Screening and brief intervention for obesity in primary care: a parallel, two-arm, randomised trial

P. Aveyard, A. Lewis, S. Tearne, K. Hood, A. Christian-Brown, P. Adab, R. Begh, K. Jolly, A. Daley, A. Farley, Deborah Lycett, A. Nickless, L.-M. Yu, L. Retat, L. Webber, L. Pimpin, S. A. Jebb

Research output: Contribution to journalArticle

84 Citations (Scopus)
2 Downloads (Pure)

Abstract

Background Obesity is a common cause of non-communicable disease. Guidelines recommend that physicians screen and offer brief advice to motivate weight loss through referral to behavioural weight loss programmes. However, physicians rarely intervene and no trials have been done on the subject. We did this trial to establish whether physician brief intervention is acceptable and effective for reducing bodyweight in patients with obesity. Methods In this parallel, two-arm, randomised trial, patients who consulted 137 primary care physicians in England were screened for obesity. Individuals could be enrolled if they were aged at least 18 years, had a body-mass index of at least 30 kg/m2 (or at least 25 kg/m2 if of Asian ethnicity), and had a raised body fat percentage. At the end of the consultation, the physician randomly assigned participants (1:1) to one of two 30 s interventions. Randomisation was done via preprepared randomisation cards labelled with a code representing the allocation, which were placed in opaque sealed envelopes and given to physicians to open at the time of treatment assignment. In the active intervention, the physician offered referral to a weight management group (12 sessions of 1 h each, once per week) and, if the referral was accepted, the physician ensured the patient made an appointment and offered follow-up. In the control intervention, the physician advised the patient that their health would benefit from weight loss. The primary outcome was weight change at 12 months in the intention-to-treat population, which was assessed blinded to treatment allocation. We also assessed asked patients' about their feelings on discussing their weight when they have visited their general practitioner for other reasons. Given the nature of the intervention, we did not anticipate any adverse events in the usual sense, so safety outcomes were not assessed. This trial is registered with the ISRCTN Registry, number ISRCTN26563137. Findings Between June 4, 2013, and Dec 23, 2014, we screened 8403 patients, of whom 2728 (32%) were obese. Of these obese patients, 2256 (83%) agreed to participate and 1882 were eligible, enrolled, and included in the intention-to-treat analysis, with 940 individuals in the support group and 942 individuals in the advice group. 722 (77%) individuals assigned to the support intervention agreed to attend the weight management group and 379 (40%) of these individuals attended, compared with 82 (9%) participants who were allocated the advice intervention. In the entire study population, mean weight change at 12 months was 2·43 kg with the support intervention and 1·04 kg with the advice intervention, giving an adjusted difference of 1·43 kg (95% CI 0·89–1·97). The reactions of the patients to the general practitioners' brief interventions did not differ significantly between the study groups in terms of appropriateness (adjusted odds ratio 0·89, 95% CI 0·75–1·07, p=0·21) or helpfulness (1·05, 0·89–1·26, p=0·54); overall, four (<1%) patients thought their intervention was inappropriate and unhelpful and 1530 (81%) patients thought it was appropriate and helpful. Interpretation A behaviourally-informed, very brief, physician-delivered opportunistic intervention is acceptable to patients and an effective way to reduce population mean weight. Funding The UK National Prevention Research Initiative.
Original languageEnglish
Pages (from-to)2492-2500
Number of pages9
JournalThe Lancet
Volume388
Issue number10059
DOIs
Publication statusPublished - 24 Oct 2016

Fingerprint

Primary Health Care
Obesity
Physicians
Weights and Measures
Referral and Consultation
Random Allocation
General Practitioners
Weight Loss
Population
Weight Reduction Programs
Intention to Treat Analysis
Self-Help Groups
Primary Care Physicians
Insurance Benefits
England
Registries
Adipose Tissue
Appointments and Schedules
Emotions
Body Mass Index

Bibliographical note

The full text is also available from: http://dx.doi.org/10.1016/S0140-6736(16)31893-1

This article is currently in press. Full citation details will be uploaded when available.
This article is under a Creative Commons CC BY licence (https://creativecommons.org/licenses/by/3.0/).

