Interventions for body weight reduction in obese patients during short consultations: an open-label randomized controlled trial in the Japanese primary care setting
Tóm tắt
Family physicians should maintain regular contact with obese patients to ensure they effectively reduce their body weight. However, family physicians in Japan have on average only 6 (min) per consultation, and conventional interventions for body weight reduction require a longer consultation or additional manpower. A brief intervention within the limited consultation time available is therefore needed. Here we investigated the effectiveness of a brief weight reduction intervention for obese patients and the related factors for reducing body weight during routine consultations in the primary care setting. We conducted an open-label randomized controlled trial at a family medicine clinic in Fukushima, Japan from January 2010 to June 2011. Patients aged 30 to 69 years with body mass index ≥25 who were diagnosed with hypertension, dyslipidemia, and/or type 2 diabetes mellitus were randomly assigned to the intervention or control group. At every consultation, body weight in the intervention group was measured by a family physician who provided weight reduction advice in addition to usual care. The primary outcome was body weight change at 1-year follow up. Analysis was done by intention to treat. We randomly assigned 29 participants to the intervention group and 21 to the control group. Forty participants (80 %) remained in the trial until the 1-year follow up. At follow up, the median body weight change from baseline was not significantly different between the groups (p = 0.68), at −0.8 (interquartile range [IQR] −2.5 to 1.0) kg in the intervention group and 0.2 (IQR −2.4 to 0.8) kg in the control group. We devised an intervention method for physicians to measure body weight and advise on weight reduction during routine consultations. In our setting, this method did not extend the consultation time, but also had no significant additional effects on body weight reduction in moderately obese patients. This trial is registered with the UMIN Clinical Trial Registry (
UMIN000002967
).
Tài liệu tham khảo
Ministry of Health, Labour and Welfare, Japan: 2011 Patient survey. http://www.mhlw.go.jp/english/database/db-hss/sps_2011.html. Accessed 13 Nov 2013
Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F, Bales VS, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA. 2003;289:76–9.
Xiao J, Yang W. Weight loss is still an essential intervention in obesity and its complications: a review. J Obes. 2012;2012:1–6.
World Health Organization. Obesity and overweight WHO fact sheet No311. 2013.
Ministry of Health, Labour and Welfare, Japan: 2011 National Health and Nutrition Survey. http://www.mhlw.go.jp/bunya/kenkou/kenkou_eiyou_chousa.html. Accessed 11 Nov 2013. [in Japanese]
Kanazawa M, Yoshiike N, Osaka T, Numba Y, Zimmet P, Inoue S. Criteria and classification of obesity in Japan and Asia-Oceania. Asia Pac J Clin Nutr. 2002;11 Suppl 8:S732–7.
World Health Organization. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363:157–63.
Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation. 2014;129(25 Suppl 2):S102–38. doi:10.1161/01.cir.0000437739.71477.ee. Epub 2013 Nov 12.S102-38.
Galuska DA, Will JC, Serdula MK, Ford ES. Are health care professionals advising obese patients to lose weight? JAMA. 1999;282:1576–8.
Stecker T, Sparks S. Prevalence of obese patients in a primary care setting. Obesity (Silver Spring). 2006;14:373–6.
Epstein L, Ogden J. A qualitative study of GPs’ views of treating obesity. Br J Gen Pract. 2005;55:750–4.
Beasley JW. How many problems do family physicians manage at each encounter? A WReN study. Ann Fam Med. 2004;2:405–10.
Wadden TA, Volger S, Sarwer DB, Vetter ML, Tsai AG, Berkowitz RI, et al. A two-year randomized trial of obesity treatment in primary care practice. N Engl J Med. 2011;365:1969–79.
Nanchahal K, Townsend J, Letley L, Haslam D, Wellings K, Haines A. Weight-management interventions in primary care: a pilot randomised controlled trial. Br J Gen Pract. 2009;59:157–66.
ter Bogt NCW, Bemelmans WJE, Beltman FW, Broer J, Smit AJ, van der Meer K. Preventing weight gain by lifestyle intervention in a general practice setting: three-year results of a randomized controlled trial. Arch Intern Med. 2011;171:306–13.
Bennett GG, Herring SJ, Puleo E, Stein EK, Emmons KM, Gillman MW. Web-based weight loss in primary care: a randomized controlled trial. Obesity. 2009;18:308–13.
Appel LJ, Clark JM, Yeh H-C, Wang N-Y, Coughlin JW, Daumit G, et al. Comparative effectiveness of weight-loss interventions in clinical practice. N Engl J Med. 2011;365:1959–68.
