E. Stephanie Krauthamer Ewing, MPH, Thomas A. Wadden, PhD, Gary D. Foster, PhD, David B. Sarwer, PhD, Drew A. Anderson, PhD, and Myles A. Faith, PhD. Weight and Eating Disorders Program, Department of Psychiatry, University of Pennsylvania, 3535 Market St., Suite 3108, Philadelphia, PA 19103, 215 573 0742, sewing@mail.med.upenn.edu

Background: Obesity and its associated health complications are a serious public health concern. However, fewer than 75% of primary care physicians discuss obesity with obese patients and far fewer provide treatment¹. Little research exists on the management of obesity in primary care practice. Treatment has largely been developed in academic settings and customarily uses weekly group treatment sessions to provide diet, exercise, and behavior counseling. This model appears too time-intensive and costly for many health care settings, including primary care, and potentially too demanding for many patients. Objectives: To compare the effectiveness of traditional weekly group behavioral treatment for weight loss with briefer monthly individual treatment that could potentially be provided in primary care settings. Methods: 103 obese women were randomly assigned to: 1) traditional group behavioral treatment (GBT) that prescribed a 1200-1500 kcal/d balanced deficit diet (BDD) and weekly 90 minute meetings from weeks 1-20 and bi-weekly visits from weeks 20-40; 2) individual behavioral treatment (IBT) that included a 1200-1500 kcal/d BDD with 20-min visits delivered monthly; 3) or a non-dieting (ND) control group instructed not to reduce caloric intake. Follow-up assessments were performed at week 65. Results: At week 20, participants in both GBT and IBT lost a significantly greater percentage of initial weight (7.8 + 6.0 % and 4.7 + 5.3%, respectively) than participants in the control group (0.1 + 2.4%) (ps < .001). Losses of GBT participants were significantly greater than those of IBT patients at this time (p = .049). Week 40 losses for GBT, IBT, and ND were 8.4 + 8.7%, 4.7 + 6.7 %, and 0.8 + 3.2%, respectively, and week 65 losses were 6.3 + 8.3%, 2.5 + 7.0 %, and -0.8 + 3.4% respectively. Losses for GBT and IBT were significantly greater than ND at both week 40 (ps ≤ .003) and week 65 (ps < .02) with no significant differences between GBT and IBT at these times. Conclusions: Monthly brief individual weight loss treatment produced a mean loss of 4.7% of initial weight in 40 weeks. Losses of this size may be associated with significant improvements in health². Brief individual counseling was more effective than a non-dieting approach at all times, and did not differ at weeks 40 and 65 from traditional group behavior modification. Primary care providers or their medical support staff could potentially provide effective obesity treatment through brief individual weight loss counseling.

Learning Objectives:

• To investigate potential models for the treatment of obesity in primary care settings

Keywords: Obesity, Health Care Delivery

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.