Cite this

Aveyard, P., Lewis, A., Tearne, S., Hood, K., Christian-Brown, A., Adab, P., ... Jebb, S. A. (2016). Screening and brief intervention for obesity in primary care: a parallel, two-arm, randomised trial. The Lancet, 388(10059), 2492-2500. https://doi.org/10.1016/S0140-6736(16)31893-1

Screening and brief intervention for obesity in primary care: a parallel, two-arm, randomised trial. / Aveyard, P.; Lewis, A.; Tearne, S.; Hood, K.; Christian-Brown, A.; Adab, P.; Begh, R.; Jolly, K.; Daley, A.; Farley, A.; Lycett, Deborah; Nickless, A.; Yu, L.-M.; Retat, L.; Webber, L.; Pimpin, L.; Jebb, S. A.

In: The Lancet, Vol. 388, No. 10059, 24.10.2016, p. 2492-2500.

Research output: Contribution to journalArticle

Aveyard, P, Lewis, A, Tearne, S, Hood, K, Christian-Brown, A, Adab, P, Begh, R, Jolly, K, Daley, A, Farley, A, Lycett, D, Nickless, A, Yu, L-M, Retat, L, Webber, L, Pimpin, L & Jebb, SA 2016, 'Screening and brief intervention for obesity in primary care: a parallel, two-arm, randomised trial' The Lancet, vol. 388, no. 10059, pp. 2492-2500. https://doi.org/10.1016/S0140-6736(16)31893-1
Aveyard P, Lewis A, Tearne S, Hood K, Christian-Brown A, Adab P et al. Screening and brief intervention for obesity in primary care: a parallel, two-arm, randomised trial. The Lancet. 2016 Oct 24;388(10059):2492-2500. https://doi.org/10.1016/S0140-6736(16)31893-1
Aveyard, P. ; Lewis, A. ; Tearne, S. ; Hood, K. ; Christian-Brown, A. ; Adab, P. ; Begh, R. ; Jolly, K. ; Daley, A. ; Farley, A. ; Lycett, Deborah ; Nickless, A. ; Yu, L.-M. ; Retat, L. ; Webber, L. ; Pimpin, L. ; Jebb, S. A. / Screening and brief intervention for obesity in primary care: a parallel, two-arm, randomised trial. In: The Lancet. 2016 ; Vol. 388, No. 10059. pp. 2492-2500.
@article{7da2ef34b5794ff08d6b555f34552315,
title = "Screening and brief intervention for obesity in primary care: a parallel, two-arm, randomised trial",
abstract = "Background Obesity is a common cause of non-communicable disease. Guidelines recommend that physicians screen and offer brief advice to motivate weight loss through referral to behavioural weight loss programmes. However, physicians rarely intervene and no trials have been done on the subject. We did this trial to establish whether physician brief intervention is acceptable and effective for reducing bodyweight in patients with obesity. Methods In this parallel, two-arm, randomised trial, patients who consulted 137 primary care physicians in England were screened for obesity. Individuals could be enrolled if they were aged at least 18 years, had a body-mass index of at least 30 kg/m2 (or at least 25 kg/m2 if of Asian ethnicity), and had a raised body fat percentage. At the end of the consultation, the physician randomly assigned participants (1:1) to one of two 30 s interventions. Randomisation was done via preprepared randomisation cards labelled with a code representing the allocation, which were placed in opaque sealed envelopes and given to physicians to open at the time of treatment assignment. In the active intervention, the physician offered referral to a weight management group (12 sessions of 1 h each, once per week) and, if the referral was accepted, the physician ensured the patient made an appointment and offered follow-up. In the control intervention, the physician advised the patient that their health would benefit from weight loss. The primary outcome was weight change at 12 months in the intention-to-treat population, which was assessed blinded to treatment allocation. We also assessed asked patients' about their feelings on discussing their weight when they have visited their general practitioner for other reasons. Given the nature of the intervention, we did not anticipate any adverse events in the usual sense, so safety outcomes were not assessed. This trial is registered with the ISRCTN Registry, number ISRCTN26563137. Findings Between June 4, 2013, and Dec 23, 2014, we screened 8403 patients, of whom 2728 (32{\%}) were obese. Of these obese patients, 2256 (83{\%}) agreed to participate and 1882 were eligible, enrolled, and included in the intention-to-treat analysis, with 940 individuals in the support group and 942 individuals in the advice group. 722 (77{\%}) individuals assigned to the support intervention agreed to attend the weight management group and 379 (40{\%}) of these individuals attended, compared with 82 (9{\%}) participants who were allocated the advice intervention. In the entire study population, mean weight change at 12 months was 2·43 kg with the support intervention and 1·04 kg with the advice intervention, giving an adjusted difference of 1·43 kg (95{\%} CI 0·89–1·97). The reactions of the patients to the general practitioners' brief interventions did not differ significantly between the study groups in terms of appropriateness (adjusted odds ratio 0·89, 95{\%} CI 0·75–1·07, p=0·21) or helpfulness (1·05, 0·89–1·26, p=0·54); overall, four (<1{\%}) patients thought their intervention was inappropriate and unhelpful and 1530 (81{\%}) patients thought it was appropriate and helpful. Interpretation A behaviourally-informed, very brief, physician-delivered opportunistic intervention is acceptable to patients and an effective way to reduce population mean weight. Funding The UK National Prevention Research Initiative.",
author = "P. Aveyard and A. Lewis and S. Tearne and K. Hood and A. Christian-Brown and P. Adab and R. Begh and K. Jolly and A. Daley and A. Farley and Deborah Lycett and A. Nickless and L.-M. Yu and L. Retat and L. Webber and L. Pimpin and Jebb, {S. A.}",
note = "The full text is also available from: http://dx.doi.org/10.1016/S0140-6736(16)31893-1 This article is currently in press. Full citation details will be uploaded when available. This article is under a Creative Commons CC BY licence (https://creativecommons.org/licenses/by/3.0/).",
year = "2016",
month = "10",
day = "24",
doi = "10.1016/S0140-6736(16)31893-1",
language = "English",
volume = "388",
pages = "2492--2500",
journal = "The Lancet",
issn = "0140-6736",
publisher = "Elsevier",
number = "10059",

