Interventions to change the behaviour of health professionals and the organisation of care to promote weight reduction in overweight and obese adults

Abstract

Background The prevalence of obesity is increasing globally and will, if left unchecked, have major implications for both population health and costs to health services. Objectives To assess the effectiveness of strategies to change the behaviour of health professionals and the organisation of care to promote weight reduction in overweight and obese people. Search methods We updated the search for primary studies in the following databases, which were all interrogated from the previous (version 2) search date to May 2009: The Cochrane Central Register of Controlled Trials (which at this time incorporated all EPOC Specialised Register material) (The Cochrane Library 2009, Issue 1), MEDLINE (Ovid), EMBASE (Ovid), CINAHL (EBSCO), and PsycINFO (Ovid). We identified further potentially relevant studies from the reference lists of included studies. Selection criteria Randomised controlled trials (RCTs) that compared routine provision of care with interventions aimed either at changing the behaviour of healthcare professionals or the organisation of care to promote weight reduction in overweight or obese adults. Data collection and analysis Two reviewers independently extracted data and assessed study quality. Main results We included six RCTs, involving more than 246 health professionals and 1324 overweight or obese patients. Four of the trials targeted professionals and two targeted the organisation of care. Most of the studies had methodological or reporting weaknesses indicating a risk of bias. Meta-analysis of three trials that evaluated educational interventions aimed at GPs suggested that, compared to standard care, such interventions could reduce the average weight of patients after a year (by 1.2 kg, 95% CI −0.4 to 2.8 kg); however, there was moderate unexplained heterogeneity between their results (I2 = 41%). One trial found that reminders could change doctors’ practice, resulting in a significant reduction in weight among men (by 11.2 kg, 95% CI 1.7 to 20.7 kg) but not among women (who reduced weight by 1.3 kg, 95% CI −4.1 to 6.7 kg). One trial found that patients may lose more weight after a year if the care was provided by a dietitian (by 5.6 kg, 95% CI 4.8 to 6.4 kg) or by a doctor-dietitian team (by 6 kg, 95% CI 5 to 7 kg), as compared with standard care. One trial found no significant difference between standard care and either mail or phone interventions in reducing patients’ weight. Authors’ conclusions Most of the included trials had methodological or reporting weaknesses and were heterogeneous in terms of participants, interventions, outcomes, and settings, so we cannot draw any firm conclusions about the effectiveness of the interventions. All of the evaluated interventions would need further investigation before it was possible to recommend them as effective strategies.

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.…”

Managing obesity in adults in primary care

“…4,14,16,47,48 In a randomized controlled trial, 48 patients who had a prompt to calculate BMI in their electronic medical record were significantly more likely than patients without a prompt to receive a diagnosis of obesity (16.6% v. 10.7%; p = 0.016) and referrals for dietary (14.0% v. 7.3%, p = 0.002) and physical activity (12.1% v. 7.1%, p = 0.016) interventions. Furthermore, one trial found that reminders to perform specific preventive actions could change practice, resulting in a significant reduction in weight among men (by 11.2 kg, 95% CI 1.7 to 20.7 kg, at 1 year).…”

“…Furthermore, one trial found that reminders to perform specific preventive actions could change practice, resulting in a significant reduction in weight among men (by 11.2 kg, 95% CI 1.7 to 20.7 kg, at 1 year). 47 Compared with standard care, educational interventions aimed at changing the behaviour of health care professionals to promote weight reduction have been shown to be effective (level I evidence). Box 5 includes resources for primary care physicians.…”

Gap Between Evidence and Patient Access: Policy Implications for Bariatric and Metabolic Surgery in the Treatment of Obesity and its Complications

“…Thus, it is crucial to raise stakeholders' awareness about the limitations of patients' willpower to prevent and reverse obesity, and thus the importance of treating obesity as a disease with appropriate treatment. Indeed, education of healthcare providers about overweight and obesity has been shown to change negative attitudes [96,99].…”