Weight-management interventions in primary care: a pilot randomised controlled trial

Nanchahal, Kiran; Townsend, Joy; Letley, Louise; Haslam, David; Wellings, Kaye; Haines, Andy

doi:10.3399/bjgp09x420617

Cited by 33 publications

(44 citation statements)

References 33 publications

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“…73 In Wylie-Rosett et al, 73 only about 50 % of participants enjoyed working on the kiosks, 75 % found them a poor substitute for human contact, yet 75 % found the kiosk easy to use. In contrast, about 75 % and 67 % of participants in Nanchahal (2009) et al 67 found automated and RN web-based feedback and motivation very/extremely helpful, respectively.…”

Section: Sixteen Trialsmentioning

confidence: 93%

“…We therefore aggregated our results with ranges and narrative summation in most instances. [58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73] met inclusion criteria and are summarized in Table 1. For readers interested in additional tabular detail and narrative summation of each trial, see Supplemental Table 2 Personnel Figure 2 illustrates the association between weight loss and mix of personnel delivering the intervention.…”

Section: Discussionmentioning

confidence: 99%

“…3). The most common was self-monitoring (13/16, 81 %), [58][59][60][63][64][65][66][67][68][69][70][71][72] where participants recorded daily dietary and physical activity behaviors, usually on web-based software. This technology-supported self-monitoring occurred in 11/13 (85 %) …”

Section: Behavior Change Elementsmentioning

confidence: 99%

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Technology-Assisted Weight Loss Interventions in Primary Care: A Systematic Review

et al. 2014

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BACKGROUND:The US Preventive Services Task Force recommends screening for and treating obesity. However, there are many barriers to successfully treating obesity in primary care (PC). Technology-assisted weight loss interventions offer novel ways of improving treatment, but trials are overwhelmingly conducted outside of PC and may not translate well into this setting. We conducted a systematic review of technology-assisted weight loss interventions specifically tested in PC settings. METHODS: We searched the literature from January 2000 to March 2014. Inclusion criteria: (1) Randomized controlled trial; (2) trials that utilized the Internet, personal computer, and/or mobile device; and (3) occurred in an ambulatory PC setting. We applied the Cochrane Effective Practice and Organization of Care (EPOC) and Delphi criteria to assess bias and the Pragmatic-Explanatory Continuum Indicator Summary (PRECIS) criteria to assess pragmatism (whether trials occurred in the real world versus under ideal circumstances). Given heterogeneity, results were not pooled quantitatively. RESULTS: Sixteen trials met inclusion criteria. Twelve (75 %) interventions achieved weight loss (range: 0.08 kg -5.4 kg) compared to controls, while 5-45 % of patients lost at least 5 % of baseline weight. Trial duration and attrition ranged from 3-36 months and 6-80 %, respectively. Ten (63 %) studies reported results after at least 1 year of follow-up. Interventions used various forms of personnel, technology modalities, and behavior change elements; trials most frequently utilized medical doctors (MDs) (44 %), webbased applications (63 %), and self-monitoring (81 %), respectively. Interventions that included clinician-guiding software or feedback from personnel appeared to promote more weight loss than fully automated interventions. Only two (13 %) studies used publically available technologies. Many studies had fair pragmatism scores (mean: 2.8/4), despite occurring in primary care. DISCUSSION: Compared to usual care, technologyassisted interventions in the PC setting help patients achieve weight loss, offering evidence-based options to PC providers. However, best practices remain undetermined. Despite occurring in PC, studies often fall short in utilizing pragmatic methodology and rarely provide publically available technology. Longitudinal, pragmatic, interdisciplinary, and opensource interventions are needed.

