Cognitive-behavioural treatment for weight loss in primary care: a prospective study.
OBJECTIVE
Cognitive-behavioural treatment (CBT) is effective for weight loss in obese patients, but such programmes are difficult to implement in primary care. We assessed whether implementation of a community-based CBT weight loss programme for adults in routine care is feasible and prospectively assessed patient outcome.


METHODS
The weight loss programme was provided by a network of Swiss general practitioners in cooperation with a community centre for health education. We chose a five-step strategy focusing on structure of care rather than primarily addressing individual physician behaviour. A multidisciplinary core group of trained CBT instructors acted as the central element of the programme. Overweight and obese adults from the community (BMI >25 kg/m2) were included. We used a patient perspective to report the impact on delivery of care and assessed weight change of consecutive participants prospectively with a follow-up of 12 months.


RESULTS
Twenty-eight courses, with 16 group meetings each, were initiated over a period of 3 years. 44 of 110 network physicians referred patients to the programme. 147 of 191 study participants were monitored for one year (attrition rate: 23%). Median weight loss after 12 months for 147 completers was 4 kg (IQR: 1-7 kg; intention-to-treat analysis for 191 participants: 2 kg, IQR: 0-5 kg).


CONCLUSIONS
The programme produced a clinically meaningful weight loss in our participants, with a relatively low attrition rate. Implementation of an easily accessible CBT programme for weight loss in daily routine primary care is feasible.
Eichler
Klaus
K
Horten Centre, University Hospital of Zurich, Zurich, Switzerland. klaus.eichler@zhwin.ch
Zoller
Marco
M
Steurer
Johann
J
Bachmann
Lucas M
LM
D000328:Adult; D015928:Cognitive Behavioral Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000628:therapy*; D050177:Overweight; D010348:Patient Care Team; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation; D011446:Prospective Studies; D011787:Quality of Health Care; D013557:Switzerland; D016896:Treatment Outcome; D015431:Weight Loss