CHICAGO – A behavioral intervention program appears to be associated with modest weight loss and improved blood pressure control in a high-risk, socioeconomically disadvantaged group of obese patients, according to a study published Online First by Archives of Internal Medicine, one of the JAMA/Archives journals.
Obesity is not sufficiently addressed in the U.S. primary care system and socioeconomically disadvantaged patients who seek care at community health centers are particularly affected by the limited availability of obesity treatments, the authors write in their study background.
Gary G. Bennett, Ph.D., of Duke University, Durham, N.C., and colleagues conducted a two-group, 24-month randomized effectiveness trial in three Boston community health centers from February 2008 to May 2011. The participants were 365 obese patients receiving hypertension treatment (71.2 percent black, 13.1 percent Hispanic, 68.5 percent female and 32.9 percent with less than a high school education).
The patients were assigned to a usual care group or a behavioral intervention group that included behavior change goals, self-monitoring of progress via a website or interactive voice response system, 18 telephone counseling calls, a dozen optional group support sessions and community resource links.
"The Be Fit, Be Well lifestyle intervention slowed weight and blood pressure increases in this high-risk patient population. Although six-month weight losses were modest, they were sustained for 24 months and were associated with clinically significant alterations in blood pressure trajectories," the authors comment.
At 24 months, weight change in the intervention group compared with the usual care group was -1.03 kg (about 2.2 pounds) and change in body mass index in the intervention group compared with the usual care group was -0.38. During 24 months, mean (average) systolic blood pressure (SBP) was lower in the intervention group compared with the usual care group but not significantly different. The slope of increasing SBP per year was significantly higher in the usual care group. At 24 months, patients in the intervention group had greater odds of blood pressure control than those patients in the usual care group and the difference in trend was significant.
"As a pragmatic effectiveness trial, our findings are arguably more generalizable to real-world health center settings than are those of highly controlled efficacy trials with larger treatment effects," the authors conclude. "More work is necessary to best address the needs of socioeconomically disadvantaged patients who bear the greatest risk and disease burden of obesity."
(Arch Intern Med. Published online March 12, 2012. doi:10.1001/archinternmend.2012.1 Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: This study was supported in part by grants from the National Heart, Lung and Blood Institute and the National Cancer Institute. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
To contact author Gary G. Bennett, Ph.D., call Steve Hartsoe at 919-681-4515 at steve.hartsoe@duke.edu.
Journal
Archives of Internal Medicine