Background
Weigh Forward was an RACGP-accredited prospective audit that systematically reviewed the clinical performance of GP’s against best practice guidelines (NHMRC). These guidelines advocate multi-component lifestyle interventions first-line, with intensive pharmaceutical or dietary interventions introduced or referral provided if required.
Methods
Weigh Forward assessed the effect of a 12-week structured education program for weight loss, delivered by GP’s and practice nurses, and followed for a further 12-weeks. Inclusion criteria were adult patients who had:
• BMI >30 kg/m2 or 25–29.9 kg/m2 with co-morbidities;
• been screened and considered ready to lose weight;
• been weight stable for ≥3 months; and
• baseline data available including comorbidities and biochemistry (including HbA1c, if diagnosed with diabetes).
Results
Practitioners engaged 258 patients with retention of 185 (71%) through to 24-weeks. The primary cohort had a mean BMI of 36.4±0.4, M:F ratio of 68:190 and mean age of 48.1±0.9. The cohort averaged a weight loss of 5.9kg±0.7, with 51.7% of participants achieving a weight loss (WL) of >5%, and 27.2% achieving >10%WL. Patients on intensified treatments achieved >10%WL in 44.1% of cases, compared to 15.9% of those with lifestyle intervention only. Practitioners more frequently prescribed lifestyle interventions (61.2%) over intensive treatments (38.8%). 3.5% of patients were prescribed VLED’s, 34.8% Duramine, and 0.4% Orlistat, and 0% bariatric surgery. Patients with comorbidities were 1.82 (95%CI; 1.376, 2.430) times less likely to have treatment intensified, while those with diabetes had a 5.53 (95%CI; 2.030, 15.109) times lower chance. As a result, patients with diabetes achieved > 10% weight loss in only 8.0% of cases, compared to 31.1% among those without.
Conclusion
It seems practitioners lack confidence to intensify treatment in patients with comorbidities despite there being no contraindications in most cases, and weight loss outcomes being significantly better in those treated more aggressively.