Obesity management in primary care: systematic review exploring the influence of therapeutic alliance

Abstract

Purpose To identify the influence of the therapeutic alliance on the effectiveness of obesity interventions delivered in primary care. Method Systematic review of randomized controlled trials of primary care interventions for adult patients living with obesity. Comprehensive search strategy using the terms ‘obesity’, ‘primary care’ and ‘intervention’ of seven databases from 1 January 1998 to March 2018. Primary outcome was difference in weight loss in interventions where a therapeutic alliance was present. Results From 10 636 studies, 11 (3955 patients) were eligible. Only one study had interventions that reported all aspects of therapeutic alliance, including bond, goals and tasks. Meta-analysis was not included due to high statistical heterogeneity and low numbers of trials; as per our protocol, we proceeded to narrative synthesis. Some interventions included the regular primary care practitioner in management; very few included collaborative goal setting and most used prescriptive protocols to direct care. Conclusions We were surprised that so few trials reported the inclusion of elements of the therapeutic alliance when relational aspects of primary care are critical for effectiveness. Interventions could be developed to maximize therapeutic relationships and research reports should describe interventions comprehensively. Systematic review registration number CRD42018091338 in PROSPERO (International prospective register of systematic reviews).

Perceived barriers in family‐based behavioural treatment of paediatric obesity – Results from theFABOstudy

“…Furthermore, the relationship with the therapist subscale investigated alliance, bonding, liking of, perceived support from and disclosure with the therapist 26 . Within psychotherapeutic approaches, the therapeutic alliance is a known predictor for patient outcomes 33,34 . Our study was not able to detect any group difference related to treatment completion, as the whole group of participating families had a low mean score on this subscale.…”

“…26 Within psychotherapeutic approaches, the therapeutic alliance is a known predictor for patient outcomes. 33,34 Our study was not able to detect any group difference related to treatment completion, as the whole group of participating families had a low mean score on this subscale. However, it is very positive for the FABO study and the FBSFT intervention that participating families experienced a supportive, strong therapeutic alliance with their therapist.…”

Malnutrición e inadecuados hábitos de alimentación en bomberos de Panamá

“…Modificar los hábitos de consumo no es una tarea fácil, sobre todo en la población adulta 23 . Los hábitos inadecuados de consumo de alimentos se definen como comportamientos conscientes, repetitivos y colectivos que llevan a cada persona a seleccionar, consumir y utilizar ciertos alimentos en respuesta a influencias sociales y culturales 24 .…”