A closer look at weight loss interventions in primary care: A systematic review and meta-analysis

Abstract

ABSTRACTBackgroundWeight loss observed in clinical trials has failed to translate into real world clinical settings. The objective of the current review was to quantify patient weight loss using various approaches tested in primary care and to unveil relevant contextual factors that could improve patient weight loss on a long-term basis.MethodsData were compiled from Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Scopus, and Web of Science from inception to October 30, 2022. Only randomized clinical trials conducted in people with overweight or obesity in a primary care setting where the intervention was administered by a primary care provider for at least 6 months were included. All investigators identified studies and independently abstracted data using COVIDENCE systematic review software. Quality assessment and risk of bias of individual studies was assessed in the context of the primary outcome using the template provided by COVIDENCE.ResultsThe seven studies included 2,187 people with obesity who had weight-related comorbidities or risk factors. Substantial heterogeneity in the outcomes was observed, as well as bias toward lack of published studies showing no effect. The random effect model estimated a treatment effect for the aggregate efficacy of primary care interventions −3.54 kg (95% CI: - 5.61 kg to −1.47 kg). Interventions that included a medication component (alone or as part of a multipronged intervention) achieved a greater weight reduction by −2.94 kg (p<0.0001). In all interventions, efficacy declined with time (reduction in weight loss by 0.53 kg per six months, 95%CI: 0.04-1.0 kg, p-value=0.04).DiscussionWeight loss interventions administered by a primary care provider can lead to modest weight loss. Weight loss is approximately doubled if anti-obesity medication is part of the treatment strategy. Nevertheless, weight loss is attenuated over time and underscores the need for long-term treatment.