Testing the effectiveness of a novel, evidence-based weight management and lifestyle modification programme in primary care: the Healthy Weight Initiative
Scott Slater 1 * , David Lambkin 2 , Tracy Schumacher 3 , Annabelle Williams 1 , John Baillie 11 Hunter New England and Central Coast Primary Health Network, 11/125 Bull Street, Newcastle West, NSW 2302, Australia.
2 Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
3 Department of Rural Health, Faculty of Health and Medicine, The University of Newcastle, Tamworth, NSW, Australia.
Journal of Primary Health Care 14(1) 64-73 https://doi.org/10.1071/HC21065
Published: 13 April 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of the Royal New Zealand College of General Practitioners. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
Introduction: Primary care prevention strategies that support and provide tools for general practice have the potential to slow and reverse rates of overweight and obesity.
Aim: To test the effectiveness of a novel 12-week, online, structured, evidence-based weight management and lifestyle modification programme in general practices.
Methods: Between August 2018 and March 2020, participants with a body mass index (BMI) ≥ 25 were recruited from general practices in the Hunter New England and Central Coast Primary Health Network region of Australia. Practices were randomly assigned to deliver a ‘low-intensity’ (LI) or ‘high-intensity’ (HI) variant of the programme. Practitioners were trained in programme delivery. The intervention involved weekly progress and accountability checks and scripted education sessions on evidenced-based nutrition, physical activity and lifestyle modification. The trial included follow-up evaluations at 6 and 12 months.
Results: In total, 695 participants were recruited from 26 practices. At the end of the 12-week programme, participants in the HI treatment arm lost an average of 3.2 kg (s.d. 3.8) and 29% (50/172) achieved clinically significant weight loss (>5% of initial body weight). Positive results were maintained at evaluations by participants in the HI treatment arm who attended, but only 31% of participants at 6 months and 21% at 12 months were followed up.
Discussion: Participant engagement and retention and practitioner workload burden are key factors in the design of weight management programmes in primary care. Many lessons can be obtained as a result of this trial, and programme adjustments have been identified to improve its delivery model.
Keywords: chronic disease prevention, evidence-based weight management, general practice, GP-led weight management, nutrition, obesity, physical activity, primary care.
References
[1] NSW Ministry of Health. NSW Population Health Survey Results 2018.Centre for Epidemiology and Evidence: NSW Ministry of Health; 2018.[2] Colagiuri S, Lee CMY, Colagiuri R, et al. The cost of overweight and obesity in Australia. Med J Aust 2010; 192 260–4.
| The cost of overweight and obesity in Australia.Crossref | GoogleScholarGoogle Scholar | 20201759PubMed |
[3] Jansen S, Desbrow B, Ball L. Obesity management by general practitioners: the unavoidable necessity. Aust J Prim Health 2015; 21 366–8.
| Obesity management by general practitioners: the unavoidable necessity.Crossref | GoogleScholarGoogle Scholar | 26349423PubMed |
[4] Booth HP, Prevost TA, Wright AJ, Gulliford MC. Effectiveness of behavioural weight loss interventions delivered in a primary care setting: a systematic review and meta-analysis. Fam Pract 2014; 31 643–53.
| Effectiveness of behavioural weight loss interventions delivered in a primary care setting: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar | 25298510PubMed |
[5] Glenister KM, Malatzky CA, Wright J. Barriers to effective conversations regarding overweight and obesity in regional Victoria. Aust Fam Physician 2017; 46 769–73.
| 29036779PubMed |
[6] National Health and Medical Research Council. Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia. Melbourne: NHMRC; 2013. Available at https://www.nhmrc.gov.au/about-us/publications/clinical-practice-guidelines-management-overweight-and-obesity [Accessed 22 February 2022]
[7] Greaves CJ, Sheppard KE, Abraham C, et al. Systematic review of reviews of intervention components associated with increased effectiveness in dietary and physical activity interventions. BMC Public Health 2011; 11 119
| Systematic review of reviews of intervention components associated with increased effectiveness in dietary and physical activity interventions.Crossref | GoogleScholarGoogle Scholar | 21333011PubMed |
[8] Sturgiss EA, van Weel C, Ball L, et al. Obesity management in Australian primary care: where has the general practitioner gone? Aust J Prim Health 2016; 22 473–6.
| Obesity management in Australian primary care: where has the general practitioner gone?Crossref | GoogleScholarGoogle Scholar | 27816067PubMed |
[9] Sturgiss EA, Elmitt N, Haesler E, et al. Feasibility and acceptability of a physician-delivered weight management programme. Fam Pract 2017; 34 43–8.
| Feasibility and acceptability of a physician-delivered weight management programme.Crossref | GoogleScholarGoogle Scholar | 28122922PubMed |
[10] Tan D, Zwar NA, Dennis SM, Vagholkar S. Weight management in general practice: what do patients want? Med J Aust 2006; 185 73–5.
| Weight management in general practice: what do patients want?Crossref | GoogleScholarGoogle Scholar | 16842059PubMed |
[11] Forgione N, Deed G, Kilov G, Rigas G. Managing obesity in primary care: breaking down the barriers. Adv Therapy 2018; 35 191–8.
