Clinicians important influencers in weight and related health issues for overweight patients

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Physicians can have an influence on their overweight and obese patients by counseling them to prevent further weight gain and by helping patients to have a more realistic perception of their weight, which may lead to behavioral changes, according to two reports in the February 28 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

In background information in the articles, the authors comment that the increasing prevalence of overweight and obesity is now a worldwide problem that is associated with higher risk of death, and the development of certain cardiovascular diseases, type 2 diabetes and some cancers. “Studies show that lifestyle intervention (including a nutrition and physical activity component) are needed to maintain or lose weight,” the authors note. “The primary care setting is suitable for weight maintenance; previous studies have shown that lifestyle interventions in primary care can be effective, at least in the short term.”

Nancy C.W. ter Bogt, M.Sc., from the University Medical Center Groningen, the Netherlands, and colleagues, examined the results of a long-term, 3-year study on lifestyle counseling by nurse practitioners compared with general practitioners and usual care in overweight and obese patients in preventing weight gain and improving health status. The 457 study participants, average age 56 years and 52 percent female, were randomized into two groups.

The 225 patients in the nurse practitioner group received lifestyle counseling using a standardized program of individual visits and feedback sessions by telephone. The remaining 232 patients were in the general practitioner usual care group. All patients had medical examinations that included measurements of body weight, length, waist circumference and blood pressure. The measurements were performed at baseline (between January and July 2006), after one and three years.

“In both groups, approximately 60 percent of the participants achieved weight maintenance after three years,” the authors report. There was no significant difference in the average weight change and change of waist circumference between the two groups. There was a significant difference in the impaired fasting glucose level between the two groups: 6 percent in the nurse practitioner group vs. 12 percent in the general practitioner usual care group. But, there were no significant differences for lipid levels and blood pressure readings.

In conclusion the authors write: “Lifestyle counseling by nurse practitioners did not lead to significantly better prevention of weight gain compared with general practitioners. In the majority in both groups, lifestyle counseling succeeded in preventing (further) weight gain.”

(Arch Intern Med. 2011; 171[4]:306-313. Available pre-embargo to the media at http://www.jamamedia.org)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Commentary: Is Primary Care Practice Equipped to Deal with Obesity?

In an accompanying invited commentary, Debra Haire-Joshu, Ph.D. and Samuel Klein, M.D., from Washington University School of Medicine, St. Louis, write that “the primary care provider is a critical entry point to the health care setting for the obese population.”

“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.”

(Arch Intern Med. 2011; 171[4]:313-315. Available pre-embargo to the media at http://www.jamamedia.org)

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