Article

Preventing Weight Gain by Lifestyle Intervention in a General Practice Setting Three-Year Results of a Randomized Controlled Trial

Department of General Practice, University Medical Center Groningen, the Netherlands.
Archives of internal medicine (Impact Factor: 17.33). 02/2011; 171(4):306-13. DOI: 10.1001/archinternmed.2011.22
Source: PubMed
ABSTRACT
Weight regain after initial loss of weight is common, which indicates a need for lifestyle counseling aimed at preventing weight gain instead of weight loss. This study was conducted to determine whether structured lifestyle counseling by nurse practitioners (NPs) group compared with usual care by general practitioners (GP-UC) in overweight and obese patients can prevent (further) weight gain.
A randomized controlled trial in 11 general practice locations in the Netherlands of 457 patients (body mass index, 25-40 [calculated as weight in kilograms divided by height in meters squared]; mean age, 56 years; 52% female) with either hypertension or dyslipidemia or both. The NP group received lifestyle counseling with guidance of the NP using a standardized software program. The GP-UC group received usual care from their GP. Main outcome measures were changes in body weight, waist circumference, blood pressure, and fasting glucose and blood lipid levels after 3 years.
In both groups, approximately 60% of the participants achieved weight maintenance after 3 years. There was no significant difference in mean (SD) weight change and change of waist circumference between the NP and GP-UC groups (weight change: NP group, -1.2% [5.8%], and GP-UC group, -0.6% [5.6%] [P = .37]; and change of waist circumference: NP group, -0.8 [7.1] cm, and GP-UC group, 0.4 [7.2] cm [P = .11]). A significant difference occurred for mean (SD) fasting glucose levels (NP group, -0.02 [0.49] mmol/L, and GP-UC group, 0.10 [0.53] mmol/L [P = .02]) (to convert to milligrams per deciliter, divide by 0.0555) but not for lipid levels and blood pressure.
Lifestyle counseling by NPs did not lead to significantly better prevention of weight gain compared with GPs. In the majority in both groups, lifestyle counseling succeeded in preventing (further) weight gain.
trialregister.nl Identifier: NTR1365.

Full-text

Available from: Jan Broer
1
Preventing weight gain by lifestyle intervention in general practice setting: 3-years 1
results of a randomized controlled trial 2
a
Nancy C.W. ter Bogt
1
, MSc 3
Wanda J.E. Bemelmans
2
, PhD 4
Frank W. Beltman
1
, MD, PhD 5
Jan Broer
3
, MD, PhD 6
Andries J.Smit
4
, MD, PhD 7
Klaas van der Meer
1
, MD, PhD 8
9
1 Department of General Practice, University Medical Center Groningen, P.O. Box 196, 9700 10
AD Groningen, The Netherlands 11
2 Centre for Prevention and Health Services Research, National Institute for Public Health 12
and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands 13
3 Municipal Public Health Service Groningen, P.O. Box 584, 9700 AN Groningen, The 14
Netherlands 15
4 Department of Internal Medicine, University Medical Center Groningen, P.O. Box 30.001, 16
9700 RB
Groningen, The Netherlands 17
18
Correspondence and requests for reprint: 19
Ms. N.C.W. ter Bogt 20
University Medical Center Groningen, 21
Sector F: Department of General Practice 22
A. Deusinglaan 1 23
9713 AV Groningen, The Netherlands 24
Tel: 0031503632966 / Fax: 0031503632964 25
n.c.w.ter.bogt@med.umcg.nl
26
27
Total word count text: 3,273 28
29
a
Financial Disclosures: All authors declare no conflict of interest
Page 1
2
ABSTRACT 30
Context 31
Weight regain after initial loss of weight is common, which pleads for lifestyle counseling 32
aimed at preventing weight gain instead of weight loss. 33
34
Objective 35
To determine whether structured lifestyle counseling by nurse practitioners (NP) compared to 36
care as usual by general practitioners (GP-UC) in overweight and obese patients can prevent 37
weight gain. 38
39
Design, Setting, and Participants 40
A randomized controlled trial in 11 general practice locations in the Netherlands of 457 41
patients (body mass index 25 to 40 kg/m
2
; mean age 56 years; 52% female) with either 42
hypertension or dyslipidemia, or both who were followed up for 3 years. The study was 43
performed between June 2005 and July 2009. 44
45
Intervention 46
The NP group received lifestyle counseling with guidance of the NP using a standardized 47
software program. In the first year four individual visits and one feedback session by 48
telephone were scheduled, and in the second and third year one individual visit and two 49
feedback sessions by telephone per year. The GP-UC group received usual care from their 50
general practitioner (GP). 51
52
Main outcome measures 53
Page 2
3
Changes in body weight, waist circumference, blood pressure, fasting glucose and blood 54
lipids after 3 years. 55
56
Results 57
In both groups about 60% of the participants achieved weight maintenance after 3 years. 58
There was no significant difference in weight change and change of waist circumference 59
between NP and GP-UC group (respectively, NP: -1.2% (SD: 5.8), GP-UC: -0.6% (SD: 5.6); 60
P=0.37 and NP: -0.8 cm (SD: 7.1), GP-UC: 0.4 cm (SD: 7.2); P=0.11). A significant 61
difference occurred for fasting glucose (NP: -0.02 mmol/L (SD: 0.49), GP-UC: 0.10 mmol/L 62
(SD: 0.53); P=0.02) but not for lipids and blood pressure. 63
64
Conclusion 65
Lifestyle counseling by NP did not lead to significantly better prevention of weight gain 66
compared to GP. The majority in both groups succeeded in preventing (further) weight gain. 67
68
Trial Registration: 69
The study was registered with the Netherlands Trial Register (NTR), www.trialregister.nl
, 70
study no. TC 1365. 71
72
73
74
75
76
77
78
Page 3
4
INTRODUCTION 79
Raising prevalence of overweight and obesity is a worldwide problem. An increased 80
body mass index (BMI) is associated with higher mortality
1
, the development of coronary 81
vascular disease (partly independent of blood pressure and cholesterol levels
2
), type 2 82
diabetes mellitus, certain types of cancer, gastrointestinal diseases and arthritis
3
. The large 83
impact of these diseases on shortening healthy lifespan and health care costs stress the need 84
for strategies to tackle this problem. 85
Studies show that lifestyle interventions (including a nutrition and physical activity 86
component) are needed to maintain or lose weight
4
. Intensive lifestyle programs such as DPP 87
(Diabetes Prevention Program) and DPS (Diabetes Prevention Study) showed weight losses of 88
respectively about 4 and 3 kg after 3 years, accompanied by improvements in cardiovascular 89
risk factor levels
5, 6
. Because weight regain after weight loss in obese persons is a common 90
problem, a more successful approach may be to prevent weight gain and focus on weight 91
management in those with milder degrees of overweight. Small changes in lifestyle can 92
improve health status even without losing weight
7, 8
and might be easier to maintain in the 93
long term. 94
The primary care setting is suitable for weight maintenance; previous studies have 95
shown that lifestyle interventions in primary care can be effective at least in the short-term
9-11
. 96
However, little is known on long-term (over several years) effects in this setting. Guidelines 97
in the treatment of hypertension and dyslipidemia (often accompanied by overweight and 98
obesity) for GPs include lifestyle advice
12
but in practice compliance to the lifestyle 99
component of these guidelines seems limited.
