Improving health professionals' management and the organisation of care for overweight and obese people.
BACKGROUND
Obesity is increasing throughout the industrialised world. If left unchecked it will have major implications for both population health and costs to health services.


OBJECTIVE
To assess whether health professionals' management or the organisation of care for overweight and obese people could be improved.


METHODS
We searched the specialised registers of the Cochrane Effective Practice and Organisation of Care Group (April 2000), the Cochrane Depression, Anxiety and Neurosis Group (August 1997), the Cochrane Diabetes Group (August 1997), the Cochrane Controlled Trials Register (September 1997), MEDLINE to April 2000, EMBASE to February 2000, Cinahl (1982 to February 2000), PsycLit (1974 to May 2000), Sigle (1980 to April 2000), Sociofile (1974 to October 1997), Dissertation Abstracts (1861 to January 1998), Conference Papers Index (1973 to January 1998), Resource Database in Continuing Medical Education. We also hand searched seven key journals and contacted experts in the field.


METHODS
Randomised trials, controlled before-and-after studies and interrupted time series analyses of providers' management of obesity or the organisation of care to improve provider practice or patient outcomes. We addressed three a priori comparisons and a fourth post hoc comparison. 1. Interventions aimed at improving health professionals' management or the delivery of health care for overweight/obese patients are more effective than usual care. 2. Interventions aimed at redressing negative attitudes and related practices towards overweight/obese patients are more effective than usual care. 3. Organisational interventions designed to change the structure of services for overweight/obese people are more effective than educational or behavioural interventions for health professionals. 4. Comparisons of different organisational interventions.


METHODS
Two reviewers independently extracted data and assessed study quality.


RESULTS
Eighteen studies were included involving more than 447 providers and 4104 patients. Six studies were identified for comparison 1. Five were professional-oriented interventions (the use of reminders and training) and the sixth was a study of professional and organisational interventions of shared care. No studies were identified for comparisons 2 or 3. Twelve studies were identified for post hoc comparison 4. These compared either the deliverer of weight loss interventions or the setting of interventions. The included studies were heterogeneous and of generally poor quality.


CONCLUSIONS
At present, decisions about improving provision of services must be based on the evidence of patient interventions and good clinical judgement. Further research is needed to identify cost effective strategies for improving the management of obesity.
Harvey
E L
EL
Health Sciences and Clinical Evaluation, University of York, Alcuin College, Heslington, York, UK, YO10 5DD. elh4@york.ac.uk
Glenny
A
A
Kirk
S F
SF
Summerbell
C D
CD
D001835:Body Weight; D018849:Controlled Clinical Trials as Topic; D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards; D006801:Humans; D009765:Obesity / Q000628:therapy*; D010353:Patient Education as Topic; D011364:Professional Practice / Q000458:organization & administration / Q000592:standards*; D016032:Randomized Controlled Trials as Topic; D015431:Weight Loss