}

TY - JOUR

T1 - Screening and brief intervention for obesity in primary care: a parallel, two-arm, randomised trial

AU - Aveyard, P.

AU - Lewis, A.

AU - Tearne, S.

AU - Hood, K.

AU - Christian-Brown, A.

AU - Adab, P.

AU - Begh, R.

AU - Jolly, K.

AU - Daley, A.

AU - Farley, A.

AU - Lycett, Deborah

AU - Nickless, A.

AU - Yu, L.-M.

AU - Retat, L.

AU - Webber, L.

AU - Pimpin, L.

AU - Jebb, S. A.

N1 - The full text is also available from: http://dx.doi.org/10.1016/S0140-6736(16)31893-1 This article is currently in press. Full citation details will be uploaded when available. This article is under a Creative Commons CC BY licence (https://creativecommons.org/licenses/by/3.0/).

PY - 2016/10/24

Y1 - 2016/10/24

N2 - Background Obesity is a common cause of non-communicable disease. Guidelines recommend that physicians screen and offer brief advice to motivate weight loss through referral to behavioural weight loss programmes. However, physicians rarely intervene and no trials have been done on the subject. We did this trial to establish whether physician brief intervention is acceptable and effective for reducing bodyweight in patients with obesity. Methods In this parallel, two-arm, randomised trial, patients who consulted 137 primary care physicians in England were screened for obesity. Individuals could be enrolled if they were aged at least 18 years, had a body-mass index of at least 30 kg/m2 (or at least 25 kg/m2 if of Asian ethnicity), and had a raised body fat percentage. At the end of the consultation, the physician randomly assigned participants (1:1) to one of two 30 s interventions. Randomisation was done via preprepared randomisation cards labelled with a code representing the allocation, which were placed in opaque sealed envelopes and given to physicians to open at the time of treatment assignment. In the active intervention, the physician offered referral to a weight management group (12 sessions of 1 h each, once per week) and, if the referral was accepted, the physician ensured the patient made an appointment and offered follow-up. In the control intervention, the physician advised the patient that their health would benefit from weight loss. The primary outcome was weight change at 12 months in the intention-to-treat population, which was assessed blinded to treatment allocation. We also assessed asked patients' about their feelings on discussing their weight when they have visited their general practitioner for other reasons. Given the nature of the intervention, we did not anticipate any adverse events in the usual sense, so safety outcomes were not assessed. This trial is registered with the ISRCTN Registry, number ISRCTN26563137. Findings Between June 4, 2013, and Dec 23, 2014, we screened 8403 patients, of whom 2728 (32%) were obese. Of these obese patients, 2256 (83%) agreed to participate and 1882 were eligible, enrolled, and included in the intention-to-treat analysis, with 940 individuals in the support group and 942 individuals in the advice group. 722 (77%) individuals assigned to the support intervention agreed to attend the weight management group and 379 (40%) of these individuals attended, compared with 82 (9%) participants who were allocated the advice intervention. In the entire study population, mean weight change at 12 months was 2·43 kg with the support intervention and 1·04 kg with the advice intervention, giving an adjusted difference of 1·43 kg (95% CI 0·89–1·97). The reactions of the patients to the general practitioners' brief interventions did not differ significantly between the study groups in terms of appropriateness (adjusted odds ratio 0·89, 95% CI 0·75–1·07, p=0·21) or helpfulness (1·05, 0·89–1·26, p=0·54); overall, four (<1%) patients thought their intervention was inappropriate and unhelpful and 1530 (81%) patients thought it was appropriate and helpful. Interpretation A behaviourally-informed, very brief, physician-delivered opportunistic intervention is acceptable to patients and an effective way to reduce population mean weight. Funding The UK National Prevention Research Initiative.