13
. Frequently reported barriers for lifestyle 100
counseling by GPs include lack of time; lack of patient compliance; insufficient knowledge 101
about the subject, and lack of evidence-based interventions
14
. A solution to some of these 102
barriers may be to delegate lifestyle counseling to nurse practitioners (NP). 103
Page 4
5
The Groningen Overweight And Lifestyle (GOAL)-study was conducted to compare 104
the effects of structured lifestyle counseling by NP to care as usual by general practitioners 105
(GP-UC) on preventing weight gain and improving health status in overweight and obese 106
patients with either hypertension, dyslipidemia or both. 107
Short-term, 1-year, results of the GOAL-study showed that in men mean weight losses 108
were 2.3% in the NP group and 0.1% in the GP-UC group (p<0.05), while no significant 109
reductions were found in blood lipids, fasting glucose and blood pressure. In women weight 110
change in both groups was -1.6%. In the NP group were more weight losers and stabilizers 111
than in the GP-UC group (77% vs. 65% (p<0.05)
15
. 112
The current manuscript reports the long-term (3 years) results of lifestyle counseling 113
by nurse practitioners (NP) compared to care as usual by general practitioners (GP-UC) in 114
overweight and obese patients at relatively ‘low risk’ for cardiovascular disease in preventing 115
weight gain and improve health status. As secondary questions it was investigated if above 116
mentioned 1-year results were sustained after 3 years and if weight change differed within and 117
between subgroups. 118
119
120
121
Page 5
6
METHODS 122
123
Subjects 124
Participants were recruited (between June 2005 and February 2006) at 11 general practice 125
locations in the northern part of the Netherlands. As elsewhere described in detail, after 126
screening and selection, 457 participants (aged 40-70 years) were enrolled within the setting 127
of the general practices
15
. Eligible participants had a BMI between 25 and 40 kg/m
2
and 128
either hypertension and/or dyslipidemia. Hypertension was defined as mean systolic blood 129
pressure 140 mmHg and/or diastolic 90 mmHg (based on two measurements on at least 130
two different visits) or current use of blood pressure-lowering medication, and dyslipidemia 131
was defined as a total serum cholesterol > 5.5 mmol/L or low HDL (male: < 0.9; female: < 1.1 132
mmol/L) or ratio total/HDL cholesterol > 6 and/or current use of cholesterol lowering 133
medication. Exclusion criteria were diabetes mellitus, hypothyroidism, pregnancy, liver- or 134
kidney disease, current treatment for malignancy, severely shortened life expectancy, mental 135
illness and addiction to alcohol or drugs. The GOAL-study was approved by the Medical 136
Ethics Review Committee (METc) of the University Medical Center Groningen and written 137
informed consent was given by all participants. 138
139
Measurements 140
At the GP locations a trained research team (not blinded for study group) performed a 141
structured medical exam which included measurements of body weight, length, waist 142
circumference and blood pressure. Body weight was measured on a digital scale with subjects 143
wearing light clothing and no shoes, height was measured using a wall-mounted measuring 144
tape, and waist circumference was measured at the level midway between the lowest rib and 145
the iliacal crest. Blood pressure was measured twice and average values were used in analysis. 146
Page 6
7
The presence of cardiovascular risk factors, medication use and family history of disease and 147
overweight/obesity were documented. Blood samples were collected in general practice 148
setting after an overnight fast to analyze fasting serum lipids and glucose (in the same central 149
laboratory, LabNoord in Groningen, using conventional and certified laboratory assays). 150
Several questionnaires were completed via the internet (as part of the software program for 151
the lifestyle intervention) or on paper (in case of no internet). They contained questions on 152
general characteristics (e.g. education level, gender) and on several issues related to body 153
weight (e.g. history of dieting). The SQUASH-questionnaire was used to determine physical 154
activity
16
. Metabolic syndrome was defined according to criteria from the National 155
Cholesterol Education Program’s Adult Treatment Panel III
17
and SCORE scores to estimate 156
ten-year risk of fatal cardiovascular disease were calculated as described by Conroy et al
18
. 157
Baseline data were available for all participants, with the following exceptions: waist 158
circumference (n=2), blood analyses (n=11), complete questionnaires (n=11) and items in 159
questionnaire (range missing items: 5-11%). These missing baseline values are distributed 160
equally among NP and GP-UC group. The measurements were performed at baseline 161
(between January and July 2006), after 1 and 3 years. 162
163
Intervention 164
Patients were allocated by computer generated random numbers to the “nurse 165
practitioner” (NP) (n = 225) or “GP care as usual” (GP-UC) group (n = 232). The lifestyle 166
intervention consisted of four individual visits and one feedback session by telephone in the 167
first year, in the next two years one individual visit and two feedback sessions were planned 168
each year. During these contact sessions the NP is guided by the standardized computerized 169
software program (exclusive use for the NP group was guaranteed) which contains 170
instructions on lifestyle counseling according to (inter)national guidelines
19, 20
and allows 171
Page 7
8
data entry of the measurements. The NPs followed a specially developed training program (5 172
sessions of 4 hours each; 4 sessions before the intervention and 1 session after 1 year) and 173
received an individual instruction about the software program before the start of the study. 174
The program consisted of several elements of behavioral counseling such as individual goal-175
setting, monitoring using food diaries and pedometers, and addressing barriers for lifestyle 176
change. 177
Primary aim of the intervention was to prevent weight gain and if patients were 178
motivated, to lose 5-10% weight. The intervention was elsewhere described in detail
15
. 179
The control group visited the GP after each measurement to discuss the results, and 180
thereafter they received usual care according to GP guidelines
