An innovative program for changing health behaviours (original) (raw)
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Nutrition & Diabetes, 2013
OBJECTIVE: To investigate whether the effects on weight loss and cardiometabolic risk factor reduction of two technologymediated lifestyle interventions for 15 months in a primary care-based translation trial sustained at 24 months (that is, 9 months after the end of intervention). DESIGN: This study analyzed data from an extended follow-up of participants in the original 'E-LITE' (Evaluation of Lifestyle Interventions to Treat Elevated Cardiometabolic Risk in Primary Care)-randomized controlled trial, which demonstrated the effectiveness of two adapted Diabetes Prevention Program (DPP) lifestyle interventions compared with usual primary care. SUBJECTS: ELITE randomized 241 overweight or obese participants with pre-diabetes and/or metabolic syndrome to receive usual care alone (n ¼ 81) or usual care plus a coach-led (n ¼ 79) or self-directed intervention (n ¼ 81). The interventions provided coach-led group behavioral weight-loss treatment or a take-home, self-directed DVD using the same 12-week curriculum, followed by 12 additional months of technology-mediated coach contact and self-monitoring support. Participants received no further intervention after month 15. A blinded assessor conducted 24-month visits by following the measurement protocols of the original trial. Measurements include weight and cardiometabolic risk factors (waist circumference, fasting plasma glucose, resting blood pressure, triglycerides, high-and low-density lipoprotein cholesterol, total cholesterol and triglyceride to high-density lipoprotein cholesterol ratio). RESULTS: At month 24, mean ± s.e. changes in body mass index (trial primary outcome) and weight (kg) from baseline were-1.9 ± 0.3 (P ¼ 0.001) and-5.4 ± 0.9 (Po0.001) in the coach-led intervention, and-1.6 ± 0.3 (P ¼ 0.03) and-4.5 ± 0.9 (P ¼ 0.001) in the self-directed intervention, compared with-0.9±0.3 and 2.4±0.9 in the usual care group. In addition, both interventions led to a greater percentage of participants maintaining X7% weight loss and sustained improvements in waist circumference and fasting plasma glucose levels than usual care. CONCLUSION: This study shows sustained benefits of the two primary care-based, technology-mediated DPP lifestyle interventions. The findings warrant replication in long-term studies involving diverse populations.
BMC Research Notes, 2013
Background: Overweight and obesity are growing public health problems in high income countries and is now growing at a dramatic pace in low and middle income countries, particularly in urban settings. The aim of this trial was to examine the effects of a weight reduction program in adults and to determine whether or not a more extensive intervention was superior to ordinary care. Methods: Patients seeking advice for overweight/obesity or illness related to overweight/obesity at eight primary health care centers in Sweden were randomized either to intervention or control care groups with both groups given dietary advice and individualized information on increased regular physical activity. In the intervention group advice was more extensive and follow-up more frequent than in the control group during the study period of two years. Main outcome measure was reduction in body weight of five percent or more from study start. Results: From October 2004 to April 2006, 133 patients, 67 in the intervention group and 66 in the control group, were randomized over a period of 18 months. Target weight was achieved at 12 months by 26.7% of the patients in the intervention group compared with 18.4% in the control group (p = 0.335). There was an average absolute weight loss of 2.5 kg in the intervention group and 0.8 kg in the control group at 12 months as compared with the weight at study entry. There were no significant differences between the groups in quality of life, blood glucose and lipids. At 24 months target weight was achieved in 21.9% versus 15.6%, with an average weight reduction of 1.9 kg and 1.2 kg in the two groups, respectively. Conclusions: Promotion of a diet with limited energy intake, appropriate composition of food and increased physical activity had limited effects on body weight in a Swedish primary care setting. More extensive advice and more frequent visits made no significant difference to the outcome.