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Section: Sixteen Trialsmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

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Technology-Assisted Weight Loss Interventions in Primary Care: A Systematic Review

et al. 2014

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“…11 One randomised controlled trial of a nurse-led, general practice-based weight management programme for individuals with a BMI of ≥27 kg/m 2 reported that, at 12 weeks, 34% of participants in the intervention arms of the trial lost at least 5% of their initial weight compared to 19% in the usual care arms. 12 In the Counterweight Project, 31% and 32% of participants respectively had maintained a weight loss of at least 5% of initial weight at 12…”

Section: Introductionmentioning

confidence: 99%

A comparison of the provision of the My Choice Weight Management Programme via general practitioner practices and community pharmacies in the United Kingdom

et al. 2014

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SummaryThis study aimed to assess the effectiveness of a novel, community‐based weight management programme delivered through general practitioner (GP) practices and community pharmacies in one city in the United Kingdom. This study used a non‐randomized, retrospective, observational comparison of clinical data collected by participating GP practices and community pharmacies. Subjects were 451 overweight or obese men and women resident in areas of high socioeconomic deprivation (82% from black and minority ethnic groups, 86% women, mean age: 41.1 years, mean body mass index [BMI]: 34.5 kg m−2). Weight, waist circumference and BMI at baseline, after 12 weeks and after 9 months were measured. Costs of delivery were also analysed. Sixty‐four per cent of participants lost weight after the first 12 weeks of the My Choice Weight Management Programme. There was considerable dropout. Mean percentage weight loss (last observation carried forward) was 1.9% at 12 weeks and 1.9% at final follow‐up (9 months). There was no significant difference in weight loss between participants attending GP practices and those attending pharmacies at both 12 weeks and at final follow‐up. Costs per participant were higher via community pharmacy which was attributable to better attendance at sessions among community pharmacy participants than among GP participants. The My Choice Weight Management Programme produced modest reductions in weight at 12 weeks and 9 months. Such programmes may not be sufficient to tackle the obesity epidemic.

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“…Previous studies have shown that lifestyle interventions in primary care can be effective at least in the short term (4)(5)(6) and may already be (cost) effective in persons with moderate overweight (BMI 25-30 kg/m 2 ) (7) . In persons with at least one additional risk factor such as hypertension and/or dyslipidaemia, larger health gains may be achieved.…”

mentioning

confidence: 99%

Changes in lifestyle habits after counselling by nurse practitioners: 1-year results of the Groningen Overweight and Lifestyle study

Bogt

Milder

Bemelmans

et al. 2011

Public Health Nutr.

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Objectives: The Groningen Overweight and Lifestyle (GOAL) study primarily aims at preventing weight gain by nurse practitioners (NP) guided by a standardized computerized software program. Since favourable changes in physical activity (PA) and diet may improve health independently of weight (loss), insight into effects on lifestyle habits is essential. We examined the 1-year effects of lifestyle counselling by NP on PA and diet, compared with usual care from the general practitioner (GP-UC). Design: A randomized controlled trial. Setting: Eleven general practice locations in the Netherlands. Subjects: A total of 341 GOAL participants with overweight or obesity and either hypertension or dyslipidaemia, or both, who completed an FFQ and Short Questionnaire to Assess Health-Enhancing Physical Activity (SQUASH) at baseline and after 1 year. Results: After 1 year, the NP group spent 33 min/week more on walking compared with the GP-UC group who spent 25 min/week on walking (P 5 0?05). No significant differences were found between the NP and GP-UC groups on the percentage of persons complying with the PA guidelines. In both groups, nutrient intake changed in a favourable direction and participants complied more often with dietary guidelines, but without overall difference between the NP and GP-UC groups. Conclusions: With the exception of an increase in walking (based on self-reported data) in the NP group, no intervention effects on PA and diet occurred. Positive changes in nutrient intake were seen in both groups.

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Weight-management interventions in primary care: a pilot randomised controlled trial

Cited by 33 publications

References 33 publications

Technology-Assisted Weight Loss Interventions in Primary Care: A Systematic Review

Technology-Assisted Weight Loss Interventions in Primary Care: A Systematic Review

A comparison of the provision of the My Choice Weight Management Programme via general practitioner practices and community pharmacies in the United Kingdom

Changes in lifestyle habits after counselling by nurse practitioners: 1-year results of the Groningen Overweight and Lifestyle study

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