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Effectiveness of a tailor-made weight loss intervention in primary care

European Journal of Nutrition volume 53, pages 95–104 (2014)Cite this article

Abstract

Introduction

Weight loss interventions have been studied extensively, but methodological limitations negatively affecting applicability in everyday clinical practice are a very common problem in these studies. Despite the fact that obesity is treated mostly in a primary care setting, studies that investigate weight loss interventions in a primary care setting are scarce. Our objective was to assess the effectiveness of a tailor-made weight loss intervention in achieving a clinically significant weight loss in overweight (BMI ≥ 27 kg/m²) women aged 50–60 years in a primary care setting.

Methods

As part of a randomized controlled trial on the effects of a tailor-made weight loss intervention and oral glucosamine sulphate on the incidence of osteoarthritis of the knee in 407 overweight women aged 50–60 years, we analysed the effectiveness of the weight loss intervention in achieving clinically relevant weight loss.

Results

At baseline, the mean body weight for all participants was 88.7 ± 13.2 kg, and the mean BMI was 32.4 ± 4.3 kg/m². The percentage of participants that lost ≥5 kg or 5 % of their baseline body weight was 14.8 versus 6.3 % (p = 0.012) at 6 months for the intervention group and the control group, respectively. At 12 months, this was 18.7 versus 14.9 % (p = 0.027). Mean weight gain at 6 months was −0.9 versus 0.9 kg (p < 0.001) for the intervention group and the control group, respectively. At 12 months, this was −0.6 versus 0.6 kg (p = 0.01). At 30 months of follow-up, no significant differences were found between both groups.

Conclusions

This weight loss intervention, which, at short notice, is easily applicable in everyday clinical practice, is effective in achieving clinically significant weight loss in overweight women aged 50–60 over a 12-month period. Long-term weight loss maintenance, however, occurred only marginally. Magnitude of the effect is comparable to that achieved in many other more intensive weight loss interventions.

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References

  1. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA et al (2002) Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 346(6):393–403

    CAS  Article  Google Scholar 

  2. Neter JE, Stam BE, Kok FJ, Grobbee DE, Geleijnse JM (2003) Influence of weight reduction on blood pressure: a meta-analysis of randomized controlled trials. Hypertension 42(5):878–884

    CAS  Article  Google Scholar 

  3. Wing RR (2010) Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the look AHEAD trial. Arch Intern Med 170(17):1566–1575

    CAS  Google Scholar 

  4. Douketis JD, Macie C, Thabane L, Williamson DF (2005) Systematic review of long-term weight loss studies in obese adults: clinical significance and applicability to clinical practice. Int J Obes (Lond) 29(10):1153–1167

    CAS  Article  Google Scholar 

  5. Wadden TA, Volger S, Sarwer DB, Vetter ML (2011) A two-year randomized trial of obesity treatment in primary care practice. N Engl J Med 365(21):1969–1979

    CAS  Article  Google Scholar 

  6. Appel LJ, Clark JM, Yeh HC et al (2011) Comparative effectiveness of weight-loss interventions in clinical practice. N Engl J Med 365(21):1959–1968

    CAS  Article  Google Scholar 

  7. Franz MJ, VanWormer JJ, Crain AL, Boucher JL, Histon T, Caplan W et al (2007) Weight-loss outcomes: a systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up. J Am Diet Assoc 107(10):1755–1767

    Article  Google Scholar 

  8. Miller WC (2001) Effective diet and exercise treatments for overweight and recommendations for intervention. Sports Med 31(10):717–724

    CAS  Article  Google Scholar 

  9. Teixeira PJ, Silva MN, Coutinho SR, Palmeira AL, Mata J, Vieira PN et al (2010) Mediators of weight loss and weight loss maintenance in middle-aged women. Obesity (Silver Spring) 18(4):725–735

    Article  Google Scholar 

  10. Rubak S, Sandbaek A, Lauritzen T, Christensen B (2005) Motivational interviewing: a systematic review and meta-analysis. Br J Gen Pract 55(513):305–312

    Google Scholar 

  11. Runhaar J, van Middelkoop M, Steens R, Vroegindeweij D, van Osch G, Reijman M, Koes B, Bierma-Zeinstra S (2008) Prevention of knee osteoarthritis in overweight females; from feasibility trial to full-scale trial. Osteoarthr Cartilage 16(Supplement 4):S141

    Article  Google Scholar 

  12. Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K et al (1986) Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum 29(8):1039–1049

    CAS  Article  Google Scholar 

  13. Gezondheidsraad (2003) Overgewicht en obesitas. Den Haag: Gezondheidsraad; publicatie nr 2003/07

  14. Strecher VJ, Seijts GH, Kok GJ, Latham GP, Glasgow R, DeVellis B et al (1995) Goal setting as a strategy for health behavior change. Health Educ Q 22(2):190–200