Obesity Science & Practice, 2021
Background: Obesity and related comorbidities are the most common chronic conditions in North America where behavior modification including the adoption of physical activity (PA) and a healthful diet are primary treatment strategies. Patients are more likely to engage in behavior modification if encouraged by their physician; however, behavioral counseling in primary care rarely occurs due to lack of training and resources. A more effective method may be to refer patients from clinical settings to other health professionals. Objective: This systematic review examines the effectiveness of behavior-based counseling for obesity management among participants referred from clinical settings. Methods: PubMed, CINAHL, and EMBASE were used to identify randomized clinical trials (2014-2020) for weight loss with the following inclusion criteria: trial duration ≥12 months, included a control or usual care group, recruited adults with overweight or obesity from primary care and/or treated in the primary care setting, and the intervention included counseling on PA and diet. Results: Seventeen studies, encompassing 21 different intervention groups with 6185 unique participants (56% female) met the inclusion criteria. All participants had overweight or obesity, with a body mass index between 28.2 and 41.0 kg/m 2. In 11 (52%) of the intervention groups, significant weight loss in the intervention group was observed compared to usual care (mean weight loss: 4.9[2.1] kg vs. 1.0 [0.9] kg). In 13 out of 18 interventions (72%) reporting weight loss at two time points, weight regain was observed by 12 months. Statistically significant weight loss was observed in one intervention (of two total) that was longer than 12 months. Conclusions: Sustained weight loss regardless of the behavior-based, intervention strategy remains a challenge for most adults. Given the established benefits of routine PA and a healthful diet, prioritizing the adoption of healthy behaviors regardless of weight loss may be a more effective strategy for ensuring long-term health benefit.
Collegium Antropologicum, 2009
Prevention of obesity may help reduce the morbidity and mortality from cardiovascular diseases. In Croatia, over half of adult population is overweight. Aldo the basic medical principles of healthy weight-loss programmes are well known, it is believed that mainly because of the leak of successful therapeutic approach obesity remains the most challenging changeable cardiovascular risk factor in nowadays clinical practice. Objective of this Croatian Healthy Weight Loss Programme substudy was to determine effects and differences between the intensive group and intensive individual weight-loss program on weight loss and cardiovascular risk factor. A clinical trial included 476 adults whose body mass index (BMI) was >30 or >28 accompanied by increased blood pressure, glucose, and cholesterol. The study participants completed either a group (n=243) or individually-based (n=233) 6-month weight-loss program consisting of education, low-fat diet, pharmacological treatment with orlistat, psychological counselling, and exercise. Body weight, body mass index, blood pressure, blood sugar, and blood cholesterol were measured in all participants after 3 and 6 months. The average weight loss was 12.2 (13%) kg and 7.6 (9%) kg in the group and individual program, respectively. Beside the weight reduction, the levels of blood cholesterol, glucose, and blood pressure were also significantly reduced in comparison with baseline, decreasing to normal values in all participants (P<0.001 for all). Decrease in the monitored parameters was greater in participants in the group program. The weight loss program provided a healthy loss of extra weight in the period of 6 months. The group program produced greater decrease in body weight, body mass index, blood pressure, glucose, and cholesterol than the individual program.
A primary care intervention programme for obesity and coronary heart disease risk factor reduction
Primary Health Care, 2004
Background: Obesity is a growing problem, with its associated morbidity, mortality, and economic costs. Treatment options and the availability of resources are limited and inconsistent. Aim: To implement and evaluate a primary care dietitian-run weight management programme. Design of study: Pilot intervention study. Setting: Three health centres in the north locality of Nottingham City Primary Care Trust. Method: Two hundred and sixteen individuals, with a body mass index (BMI) >30 kg/m 2 and coronary heart disease risk factors, were recruited to attend education and support groups. Changes in BMI, waist circumference, percentage body fat, blood pressure, blood lipids, glycated haemoglobin (HbA 1c), and assessment of psychological wellbeing using the 'short form' (SF-36) general health questionnaire, were conducted at 0, 3, and 12 months. Results: One hundred and thirty patients completed the 3-month phase, and 75 completed the follow-up 9-month phase. Four per cent of patients entering the programme achieved a 10% weight loss, and 13% achieved a weight loss between 5 and 10%. Those continuing to attend achieved a mean weight loss of 2.9% (mean = 3.1 kg, ranging from a loss of 23.6 kg to a gain of 3.8 kg, P<0.001) at 3 months, which was maintained at 12 months. Waist circumference, percentage body fat, systolic blood pressure, total cholesterol, HbA 1c (in those with diabetes) (P<0.001), and triglycerides (P = 0.004) showed reduction. Psychological wellbeing improved in seven of the nine categories of the SF-36. Conclusion: Those who continued to attend the programme showed significant reduction in weight and other clinical parameters at 3 months, and this was maintained at 1 year with less intensive support. An attrition rate of approximately 66% by 12 months demonstrated that, in spite of intensive dietetic resources, patient retention and follow-up of progress was difficult.
