A primary care intervention programme for obesity and coronary heart disease risk factor reduction.
BACKGROUND
Obesity is a growing problem, with its associated morbidity, mortality, and economic costs. Treatment options and the availability of resources are limited and inconsistent.


OBJECTIVE
To implement and evaluate a primary care dietitian-run weight management programme.


METHODS
Pilot intervention study.


METHODS
Three health centres in the north locality of Nottingham City Primary Care Trust.


METHODS
Two hundred and sixteen individuals, with a body mass index (BMI) > 30 kg/m(2) and coronary heart disease risk factors, were recruited to attend education and support groups. Changes in BMI, waist circumference, percentage body fat, blood pressure, blood lipids, glycated haemoglobin (HbA(1c)), and assessment of psychological wellbeing using the "short form" (SF-36) general health questionnaire, were conducted at 0, 3, and 12 months.


RESULTS
One hundred and thirty patients completed the 3-month phase, and 75 completed the follow-up 9-month phase. Four per cent of patients entering the programme achieved a 10% weight loss, and 13% achieved a weight loss between 5 and 10%. Those continuing to attend achieved a mean weight loss of 2.9% (mean = 3.1 kg, ranging from a loss of 23.6 kg to a gain of 3.8 kg, P < 0.001) at 3 months, which was maintained at 12 months. Waist circumference, percentage body fat, systolic blood pressure, total cholesterol, HbA(1c) (in those with diabetes) (P < 0.001), and triglycerides (P = 0.004) showed reduction. Psychological wellbeing improved in seven of the nine categories of the SF-36.


CONCLUSIONS
Those who continued to attend the programme showed significant reduction in weight and other clinical parameters at 3 months, and this was maintained at 1 year with less intensive support. An attrition rate of approximately 66% by 12 months demonstrated that, in spite of intensive dietetic resources, patient retention and follow-up of progress was difficult.
Read
Anna
A
Obesity Management, Queens Medical Centre Nottingham, University Hospital NHS Trust, Nottingham NG7 2UH, UK. anna.read@mail.qmcuh-tr.trent.nhs.uk
Ramwell
Helen
H
Storer
Helen
H
Webber
Jonathan
J
D000328:Adult; D000368:Aged; D003327:Coronary Disease / Q000517:prevention & control*; D006266:Health Education / Q000379:methods; D006801:Humans; D008875:Middle Aged; D009765:Obesity / Q000517:prevention & control*; D010865:Pilot Projects; D011320:Primary Health Care / Q000379:methods*; D015397:Program Evaluation; D012307:Risk Factors