12
. 181
182
Sample-size calculation 183
The sample-size calculation was elsewhere described in detail
15
, based on previous 184
investigations a difference in weight loss of 2.8 kg after 1 year could be expected, resulting in 185
the aim to include at least 145 participants in each study arm. The follow up period in the next 186
two years was meant to investigate the percentage weight maintenance. 187
188
Statistical analyses 189
Differences in baseline characteristics and changes in main outcome measures after 1 190
and 3 years between the two study groups were evaluated with unpaired Student’s t-tests for 191
continuous and Chi-Square for categorical variables. General Linear Model (GLM) was 192
performed to adjust for baseline values in continuous variables. For lipids and blood pressure 193
adjustments were made for changes in respectively cholesterol- and blood pressure-lowering 194
medications. Logistic regression, with adjustments for baseline fasting glucose, was used to 195
Page 8
9
examine the relation between study group and the prevalence of impaired fasting glucose 196
(which is defined as fasting glucose > 6,0 mmol/L). 197
Further, GLM was used to examine the percentage weight loss after 1 and 3 years in 198
subgroups of patients. Study group, gender and each subgroup separately were entered in the 199
model as fixed variables and age, baseline BMI and weight change between screening and 200
baseline as covariates. We also used GLM to investigate interaction between gender and study 201
group. 202
Regainers were defined as subjects who lost 5% body weight after 1 year and 203
returned to baseline body weight after 3 years ( 0%). Subjects were categorized into the 204
following classes according to percentage of weight change after 1 and 3 years: successful 205
weight losers (lost 5% or more), weight losers (weight loss from 1 to 5%), stabilizers 206
(between more than 1% weight loss and 1% weight gain) and weight gainers (gain more than 207
1%). Differences in main outcome variables between these categories were tested with 208
ANOVA and post hoc Bonferroni test. 209
Results are presented with exclusion of drop-outs and missing values, and adjusted for 210
baseline values. Thereafter all analyses were also performed following the intention-to-treat 211
principle by BOCF (baseline observation carried forward) for drop-outs. Usually BOCF 212
means that there is no weight change so in our study this would mean that drop outs were 213
characterized as successful because they did not gain 1% of their body weight. But this 214
might be an overestimation of the percentages of the participants who achieved weight 215
maintenance. Therefore we also performed analyses where all drop outs were considered as 216
not successful which is probably an underestimation of the success rate. Percentages of 217
participants who achieved weight maintenance are presented as a range of both methods. 218
All analyses were performed in 2009 using SPSS/PC statistical program version 16.0 219
for Windows. P<.05 was considered statistically significant. 220
221
Page 9
10
RESULTS 222
The percentage drop out was 24% for the NP and 20% for the GP-UC group (n.s.) 223
after 3 years (Figure 1). Participants who dropped out had a higher diastolic blood pressure 224
(89 vs. 86 mmHg; P=0.003) and had more often a BMI 30 kg/m
2
(reasons of drop out did 225
not significantly differ between participants with a BMI above or under 30 kg/m
2
); in other 226
characteristics there were no differences between drop outs and the participants who attended 227
the follow-up measurement after 3 years. Table 1 shows baseline characteristics for both 228
groups. Participants in the GP-UC group had more often done > 3 recent dieting attempts than 229
in the NP-group and fulfilled more frequently the norm on physical activity (P<0.05 for both). 230
231
Changes in main outcome measures after 3 years 232
After 3 years no differences in weight change were present between the NP and the 233
GP-UC group (NP: -1.2 (SD: 5.8) %, GP-UC: -0.6 (SD: 5.6) %; P=0.37). About 60% of the 234
participants in both groups were weight losers/stabilizers after 3 years (table 2). 235
In the NP group a positive effect was found on fasting glucose at 3 years follow up 236
compared to the GP-UC group (-0.02 (SD: 0.49) mmol/L vs. 0.10 (SD: 0.53) mmol/L; 237
P=0.02). After 3 years the prevalence of impaired fasting glucose was 6% (n=10) in the NP 238
group versus 12% (n=21) in the GP-UC group (P=0.17)) (table 2). In persons with a BMI 239
30 kg/m
2
the prevalence was lower in the NP than in the GP-UC group, respectively 7% (n=4) 240
vs. 22% (n=14) but not significant after adjustment for baseline values (P=0.14) (data not 241
shown). 242
No significant differences between the NP and GP-UC group occurred for serum lipids 243
and blood pressure at 3 years follow up (table 2). 244
245
Page 10
11
Results of changes in main outcome measures after 3 years compared to the results after 1 246
year 247
Contrary to the results after 3 years, the percentage of weight loss after 1 year differed 248
between the NP and GP-UC group (NP: -2.2 (SD: 7.0), GP-UC: -0.7 (SD: 4.6); P=0.002) and 249
there were more weight losers/stabilizers after 1 year in the NP group than in the GP-UC 250
group (80% vs. 64%; P=0.001) (table 3). The percentage of regainers in the NP group was 251
comparable to the GP-UC group, respectively 14% and 16% (table 2). 252
253
Weight loss after 3 years between and within subgroups 254
There were no differences in weight change after 3 years between the NP and GP-UC 255
group in subgroups of patients’ characteristics at baseline (table 3). Interaction between 256
gender and study group was absent. Within the NP group, participants with 3 attempts to 257
lose weight during the last 5 years lost more weight after 3 years than participants with 4 or 258
more attempts (P<0.05). These participants gained +1.4% (CI: -0.9 to 3.7) of their baseline 259
weight after 3 years. 260
261
Changes in main outcome variables after 3 years stratified for weight loss categories 262
Successful weight losers achieved the most favorable results and weight gainers the 263
least favorable results after 3 years on physiological outcome variables except for systolic 264
blood pressure (table 4). After 3 years stabilizers/weight gainers (n=192) did achieve 265
significantly better results on fasting glucose (+0.10 (SD: 0.50) mmol/L) than regainers 266
