Nutritional counselling in general practice: a cost effective analysis

Abstract

Study objective-To study the clinical and cost outcomes of providing nutritional counselling to patients with one or more of the following conditions: overweight, hypertension and type 2 diabetes. Design-The study was designed as a random controlled trial. Consecutive patients were screened opportunistically for one or more of the above conditions and randomly allocated to one of two intervention groups (doctor/dietitian or dietitian) or a control group. Both intervention groups received six counselling sessions over 12 months from a dietitian. However, in the doctor/dietitian group it was the doctor and not the dietitian who invited the patient to join the study and the same doctor also reviewed progress at two of the six counselling sessions. Setting-The study was conducted in a university group general practice set in a lower socioeconomic outer suburb of Perth, Western Australia. Patients-Of the 273 patients randomly allocated to a study group, 198 were women. Age ranged from 25 to 65 years. Seventy eight per cent of patients resided in the lower two socioeconomic quartiles, 56 per cent described their occupation as home duties and 78 per cent were partnered. Results-Both intervention groups reduced weight and blood pressure compared with the control group. Patients in the doctor/dietitian group were more likely to complete the 12 month programme than those in the dietitian group. Patients in the doctor/dietitian group lost an average of 6.7 kg at a cost of $A9.76 per kilogram, while the dietitian group lost 5.6 kg at a cost of $A7.30 per kilogram. Conclusion-General practitioners, in conjunction with a dietitian, can produce significant weight and blood pressure improvement by health promotion methods. (J Epidemiol Community Health 1999;53:311-316)

Potentials and pitfalls for nutrition counselling in general practice

“…This may be due in part by the fact that some people have adopted the fatalistic viewpoint that nutrition counselling in general practice does not help (Price et al, 2000). Several studies, however, have shown the opposite (Lindholm et al, 1995;Mant, 1997;Pritchard et al, 1999;Steptoe et al, 1999Steptoe et al, , 2001; Van der Veen et al, 2002). As large groups of people still fail to meet the dietary recommendations set out by the Health Council, continuous efforts to improve the lifestyle of the population are needed.…”

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

“…The personnel delivering the intervention were allied health-care providers (including nurses or dietitians) or non-health-care providers. The types of interventions included meal replacements (26) , nurse-or dietitian-delivered counselling (27,36,37) , weight-loss websites (30,32) and counselling delivered by non-medical health coaches (28,32,33,38) . Two studies compared two interventions, without a control group (26,27) .…”

Obesity management in liver clinics: Translation of research into clinical practice

“…13,19 We believe the degree to which the nutrition intervention has been adopted by the gastroenterologists, and the encouragement they provide to their eligible patients, has contributed to the high attendance rates of the program.…”

“…11 However, recent findings show that clinically significant weight losses can be achieved at nonacademic centers when obese patients are offered structured and continuous treatment including dietary and behavioral support. 12,13 Higher number of attendances and an initial intensive treatment period result in greater maintained weight loss. Our results support these findings and demonstrate that intensive review can produce significant weight loss in an outpatient clinical setting.…”