Thursday, September 29

How effective are behavioural weight loss interventions in primary care?

Multiple supportive relationships in the community can aid in weight loss.

Achieving and maintaining a healthy weight is a major global health concern, not only in the United States but also in many other nations. Governments are searching for the most effective services to assist individuals in losing weight and improving their overall health. Data from the United States, the United Kingdom, and Spain were used in a recent systematic review and meta-analysis (a large study of studies) that looked at how well weight management interventions in primary care settings work.

Examining weight loss assistance in primary care

Researchers analysed 34 studies involving adults with a body mass index of 25 or higher (overweight). They investigated individuals who had received weight loss interventions in primary care settings. Instruction on weight management behaviours such as low-calorie diets, increased exercise, use of food diaries, and/or behavioural self-management approaches with support from clinic staff to set weight-related goals, solve problems, and increase self-efficacy were included in the interventions.

Interventions for weight loss were delivered via telephone, internet, email, or in-person and included group-based and/or individual connections. The study compared these interventions to not doing anything to help people lose weight, using printed or electronic information about weight loss, or teaching people how to control their attention to resist urges or behaviours without focusing on weight loss.

Programs delivered through primary care did result in significant weight loss.

The interventions were administered by various medical professionals (nurses, dietitians, and general practitioners) and nonmedical practitioners, such as health coaches. The length of the interventions ranged from one session (where patients followed the programme on their own for three months) to multiple sessions over three years, with the average being 12 months.

At one year, the average difference in weight loss between the intervention and comparison groups (no specific weight loss intervention) was 5,1 pounds, and at two years, it was 4 pounds for those who received weight loss interventions in primary care. At one year, there was also a -2.5 cm mean difference in waist circumference in favour of the intervention.

Importantly, because this was a systematic review of 34 trials involving a wide variety of interventions, the authors were unable to determine which interventions specifically produced the results.

Even modest weight reduction affects health.

Even though a 5-pound weight loss difference between the intervention group and the control group may not seem like much, research has shown that a 2% to 5% weight loss is linked to health benefits, such as lower systolic blood pressure and lower triglyceride and glucose levels, which may have an effect on cardiac health.

Does individual monitoring and support affect weight loss?

It was acknowledged in the study that the comparison groups had fewer interpersonal contacts than the intervention groups, and this may have played a significant role in the findings. More interactions between patients and providers led to greater weight loss. The research indicates that programmes should include at least twelve contacts (face-to-face, telephone, or a combination).

Although the cost of the programmes was not determined by the study, it is probable that interventions delivered by nonmedical personnel under the supervision and support of primary care health professionals would be less expensive. Since physicians and general practitioners are unlikely to have the time for 12 consultations to support a weight management programme, it is possible that a combination of practitioners would be more effective.

Prior research supports community-based behavioural weight loss interventions.

A 2018 research, conducted for the US Preventive Services Task Force and published with similar findings, This review found that participants who received weight management interventions in a variety of settings, including universities, primary care, and the community, lost an average of 5.3 pounds. At 12 to 18 months, participants in behavior-based interventions had greater mean weight loss and less weight gain compared to controls.

In the two largest trials (of the 124 identified), those who received weight management interventions were less likely to develop type 2 diabetes than those who did not. Over a period of three to nine years, the risk of diabetes went down by about 14.5% in both trials. This means that people in the weight loss management group were 14.5% less likely to get diabetes than those in the control group.

What is the conclusion?

The delivery of weight management interventions in primary care settings is an efficient method of providing services. Primary care practises have extensive community reach and are frequently the first point of contact for individuals with the healthcare system. With the number of obese people rising, every effort should be made to reach out to patients who are trying to lose weight and help them in ways that work.

How can you proceed?

Ask your primary care physician if their office or clinic offers weight management programmes.
Contact your health insurance provider and inquire about weight management and risk factor reduction programmes. Inquire if they are free or discounted under your plan.
Check to see if there are any community-based wellness and weight management programmes in your area, such as the YMCA, a school-based programme, or a senior centre.

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