(+0.57 (SD: 0.60) mmol/L) (P=0.008) but not on lipids and blood pressure (data not shown). 267
268
Results of intention-to-treat analysis 269
Page 11
12
Intention-to-treat analysis did not alter the results after 3 years substantially. For 270
example, weight loss after 3 years in the NP group was -0.8 (SD: 5.0) % and -0.5 (SD: 5.0) % 271
in the GP-UC group (P=0.45). LDL-cholesterol change did not differ between the NP en the 272
GP-UC group (NP +0.15 (SD: 0.71) mmol/L, GP-UC +0.04 (SD: 0.77) mmol/L; P=0.11). 273
Change in fasting glucose after 3 years differed significantly between the NP and the GP-UC 274
group (respectively -0.01 (SD: 0.43) mmol/ L vs. +0.08 (SD: 0.47) mmol/L; P=0.03). The 275
percentages of participants who achieved weight maintenance varied from 47% to 71% in the 276
NP group and from 51% to 71% in the GP-UC group (depending on whether dropouts are 277
supposed to be successful or not). 278
279
280
281
282
Page 12
13
DISCUSSION 283
The design of our study was different from several other published weight intervention 284
studies because we focused on weight maintenance in persons with a relatively low mean 285
BMI (almost 30 kg/m
2
), and because we had a considerably longer follow up than in most 286
other studies, within a ‘realistic’ primary care setting. The relevance of prolonged follow-up is 287
reflected by the differences between the 1-year and the somewhat disappointing 3-years 288
results on weight maintenance. After 1 year, 80% of the participants in the NP group indeed 289
achieved weight maintenance versus 64% in the GP-UC group. However, after 3 years 290
differences between both groups had disappeared: with 60% success in weight maintenance of 291
the participants in both groups. Changes in fasting glucose differed in favor of the NP group, 292
especially among obese persons the prevalence of impaired fasting glucose differed 293
considerably after 3 years (7% vs. 22%), but –due to lack of power in this subgroup analysis– 294
this result was not significant when adjusted for baseline values (P=0.14). 295
In comparison with other studies with prolonged follow-up, Jeffery et al described a 296
weight gain of about 1.5 kg after 3 years for treatment and control groups, but they used a low 297
intensity intervention mostly per mail
21
. Another RCT with a longer follow-up of 54 months 298
was reported by Simkin-Silverman, but this was done in postmenopausal women, with normal 299
weight and CV risk and showed that weight maintenance is possible with a lifestyle 300
intervention
22
. It is notable that we found a small difference in fasting glucose while in DPS 301
differences between intervention and control group were absent for fasting glucose although 302
significant differences in weight change did occur
6
. Other studies have shown that changes in 303
lifestyle without losing weight can improve health status
7, 8
. 304
Most of the participants in both groups achieved weight maintenance. Several factors 305
may be responsible for the long-term lack of difference that we expected between the NP and 306
the GP group. Patients in the GP-UC group may be more adherent to advices given by the GP 307
Page 13
14
due to the study circumstances. In line with the ethical committee demands all patients were 308
fully informed about the study purpose and hence they knew beforehand that body weight was 309
assessed as well as adherence to lifestyle advices. This in itself may, through some kind of 310
Hawthorne effect, lead to modified behavior so that all patients were more adherent than they 311
might have been under other circumstances and this may have diluted any differences between 312
the groups. Moreover, both groups are also by definition as volunteers for this trial a selection 313
of motivated patients. 314
The attention on health (and body weight) during the measurements in combination 315
with abundant countrywide campaigns for a healthy lifestyle held during the course of the 316
study may besides the visits to the GP also have been responsible for lifestyle changes in the 317
control group. In comparison to the Dutch population where an average increase in BMI of 318
0.05 kg/m
2
per year (between 1981 and 2004) was described by Gast et al
23
we found a 319
decrease of -0.4 kg/m
2
in the NP and -0.2 kg/m
2
in the GP-UC group. Thus we can consider 320
that the majority in the NP and GP-UC group succeeded in preventing (further) weight gain. 321
Besides the limitations like baseline differences between NP en GP group and 322
randomization at patient level in stead of at practice level, as elsewhere described in detail
15
323
another limitation of the GOAL study needs to be discussed. The visits to the NP after the first 324
year were with a low frequency and may not be sufficient to sustained weight loss. In the DPS 325
four face-to-face visits each year were scheduled after the first year to achieve sustained 326
weight loss after 3 years
6
. Bogers et al also described that higher intervention costs 327
(indicative for the intensity of an intervention) are associated with higher weight loss
24
, 328
although this association for weight loss is after 1 year it’s plausible that this will also count 329
for long term weight loss. 330
In intention-to-treat analysis regarding weight change we chose a conservative way to 331
deal with the drop outs by carrying the baseline observation forward. This means that we 332
Page 14
15
assumed that drop outs during the intervention lost no weight or regain all the weight that 333
might be lost in the first year of the intervention and hereby possibly underestimate the weight 334
loss of the drop outs in both groups. 335
Strengths of our study are the large study population with an equal amount of male and 336
female participants, a relatively low drop out after 3 years, the prolonged follow-up and the 337
use of an intervention which is quite feasible in a primary care setting. The software program 338
can easily be used at other locations and the intervention is not time-intensive and expensive. 339
More research is planned to evaluate the process of the GOAL intervention, which is useful 340
for further implementation. 341
Analyses in subgroups showed that within the NP group participants with 3 recent 342
attempts to lose weight had a lower weight after 3 years compared to participants with more 343