    CAS  Article  Google Scholar 

  15. Gollwitzer PM (1999) Implementation intentions—strong effects of simple plans. Am Psychol 54(7):493–503

    Article  Google Scholar 

  16. Lean ME, Han TS, Deurenberg P (1996) Predicting body composition by densitometry from simple anthropometric measurements. Am J Clin Nutr 63(1):4–14

    CAS  Google Scholar 

  17. Group E (2007) EQ-5D value sets: inventory, comparative review and user guide. Springer, Dordrecht

    Google Scholar 

  18. Wendel-Vos GC, Schuit AJ, Saris WH, Kromhout D (2003) Reproducibility and relative validity of the short questionnaire to assess health-enhancing physical activity. J Clin Epidemiol 56(12):1163–1169

    Article  Google Scholar 

  19. de Hollander EL, Zwart L, de Vries SI, Wendel-Vos W (2012) The SQUASH was a more valid tool than the OBiN for categorizing adults according to the Dutch physical activity and the combined guideline. J Clin Epidemiol 65(1):73–81

    Google Scholar 

  20. Ainsworth BE, Haskell WL, Leon AS, Jacobs DR Jr, Montoye HJ, Sallis JF et al (1993) Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc 25(1):71–80

    CAS  Article  Google Scholar 

  21. Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ et al (2000) Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 32(9 Suppl):S498–S504

    CAS  Article  Google Scholar 

  22. Figard-Fabre H, Fabre N, Leonardi A, Schena F (2010) Physiological and perceptual responses to Nordic walking in obese middle-aged women in comparison with the normal walk. Eur J Appl Physiol 108(6):1141–1151

    CAS  Article  Google Scholar 

  23. van Assema P, Brug J, Ronda G, Steenhuis I (2001) The relative validity of a short Dutch questionnaire as a means to categorize adults and adolescents to total and saturated fat intake. J Hum Nutr Diet 14(5):377–390

    Article  Google Scholar 

  24. Thabane L, Chu R, Cuddy K, Douketis J (2007) What is the quality of reporting in weight loss intervention studies? A systematic review of randomized controlled trials. Int J Obes (Lond) 31(10):1554–1559

    CAS  Article  Google Scholar 

  25. DeSouza CM, Legedza AT, Sankoh AJ (2009) An overview of practical approaches for handling missing data in clinical trials. J Biopharm Stat 19(6):1055–1073

    Article  Google Scholar 

  26. Soper DS (2012) Sobel test calculator for the significance of mediation (Online Software). http://www.danielsoper.com/statcalc3

  27. Sobel ME (1982) Asymptotic confidence intervals for indirect effects in structural equation models. Sociol Methodol 13:290–312

    Article  Google Scholar 

  28. Kraemer HC, Wilson GT, Fairburn CG, Agras WS (2002) Mediators and moderators of treatment effects in randomized clinical trials. Arch Gen Psychiatry 59(10):877–883

    Article  Google Scholar 

  29. Kemper HCG, Ooijendijk WTM, Stiggelbout M (2000) Consensus about the Dutch physical activity guideline. Tijdschr Soc Geneeskd 78:180–183 [in Dutch]

    Google Scholar 

  30. Finkler E, Heymsfield SB, St-Onge MP (2012) Rate of weight loss can be predicted by patient characteristics and intervention strategies. J Acad Nutr Diet 112:75–80

    Google Scholar 

  31. Tsai AG, Wadden TA (2009) Treatment of obesity in primary care practice in the United States: a systematic review. J Gen Intern Med 24(9):1073–1079

    Article  Google Scholar 

  32. Arem H, Irwin M (2011) A review of web-based weight loss interventions in adults. Obes Rev 12(5):e236–e243

    CAS  Article  Google Scholar 

Download references

Acknowledgments

This study was financed by ZonMw, Netherlands Organisation for Health Research and Development.

Conflict of interest

The authors declare no conflict of interest.

Author information

Affiliations

  1. Department of General Practice, Erasmus MC, University Medical Centre Rotterdam, Room GK 1048, PO Box 2040, 3000 CA, Rotterdam, The Netherlands

    Bastiaan C. de Vos, Jos Runhaar & Sita M. A. Bierma-Zeinstra

  2. Department of Orthopaedics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands

    Sita M. A. Bierma-Zeinstra

Authors
  1. Bastiaan C. de Vos
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  2. Jos Runhaar
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  3. Sita M. A. Bierma-Zeinstra
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Correspondence to Jos Runhaar.

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de Vos, B.C., Runhaar, J. & Bierma-Zeinstra, S.M.A. Effectiveness of a tailor-made weight loss intervention in primary care. Eur J Nutr 53, 95–104 (2014). https://doi.org/10.1007/s00394-013-0505-y

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  • DOI: https://doi.org/10.1007/s00394-013-0505-y

Keywords

  • Overweight
  • Weight reduction
  • Weight loss intervention