title: Effect of nutritional counselling and nutritional plus exercise counselling in overweight adults: a randomized trial in multidisciplinary primary care practice.
abstract: OBJECTIVE
  To compare the effects of nutritional counselling with nutritional plus exercise counselling on body weight and waist circumference in overweight adults in a multidisciplinary primary care setting.
  
  
  METHODS
  One hundred and thirty-four overweight adults (body mass index 28-35) were randomly assigned to individual counselling sessions by a dietician (D) or counselling sessions by a dietician plus physiotherapist (D + E) during 6 months with one follow-up session at 12 months. Outcomes were assessed at baseline, 6 and 12 months. Difference in changes of outcome measures between groups were analysed using generalized estimating equations.
  
  
  RESULTS
  Weight reduced from baseline to 6 months in D [-2.2 (-3.1 to -1.4) kg] and D + E [-3.0 (-4.0 to -2.0) kg] and was sustained at 12 months [-2.0 (-3.1 to -1.4) kg and -3.1 (-4.5 to -1.6) kg, respectively]. The reduction in weight did not significantly differ between D and D + E (P = 0.48). In both groups, waist circumference decreased from baseline to 6 months [-2.1 (-3.3 to -0.8) cm for D; -3.7 (-5.1 to -2.3) cm for D + E] and was sustained at 12 months [-2.1 (-3.5 to -0.7) cm and -4.2 (-6.0 to -2.5) cm, respectively]. Participants in D + E tended to decrease their waist circumference more than those in D (P = 0.14).
  
  
  CONCLUSIONS
  Nutritional counselling by a dietician resulted in modest reductions in weight and waist circumference in overweight adults, which were sustained up to 12 months. Adding exercise counselling by a physiotherapist did not significantly enhance the effect on body weight. Exercise counselling may, however, further improve waist circumference.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands. e.a.molenaar@umcutrecht.nl
authors.forename: Esther A
authors.initials: EA
authors.lastname: Molenaar
authors.forename: Erik J C
authors.initials: EJ
authors.lastname: van Ameijden
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Vergouwe
authors.forename: Diederick E
authors.initials: DE
authors.lastname: Grobbee
authors.forename: Mattijs E
authors.initials: ME
authors.lastname: Numans
mesh_terms: D000293:Adolescent; D000328:Adult; D003131:Combined Modality Therapy; D003376:Counseling; D015444:Exercise; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008511:Medicine; D008875:Middle Aged; D015596:Nutrition Assessment; D009765:Obesity / Q000517:prevention & control; D017063:Outcome Assessment, Health Care / Q000379:methods; D050177:Overweight / Q000178:diet therapy*; D055815:Young Adult