AB - Background Obesity is a common cause of non-communicable disease. Guidelines recommend that physicians screen and offer brief advice to motivate weight loss through referral to behavioural weight loss programmes. However, physicians rarely intervene and no trials have been done on the subject. We did this trial to establish whether physician brief intervention is acceptable and effective for reducing bodyweight in patients with obesity. Methods In this parallel, two-arm, randomised trial, patients who consulted 137 primary care physicians in England were screened for obesity. Individuals could be enrolled if they were aged at least 18 years, had a body-mass index of at least 30 kg/m2 (or at least 25 kg/m2 if of Asian ethnicity), and had a raised body fat percentage. At the end of the consultation, the physician randomly assigned participants (1:1) to one of two 30 s interventions. Randomisation was done via preprepared randomisation cards labelled with a code representing the allocation, which were placed in opaque sealed envelopes and given to physicians to open at the time of treatment assignment. In the active intervention, the physician offered referral to a weight management group (12 sessions of 1 h each, once per week) and, if the referral was accepted, the physician ensured the patient made an appointment and offered follow-up. In the control intervention, the physician advised the patient that their health would benefit from weight loss. The primary outcome was weight change at 12 months in the intention-to-treat population, which was assessed blinded to treatment allocation. We also assessed asked patients' about their feelings on discussing their weight when they have visited their general practitioner for other reasons. Given the nature of the intervention, we did not anticipate any adverse events in the usual sense, so safety outcomes were not assessed. This trial is registered with the ISRCTN Registry, number ISRCTN26563137. Findings Between June 4, 2013, and Dec 23, 2014, we screened 8403 patients, of whom 2728 (32%) were obese. Of these obese patients, 2256 (83%) agreed to participate and 1882 were eligible, enrolled, and included in the intention-to-treat analysis, with 940 individuals in the support group and 942 individuals in the advice group. 722 (77%) individuals assigned to the support intervention agreed to attend the weight management group and 379 (40%) of these individuals attended, compared with 82 (9%) participants who were allocated the advice intervention. In the entire study population, mean weight change at 12 months was 2·43 kg with the support intervention and 1·04 kg with the advice intervention, giving an adjusted difference of 1·43 kg (95% CI 0·89–1·97). The reactions of the patients to the general practitioners' brief interventions did not differ significantly between the study groups in terms of appropriateness (adjusted odds ratio 0·89, 95% CI 0·75–1·07, p=0·21) or helpfulness (1·05, 0·89–1·26, p=0·54); overall, four (<1%) patients thought their intervention was inappropriate and unhelpful and 1530 (81%) patients thought it was appropriate and helpful. Interpretation A behaviourally-informed, very brief, physician-delivered opportunistic intervention is acceptable to patients and an effective way to reduce population mean weight. Funding The UK National Prevention Research Initiative.

U2 - 10.1016/S0140-6736(16)31893-1

DO - 10.1016/S0140-6736(16)31893-1

M3 - Article

VL - 388

SP - 2492

EP - 2500

JO - The Lancet

JF - The Lancet

SN - 0140-6736

IS - 10059

ER -