Counselling overweight and obese patients in primary care: a prospective cohort study.
BACKGROUND
Primary care physicians are well positioned to provide counselling for overweight and obese patients, but no prospective study has assessed the effectiveness of this counselling in primary care. We aimed to evaluate weight reduction counselling by primary care physicians, and its relationship with weight change and patients' behaviour to control weight.


METHODS
A prospective cohort study.


METHODS
We enrolled 523 consecutive overweight and obese patients from two Swiss academic primary care clinics. Physicians and patients were blinded to the study aims. We assessed the use of 10 predefined counselling strategies for weight reduction, and weight change and behaviour to control weight after 1 year.


RESULTS
Sixty-five per cent of patients received some form of weight reduction counselling whereas 35% received no counselling. A total of 407 patients completed the 1-year follow-up. Those who received counselling lost on average (SD) 1.0 (5.0) kg after 1 year, whereas those who were not advised gained 0.3 (5.0) kg (P = 0.02). In multivariate analysis, each additional counselling strategy was associated with a mean weight loss of 0.2 kg (95% confidence interval 0.03-0.4, P = 0.02). Patients counselled by their physician had more favourable behaviour to control weight than those not counselled, such as setting a target weight (56 versus 36%) or visiting a dietician (23 versus 10%, both P < 0.001).


CONCLUSIONS
Weight reduction counselling by primary care physicians is associated with a modest weight loss and favourable behaviour to control weight. However, many obese and overweight patients receive no advice on weight loss during primary care visits.
Rodondi
Nicolas
N
University Outpatient Clinic and University Institute of Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland. nicolas.rodondi@hospvd.ch
Humair
Jean-Paul
JP
Ghali
William A
WA
Ruffieux
Christiane
C
Stoianov
Rebecca
R
Seematter-Bagnoud
Laurence
L
Stalder
Hans
H
Pecoud
Alain
A
Cornuz
Jacques
J
D000328:Adult; D001835:Body Weight; D015331:Cohort Studies; D037001:Directive Counseling; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000534:rehabilitation*; D050177:Overweight; D010821:Physicians, Family; D013997:Time Factors; D015431:Weight Loss