Effect of physician-delivered nutrition counseling training and an office-support program on saturated fat intake, weight, and serum lipid measurements in a hyperlipidemic population: Worcester Area Trial for Counseling in Hyperlipidemia (WATCH).
OBJECTIVE
To evaluate the effectiveness of a training program for physician-delivered nutrition counseling, alone and in combination with an office-support program, on dietary fat intake, weight, and blood low-density lipoprotein cholesterol levels in patients with hyperlipidemia.


METHODS
Forty-five primary care internists at the Fallon Community Health Plan, a central Massachusetts health maintenance organization, were randomized by site into 3 groups: (1) usual care; (2) physician nutrition counseling training; and (3) physician nutrition counseling training plus an office-support program. Eleven hundred sixty-two of their patients with blood total cholesterol levels in the highest 25th percentile, having previously scheduled physician visits, were recruited. Physicians in groups 2 and 3 attended a 3-hour training program on the use of brief patient-centered interactive counseling and the use of an office-support program that included in-office prompts, algorithms, and simple dietary assessment tools. Primary outcome measures included change at 1-year of follow-up in percentage of energy intake from saturated fat; weight; and blood low-density lipoprotein cholesterol levels.


RESULTS
Improvement was seen in all 3 primary outcome measures, but was limited to patients in group 3. Compared with group 1, patients in group 3 had average reductions of 1.1 percentage points in percent of energy from saturated fat (a 10.3% decrease) (P = .01); a reduction in weight of 2.3 kg (P<.001); and a decrease of 0.10 mmol/L (3.8 mg/dL) in low-density lipoprotein cholesterol level (P = .10). Average time for the initial counseling intervention in group 3 was 8.2 minutes, 5.5 minutes more than in the control group.


CONCLUSIONS
Brief supported physician nutrition counseling can produce beneficial changes in diet, weight, and blood lipids.
Ockene
I S
IS
Department of Medicine, University of Massachusetts Medical School, Worcester 01655, USA. ira.ockene@ummed.edu
Hebert
J R
JR
Ockene
J K
JK
Saperia
G M
GM
Stanek
E
E
Nicolosi
R
R
Merriam
P A
PA
Hurley
T G
TG
D000328:Adult; D000368:Aged; D001835:Body Weight; D003376:Counseling / Q000379:methods; D004041:Dietary Fats / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006279:Health Maintenance Organizations; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood / Q000178:diet therapy / Q000503:physiopathology; D007388:Internal Medicine; D008055:Lipids / Q000097:blood*; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D052756:Nutritional Sciences / Q000193:education*; D010353:Patient Education as Topic / Q000379:methods*; D010820:Physicians; D011320:Primary Health Care
D004041:Dietary Fats; D008055:Lipids