promoting Successful Weight Loss in Primary Care in Louisiana) trial were used for the present analysis. A total of 18 clinics were randomized to an intensive weight loss intervention or usual care. The intensive weight loss intervention participants received a 24-month high-intensity lifestyle-based obesity treatment program, embedded in the clinic setting and delivered by health coaches in weekly sessions initially and monthly sessions in months 7-24. The primary outcomes included weight loss, fasting blood glucose and lipids, blood pressure, and metabolic syndrome severity score.
Results:
A total of 803 participants (351 usual care, 452 intensive weight loss intervention), all with obesity, were included. The study population was 67% Black race, 84% female, with a mean age of 49.4 years. Participants randomized to the weight loss intervention lost significantly more weight over 24 months than those receiving usual care (mean difference, −4.51%; 95% confidence interval [CI], −5.93 to −3.10; p < 0.01). Fasting glucose decreased more in the intensive weight loss intervention group compared with the usual care group at 12 months (mean difference, −7.1 mg/dl; 95% CI, −12.0 to −2.1; p < 0.01), but not 24 months. Increases in high-density lipoprotein cholesterol (HDL-C) were greater in the intensive weight loss intervention than in the usual care group at both time points (mean difference at 24 months, 4.6 mg/dl; 95% CI, 2.9–6.3; p < 0.01). Total cholesterol to HDL ratio and metabolic syndrome severity (z score) decreased more in the intervention group than in the usual care group at both time points. Changes in total cholesterol, LDL-C, triglycerides, and blood pressure did not differ significantly between groups at any time point.
Conclusions:
The investigators concluded that a pragmatic intensive weight loss intervention consistent with national guidelines and delivered by trained health coaches in primary care produced clinically relevant improvements in cardiometabolic health in an underserved population over 24 months.
Perspective:
This primary care-based weight loss intervention was associated with improvements in metabolic syndrome and lipid levels. These data suggest delivery such as in this intervention is feasible and effective for diverse primary care populations with obesity.
Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Hypertriglyceridemia, Lipid Metabolism, Nonstatins, Diet
Keywords: Blood Glucose, Blood Pressure, Cholesterol, HDL, Cholesterol, LDL, Dyslipidemias, Fasting, Glucose, Life Style, Metabolic Syndrome, Obesity, Primary Health Care, Primary Prevention, Triglycerides, Vulnerable Populations, Weight Loss
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