Can certified health professionals treat obesity in a community-based programme? A quasi-experimental study

Abstract

ObjectiveTo test the effectiveness of a non-pharmaceutical programme for obese participants in a rural Eastern Canadian Province using certified health professionals.DesignA prospective quasi-experimental design with repeated premeasure and postmeasure.Participants146 participants with obesity (body mass index >30 kg/m2) from rural and urban communities in an Eastern Canadian Province were divided into four groups.InterventionA 6-month intensive active community-based lifestyle intervention (InI) delivered by Certified Exercise Physiologists, Certified Personal Trainers and Registered Dietitians, followed by 6 months of self-management. A second intervention (InII) was nested in InI and consisted of group-mediated cognitive–behavioral intervention (GMCBI) delivered by an exercise psychologist to two of the four InI groups.Outcomes(1) Improving health outcomes among the participants’ preactive and postactive 6-month intervention and self-management period, (2) Documenting the impact of InII (GMCBI) and location of the intervention (urban vs rural).ResultsThe 6-month active InI significantly improved cardiovascular health for participants who completed the intervention. InII (GMCBI) significantly lowered the attrition rate among the participants. The self-management period was challenging for the participants and they did not make further gains; however, most were able to maintain the gains achieved during the active intervention. The location of the intervention, urban or rural, had little impact on outcomes.ConclusionsA community-based programme utilising healthcare professionals other than physicians to treat obese patients was effective based on premeasure and postmeasure. During the self-management phase, the participants were able to maintain the gains. Psychological support is essential to participant retention.

Evaluation of a multiprofessional, nonsurgical obesity treatment program: which parameters indicated life style changes and weight loss?

“…Further, due to the complexity of obesity, not adequately represented by a single outcome and the naturalistic design of the study, we did not define a single outcome variable in the study but measured treatment outcome and showed treatment effectiveness by several variables of interest. There was a high rate of dropouts, which is comparable with other international studies [ 38 ]. Income and education were not controlled, which are known as relevant factors in obesity [ 39 , 40 ].…”

Physical activity promotion in rural health care settings: A rapid realist review

“…Over half of the articles in our sample originated from the United States (n = 11) ( Batsis et al, 2020 , Batsis et al, 2021 , Currie et al, 2018 , Greaney et al, 2017 , Melton et al, 2016 , Peterson and Cheng, 2013 , Reed et al, 2018 , Reed et al, 2020 , Sherman et al, 2007 , Batsis et al, 2021 , Robles et al, 2014 ), followed by Australia (n = 3) ( Paul et al, 2019 , Eakin et al, 2012 , Sangster et al, 2016 ), Canada (n = 2) ( Miedema et al, 2015 , Davis et al, 2016 ), and the United Kingdom (n = 2; Table 3 ) ( Connelly et al, 2017 , Lee et al, 2007 ). Most studies were longitudinal or prospective cohort studies (n = 8) ( Batsis et al, 2020 , Batsis et al, 2021 , Davis et al, 2016 , Peterson and Cheng, 2013 , Reed et al, 2020 , Sherman et al, 2007 , Batsis et al, 2021 , Robles et al, 2014 ) or randomized control trials (n = 7) ( Reed et al, 2018 , Connelly et al, 2017 , Greaney et al, 2017 , Currie et al, 2018 , Eakin et al, 2012 , Lee et al, 2007 , Sangster et al, 2016 ).…”

