Does brief physician counseling promote weight loss?

Counseling with follow-up leads to drop in BMI
Physician counseling in an Italian RCT included a 1-minute, patient-centered assessment of readiness for change, 2 to 5 minutes of exercise counseling by a physician for patients in active and maintenance stages, and phone or mail follow-up at 2 to 3 weeks.⁴ The reported decreases in body mass index (BMI) in the counseling group would translate to 2.4 and 1.0 kg of weight loss for men and women of average height, respectively.

No significant weight loss in a pediatric study
An RCT of children brought to a pediatric clinic for well-child visits recruited children who had either a BMI in the 85th to 95th percentile or obese parents (BMI ≥30 kg/m²).⁵ Parents were randomized to intensive counseling, minimal counseling, or usual care. The intensive intervention group participated in a 10- to 15-minute motivational interview with the pediatrician, followed by 2 45-minute sessions with a dietician at months 1 and 3 of the 6-month program; the minimal intervention group only participated in the motivational interview. No significant weight loss occurred in any of the 3 study groups.

The smallest RCT compared counseling by a family medicine resident with usual care in 30 adult patients.⁶ At 6 months, the counseling group had lost 0.9 kg compared with a gain of 1.3 kg in the usual care group, but follow-up at 12 months found no difference between the groups.

Recommendations

The US Preventive Services Task Force (USPSTF) says that intensive counseling (person-to-person meetings at least monthly, combined with diet, exercise, and behavioral interventions plus longer-term maintenance) can promote modest sustained weight loss and improve clinical outcomes.⁷ They recommend screening adults for obesity and offering intensive counseling and behavioral interventions for obese adults.

USPSTF notes, however, that evidence is insufficient to recommend for or against low- or moderate-intensity counseling and behavioral interventions in obese or overweight adults because the trials showed mixed results, typically had small sample sizes and high dropout rates, and reported average weight change rather than frequency of response.⁸