title: Effect of onsite dietitian counseling on weight loss and lipid levels in an outpatient physician office.
abstract: We examined the effect of an outpatient office-based diet and exercise counseling program on weight loss and lipid levels with an onsite dietitian who sees patients at the same visit with the physician and is fully reimbursable. Eighty overweight or obese patients (average age 55 +/- 12 years, baseline body mass index 30.1 +/- 6.4 kg/m(2)) with > or =1 cardiovascular risk factor (86%) or coronary heart disease (14%) were counseled to exercise 30 minutes/day and eat a modified Dietary Approaches to Stop Hypertension (DASH) diet (saturated fat <7%, polyunsaturated fat to 10%, monounsaturated fat to 18%, low in glycemic index and sodium and high in fiber, low-fat dairy products, fruits, and vegetables). Weight, body mass index, lipid levels, and blood pressure were measured at 1 concurrent follow-up visit with the dietitian and physician and > or =1 additional follow-up with the physician. Maximum weight lost was an average of 5.6% (10.8 lb) at a mean follow-up of 1.75 years. Sixty-four (81%) of these patients maintained significant weight loss (average weight loss 5.3%) at a mean follow-up of 2.6 years. Average decrease in low-density lipoprotein cholesterol was 9.3%, average decrease in triglycerides was 34%, and average increase in high-density lipoprotein cholesterol was 9.6%. Systolic blood pressure was lowered from 129 to 126 mm Hg (p = 0.21) and diastolic blood pressure from 79 to 75 mm Hg (p = 0.003). In conclusion, having a dietitian counsel patients concurrently with a physician in the outpatient setting is effective in achieving and maintaining weight loss and is fully reimbursable.
authors.affiliation: Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. fwelty@bidmc.harvard.edu
authors.forename: Francine K
authors.initials: FK
authors.lastname: Welty
authors.forename: Melita M
authors.initials: MM
authors.lastname: Nasca
authors.forename: Natalie S
authors.initials: NS
authors.lastname: Lew
authors.forename: Sue
authors.initials: S
authors.lastname: Gregoire
authors.forename: Yuheng
authors.initials: Y
authors.lastname: Ruan
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D015992:Body Mass Index; D003327:Coronary Disease / Q000517:prevention & control; D050528:Diet, Carbohydrate-Restricted; D018752:Diet, Fat-Restricted; D004039:Diet, Sodium-Restricted; D004046:Dietetics; D037001:Directive Counseling; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008055:Lipids / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000178:diet therapy / Q000628:therapy*; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D008055:Lipids