Efficiency of community based intervention programme on keeping lowered weight
Slovenian Journal of Public Health, 2011
Objective: To establish the effectiveness of community based intervention on lowering and sustaining weight. Methods: We performed a longitudinal retrospective study in three primary care centres in Slovenia. 333 men aged 35 to 65 and women aged 45 to 70 with body mass index higher than 25 kg/m 2 and high risk for cardiovascular diseases or with body mass index higher than 30 kg/m 2 were included. The data for the analysis were extracted from the forms of National cardio-vascular disease prevention programme. Long-term follow-up of their weight was performed 12 to 24 months after the intervention. Results: The inclusion criteria fulfilled 250 (75%) participants. During the programme the participants' weight lowered by a mean 6.7 kg from 95.5±15.1 to 88.8±14.7 kg (7.1% of the entry body weight, 95% CI:-7.2 to-6.1 %). One to two years after the intervention 62.8% of the participants could not keep the weight they achieved during the intervention phase. Mean regain of the weight was 1.6 kg, (23% of the lost weight, 95% CI: 0.8 to 2.4 kg). Initial body weight of people, who long-term succeeded to keep achieved weight was higher than initial body weight of those people, who regained weight after the programme (t=3.490, P= 0.001) Gender and age did not show any statistically significant impact on long-term weight gain. Conclusions: The intervention programme was successful by the criteria that weight reduction should be at least 5-10%. Majority of the participants could not sustain the reduced weight, but the mean weight gain was less than one fourth of the weight, lost in the intervention period. Besides the interventions for weight reduction also the longterm programmes for sustaining the achieved weight loss are very important.
Nursing & Health Sciences, 2012
Objectives: To determine whether weight loss interventions, which combine dietary, exercise and behaviour change strategies, result in reduced weight, body mass index (BMI) and waist circumference in people with coronary heart disease (CHD), hypertension (HTN) and/or type 2 diabetes mellitus (T2DM). Design: A systematic review of studies published 1997 to 2010. Data Sources: The electronic databases MEDLINE, PsycINFO, COCHRANE, CINAHL and EMBASE. Review Methods: Studies were included if samples were: ≥ 18 years old, overweight or obese (BMI 26-39.99 kg/m 2 ), and diagnosed with CHD, T2DM and/or HTN. Only randomised controlled trials (RCTs) or systematic reviews of RCTs reporting group-based interventions that combined dietary, exercise and behavioural change strategies and outcomes for weight, BMI and/or waist circumference up to 12 months were included. Two researchers extracted data and appraised quality, with a third making final decisions. Results: Eight RCTs were included (total n = 1428). Participants' mean age was 60.4 years and 61% were female. Interventions varied by contact time, content and delivery. Mean weight loss ranged from -2 kg to -4 kg (SD 4 kg) at 3-4 months, -1.3 kg to -8.2 kg (SD 4 kg) at 5-6 months and -0.87 (SD 0.57 kg) to -6.9 kg (SD 4 kg) at 12 months. Of the few studies that measured waist circumference the mean reduction was -3.1 cm at three and 12 months. Conclusions: Weight loss interventions that combine exercise, diet and behaviour change strategies result in minor weight loss at 3-12 months in people with CHD, T2DM or HTN. Further research is required to determine the most effective and efficient methods.
European Journal of Clinical Nutrition, 1999
To test the short and long-term effectiveness of a four week residential program for primary health care patients to control obesity and related risk factors for cardio-vascular disease (CVD), especially blood pressure (BP). Prospective clinical study, with follow up after 1 and 5 y. Vindeln Patient Education Centre, Vindeln, and Department of Social Medicine, University of Umea, Sweden. Approximately 2500 individuals, with two or more of the traditional risk factors for CVD, participated in the program. This report describes a subsample of 100 consecutive patients, 52+/-9 y, 53 men, with obesity and/or high BP. Four week residential program with lectures and group discussions as well as practical sessions in smaller groups (meal preparations, physical exercise, etc). The patients were followed-up medically in their home area. Weight and blood pressure. Dramatic reductions of weight and, especially, of blood pressure (BP) occurred during the residential weeks, and the reductions were pronounced also after 1 y. After 5 y, the total mean weight among men with initial BMI > or = 30 kg/m2 was still 5 kg lower, and diastolic and systolic BP among those with hypertension was 15 and 20 mm Hg lower, respectively, than before the program. The full-time participation in the residential program and the enrollment and commitment of the patients may explain the clinical outcome. A level of predisposition greater than that required of most weight- and BP-control programs was confirmed and a great preventive or therapeutic potential was indicated. The study illustrates an effective application of the Precede-Proceed model of health promotion planning.