Treating morbid obesity without surgery: Studies aim for primary care alternatives

Researchers are examining behavioral approaches for those with severe excess weight.

By Victoria Stagg Elliott, AMNews staff. April 3, 2006.

Todd M. Sheperd, MD, a family physician in Petoskey, Mich., has a couple of morbidly obese patients contemplating bariatric surgery and a couple more who have lost a significant amount of weight as a result of undergoing this procedure. But he'd love to have something else he could offer.

"We would all prefer to find something that worked better than surgery, with no surgical risks," he said.

More doctors are recognizing that more interventions are needed to treat the swelling ranks of people who have body mass indexes higher than 40. Until recently, though, research in this area -- and, therefore, treatment innovations -- was lacking.

To fill the gap, two targeted projects have been launched within the past year.

In March, the University at Buffalo School of Public Health and Health Professions kicked off a $5 million, five-year study that will randomize morbidly obese patients to various combinations of behavioral therapy, weight-loss medications and low-calorie diets. The groups will be compared with each other and with a group of bariatric surgery patients.

"Surgery is not a magic bullet for this problem by any means," said Michael F. Noe, MD, MPH, principal investigator and clinical professor of social and preventive medicine at the University at Buffalo. "It's essential that alternative nonsurgical approaches to help people who are severely overweight be evaluated."

Also, last July the Pennington Biomedical Research Center at Louisiana State University in Baton Rouge began the Louisiana Obese Subjects Study. It randomized several hundred patients to either usual primary care treatment or a more intensive intervention, which is also conducted in the primary care setting.