Interventions to change the behaviour of health professionals and the organisation of care to promote weight reduction in overweight and obese people.
BACKGROUND
The prevalence of obesity is increasing globally and will, if left unchecked, have major implications for both population health and costs to health services.


OBJECTIVE
To assess the effectiveness of strategies to change the behaviour of health professionals and the organisation of care to promote weight reduction in overweight and obese people.


METHODS
We updated the search for primary studies in the following databases, which were all interrogated from the previous (version 2) search date to May 2009: The Cochrane Central Register of Controlled Trials (which at this time incorporated all EPOC Specialised Register material) (The Cochrane Library 2009, Issue 1), MEDLINE (Ovid), EMBASE (Ovid), CINAHL (EBSCO), and PsycINFO (Ovid). We identified further potentially relevant studies from the reference lists of included studies.


METHODS
Randomised controlled trials (RCTs) that compared routine provision of care with interventions aimed either at changing the behaviour of healthcare professionals or the organisation of care to promote weight reduction in overweight or obese adults.


METHODS
Two reviewers independently extracted data and assessed study quality.


RESULTS
We included six RCTs, involving more than 246 health professionals and 1324 overweight or obese patients. Four of the trials targeted professionals and two targeted the organisation of care. Most of the studies had methodological or reporting weaknesses indicating a risk of bias.Meta-analysis of three trials that evaluated educational interventions aimed at GPs suggested that, compared to standard care, such interventions could reduce the average weight of patients after a year (by 1.2 kg, 95% CI -0.4 to 2.8 kg); however, there was moderate unexplained heterogeneity between their results (I(2) = 41%). One trial found that reminders could change doctors' practice, resulting in a significant reduction in weight among men (by 11.2 kg, 95% CI 1.7 to 20.7 kg) but not among women (who reduced weight by 1.3 kg, 95% CI -4.1 to 6.7 kg). One trial found that patients may lose more weight after a year if the care was provided by a dietitian (by 5.6 kg, 95% CI 4.8 to 6.4 kg) or by a doctor-dietitian team (by 6 kg, 95% CI 5 to 7 kg), as compared with standard care. One trial found no significant difference between standard care and either mail or phone interventions in reducing patients' weight.


CONCLUSIONS
Most of the included trials had methodological or reporting weaknesses and were heterogeneous in terms of participants, interventions, outcomes, and settings, so we cannot draw any firm conclusions about the effectiveness of the interventions. All of the evaluated interventions would need further investigation before it was possible to recommend them as effective strategies.
Flodgren
Gerd
G
Institute of Health and Society, Newcastle University, 21 Claremont Place, Newcastle upon Tyne, UK, NE2 4AA.
Deane
Katherine
K
Dickinson
Heather O
HO
Kirk
Sara
S
Alberti
Hugh
H
Beyer
Fiona R
FR
Brown
James G
JG
Penney
Tarra L
TL
Summerbell
Carolyn D
CD
Eccles
Martin P
MP
D000328:Adult; D001835:Body Weight; D018849:Controlled Clinical Trials as Topic; D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity / Q000523:psychology / Q000628:therapy*; D050177:Overweight / Q000523:psychology / Q000628:therapy; D010353:Patient Education as Topic; D011364:Professional Practice / Q000458:organization & administration / Q000592:standards*; D016032:Randomized Controlled Trials as Topic; D015431:Weight Loss