Suzuka T. The needs assessment of nutrition counseling in primary internal medicine clinic. Kyoto Igakukai Zassi. 2008;55:173–6 [in Japanese].
Christian JG, Bessesen DH, Byers TE, Christian KK, Goldstein MG, Bock BC. Clinic-based support to help overweight patients with type 2 diabetes increase physical activity and lose weight. Arch Intern Med. 2008;168:141–6.
Martin PD, Dutton GR, Rhode PC, Horswell RL, Ryan DH, Brantley PJ. Weight loss maintenance following a primary care intervention for low-income minority women. Obesity. 2012;16:2462–7.
Wooldridge AN, Arató N, Sen A, Amenomori M, Fetters MD. Truth or fallacy? Three hour wait for threeminutes with the doctor: findings from a privateclinic in rural Japan. Asia Pac Fam Med. 2010;9:11. doi:10.1186/s12930-014-0011-2.
Butryn ML, Webb V, Wadden TA. Behavioral treatment of obesity. Psychiatr Clin North Am. 2011;34:841–59.
German PS. Compliance and chronic disease. Hypertension. 1988;11:II56–60.
Stewart MA. Effective physician-patient communication and health outcomes: a review. CMAJ. 1995;152:1423–33.
Serretti A, Mandelli L. Antidepressants and body weight. J Clin Psychiatry. 2010;71:1259–72.
Vanina Y, Podolskaya A, Sedky K, Shahab H, Siddiqui A, Munshi F, et al. Body weight changes associated with psychopharmacology. Psychiatr Serv. 2002;53:842–7.
Espeland MA, Stefanick ML, Kritz-Silverstein D, Fineberg SE, Waclawiw MA, James MK, et al. Effect of postmenopausal hormone therapy on body weight and waist and hip girths. Postmenopausal Estrogen-Progestin Interventions Study Investigators. J Clin Endocrinol Metab. 1997;82:1549–56.
Committee to Evaluate Diagnostic Standards for Metabolic Syndrome. Definition and the diagnostic standard for metabolic syndrome--Committee to Evaluate Diagnostic Standards for Metabolic Syndrome. Nippon Naika Gakkai Zasshi. 2005;94:794–809. in Japanese.
Grundy SM. Diagnosis and management of the metabolic syndrome: an American heart association/national heart, lung, and blood institute scientific statement. Circulation. 2005;112:2735–52.
Japan Society for the Study of Obesity. Obesity disease treatment guideline 2006. Himan Kenkyu. 2006;12(suppl):1–91. in Japanese.
Ogihara T, Kikuchi K, Matsuoka H, Fujita T, Higaki J, Horiuchi M, et al. The Japanese society of hypertension guidelines for the management of hypertension (JSH. Hypertens Res. 2009;2009:3–107.
Japan Atherosclerosis Society. Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Disease 2007. Tokyo: Kyowa Kikaku; 2007. in Japanese.
The Japan Diabetes Society. Evidence-based practice guideline for the treatment of diabetes in Japan 2010. Tokyo: Nankodo; 2010. in Japanese.
Tsai AG, Wadden TA, Rogers MA, Day SC, Moore RH, Islam BJ. A primary care intervention for weight loss: results of a randomized controlled pilot study. Obesity. 2009;18:1614–8.
Stead LF, Buitrago D, Preciado N, Sanchez G, Hartmann-Boyce J, Lancaster T. Physician advice for smoking cessation. Cochrane Database Syst Rev. 2013;5:CD000165.
US Department of Health and Human Services Tobacco Use and Dependence Guideline Panel: Treating Tobacco Use and Dependence: 2008 update. http://www.ahrq.gov/professionals/clinicians-providers/guidelinesrecommendations/tobacco/clinicians/update/treating_tobacco_use08.pdf. Accessed 5 Jan 2014
NHLBI Obesity Education Initiative Expert Panel on the Identification, Evaluation, and Treatment of Obesity in Adults: Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Bethesda; 1998
Jakicic JM, Tate DF, Lang W, Davis KK, Polzien K, Rickman AD, et al. Effect of a stepped-care intervention approach on weight loss in adults: a randomized clinical trial. JAMA. 2012;307:2617–26.
Wu T, Gao X, Chen M, van Dam RM. Long-term effectiveness of diet-plus-exercise interventions vs. diet-only interventions for weight loss: a meta-analysis. Obes Rev. 2009;10:313–23.
Butryn ML, Phelan S, Hill JO, Wing RR. Consistent self‐monitoring of weight: a key component of successful weight loss maintenance. Obesity. 2007;15:3091–6.
Burke LE, Wang J, Sevick MA. Self-monitoring in weight loss: a systematic review of the literature. J Am Diet Assoc. 2011;111:92–102.