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


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. Identifier: NTR1365.

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    • "Overall, participants found the cards helpful and expressed the desire to use them in a clinical setting, but they doubted physicians would take the time to talk with them long enough to address their concerns. There is evidence that when family doctors do take the time to engage in behavioural counselling around obesity there are positive outcomes, including weight loss [8, 49] and prevention of weight gain [50]. Use of the cards may help patients to connect better with their physicians, while helping physicians feel there are relevant, tangible goals to work toward collectively. "
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    • "After one year the glucose might rise slightly due to increase of age. Besides, the focus of this study was on combined cardiovascular risk and not on weight only [28]. Another explanation is the prescription of antihypertensive medication; beta blocking agents and diuretics increase the risk of incident diabetes [29]. "
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    • "The GOAL-study aims to permanently change lifestyle and to prevent weight gain in the long term. Previous research showed that the GOAL-study significantly increased leisure-time walking after one year [26] and succeeded in preventing weight gain after three years [27]. "
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