Lifestyle Counseling in General Practice May Prevent Further Weight Gain

Laurie Barclay, MD

March 01, 2011

March 1, 2011 — Lifestyle counseling by nurse practitioners (NPs) or general practitioners (GPs) leads to similarly effective prevention of further weight gain among overweight and obese patients, according to 3-year results of a randomized controlled trial reported in the February 28 issue of the Archives of Internal Medicine.

"Weight regain after initial loss of weight is common, which indicates a need for lifestyle counselling aimed at preventing weight gain instead of weight loss," write Nancy C. W. ter Bogt, MSc, from the University Medical Center Groningen, the Netherlands, and colleagues. "This study was conducted to determine whether structured lifestyle counseling by nurse practitioners (NPs) group compared with usual care by general practitioners (GP-UC) in overweight and obese patients can prevent (further) weight gain."

The study sample consisted of 457 patients with a body mass index (calculated as weight in kilograms divided by height in meters squared) of 25 to 40, and either hypertension or dyslipidemia or both, seen at 11 general practice locations in the Netherlands. Mean age was 56 years, and 52% were women. Participants were randomly assigned to the NP group, receiving lifestyle counseling with guidance of the NP using a standardized software program, or to the GP-UC group, receiving usual care from their GP. The primary study endpoints were changes after 3 years in body weight, waist circumference, blood pressure, and fasting glucose and blood lipid levels.

Approximately 60% of the participants in both groups were able to maintain their weight after 3 years. The NP and GP-UC groups had no significant difference in mean change in weight (NP group, −1.2% ± 5.8%, and GP-UC group, −0.6% ± 5.6%; P = .37) or in waist circumference (NP group, −0.8 ± 7.1 cm, and GP-UC group, 0.4 ± 7.2 cm; P = .11). There was a significant difference in mean fasting glucose levels (NP group, −0.02 ± 0.49 mmol/L, and GP-UC group, 0.10 ± 0.53 mmol/L; P = .02) [to convert to milligrams per deciliter, divide by 0.0555]. However, lipid levels and blood pressure did not differ between groups.

"Lifestyle counseling by NPs did not lead to significantly better prevention of weight gain compared with GPs," the study authors write. "In the majority in both groups, lifestyle counseling succeeded in preventing (further) weight gain."

Limitations of this study include baseline differences between NP and GP-UC groups; randomization at a patient level vs a practice level; and low frequency of visits to the NP after the first year, which may be insufficient to sustain weight loss.

In an accompanying invited commentary, Debra Haire-Joshu, PhD, and Samuel Klein, MD, from Washington University School of Medicine in St. Louis, Missouri, note that using a trained NP to provide limited lifestyle counseling within a general medical practice did not result in clinically meaningful long-term weight loss. However, they point out that large, multicenter clinical trials have suggested that intensive interventions may achieve weight loss associated with improved health outcomes.

"Effective therapy for obesity will need to support integrated interventions across multiple environments where individuals spend time," Drs. Haire-Joshu and Klein write. "...Weight loss interventions in primary care settings will be more effective if coordinated care is reimbursed and more sustainable if supported by complementary actions of multiple settings, such as worksite or community. These systems will require new cost-benefit models to determine the most efficient and effective approaches for specific patient populations."

The Netherlands Organization for Health Research and Development and Foundation Fund "De Gavere" supported this study. The study authors and editorialists have disclosed no relevant financial relationships.

Arch Intern Med. 2011;171:306-313, 313-315. Abstract Extract


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