Research article
Preventing Weight Gain: One-Year Results of a Randomized Lifestyle Intervention

https://doi.org/10.1016/j.amepre.2009.06.011Get rights and content

Background

Lifestyle interventions targeting prevention of weight gain may have better long-term success than when aimed at weight loss. Limited evidence exists about such an approach in the primary care setting.

Design

An RCT was conducted.

Setting/participants

Participants were 457 overweight or obese patients (BMI=25–40 kg/m2, mean age 56 years, 52% women) with either hypertension or dyslipidemia, or both, from 11 general practice locations in the Netherlands.

Intervention

In the intervention group, four individual visits to a nurse practitioner (NP) and one feedback session by telephone were scheduled for lifestyle counseling with guidance of the NP using a standardized computerized software program. The control group received usual care from their general practitioner (GP).

Main outcome measures

Changes in body weight, waist circumference, blood pressure, and blood lipids after 1 year (dropout <10%). Data were collected in 2006 and 2007. Statistical analyses were conducted in 2007 and 2008.

Results

There were more weight losers and stabilizers in the NP group than in the general practitioner usual care (GP-UC) group (77% vs 65%; p<0.05). In men, mean weight losses were 2.3% for the NP group and 0.1% for the GP-UC group (p<0.05). Significant reductions occurred also in waist circumference but not in blood pressure, blood lipids, and fasting glucose. In women, mean weight losses were in both groups 1.6%. In the NP group, obese people lost more weight (−3.0%) than the non-obese (−1.3%; p<0.05).

Conclusions

Standardized computer-guided counseling by NPs may be an effective strategy to support weight-gain prevention and weight loss in primary care, in the current trial, particularly among men.

Trial registration

The study was registered with the Netherlands Trial Register (NTR), www.trialregister.nl, study no. TC 1365.

Introduction

The prevalence of overweight and obesity is increasing in the Netherlands. The upward trend since 1980 is similar across genders, age groups, and degrees of urbanization.1 Prevention of overweight is a public health priority because overweight and obesity are important risk factors for the development of coronary vascular diseases (partly independent of blood pressure and cholesterol levels2), type 2 diabetes, certain types of cancer, gastrointestinal diseases, and arthritis.3

According to (inter)national guidelines, persistent lifestyle changes are necessary for preventing and managing obesity.4, 5 Studies on lifestyle interventions have shown a decrease in the risk of type 2 diabetes6, 7, 8 and hypertension.9 Positive changes in lifestyle may improve health status even without losing weight.10 There is no clear consensus on the most (cost) effective way to implement lifestyle interventions, but attention to both nutrition and physical activity, applying components from behavioral therapy, and continuity and intensity are important aspects.11, 12

In the Netherlands, general practitioners (GPs) are often responsible for the treatment of hypertension and dyslipidemia, and according to their guidelines this treatment includes lifestyle advice. However, lack of time and knowledge to achieve behavioral changes and insufficient continuity of care impede this approach by GPs.13 Specially trained nurse practitioners (NPs) are probably better equipped for lifestyle counseling than GPs and can avoid these barriers.14

Previous lifestyle interventions showed clinically relevant reductions in body weight after 1 year.6 However, weight regain after initial success is a commonly acknowledged problem. Most of these studies were performed in obese populations. Further, many studies included small and mainly female samples and were hampered by large dropout rates. According to the WHO, additional high-quality trials are needed to widen our insight into the sustained effectiveness of lifestyle counseling on body weight.3

To investigate the long-term effects of lifestyle counseling by NPs, and its potential contribution in counteracting the rising trend of overweight and obesity, the Groningen Overweight and Lifestyle (GOAL) study was started in 2006. This RCT included more than 400 overweight or obese patients at relatively low risk for cardiovascular diseases. An early focus on preventing (progression of) overweight and comorbidities rather than on weight loss may be more successful in the long term. A 3-year follow-up for GOAL is foreseen.

The effects were evaluated after a 1-year follow-up of computer-guided lifestyle advice by NPs (intervention condition) in comparison to care as usual by GPs (control condition) on body weight and conventional risk markers. A secondary aim was to identify patient and study characteristics that are associated with weight loss.

Section snippets

Recruitment and Assignment

Initially, 12 general practice locations (varying from one to seven GPs and one to three NPs per location) in the northern part of the Netherlands were willing to participate. Between June 2005 and February 2006, a total of 5738 patients (aged 40–70 years) were invited for a screening visit to check on the inclusion criteria for the GOAL study (chosen at random 200–250 patients for each GP). Almost 25% of the invited patients participated in the screening (n=1378). Presuming a BMI >25 kg/m2 for

Baseline Measurements

Table 2 shows that there were no differences in the two study groups at baseline except for higher percentages having sufficient physical activity and a history of >3 previous attempts to lose weight in the past 5 years in the GP-UC group compared with those in the NP group. When stratified for gender, women in the GP-UC group were older (aged 57 vs 55 years); had hypertension more often (66% vs 54%); and were sufficiently physically active more often (75% vs 58%) (p<0.05 for all); in men there

Discussion

Lifestyle counseling using a prestructured software program in a primary care setting succeeded in a weight reduction of 3% in obese people and weight maintenance in people with moderate overweight, which is precisely according to the guidelines.4, 5 The results were more favorable in men, with significant effects on waist circumference, than in women, where no differences were found between the NP and the GP-UC groups.

Previous research showed that clinically relevant weight loss of 5% can be

References (24)

  • L.J. Appel et al.

    Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial

    JAMA

    (2003)
  • K.E. Powell et al.

    Physical activity and health

    Br Med J

    (1996)
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