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Preventing Weight Gain by Lifestyle Intervention in a General Practice Setting: Three-Year Results of a Randomized Controlled Trial
Study Questions:
Can an intervention implemented in a general office practice prevent weight gain among adults?
Methods:
This was a randomized controlled trial in 11 general practice locations in the Netherlands. All patients included had a body mass index (BMI) between 25 and 40 kg/m2 and a diagnosis of hypertension and/or dyslipidemia. The intervention group received lifestyle counseling from a nurse practitioner (NP). Those in the control group received usual care from their general practitioner (GP). The primary outcome of interest was body weight, waist circumference, blood pressure, fasting glucose, and lipids after 3 years.
Results:
A total of 457 patients were included (mean age 56 years, 52% female). The dropout rate was 24% in the intervention (NP) group and 20% in the usual care (GP) group. In both groups, approximately 60% of participants achieved weight maintenance after 3 years. The change in weight over 3 years was -1.1 in the NP group and -0.5 in the GP group (p = 0.34). There was no significant difference in mean weight change or change in waist circumference. Fasting glucose was lower among those in the NP group (-0.02) compared with the GP group (0.10) (p = 0.02). No difference between groups was observed for changes in lipids or blood pressure.
Conclusions:
The investigators concluded that lifestyle counseling by NPs did not result in significant benefits in terms of weight maintained, waist circumference, or other measures of prevention efforts, including lipids and blood pressure. In the majority of patients, lifestyle counseling by providers or NPs results in prevention of weight gain.
Perspective:
This suggests that lifestyle counseling by GPs can help patients prevent weight gain, and is equivalent to an intervention by NPs. However, the majority of physicians do not routinely counsel patients regarding lifestyle modification.
Keywords: Waist Circumference, Life Style, Body Mass Index, Nurse Practitioners, Body Weight, Counseling, Netherlands, Weight Gain, Patient Dropouts, General Practitioners, Glucose
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