than 3 attempts. The latter participants’ average weight gain was +1.4% (-0.9 to 3.7). This 344
means that our intervention is not suitable for experienced dieters. 345
Regainers achieved unfavorable results on fasting glucose compared to 346
stabilizers/weight gainers which is in line with other negative health effects of weight cycling 347
that were described
25-27
. No clear results have been reported on the relation between repeated 348
weight losses and mortality and the underlying mechanisms
28-31
. 349
We can conclude that preventing (further) weight gain by NP did not lead to 350
significantly better results than by GP. More follow up sessions in the NP group may lead to a 351
higher percentage maintenance of the lost weight after 1 year. 352
353
Page 15
16
References 354
355
1. Prospective Studies C. Body-mass index and cause-specific mortality in 900 000 356
adults: collaborative analyses of 57 prospective studies. The Lancet. 357
2009;373(9669):1083-1096. 358
2. Bogers RP, Bemelmans WJ, Hoogenveen RT, et al. Association of overweight with 359
increased risk of coronary heart disease partly independent of blood pressure and 360
cholesterol levels: a meta-analysis of 21 cohort studies including more than 300 000 361
persons. Arch Intern Med. Sep 10 2007;167(16):1720-1728. 362
3. Branca F, Nikogosian H, Lobstein T. The challenge of obesity in the WHO European 363
Region and the strategies for response: WHO Regional Office for Europe; 2007. 364
4. Wu T, Gao X, Chen M, van Dam RM. Long-term effectiveness of diet-plus-exercise 365
interventions vs. diet-only interventions for weight loss: a meta-analysis. Obes Rev. 366
May 2009;10(3):313-323. 367
5. Diabetes Prevention Program Research Group. Reduction in the Incidence of Type 2 368
Diabetes with Lifestyle Intervention or Metformin. N Engl J Med. February 7, 2002 369
2002;346(6):393-403. 370
6. Lindström J, Louheranta A, Mannelin M, et al. The Finnish Diabetes Prevention Study 371
(DPS). Diabetes Care. December 2003 2003;26(12):3230-3236. 372
7. Laaksonen DE, Lindstrom J, Lakka TA, et al. Physical activity in the prevention of 373
type 2 diabetes: the Finnish diabetes prevention study. Diabetes. Jan 2005;54(1):158-374
165. 375
8. Powell KE, Pratt M. Physical activity and health. BMJ. July 20, 1996 376
1996;313(7050):126-127. 377
Page 16
17
9. Martin PD, Rhode PC, Dutton GR, Redmann SM, Ryan DH, Brantley PJ. A primary 378
care weight management intervention for low-income African-American women. 379
Obesity. Aug 2006;14(8):1412-1420. 380
10. Nanchahal K, Townsend J, Letley L, Haslam D, Wellings K, Haines A. Weight-381
management interventions in primary care: a pilot randomised controlled trial. Br J 382
Gen Pract. May 2009;59(562):e157-166. 383
11. Team CP. Evaluation of the Counterweight Programme for obesity management in 384
primary care: a starting point for continuous improvement. Br J Gen Pract. Aug 385
2008;58(553):548-554. 386
12. CBO (Dutch Institute for Healthcare Improvement). Dutch Guideline Cardiovascular 387
Risk Management. 2006. 388
13. Milder IEJ, Blokstra A, de Groot J, van Dulmen S, Bemelmans WJE. Lifestyle 389
counseling in hypertension-related visits--analysis of video-taped general practice 390
visits. BMC Fam Pract. 2008;9:58. 391
14. Hiddink GJ, Hautvast JG, Van Woerkum CM, Fieren CJ, van 't Hof MA. Driving 392
forces for and barriers to nutrition guidance practices of Dutch primary care physicians. 393
Journal of Nutrition Education. 1997;29:1163-1169. 394
15. ter Bogt NC, Bemelmans WJ, Beltman FW, Broer J, Smit AJ, van der Meer K. 395
Preventing weight gain: one-year results of a randomized lifestyle intervention. Am J 396
Prev Med. Oct 2009;37(4):270-277. 397
16. Wendel-Vos GC, Schuit AJ, Saris WH, Kromhout D. Reproducibility and relative 398
validity of the short questionnaire to assess health-enhancing physical activity. J Clin 399
Epidemiol. Dec 2003;56(12):1163-1169. 400
17. Executive Summary of The Third Report of The National Cholesterol Education 401
Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High 402
Page 17
18
Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. May 16 403
2001;285(19):2486-2497. 404
18. Conroy RM, Pyorala K, Fitzgerald AP, et al. Estimation of ten-year risk of fatal 405
cardiovascular disease in Europe: the SCORE project. Eur Heart J. Jun 406
2003;24(11):987-1003. 407
19. NIH. The practical guide: identification, evaluation and treatment of overweight and 408
obesity in adults. 2000;Number 00-4084. 409
20. Zelissen PM, Mathus-Vliegen EM. [Treatment of overweight and obesity in adults: 410
proposal for a guideline]. Ned Tijdschr Geneeskd. Oct 16 2004;148(42):2060-2066. 411
21. Jeffery RW, French SA. Preventing weight gain in adults: the pound of prevention 412
study. Am J Public Health. May 1, 1999 1999;89(5):747-751. 413
22. Simkin-Silverman LR, Wing RR, Boraz MA, Kuller LH. Lifestyle Intervention Can 414
Prevent Weight Gain During Menopause: Results From a 5-Year Randomized Clinical 415
Trial. Annals of Behavioral Medicine. 2003;26(3):212-220 416
23. Gast GCM, Frenken FJM, van Leest LATM, Wendel-Vos GCW, Bemelmans WJE. 417
Intra-national variation in trends in overweight and leisure time physical activities in 418
The Netherlands since 1980: stratification according to sex, age and urbanisation 419
degree. Int J Obes. 2006;31(3):515-520. 420
24. Bogers R, Barte J, Schipper C, et al. Relationship between costs of lifestyle 421
interventions and weight loss in overweight adults. Obesity Reviews. .Early view July 422
2009. 423
25. Hamm P, Shekelle RB, Stamler J. Large fluctuations in body weight during young 424
adulthood and twenty-five-year risk of coronary death in men. Am J Epidemiol. Feb 425
1989;129(2):312-318. 426
Page 18
19
26. Lissner L, Odell PM, D'Agostino RB, et al. Variability of body weight and health 427
outcomes in the Framingham population. N Engl J Med. Jun 27 1991;324(26):1839-428
1844. 429
27. Olson MB, Kelsey SF, Bittner V, et al. Weight cycling and high-density lipoprotein 430
cholesterol in women: evidence of an adverse effect : A report from the NHLBI-431
sponsored WISE study. Journal of the American College of Cardiology. 432
2000;36(5):1565-1571. 433
28. Brownell KD, Rodin J. Medical, metabolic, and psychological effects of weight 434
cycling. Arch Intern Med. Jun 27 1994;154(12):1325-1330. 435
29. Field AE, Malspeis S, Willett WC. Weight cycling and mortality among middle-aged 436
or older women. Arch Intern Med. May 11 2009;169(9):881-886. 437
