A brief intervention for weight management in primary care: study protocol for a randomized controlled trial

Trials

Paul Aveyard¹  Ben Thompson¹  Jing Jin¹  Anna Christian¹  Sarah Clarke¹  Deborah Lycett³  Susan Jebb⁵  Amanda Farley²  Amanda Daley²  Peymane Adab⁴  Kate Jolly⁴  Amanda Lewis¹ 

[1] Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK;Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK;Faculty of Health and Life Sciences, Coventry University, Priory Street, Coventry CV1 5FB, UK;Public Health, Epidemiology and Biostatistics, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK;Medical Research Council Human Nutrition Research Unit, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge CB1 9NL, UK

关键词: Commercial weight management services;    Primary care;    Weight management;    Brief intervention;    Obesity;   

Others  :  807901
DOI  :  10.1186/1745-6215-14-393

 received in 2013-07-15, accepted in 2013-10-31,  发布年份 2013

【 摘 要 】

Background

Obesity affects 25% of the UK adult population but modest weight loss can reduce the incidence of obesity-related chronic disease. Some effective weight loss treatments exist but there is no nationally available National Health Service (NHS) treatment service, and general practitioners (GPs) rarely discuss weight management with patients or support behavior change. Evidence shows that commercial weight management services, that most primary care trusts have 'on prescription', are more effective than primary care treatment.

Methods/design

We propose a controlled trial where patients will be randomized to receive either the offer of help by referral to a weight management service and follow-up to assess progress, or advice to lose weight on medical grounds. The primary outcome will be weight change at 12-months. Other questions are: what actions do people take to manage their weight in response to the two GP intervention types? How do obese patients feel about GPs opportunistically discussing weight management and how does this vary by intervention type? How do GPs feel about raising the issue opportunistically and giving the two types of brief intervention? What is the cost per kg/m² lost for each intervention? Research assistants visiting GP practices in England (n = 60) would objectively measure weight and height prior to GP consultations and randomize willing patients (body mass index 30+, excess body fat, 18+ years) using sealed envelopes. Full recruitment (n = 1824) is feasible in 46 weeks, requiring six sessions of advice-giving per GP. Participants will be contacted at 3 months (postintervention) via telephone to identify actions they have taken to manage their weight. We will book appointments for participants to be seen at their GP practice for a 12-month follow-up.

Discussion

Trial results could make the case for brief interventions for obese people consulting their GP and introduce widespread simple treatments akin to the NHS Stop Smoking Service. Likewise, the intervention could be introduced in the Quality and Outcomes Framework and influence practice worldwide.

Trial registration

Current Controlled Trials ISRCTN26563137.

