Lifestyle interventions can help people lose weight, but experts have worried whether such programs can work in low-income communities where obesity rates can be high and access to health care can be limited.
A new study found that when these programs are made accessible, meaningful weight loss can be achieved.
The research team, led by Peter Katzmarzyk, from the Pennington Biomedical Research Center in Baton Rouge, studied around 800 patients with obesity across Louisiana who were racially diverse and mostly low-income.
Since most Americans have access to a clinic or physician for primary care, the researchers looked at whether primary care facilities that treat low-income patients could implement an effective weight-loss program to treat obesity.
"A lot of people, especially low-income people, have a lot of barriers to receiving treatment," Katzmarzyk explained. "So we really wanted to test a program that would be kind of embedded in their primary care clinics -- an environment that they are already familiar with."
Around half of the study's participants were randomly assigned to take part in a weight-loss program that consisted of weekly sessions with a health coach for the first six months of the study, followed by monthly sessions for the remaining 18 months. The sessions focused on setting goals and developing plans to lower caloric intake and increase physical activity.
The researchers then compared the progress of those in the program with the other study participants, who were only given routine medical care.
The people who participated in the program lost significantly more weight -- an average of 5% of their body weight -- compared to those who did not, who lost less than 1% of their body weight on average.
And many were able to keep off the pounds. Half of the patients enrolled in the program maintained at least a 5% decrease in body weight throughout the two years of the study.
Shedding 5% of your body weight may not seem like a lot, especially for someone who is already overweight. For a 200-pound person, 5% would only amount to 10 pounds.
But Katzmarzyk and Penny Kris-Etherton, a dietitian and professor of nutrition at Penn State University, emphasized that even a small amount of weight loss can yield significant health benefits for people with obesity. A 5% weight reduction, according to Kris-Etherton, could help lower a patients' risk of developing heart disease, stroke, high blood pressure, and diabetes -- all conditions that are linked to obesity.
"So they're not only losing 10 pounds, but they're lowering their risk of cardiometabolic diseases," said Kris-Etherton, who was not involved in the study. "Most people have more than 5% to lose, but if they could just lose that 5%, it would be very meaningful in terms of their health."
And Katzmarzyk highlighted that the participants were largely able to keep off the pounds throughout the two-year-long study. "A lot of people who are on diets lose weight and then regain it," he said. "So, this is showing that this is a fairly durable program, and someone can lose weight and maintain that weight loss over two years."
The findings, published online Sept. 3 in the New England Journal of Medicine, suggest a broader implementation of accessible weight-loss programs across the country is the next step.
According to the study authors, primary care providers have been slow to adopt these intensive programs, and the number of obese patients who receive this kind of treatment has declined in recent years. While they acknowledged that these facilities should not be the sole deliverers of obesity treatment, they are a good place to start.
"This study emphasizes that weight loss in primary care settings is possible, but it's just not being implemented," Katzmarzyk said. "It really shows that it's feasible -- it can be done."
Physicians may be resistant to hosting these programs because they take time away from routine patient care, and the necessary behavioral counseling is outside of their area of expertise. But this type of weight-loss program alleviates the burden on physicians by utilizing a referral method, in which the primary care physician refers a patient to a trained health coach, Katzmarzyk said.
Kris-Etherton added that this study is a counterpoint against some of the cynicism surrounding weight-loss programs. "Our guidelines recommend intensive lifestyle intervention," she said. "And so many people say, 'Oh, my patients won't do that. This is much too intensive.' But that's what it's going to take to get people to successfully lose weight."
There's more about obesity at the U.S. Centers for Disease Control and Prevention.