30. Jeffery RW. Does weight cycling present a health risk? Am J Clin Nutr. Mar 438
1996;63(3 Suppl):452S-455S. 439
31. Rzehak P, Meisinger C, Woelke G, Brasche S, Strube G, Heinrich J. Weight change, 440
weight cycling and mortality in the ERFORT Male Cohort Study. Eur J Epidemiol. 441
2007;22(10):665-673. 442
443
Page 19
20
Author contributions 444
Van der Meer had full access to all of the data in the study and takes responsibility for the 445
integrity of the data and the accuracy of the data analysis. 446
Study concept and design: Bemelmans, Beltman, Broer, Smit, van der Meer 447
Acquisition of data: ter Bogt 448
Analysis and interpretation of data: ter Bogt, Bemelmans 449
Drafting of the manuscript: ter Bogt, Bemelmans, Smit 450
Critical revision of the manuscript for important intellectual content: Bemelmans, Beltman, 451
Broer, Smit, van der Meer 452
Statistical analysis: ter Bogt, Bemelmans 453
Obtaining funding: Bemelmans, Beltman, Broer, Smit 454
Administrative, technical or material support: ter Bogt, Beltman, Broer, Smit 455
Supervision: Bemelmans, Beltman, van der Meer 456
457
Financial Disclosures 458
All authors declare no conflict of interest. 459
460
Funding/support 461
The GOAL-study was financially supported by the Netherlands Organization for 462
Health Research and Development (Zon-Mw, project no 6200.0016) and Foundation Fund 463
“De Gavere”. The funders had no role in design and conduct of the study; collection, 464
management, analyses, and interpretation of the data; and preparation, review or approval of 465
the manuscript. 466
467
468
Page 20
21
Acknowledgements 469
We are grateful to the participating general practices and their patients for their 470
enthusiasm and co-operation. Thanks to all the students of the research team for performing 471
measurements and data collection. We also thank the members of the Hypertension Service 472
Groningen for generating the GOAL-study. Neither received compensation. 473
474
475
476
Page 21
22
Tables and figures 477
Figure 1 Flow of patients through the GOAL-study 478
479
480
481
a
for example not showing up at follow up measurements during the screening, without providing a reason or not willing to participate in 482
further measurements like blood analyses 483
484
NP: nurse practitioner 485
GP: general practitioner 486
GP-UC: general practitioner usual care 487
488
Page 22
23
Table 1. Baseline characteristics for nurse practitioner (NP) group and usual care from 489
general practitioner (GP-UC) group 490
Characteristic NP group
(n=225)
GP-UC group
(n=232)
General
Age, mean (SD), y 55.3 (7.7) 56.9 (7.8)
Men, Number (%) 113 (50.2) 107 (46.1)
Low education
a
, Number (%) 71/212 (33.5) 67/217 (30.9)
Relationship
b
, Number (%) 177/213 (83.1) 188/226 (85.5)
Physical exam and blood analysis
Body weight, mean (SD), kg 88.2 (12.1) 87.8 (14.0)
Body Mass Index, mean (SD), kg/m
2
29.5 (3.1) 29.6 (3.6)
BMI 30 kg/m
2
, Number (%) 79 (35.1) 85 (36.6)
Waist circumference for men, mean (SD), cm 104 (7.8) 105 (9.5)
Waist circumference for women, mean (SD), cm 97 (9.8) 97 (11.8)
Total cholesterol, mean (SD), mmol/L 5.66 (1.0) 5.56 (1.0)
HDL-cholesterol, mean (SD), mmol/L 1.44 (0.4) 1.43 (0.4)
LDL-cholesterol, mean (SD), mmol/L 3.50 (0.9) 3.43 (0.9)
Fasting glucose, mean (SD), mmol/L 5.20 (0.5) 5.25 (0.7)
Impaired fasting glucose
c
, Number (%) 14/219 (6) 20/226 (9)
Systolic blood pressure, mean (SD), mmHg 146 (18.5) 145 (15.5)
Diastolic blood pressure, mean (SD), mmHg 87 (9.6) 86 (8.2)
Hypertension, Number (%) 137 (60.9) 145 (62.5)
Using medication for hypertension, Number (%
d
) 61/136 (44.9) 74/144 (51.4)
Dyslipidemia, Number (%) 83 (36.9) 96 (41.4)
Using medication for dyslipidemia, Number (%
e
) 31/83 (37.3) 43/96 (44.8)
SCORE score, mean (SD) 3.55 (4.0) 3.29 (3.0)
SCORE score < 5, Number (%) 175/219 (79.9) 182/226 (80.5)
Metabolic syndrome, Number (%) 98/224 (43.8) 102/232 (44.0)
Lifestyle
Current smokers, Number (%) 46/224 (20.5) 42/232 (18.1)
More than 3 attempts to lose weight during last 5 years, Number
(%)
33/207 (15.9) 55/213 (25.8
f
)
30 minutes of moderate-intensity physical activity on 5 days /
week, Number (%)
123/216 (56.9)
150/220 (68.2
f
)
a
% of participants with a lower professional education or less 491
b
% of participants who were married or living together with a partner 492
c
Fasting glucose > 6 mmol/L
493
d
% of participants with hypertension 494
e
% of participants with dyslipidemia 495
f
Chi-Square NP vs. GP-UC group P<.05 496
497
498
499
500
Page 23
24
Table 2. Changes
a
in main outcome measures at 1- and 3-year follow-up in NP and GP-UC group 501
1-year follow up 3-year follow up
n NP
group
n GP-UC
group
P
n NP
group
n GP-UC
group
P
Body weight, mean (SD), kg 171 -2.0 (4.3) 186 -0.6 (4.0)
.002
171 -1.1 (5.3) 186 -0.5 (5.0) .338
Body weight, mean (SD), % change 171 -2.2 (4.6) 186 -0.7 (4.6)
.002
171 -1.2 (5.8) 186 -0.6 (5.6) .370
Body Mass Index, mean (SD), kg/m
2
171 -0.7 (1.4) 186 -0.2 (1.4)
.002
171 -0.4 (1.8) 186 -0.2 (1.7) .314
Waist circumference, mean (SD), cm 169 -2.6 (7.0) 186 -1.1 (5.8)
.028
169 -0.8 (7.1) 182 0.4 (7.2) .112
Total cholesterol, mean (SD), mmol/L 164 -0.10 (0.75) 181 -0.06 (0.71) .498 164 0.07 (0.92) 178 -0.05 (0.93) .147
HDL-cholesterol, mean (SD), mmol/L 164 -0.08 (0.22) 181 -0.09 (0.22) .613 164 -0.17 (0.26) 178 -0.17 (0.25) .752
LDL-cholesterol, mean (SD), mmol/L 162 0.04 (0.68) 179 0.05 (0.65) .630 160 0.20 (0.81) 176 0.05 (0.86) .086
Fasting glucose, mean (SD), mmol/L 163 -0.08 (0.48) 181 -0.06 (0.45) .457 162 -0.02 (0.49) 176 0.10 (0.53) .017
b
Impaired fasting glucose
c
, Number (%) 163 8 (5) 181 13 (7) .704 162 10 (6) 176 21 (12) .170
Systolic blood pressure, mean (SD), mmHg 171 -7.0 (18.6) 186 -3.3 (15.3)
.026
171 -5.9 (17.3) 186 -3.8 (14.5) .379
Diastolic blood pressure, mean (SD), mmHg 171 -1.5 (10.2) 186 -0.3 (8.1) .202 171 -2.0 (10.8) 186 -1.1 (9.3) .405
Weight losers/stabilizers
d
, Number (%) 171 136 (80) 186 119 (64)
.001
171 106 (62) 186 118 (63) .777
Regainers
e
, Number (%)
37
f
5 (14) 31
f
5 (16) .762
a
Changes are calculated as the value at 1- or 3-year follow-up minus the value at baseline, and adjusted for baseline values (for lipids and blood pressure for changes in respectively cholesterol- and blood pressure-502
lowering medications). 503
b
Adjustments for differences between the NP and the GP-UC group on baseline characteristics (physical activity and number of recent attempts to lose weight) did not alter this result 504