【 授权许可】

   
2013 Lewis et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Butland B, Jebb S, Kopelman P, McPherson K, Thomas S, Mardell J, Parry V: Foresight. Tackling Obesities: Future Choices - Project report. London: Government Office for Science; 2007.
• [2]Prospective Studies Collaboration: Body-mass index and cause-specific mortality in 900,000 adults: collaborative analyses of 57 prospective studies. Lancet 2009, 373:1083-1096.
• [3]McTigue KM, Harris R, Hemphill B, Lux L, Sutton S, Bunton AJ, et al.: Screening and interventions for obesity in adults: summary of the evidence for the U.S. Preventive services task force. Ann Intern Med 2003, 139:933-949.
• [4]Wing RR: Treatment options for obesity: do commercial weight loss programs have a role? JAMA 2010, 304:1837-1838.
• [5]Aveyard P: Benefits of medical treatment of obesity. Lancet 2011, 377:903.
• [6]West R, Fidler JA: Key findings from the Smoking Toolkit Study. 2011. [http://www.smokinginengland.info/reports/ webcite]
• [7]Department of Health: Statistics on NHS Stop Smoking Services in England. 2010. [https://catalogue.ic.nhs.uk/publications/public-health/smoking/nhs-stop-smok-serv-eng-2009-2010/nhs-stop-smok-serv-eng-2009-2010-rep.pdf webcite]
• [8]Stead LF, Bergson G, Lancaster T: Physician advice for smoking cessation. Cochrane Database Syst Rev 2008., 2CD000165
• [9]Lancaster T, Stead LF: Individual behavioural counselling for smoking cessation. Cochrane Database Syst Rev 2005., 2CD001292
• [10]Stead LF, Perera R, Bullen C, Mant D, Lancaster T: Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev 2008., 1CD000146
• [11]Ferguson J, Bauld L, Chesterman J, Judge K: The English smoking treatment services: one-year outcomes. Addiction 2005, 100(suppl 2):59-69.
• [12]Judge K, Bauld L, Chesterman J, Ferguson J: The English smoking treatment services: short-term outcomes. Addiction 2005, 100(suppl 2):46-58.
• [13]Jolly K, Daley A, Adab P, Lewis A, Denley J, Beach J, et al.: A randomised controlled trial to compare a range of commercial or primary care led weight reduction programmes with a minimal intervention control for weight loss in obesity: the lighten up trial. BMC Public Health 2010, 10:439. BioMed Central Full Text
• [14]Jolly K, Lewis A, Beach J, Denley J, Adab P, Deeks JJ, 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. BMJ 2011, 343:d6500.
• [15]Jebb S, Referral to a Commercial Weight Management Programme Enhances Weight Loss in Primary Care 2010.
• [16]Tsai AG, Wadden TA: Systematic review: an evaluation of major commercial weight loss programs in the United States. Ann Intern Med 2005, 142:56-66.
• [17]Cavill N, Hillsdon M, Anstiss T: Brief Interventions for Weight Management. London: National Obesity Observatory; 2011.
• [18]Tsai A, Wadden T: Treatment of obesity in primary care practice in the United States: a systematic review. J Gen Intern Med 2009, 24:1073-1079.
• [19]Galuska DA, Will JC, Serdula MK, Ford ES: Are health care professionals advising obese patients to lose weight? JAMA 1999, 282:1576-1578.
• [20]Huang J, Yu H, Marin E, Brock S, Carden D, Davis T: Physicians' weight loss counseling in two public hospital primary care clinics. Acad Med 2004, 79:2.
• [21]Leverence RR, Williams RL, Sussman A, Crabtree BJ: Obesity counseling and guidelines in primary care. A qualitative study. Am J Prev Med 2007, 32:334-339.
• [22]Michie S: Talking to primary care patients about weight: a study of GPs and practice nurses in the UK. Psychol Health Med 2007, 12:521-525.
• [23]Sciamanna CN, Tate DF, Lang W, Wing RR: Who reports receiving advice to lose weight? Results from a multistate survey. Arch Intern Med 2000, 160:2334-2339.
• [24]Shiffman S, Sweeney CT, Pillitteri JL, Sembower MA, Harkins AM, Wadden TA: Weight management advice: what do doctors recommend to their patients? Prev Med 2009, 49:482-486.
• [25]Potter MB, Vu JD: Weight management: what patients want from their primary care physicians. J Fam Pract 2001, 50:513-518.
• [26]Kaner EF, Dickinson HO, Beyer FR, Campbell F, Schlesinger C, Heather N, Saunders JB: Burnard B. Effectiveness of Brief Alcohol Interventions in Primary Care Populations.: Pienaar ED; 2009.
• [27]Aveyard P, Parsons A, Begh R, West R, Brief Opportunistic Smoking Cessation Interventions: a Systematic Review and Meta-Analysis to Compare Advice to Quit and Offer of Assistance. Submitted; 2011.
• [28]West R: The multiple facets of cigarette addiction and what they mean for encouraging smokers to stop. COPD 2009, 6:277-283.
• [29]Post RE, Mainous AG III, Gregorie SH, Knoll ME, Diaz VA, Saxena SK: The influence of physician acknowledgment of patients' weight status on patient perceptions of overweight and obesity in the United States. Arch Intern Med 2011, 171:316-321.
• [30]Michie S, Abraham C, Whittington C, McAteer J, Gupta S: Effective techniques in healthy eating and physical activity interventions: a meta-regression. Health Psychol 2009, 28:690-701.
• [31]LeBlanc ES, O’Connor E, Whitlock EP, Patnode CD, Kapka T: Effectiveness of primary care-relevant treatments for obesity in adults: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med 2011, 155:434-447.
• [32]Jamrozik K, Vessey M, Fowler G, Wald N, Parker G, Van VH: Controlled trial of three different antismoking interventions in general practice. Br Med J (Clin Res Ed) 1984, 288:1499-1503.
• [33]Page AR, Walters DJ, Schlegel RP, Best JA: Smoking cessation in family practice: the effects of advice and nicotine chewing gum prescription. Addict Behav 1986, 11:443-446.
• [34]Russell MA, Wilson C, Taylor C, Baker CD: Effect of general practitioners' advice against smoking. BMJ 1979, 6184:231-235.
• [35]Russell MA: Merriman R, Stapleton J, Taylor W: Effect of nicotine chewing gum as an adjunct to general practitioner's advice against smoking. Br Med J (Clin Res Ed) 1983, 287:1782-1785.
• [36]Slama K, Redman S, Perkins J, Reid AL, Sanson-Fisher RW: The effectiveness of two smoking cessation programmes for use in general practice: a randomised clinical trial. BMJ 1990, 300:1707-1709.
• [37]Stewart PJ, Rosser WW: The impact of routine advice on smoking cessation from family physicians. Can Med Assoc J 1982, 126:1051-1054.
• [38]Vetter NJ, Ford D: Smoking prevention among people aged 60 and over: a randomized controlled trial. Age Ageing 1990, 19:164-168.
• [39]Wilson DH, Wakefield MA, Steven ID, Rohrsheim RA, Esterman AJ, Graham NM: "Sick of smoking": evaluation of a targeted minimal smoking cessation intervention in general practice. Med J Aust 1990, 152:518-521.
• [40]O'Brien MA, Rogers S, Jamtvedt G, Oxman AD, Odgaard JJ, Kristoffersen DT, et al.: Educational outreach visits: effects on professional practice and health care outcomes. Cochrane Database Syst Rev 2007., 4CD000409