“…Most studies were longitudinal or prospective cohort studies (n = 8) ( Batsis et al, 2020 , Batsis et al, 2021 , Davis et al, 2016 , Peterson and Cheng, 2013 , Reed et al, 2020 , Sherman et al, 2007 , Batsis et al, 2021 , Robles et al, 2014 ) or randomized control trials (n = 7) ( Reed et al, 2018 , Connelly et al, 2017 , Greaney et al, 2017 , Currie et al, 2018 , Eakin et al, 2012 , Lee et al, 2007 , Sangster et al, 2016 ). Populations of interest included older adults (n = 7) ( Batsis et al, 2020 , Batsis et al, 2021 , Davis et al, 2016 , Hsu et al, 2018 , Lee et al, 2007 , Tarazona-Santabalbina et al, 2016 , Batsis et al, 2021 ), individuals with chronic conditions and/or risk factors (n = 5) ( Sangster et al, 2016 , Miedema et al, 2015 , Connelly et al, 2017 , Paul et al, 2019 , Eakin et al, 2012 ), women (n = 4) ( Melton et al, 2016 , Greaney et al, 2017 , Sherman et al, 2007 , Peterson and Cheng, 2013 ), and children/youth (n = 2) ( Robles et al, 2014 , Currie et al, 2018 ). The most common type of health care providers involved in intervention delivery were nurses or nurse practitioners (n = 8) ( Connelly et al, 2017 , Tarazona-Santabalbina et al, 2016 , Sherman et al, 2007 , Lee et al, 2007 , Melton et al, 2016 , Peterson and Cheng, 2013 , Reed et al, 2020 , Reed et al, 2018 ), physical therapists (n = 7) ( Batsis et al, 2020 , Batsis et al, 2021 , Davis et al, 2016 , Paul et al, 2019 , Reed et al, 2018 , Tarazona-Santabalbina et al, 2016 , Batsis et al, 2021 ), registered dietitians (n = 5) (…”

“…Populations of interest included older adults (n = 7) ( Batsis et al, 2020 , Batsis et al, 2021 , Davis et al, 2016 , Hsu et al, 2018 , Lee et al, 2007 , Tarazona-Santabalbina et al, 2016 , Batsis et al, 2021 ), individuals with chronic conditions and/or risk factors (n = 5) ( Sangster et al, 2016 , Miedema et al, 2015 , Connelly et al, 2017 , Paul et al, 2019 , Eakin et al, 2012 ), women (n = 4) ( Melton et al, 2016 , Greaney et al, 2017 , Sherman et al, 2007 , Peterson and Cheng, 2013 ), and children/youth (n = 2) ( Robles et al, 2014 , Currie et al, 2018 ). The most common type of health care providers involved in intervention delivery were nurses or nurse practitioners (n = 8) ( Connelly et al, 2017 , Tarazona-Santabalbina et al, 2016 , Sherman et al, 2007 , Lee et al, 2007 , Melton et al, 2016 , Peterson and Cheng, 2013 , Reed et al, 2020 , Reed et al, 2018 ), physical therapists (n = 7) ( Batsis et al, 2020 , Batsis et al, 2021 , Davis et al, 2016 , Paul et al, 2019 , Reed et al, 2018 , Tarazona-Santabalbina et al, 2016 , Batsis et al, 2021 ), registered dietitians (n = 5) ( Batsis et al, 2020 , Batsis et al, 2021 , Greaney et al, 2017 , Miedema et al, 2015 , Batsis et al, 2021 ), physicians (n = 4) ( Hsu et al, 2018 , Miedema et al, 2015 , Melton et al, 2016 , Currie et al, 2018 ), and exercise physiologists (n = 3) ( Paul et al, 2019 , Miedema et al, 2015 , Eakin et al, 2012 ). Two included studies reported on the same intervention delivered in a rural primary care setting, describing the effectiveness ( Reed et al, 2018 ) and feasibility/implementation ( Reed et al, 2020 …”

“…Ten articles ( Hsu et al, 2018 , Paul et al, 2019 , Connelly et al, 2017 , Greaney et al, 2017 , Miedema et al, 2015 , Melton et al, 2016 , Robles et al, 2014 , Sangster et al, 2016 , Batsis et al, 2021 , Currie et al, 2018 ) provided no definition or measure of rurality but were included as they self-identified their study as taking place in a rural setting. Seven articles defined the communities as rural by stating the location’s population (range: 5,495 – 20,613 people) ( Davis et al, 2016 , Lee et al, 2007 , Peterson and Cheng, 2013 , Reed et al, 2020 , Sherman et al, 2007 , Tarazona-Santabalbina et al, 2016 , Batsis et al, 2021 ), and three provided a specific definition of rurality based on national health policies ( Batsis et al, 2020 , Reed et al, 2018 , Eakin et al, 2012 ).…”