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This compared with 14% and 6%, respectively, of the control group. The researchers calculate that taking around 30 seconds of a primary-care consultation to discuss the intervention would cost approximately £1.45, while the 12-week program cost £50 (~$61) per patient. If the booking for the program was made by administrative staff, this would cost around £0.76 for the 2 minutes it takes to complete. With 40% of patients referred to the program actually attending, it means that each brief intervention during a primary-care consultation would cost the National Health Service approximately £22 (~$27), giving a cost per kg at 12 months of £16 (~$20). "This cost per kg is many times less than that of other available interventions for obesity, such as prescription of pharmacotherapy," the team says. Speaking to Medscape Medical News, Dr Aveyard noted that, currently, less than 10% of individuals in the United Kingdom with a BMI of ≥ 30 kg/m2 attend the kinds of programs used in the what weight loss programs does insurance cover study. And that is just a small fraction of the percentage they showed would take up such a program if offered to them, "so [the intervention] could have an enormous impact, in that it would greatly increase the take-up," he stressed. "Of course, what would need to increase commensurately is the availability of the program referrals, but that's an issue that can be solved." Fear of the F Word Deters GPs — Don't Diagnose, Just Offer Help Interestingly, Dr Aveyard believes that the fear of causing offense over mentioning weight and weight-loss programs may be partly to blame for the current low rates of take-up and that this has arisen because most of the models of how to interact with patients "start with the issue of diagnosis." He explained: "What people would tend to do is say to the person: 'Well, you're overweight or you're obese,' and the problem with the word 'obese' is it has a lay meaning that is very different from its technical meaning. "What we did was advise doctors not to do that sort of thing but to go straight in with an offer of help, and I think, as a result of that, it makes it much easier to intervene. It feels easier to me as a doctor when I…just say: 'Look, I've got this available,' rather than making some kind of qualitative statement about the overweight status of your patient." He added: "It also feels like the job of a doctor to provide help, and that's what we're doing here. So it just feels like an easier way in to the issue." Another notable aspect of the study was that even patients in the advice-only control arm benefited from the 30-second consultation. Not only did patients in the control arm lose weight, but also "the proportion of people who were doing something effective about their weight, such as attending a weight-loss program, was higher in the 3 months after the doctor's advice than in the 3 months prior to it," he stressed, with the caveat that the evidence is observational only. As a result, Dr Aveyard hopes the overriding message from this study for doctors is that they should feel that talking about weight and weight loss during their consultations is "a practical and effective way forward that need not take them long and will help some of their patients." The trial was funded by the National Prevention Research Initiative (NPRI) of the United Kingdom, administered by the Medical Research Council (MRC). The funding partners are Alzheimer's Research UK, Alzheimer's Society, Biotechnology and Biological Sciences Research Council, British Heart Foundation, Cancer Research UK, Chief Scientist Office, Scottish Government Health Directorate, Department of Health, Diabetes UK, Economic and Social Research Council, Engineering and Physical Sciences Research Council, Health and Social Care Research Division, Public Health Agency, Northern Ireland, MRC, Stroke Association, Wellcome Trust, Welsh Government, and World Cancer Research Fund.
For the original version including any supplementary images or video, visit http://www.medscape.com/viewarticle/870900
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