c
Fasting glucose > 6 mmol/L, P values: logistic regression adjusted for baseline values 505
d
Percentage of subjects who gained less than 1% body weight between baseline and 1- or 3-year measurement 506
e
Percentage of subjects who lost 5% body weight after 1 year and returned to baseline body weight after 3 years ( 0%) 507
f
Number of subjects who lost 5% body weight after 1 year 508
NP: nurse practitioner, GP-UC: general practitioner usual care 509
510
511
Page 24
25
Table 3. Percentage change in body weight at 1- and 3-year follow-up stratified in subgroups of patients’ characteristics for both study groups 512
n
NP group
% change in body weight (95% CI)
a
GP-UC group
% change in body weight (95% CI)
a
1-year follow up 3-year follow up
n
1-year follow up 3-year follow up
Total (uncorrected) 171 -2.2 (-2.9 to -1.5)
b
-1.2 (-2.0 to -0.3) 186 -0.7 (-1.3 to -0.0) -0.6 (-1.4 to 0.2)
Total (adjusted)
a
170 -2.2 (-2.9 to -1.5)
b
-1.2 (-2.1 to -0.4) 185 -0.7 (-1.4 to -0.0) -0.5 (-1.3 to 0.3)
Gender
Men 84 -2.3 (-3.2 to -1.3)
b
-1.4 (-2.6 to -0.1) 82 -0.1 (-1.1 to 0.9) -0.2 (-1.4 to 0.9)
Women 86 -2.1 (-3.2 to -1.2)
-0.9 (-2.2 to 0.3) 103 -1.1 (-2.0 to -0.3) -0.9 (-1.9 to 0.2)
Age
< 60 year 117 -2.6 (-3.5 to -1.8)
b
-0.8 (-1.9 to 0.2) 110 -0.5 (-1.4 to 0.4) 0.0 (-1.1 to 1.1)
60 year 53 -1.4 (-2.6 to -0.1)
-1.8 (-3.4 to -0.3) 75 -0.8 (-1.9 to 0.3) -1.4 (-2.7 to -0.1)
Education
Low 56 -3.0 (-4.3 to -1.7)
-1.2 (-2.8 to 0.3) 56 -1.2 (-2.4 to 0.1) -0.4 (-1.9 to 1.1)
Other 106 -1.9 (-2.8 to -1.0)
b
-1.1 (-2.3 to -0.0) 119 -0.3 (-1.1 to 0.5) -0.7 (-1.7 to 0.3)
Body Mass Index
< 30 kg/m
2
113 -1.7 (-2.5 to -0.8)
c
-0.7 (-1.7 to 0.4) 121 -0.6 (-1.4 to 0.3) -0.3 (-1.3 to 0.7)
30 kg/m
2
57 -3.3 (-4.5 to -2.1)
b
-2.1 (-3.6 to -0.6) 64 -0.8 (-2.0 to 0.4) -1.1 (-2.6 to 0.3)
Attempts to lose weight during last
5 year
3 times
131 -2.6 (-3.4 to -1.8)
b
,c
-1.5 (-2.5 to -0.5)
c
125 -0.4 (-1.3 to 0.4) -0.5 (-1.5 to 0.5)
> 3 times 26 -0.0 (-1.9 to 1.8) 1.4 (-0.9 to 3.7) 47 -1.1 (-2.5 to 0.3) -0.7 (-2.5 to 1.0)
Treatment recommended
d
Yes 159 -2.4 (-3.1 to -1.7)
b
-1.2 (-2.1 to -0.3) 171 -0.6 (-1.3 to 0.1) -0.5 (-1.3 to 0.3)
No 11 0.1 (-2.7 to 3.0) 0.2 (-3.3 to 3.7) 14 -1.3 (-3.8 to 1.2) -1.3 (-4.2 to 1.7)
a
Changes are calculated as the value at 1- or 3-year follow-up minus the value at baseline and adjusted for gender, age, BMI at baseline and weight change between screening and baseline 513
(for 1 man in the intervention group and 1 man in the control group screening data were missing) 514
b
P<.05 NP vs. GP-UC group 515
c
P<.05 within NP or GP-UC group 516
d
Treatment on overweight/obesity indicated according to (inter)national guidelines (motivation of patient not taken into account) 517
NP: nurse practitioner, GP-UC: general practitioner usual care 518
519
Page 25
26
Table 4. Changes
a
in main outcome variables at 3-year follow-up across treatment groups, stratified for four categories of weight change 520
Successful
weight
losers
(n=71)
Weight
losers
(n=84)
Stabilizers
(n=69)
Weight
gainers
(n=133)
P
values
b
Body weight, mean (SD), kg -8.4 (4.5) -2.3 (1.0)
c
-0.1 (0.4)
c
3.8 (2.6)
c
<.001
Body weight, mean (SD), % change -9.3 (4.2) -2.7 (1.0)
c
-0.1 (0.5)
c
4.4 (2.9)
c
<.001
Waist circumference, mean (SD), cm -7.0 (8.1) -1.2 (6.2)
c
0.4 (4.9)
c
3.7 (5.0)
c
<.001
Total cholesterol, mean (SD), mmol/L -0.23 (0.94) 0.02 (0.93) 0.05 (0.78) 0.11 (0.95)
d
.009
HDL-cholesterol, mean (SD), mmol/L -0.11 (0.27) -0.17 (0.30) -0.13 (0.23) -0.22 (0.22)
d
.024
LDL-cholesterol, mean (SD), mmol/L -0.14 (0.92) 0.16 (0.85) 0.16 (0.62) 0.22 (0.87)
d
.008
Fasting glucose, mean (SD), mmol/L -0.11 (0.54) -0.03 (0.46) 0.13 (0.52)
d
0.12 (0.52)
d
.001
Systolic blood pressure, mean (SD), mmHg -7.3 (17.2) -3.3 (16.5) -7.9 (13.6) -2.9 (15.6) .247
Diastolic blood pressure, mean (SD), mmHg -4.7 (10.0) -1.2 (10.1) -2.5 (7.9) 0.5 (10.6)
c
.002
a
Changes are calculated as the value at 3-year follow-up minus the value at baseline 521
b
P value for linear trend 522
c
P<.01 ANOVA with post hoc Bonferroni test with ‘successful weight losers’ as reference category 523
d
P<.05 ANOVA with post hoc Bonferroni test with ‘successful weight losers’ as reference category 524
525
526
Page 26
27
527
Page 27
Page 28
  • Source
    • "Treatment had a greater effect on weight gain prevention after one year in men in A Pound of Prevention [27] and the GOAL Study [31][32][33]which suggests women may need different types or intensities of interventions. Both of these interventions [27,[31][32][33] were relatively low in intensity , while the current trial was moderate in intensity. The nutrition education component of the current intervention included group education classes, as previous research has demonstrated that group therapy results in greater weight loss when compared to individual therapy, even among individuals who prefer individual counseling [52]. "
    [Show abstract] [Hide abstract] ABSTRACT: Body weight (BW) reduction through energy restriction is ineffective at impacting the obesity epidemic. Shifting from an obesity treatment to weight gain prevention focus may be more effective in decreasing the burden of adult obesity. This was a 1-year randomized controlled trial of weight gain prevention in healthy premenopausal women, aged 18–45 y, with a body mass index (BMI) of >18.5 kg/m 2 . Eighty-seven women were randomized to a weight gain prevention intervention delivered by a registered dietitian (RDG) or counselor (CSG), or to a control (CON) group. Eighty-one women (mean ± SD, age: 31.4 ± 8.1 y; BW: 76.1 ± 19.0 kg; BMI: 27.9 ± 6.8 kg/m 2 ) completed baseline testing and were included in intention-to-treat analyses; anthropometric, blood pressure, dietary intake and physical activity measurements and biochemical markers of health were measured every three months. Data were analyzed using repeated measures ANCOVA, with significance at P < 0.01. Sixty-two percent of women met the weight gain prevention criteria (BW change within ±3 %) after one year; this did not differ by group assignment. Body fat % was lower in the RDG versus CSG and CON groups at all intervals (P < 0.001). Systolic blood pressure increased from month 6 to 9 and decreased from month 6 to 12 in the CON group (P < 0.001), with a significant group x time interaction (P < 0.01). Estimated carbohydrate intake (%) was higher in the RDG vs. CON group at month 9 (P < 0.01); fat intake (%) was lower in the RDG vs. CON group and CSG vs. CON group at months 3 and 9, respectively (P < 0.01). Estimated fruit intake (svgs/d) was higher in the RDG vs. CON group at months 3, 6, 9 and 12 (P < 0.01), and non-meat protein sources (svgs/d) was higher in the RDG vs. CSG and CON groups at month 3 (P < 0.001). Estimated energy, macronutrient and food group intakes did not change over time. A majority of all participants maintained BW over one year and were able to do so regardless of whether they received nutrition education. Additional studies that include a variety of clinical outcomes are needed to evaluate further aspects of nutrition education on weight gain prevention and health status over the long term.
