Abstract
Introduction
Weight loss interventions have been studied extensively, but methodological limitations negatively affecting applicability in everyday clinical practice are a very common problem in these studies. Despite the fact that obesity is treated mostly in a primary care setting, studies that investigate weight loss interventions in a primary care setting are scarce. Our objective was to assess the effectiveness of a tailor-made weight loss intervention in achieving a clinically significant weight loss in overweight (BMI ≥ 27 kg/m²) women aged 50–60 years in a primary care setting.
Methods
As part of a randomized controlled trial on the effects of a tailor-made weight loss intervention and oral glucosamine sulphate on the incidence of osteoarthritis of the knee in 407 overweight women aged 50–60 years, we analysed the effectiveness of the weight loss intervention in achieving clinically relevant weight loss.
Results
At baseline, the mean body weight for all participants was 88.7 ± 13.2 kg, and the mean BMI was 32.4 ± 4.3 kg/m². The percentage of participants that lost ≥5 kg or 5 % of their baseline body weight was 14.8 versus 6.3 % (p = 0.012) at 6 months for the intervention group and the control group, respectively. At 12 months, this was 18.7 versus 14.9 % (p = 0.027). Mean weight gain at 6 months was −0.9 versus 0.9 kg (p < 0.001) for the intervention group and the control group, respectively. At 12 months, this was −0.6 versus 0.6 kg (p = 0.01). At 30 months of follow-up, no significant differences were found between both groups.
Conclusions
This weight loss intervention, which, at short notice, is easily applicable in everyday clinical practice, is effective in achieving clinically significant weight loss in overweight women aged 50–60 over a 12-month period. Long-term weight loss maintenance, however, occurred only marginally. Magnitude of the effect is comparable to that achieved in many other more intensive weight loss interventions.
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References
Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA et al (2002) Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 346(6):393–403
Neter JE, Stam BE, Kok FJ, Grobbee DE, Geleijnse JM (2003) Influence of weight reduction on blood pressure: a meta-analysis of randomized controlled trials. Hypertension 42(5):878–884
Wing RR (2010) Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the look AHEAD trial. Arch Intern Med 170(17):1566–1575
Douketis JD, Macie C, Thabane L, Williamson DF (2005) Systematic review of long-term weight loss studies in obese adults: clinical significance and applicability to clinical practice. Int J Obes (Lond) 29(10):1153–1167
Wadden TA, Volger S, Sarwer DB, Vetter ML (2011) A two-year randomized trial of obesity treatment in primary care practice. N Engl J Med 365(21):1969–1979
Appel LJ, Clark JM, Yeh HC et al (2011) Comparative effectiveness of weight-loss interventions in clinical practice. N Engl J Med 365(21):1959–1968
Franz MJ, VanWormer JJ, Crain AL, Boucher JL, Histon T, Caplan W et al (2007) Weight-loss outcomes: a systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up. J Am Diet Assoc 107(10):1755–1767
Miller WC (2001) Effective diet and exercise treatments for overweight and recommendations for intervention. Sports Med 31(10):717–724
Teixeira PJ, Silva MN, Coutinho SR, Palmeira AL, Mata J, Vieira PN et al (2010) Mediators of weight loss and weight loss maintenance in middle-aged women. Obesity (Silver Spring) 18(4):725–735
Rubak S, Sandbaek A, Lauritzen T, Christensen B (2005) Motivational interviewing: a systematic review and meta-analysis. Br J Gen Pract 55(513):305–312
Runhaar J, van Middelkoop M, Steens R, Vroegindeweij D, van Osch G, Reijman M, Koes B, Bierma-Zeinstra S (2008) Prevention of knee osteoarthritis in overweight females; from feasibility trial to full-scale trial. Osteoarthr Cartilage 16(Supplement 4):S141
Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K et al (1986) Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum 29(8):1039–1049
Gezondheidsraad (2003) Overgewicht en obesitas. Den Haag: Gezondheidsraad; publicatie nr 2003/07
Strecher VJ, Seijts GH, Kok GJ, Latham GP, Glasgow R, DeVellis B et al (1995) Goal setting as a strategy for health behavior change. Health Educ Q 22(2):190–200
Gollwitzer PM (1999) Implementation intentions—strong effects of simple plans. Am Psychol 54(7):493–503
Lean ME, Han TS, Deurenberg P (1996) Predicting body composition by densitometry from simple anthropometric measurements. Am J Clin Nutr 63(1):4–14
Group E (2007) EQ-5D value sets: inventory, comparative review and user guide. Springer, Dordrecht
Wendel-Vos GC, Schuit AJ, Saris WH, Kromhout D (2003) Reproducibility and relative validity of the short questionnaire to assess health-enhancing physical activity. J Clin Epidemiol 56(12):1163–1169
de Hollander EL, Zwart L, de Vries SI, Wendel-Vos W (2012) The SQUASH was a more valid tool than the OBiN for categorizing adults according to the Dutch physical activity and the combined guideline. J Clin Epidemiol 65(1):73–81
Ainsworth BE, Haskell WL, Leon AS, Jacobs DR Jr, Montoye HJ, Sallis JF et al (1993) Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc 25(1):71–80
Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ et al (2000) Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 32(9 Suppl):S498–S504
Figard-Fabre H, Fabre N, Leonardi A, Schena F (2010) Physiological and perceptual responses to Nordic walking in obese middle-aged women in comparison with the normal walk. Eur J Appl Physiol 108(6):1141–1151
van Assema P, Brug J, Ronda G, Steenhuis I (2001) The relative validity of a short Dutch questionnaire as a means to categorize adults and adolescents to total and saturated fat intake. J Hum Nutr Diet 14(5):377–390
Thabane L, Chu R, Cuddy K, Douketis J (2007) What is the quality of reporting in weight loss intervention studies? A systematic review of randomized controlled trials. Int J Obes (Lond) 31(10):1554–1559
DeSouza CM, Legedza AT, Sankoh AJ (2009) An overview of practical approaches for handling missing data in clinical trials. J Biopharm Stat 19(6):1055–1073
Soper DS (2012) Sobel test calculator for the significance of mediation (Online Software). http://www.danielsoper.com/statcalc3
Sobel ME (1982) Asymptotic confidence intervals for indirect effects in structural equation models. Sociol Methodol 13:290–312
Kraemer HC, Wilson GT, Fairburn CG, Agras WS (2002) Mediators and moderators of treatment effects in randomized clinical trials. Arch Gen Psychiatry 59(10):877–883
Kemper HCG, Ooijendijk WTM, Stiggelbout M (2000) Consensus about the Dutch physical activity guideline. Tijdschr Soc Geneeskd 78:180–183 [in Dutch]
Finkler E, Heymsfield SB, St-Onge MP (2012) Rate of weight loss can be predicted by patient characteristics and intervention strategies. J Acad Nutr Diet 112:75–80
Tsai AG, Wadden TA (2009) Treatment of obesity in primary care practice in the United States: a systematic review. J Gen Intern Med 24(9):1073–1079
Arem H, Irwin M (2011) A review of web-based weight loss interventions in adults. Obes Rev 12(5):e236–e243
Acknowledgments
This study was financed by ZonMw, Netherlands Organisation for Health Research and Development.
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The authors declare no conflict of interest.
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de Vos, B.C., Runhaar, J. & Bierma-Zeinstra, S.M.A. Effectiveness of a tailor-made weight loss intervention in primary care. Eur J Nutr 53, 95–104 (2014). https://doi.org/10.1007/s00394-013-0505-y
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DOI: https://doi.org/10.1007/s00394-013-0505-y