| Managing obesity in primary care: breaking down the barriers.Crossref | GoogleScholarGoogle Scholar |
[12] Hoffmann TC, Glasziou PP, Boutron I, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. Br Med J 2014; 348 g1687
| Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide.Crossref | GoogleScholarGoogle Scholar |
[13] Australian Bureau of Statistics. Australian Statistical Geography Standard (ASGS): Volume 5 – Remoteness Structure (cat. no. 1270.0.55.005). Canberra: ABS; 2014. Available from: https://www.abs.gov.au/ausstats/abs@.nsf/mf/1270.0.55.005 [Accessed 22 February 2022]
[14] Henry JD, Crawford JR. The short-form version of the depression anxiety stress scales (DASS-21): construct validity and normative data in a large non-clinical sample. Br J Clin Psychol 2005; 44 227–39.
| The short-form version of the depression anxiety stress scales (DASS-21): construct validity and normative data in a large non-clinical sample.Crossref | GoogleScholarGoogle Scholar | 16004657PubMed |
[15] Chacko SA, Chiodi SN, Wee CC. Recognizing disordered eating in primary care patients with obesity. Prev Med 2015; 72 89–94.
| Recognizing disordered eating in primary care patients with obesity.Crossref | GoogleScholarGoogle Scholar | 25572624PubMed |
[16] National Health and Medical Research Council. Australian Dietary Guidelines. Canberra: NHMRC; 2013. Available from: https://www.eatforhealth.gov.au/sites/default/files/content/n55_australian_dietary_guidelines.pdf
[17] Commonwealth of Australia: Department of Health. Physical activity and exercise guidelines for all Australians. Canberra: Australian Government; 2021. Available at https://www.health.gov.au/health-topics/physical-activity-and-exercise/physical-activity-and-exercise-guidelines-for-all-australians?utm_source=health.gov.au&utm_medium=callout-auto-custom&utm_campaigndigital_transformation [Accessed 22 February 2022]
[18] Faries MD, Boroff CS, Stults-Kolehmainen M, Bartholomew JB. Does a visual representation impact the affective response to body composition testing? Personality Individ Diff 2011; 50 502–5.
| Does a visual representation impact the affective response to body composition testing?Crossref | GoogleScholarGoogle Scholar |
[19] Evaluation of the Counterweight Programme for obesity management in primary care: a starting point for continuous improvement. Br J Gen Pract 2008; 58 548–54.
| Evaluation of the Counterweight Programme for obesity management in primary care: a starting point for continuous improvement.Crossref | GoogleScholarGoogle Scholar | 18682018PubMed |
[20] National Institutes of Health, National Heart, Lung, and Blood Institute, North American Association for the Study of Obesity. The practical guide: identification, evaluation, and treatment of overweight and obesity in adults. 2000. Available at https://www.nhlbi.nih.gov/files/docs/guidelines/prctgd_c.pdf [Accessed 22 February 2022]
[21] Kumanyika SK, Fassbender JE, Sarwer DB, et al. One-year results of the Think Health! Study of weight management in primary care practices. Obesity 2012; 20 1249–57.
| One-year results of the Think Health! Study of weight management in primary care practices.Crossref | GoogleScholarGoogle Scholar | 22051940PubMed |
[22] The Royal Australian College of General Practitioners. Australian-first program to help GPs work with patients with obesity. RACGP; 2018. Available at https://www1.racgp.org.au/newsgp/clinical/australian-first-program-launched-to-help-gps-work [Accessed 22 February 2022]
[23] Jolly K, Lewis A, Beach J, et al. Comparison of range of commercial or primary care led weight reduction programmes with minimal intervention control for weight loss in obesity: lighten up randomised controlled trial. Br Med J 2011; 343 d6500
| Comparison of range of commercial or primary care led weight reduction programmes with minimal intervention control for weight loss in obesity: lighten up randomised controlled trial.Crossref | GoogleScholarGoogle Scholar |
[24] Britt H, Valenti L, Miller G. Time for care. Length of general practice consultations in Australia. Aust Fam Phys 2002; 31 876–80.
[25] Yardley L, Ware LJ, Smith ER, et al. Randomised controlled feasibility trial of a web-based weight management intervention with nurse support for obese patients in primary care. Int J Behav Nutr Phys Activ 2014; 11 67.
| Randomised controlled feasibility trial of a web-based weight management intervention with nurse support for obese patients in primary care.Crossref | GoogleScholarGoogle Scholar |
[26] Ventura Marra M, Lilly CL, Nelson KR. A pilot randomized controlled trial of a telenutrition weight loss intervention in middle-aged and older men with multiple risk factors for cardiovascular disease. Nutrients 2019; 11 229
| A pilot randomized controlled trial of a telenutrition weight loss intervention in middle-aged and older men with multiple risk factors for cardiovascular disease.Crossref | GoogleScholarGoogle Scholar |
[27] Grimshaw JM, Shirran L, Thomas R, et al. Changing provider behavior: an overview of systematic reviews of interventions. Med Care 2001; 39 Ii2–45.
| 11583120PubMed |
[28] Kushner RF. Barriers to providing nutrition counseling by physicians: a survey of primary care practitioners. Prev Med 1995; 24 546–52.
| Barriers to providing nutrition counseling by physicians: a survey of primary care practitioners.Crossref | GoogleScholarGoogle Scholar | 8610076PubMed |
[29] Australian Government Department of Health. The National Obesity Summit: Summary of Proceedings. Canberra: Australian Government; 2019. Available at https://www.health.gov.au/sites/default/files/documents/2021/03/national-obesity-summit-summary-of-proceedings.pdf [Accessed 22 February 2022]