    Full-text · Article · Dec 2015 · Nutrition Journal
  • Source
    • "Consequently, taking into account the literature on goal setting, questions arose how goal setting was carried out during the trial, whether patient and goal characteristics were linked to the patients' behaviour change, and what lessons could be learned from that. As similar nurse-led health promotion and self-management programmes are developed in this and in various other patient groups (Sol et al. 2005, Bastiaens et al. 2009, Hospes et al. 2009, Whittemore et al. 2010, ter Bogt et al. 2011, Van Hecke et al. 2011), this exploration could give more insight in how to further improve the quality of delivery of nurse-led goal setting. Goals of high quality can be expected to contribute to the patients' behaviour change. "
    [Show abstract] [Hide abstract] ABSTRACT: To describe goals set in individual nurse-led lifestyle counselling sessions in leg ulcer patients, and to explore patient and goal characteristics in relation to health behaviour change. Goal setting is increasingly used in nurse-led counselling programmes, but the delivery is often unknown, especially in patient groups for which only recently programmes have been developed, such as patients with venous leg ulcers. A secondary analysis of data collected in the intervention arm of a randomised clinical trial of counselling sessions in venous leg ulcer patients. Nursing records (n = 71) were explored for the number of goals set, topic, quality and course of goals during the trajectory. Furthermore, goals and patient characteristics were compared in relation to health behaviour change. Forty-one patients (58%) succeeded in changing their behaviour after setting a goal. Setting goals for conducting leg exercises was chosen by most patients in this study, goals for adherence with compression therapy were chosen the least. Sixty-eight per cent of the goals met criteria for being Specific, Measurable and Time-bound. Patients who achieved behaviour change were significantly younger compared to the patients who did not. Except for age, there were no differences in characteristics between the group that did and did not achieve behaviour change. Goal setting could be improved by setting goals more Specific, Measurable and Time-bound, and by setting goals on an essential topic for behaviour change. This explorative study did not show that goal characteristics, including the quality of goals, were related to patients' behaviour change. The delivery of goal setting in this programme, and most likely in similar programmes, could be improved. Regular quality checks in daily goal setting practice should be considered. More research is needed into how to best provide health promotion to frail and elderly people. © 2015 John Wiley & Sons Ltd.
    Full-text · Article · Aug 2015 · Journal of Clinical Nursing
  • Source
    • "In general, weight reduction strategies consist of the following five approaches: dietary intervention, physical activity, behavioral treatment, pharmacotherapy, and surgical therapy [3] . Many studies in the primary care setting have reported the effects of dietary intervention, physical activity, and pharmacotherapy on body weight reduction in obese patients131415. However, weight monitoring is a component of behavioral treatment, and in the area of behavioral treatment, most studies on body weight reduction have applied an intensive approach in an academic setting; few studies have reported the effects of behavioral treatment on body weight reduction in the primary care setting [22]. "
    [Show abstract] [Hide abstract] ABSTRACT: Family physicians should maintain regular contact with obese patients to ensure they effectively reduce their body weight. However, family physicians in Japan have on average only 6 (min) per consultation, and conventional interventions for body weight reduction require a longer consultation or additional manpower. A brief intervention within the limited consultation time available is therefore needed. Here we investigated the effectiveness of a brief weight reduction intervention for obese patients and the related factors for reducing body weight during routine consultations in the primary care setting. We conducted an open-label randomized controlled trial at a family medicine clinic in Fukushima, Japan from January 2010 to June 2011. Patients aged 30 to 69 years with body mass index ≥25 who were diagnosed with hypertension, dyslipidemia, and/or type 2 diabetes mellitus were randomly assigned to the intervention or control group. At every consultation, body weight in the intervention group was measured by a family physician who provided weight reduction advice in addition to usual care. The primary outcome was body weight change at 1-year follow up. Analysis was done by intention to treat. We randomly assigned 29 participants to the intervention group and 21 to the control group. Forty participants (80 %) remained in the trial until the 1-year follow up. At follow up, the median body weight change from baseline was not significantly different between the groups (p = 0.68), at -0.8 (interquartile range [IQR] -2.5 to 1.0) kg in the intervention group and 0.2 (IQR -2.4 to 0.8) kg in the control group. We devised an intervention method for physicians to measure body weight and advise on weight reduction during routine consultations. In our setting, this method did not extend the consultation time, but also had no significant additional effects on body weight reduction in moderately obese patients. This trial is registered with the UMIN Clinical Trial Registry (UMIN000002967).
    Full-text · Article · May 2015 · Asia Pacific Family Medicine
Show more