Annals of Family Medicine: Papers examine diet and clinical strategies that could help alleviate obesity, hypertension and diabetes in the United States

ANN ARBOR, Mich., May 23, 2023 /PRNewswire/ -- Obesity is a complex health condition that may put a person at higher risk for hypertension, prediabetes and type 2 diabetes. Primary care serves as a common setting for addressing these chronic conditions. However, effective, evidence-based interventions for weight loss are not commonly delivered in the primary care context. New research in the May/June 2023 issue of the Annals of Family Medicine sheds light on how primary care providers can more effectively treat patients living with obesity.

The first of these studies compares two diets commonly used by physicians to support weight loss in patients -- MyPlate and the Diabetes Prevention Program Calorie Counting Diet. Findings suggest that the MyPlate diet, the federally-approved successor to the food pyramid, may lead to greater feelings of satiety, facilitating weight loss among patients.

Two hundred and sixty-one overweight, adult, low-income, mostly Latina patients participated in a 12-month trial, which measured satiation (feeling satisfied with a meal), satiety (feeling free of hunger) and body fat composition among primary care patients on either the MyPlate or Diabetes Prevention Program Calorie Counting Diet. Satiation and satiety scores increased for participants on both diets. Both MyPlate and Calorie Counting participants reported higher quality of life and emotional well-being, as well as decreased waist circumference and high satisfaction with their assigned weight loss program. MyPlate participants experienced lower systolic blood pressure at six months follow-up although this was not sustained over the 12-month trial period.

In another paper assessing diet-based interventions, researchers compared two diets recommended for overweight or obese adults with hypertension and prediabetes or type 2 diabetes: a very low carbohydrate (VLC) or ketogenic diet and the Dietary Approaches to Stop Hypertension (DASH) diet. Their research found that while both diets benefitted patients, those on the VLC diet experienced greater improvements in systolic blood pressure, glycemic control and weight over the four-month study period. Additionally, the researchers found that supplemental behavioral support activities—such as mindful eating, positive emotion regulation, social support and cooking education—did not have a statistically significant effect on patient outcomes.

Despite evidence showing the potential positive impact of these diet-based interventions for patients, an additional barrier remains: the practice of primary care providers themselves. In a third paper included in the same issue, researchers provide insights into how, or even if, primary care doctors provide weight-prioritized care. As part of a baseline study for a future weight management intervention, researchers describe the characteristics of patients and practice of providers during standard of care for weight management in a large, multi-clinic health system. Among patients who had received a weight prioritized visit over the last 12 months, they found that physician referral for weight-related concerns was low (<6%) and only 334 prescriptions for anti-obesity medications were ordered. Additionally, even though most patients were privately insured, referral to any weight-related service or prescription of anti-obesity medication was uncommon.

Lastly, an editorial by Denise Campbell-Scherer, MD, PhD, of the Department of Family Medicine at the University of Alberta, suggests that this gap in weight management and diabetes care in the primary care setting could be driven by a range of contextual factors or social determinants of health and recommends that future research take poverty, food insecurity and care access into consideration.

"As we conduct studies on strategies to advance care for people living with obesity and diabetes, seeking to understand the contextual factors affecting diverse people in vulnerable circumstances' access to food and care will inform interventions and implementation strategies to address the population level impacts of these chronic diseases," Campbell-Scherer writes.

Studies cited:

Randomized Comparative Effectiveness Trial of 2 Federally Recommended Strategies to Reduce Excess Body Fat in Overweight, Low-Income Patients: MyPlate.gov vs Calorie Counting. William J. McCarthy, Ph.D., et al, University of California-Los Angeles.

Comparing Very Low-Carbohydrate vs. DASH Diets for Overweight or Obese Adults With Hypertension and Prediabetes or Type 2 Diabetes: A Randomized Trial. Laura Saslow, PhD, et al, University of Michigan.  

Baseline Characteristics of PATHWEIGH: A Stepped-Wedge Cluster Randomized Study for Weight Management in Primary Care. Leigh Perreault, MD, et al, University of Colorado Anschutz Medical Campus.

New Insights and Future Directions: The Importance of Considering Poverty in Studies of Obesity and Diabetes. Denise Campbell-Scherer, MD, PhD, Family Medicine, University of Alberta.

Annals of Family Medicine is a peer-reviewed, indexed research journal that provides a cross-disciplinary forum for new, evidence-based information affecting the primary care disciplines. Launched in May 2003, Annals is sponsored by seven family medical organizations, including the American Academy of Family Physicians, the American Board of Family Medicine, the Society of Teachers of Family Medicine, the Association of Departments of Family Medicine, the Association of Family Medicine Residency Directors, the North American Primary Care Research Group, and The College of Family Physicians of Canada. Annals is published online six times each year and contains original research from the clinical, biomedical, social and health services areas, as well as contributions on methodology and theory, selected reviews, essays and editorials. Complete editorial content and interactive discussion groups for each published article can be accessed for free on the journal's website, www.AnnFamMed.org.

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SOURCE Annals of Family Medicine