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

被引：109

作者：

Ryan, Donna H. ^{[1
]}

Johnson, William D. ^{[1
]}

Myers, Valerie H. ^{[1
]}

Prather, Tiffany L. ^{[2
]}

McGlone, Meghan M. ^{[1
]}

Rood, Jennifer ^{[1
]}

Brantley, Phillip J. ^{[1
]}

Bray, George A. ^{[1
]}

Gupta, Alok K. ^{[1
]}

Broussard, Alan P. ^{[3
,4
]}

Barootes, Bryan G. ^{[3
,5
]}

Elkins, Brian L. ^{[6
]}

Gaudin, David E.

Savory, Robert L. ^{[7
]}

Brock, Ricky D. ^{[2
]}

Datz, Geralyn

Pothakamuri, Srininvasa R. ^{[2
]}

McKnight, G. Tipton

Stenlof, Kaj ^{[8
]}

Sjostrom, Lars V. ^{[8
]}

机构：

[1] Louisiana State Univ Syst, Pennington Biomed Res Ctr, Baton Rouge, LA 70808 USA

[2] Pennington Management Clin Trials, Baton Rouge, LA USA

[3] LSU Hlth Sci Ctr, New Orleans, LA USA

[4] LSU Unit, Lafayette, LA USA

[5] LSU Unit, Lake Charles, LA USA

[6] LSU Hlth Sci Ctr, Shreveport, LA USA

[7] Willis Knighton Pierremont Hlth Ctr, Shreveport, LA USA

[8] Univ Gothenburg, Dept Med, Sahlgrenska Univ Hosp, Gothenburg, Sweden

来源：

ARCHIVES OF INTERNAL MEDICINE | 2010年 / 170卷 / 02期

关键词：

BARIATRIC SURGERY; BLOOD-PRESSURE; RISK-FACTORS; TRIAL; MAINTENANCE; ORLISTAT; DIET; PREVENTION; OVERWEIGHT; REDUCTION;

D O I：

10.1001/archinternmed.2009.508

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

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 +/- 1.7kg), 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. Conclusion: Primary care practices can initiate effective medical management for extreme obesity; future efforts must target improving retention and weight loss maintenance.

引用

页码：146 / 154

页数：9

共 33 条

[1]

RANDOMIZED TRIAL OF DIET AND GASTROPLASTY COMPARED WITH DIET ALONE IN MORBID-OBESITY [J].