Does brief physician counseling promote weight loss?
IN SOME CASES, it may. While physician counseling alone isn’t more effective for weight loss than usual care (strength of recommendation [SOR]: A, larger randomized controlled trials [RCTs]), counseling (adults) as part of a multidisciplinary intervention may promote modest (2-3 kg) weight loss over 1 year (SOR: B, a single RCT).
Evidence summary
The TABLE summarizes the results of 6 RCTs that evaluated physician counseling for weight loss. The largest RCT, which included patients with elevated serum low-density lipoprotein levels (>75th percentile), randomized participants to 3 groups: physician counseling plus office support (dietary assessment tools, counseling algorithms, and in-office prompts), physician counseling alone, or usual care.1
Patients who received physician counseling with office support lost 2.3 kg (P<.001 vs usual care), whereas patients who received physician counseling alone lost 1.0 kg and patients who received usual care didn’t lose any weight.
TABLE
The effectiveness of weight loss counseling by physicians: What the RCTs reveal
| Number and characteristics of patients | Duration of intervention | Study design | Weight change |
|---|---|---|---|
| 1162 adults from internal medicine clinics (mean BMI=29 kg/m2)1 | 12 mo | 3 arms:
|
|
| 310 adult Hispanic patients with type 2 diabetes (mean BMI=35 kg/m2)2 | 12 mo | Physician counseling vs usual care | –0.1 kg vs +0.6 kg gain; P=.23 |
| 144 adult African American women (mean BMI=39 kg/m2)3 | 6 mo | Physician counseling vs usual care | –1.5 kg vs -0.6 kg at 9 mo; P=.01 0 kg net loss in both groups at 12- and 18-month follow-up |
| 96 Italian adults (mean BMI=25 kg/m2)4 | 5-6 mo | Physician counseling vs usual care | Men: BMI decrease from 30.3 to 29.5 kg/m2 vs increase from 31.9 to 32.4 kg/m2; P<.05 Women: BMI decrease from 30.6 to 30.2 kg/m2 vs increase from 30.7 to 31.0 kg/m2; P<.05 |
| 91 children (3-7 years of age) either overweight or with obese parents5 | 6 mo | 3 arms:
| No significant weight loss in any group |
| 30 Israeli adults with hypertension (mean BMI=34 kg/m2)6 | 6 mo | Resident physician counseling vs usual care | –0.9 kg vs +1.3 kg at 6 mo; P value not given No difference between groups at 12-mo follow-up |
| BMI, body mass index. | |||
Other large studies show mixed results
The second largest RCT randomized participants from community health centers in Colorado to receive either physician counseling (in which physicians reviewed nutritional and physical activity goals generated by a computer in response to a survey) or usual care (patient handouts alone).2 Although the physician-counseled group didn’t lose more total weight, more people in this group had lost 2.7 kg or more at the 12-month follow-up (32% vs 19% for usual care; P=.006).
The third largest RCT assigned low-income women from primary care clinics in Louisiana to either a 6-month tailored weight loss intervention or usual care.3 The intervention included monthly 15-minute visits with physician counseling about weight loss, fat intake, physical activity, barriers to weight loss, and weight loss maintenance. Women who received counseling lost 1.5 kg at the 9-month follow-up compared with a loss of 0.6 kg for women who received usual care. Both groups showed no net loss at the 12- and 18-month follow-up.
