A systematic review of interventions to improve health professionals’ management of obesity

Abstract

OBJECTIVE: To determine the existence and effectiveness of interventions to improve health professionals' management of obesity or the organisation of care for overweight and obese people. DESIGN: A systematic review of intervention studies, undertaken according to standard methods developed by the Cochrane Effective Practice and Organisation of Care (EPOC) Group. 1 PARTICIPANTS: Trained health care professionals and overweight and obese patients. MEASUREMENTS: Objective measures of health professionals' practice and behaviours, and patient outcomes including satisfaction, behaviour, psychological factors, disease status, risk factors, and measures of body weight, fat, or BMI. RESULTS: Twelve studies that met all the review inclusion criteria were identi®ed. Three were randomised controlled trials of health professional-oriented interventions (such as the use of reminders and training) and one was a controlled before and after study to improve collaboration between a hospital clinic and GPs. A further eight randomised controlled trials were identi®ed of interventions comparing either the deliverer of weight loss interventions or the setting of the delivery of the intervention. The heterogeneity and generally limited quality of identi®ed studies make it dif®cult to provide recommendations for improving health professionals' obesity management. CONCLUSIONS: At present, decisions about improving the provision of services for overweight and obese people must be based on the evidence from patient interventions and good clinical judgement. Future research is required to identify cost-effective strategies for improving health professionals' management and the organisation of care for overweight and obese people.A full version of this review, including detailed descriptions of the included studies and data tables, is available in the Cochrane Library.2 The Cochrane Library is a database of systematic review and other evidence on the effects of health care, available on CD ROM from Update Software. For further information see: http:aawww.cochrane.co.uk.

A systematic review of behavioural weight-loss interventions involving primary-care physicians in overweight and obese primary-care patients (1999–2011)

“…The authors noted that practitioners' adherence to the intervention protocol was low, thus intensity could not be accurately estimated. Provider-targeted interventions for weight loss have been discussed in detail in other reviews (43)(44)(45) . While a structured protocol to assist practitioners with delivery of weight-loss counselling appeared effective in producing some weight loss in overweight or obese patients, none of the interventions reported achieving clinically significant weight loss, making it questionable whether physician-delivered interventions alone are worth implementing in primary care.…”

Variables predictive of adherence to diet and physical activity recommendations in the treatment of obesity and overweight, in a group of Spanish subjects

“…Perhaps of more importance would be the identification of those factors such as ethnicity, sociocultural differences as well as genetic, psychological and environmental predisposition to weight fluctuations, which could provide an insight into the factors predictive of completing a weight loss program. 9,10 These factors are attracting attention 11 but, to-date, there are only a few such studies and the results are, frequently, contradictory. Some studies have focussed on the characteristics of patients who have achieved long-term solutions to their weight problems and, from the data, the investigators have attempted to establish methods for treatment together with profiling of individuals who would be ideally suited for weight reduction treatments.…”

Diagnosis and Treatment of Obesity in Adults: An Applied Evidence-Based Review

“…It integrates the evidence supporting the recommendations from a number of systematic reviews. 6,18,19,21,43 Among these reviews are the more conservative Canadian Task Force recommendations, 18 and the more aggressive National Heart, Lung, and Blood Institute (NHLBI) recommendations, 6 which prepared the clinical guidelines in 1998 based on a systematic review of the literature from the years 1980 to 1997. In addition, this review incorporates pertinent additions based on 2 recent reports from the US Preventive Services Task Force 15,44 and results from clinical trials, in particular those related to the drug treatment of obesity, that were completed after the above published recommendations.…”