title: Reducing weight in an internal medicine outpatient clinic using a lifestyle medicine approach: A proof of concept.
abstract: BACKGROUND
  Chronic non-communicable diseases represent the major drivers of disease burden, being responsible for the majority of health care cost and deaths. Almost half of premature deaths is due to behaviors amenable to change. Accordingly, addressing behavior might represent a strategic change in the health delivery system. Improving lifestyle requires a specific strategy embedding the active collaboration of individuals with a multilevel team-oriented medical practice. With the present study we sought to assess whether the implementation of cognitive-behavioral strategies, following the principles of lifestyle medicine in an outpatient clinic provides better results in weight reduction as compared to simpler strategies as presently executed in General Practitioners' offices.
  
  
  METHODS
  This is an observational study on 173 subjects (age 53.1 ± 11.5), comparing three different groups of preventive practice: a personalized lifestyle medicine, combining cognitive behavioral strategies with patient tailored prescription of exercise and nutrition (Group A); a semi-structured approach with generic counseling (Group B); and an unstructured advice (Group C).
  
  
  RESULTS
  At the end of the intervention period (17-20 months), group A showed an average weight loss of 5.4 ± 5.1 kg, which was significantly (p<0.001)more than observed in group B (2.8 ± 5.1 kg) and group C (1.2 ± 4.8 kg). Likewise BMI and waist were progressively more reduced from A to C.
  
  
  CONCLUSIONS
  It is possible to implement preventive cognitive-behavioral lifestyle strategies in outpatient internal medicine clinics. This methodology appears more efficacious in inducing weight reduction after more than a year as compared to usual family medicine approaches.
authors.affiliation: University of Milan, Department BIOMETRA, Milan, Italy; Exercise Medicine Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy. Electronic address: daniela.lucini@unimi.it.
authors.forename: Daniela
authors.initials: D
authors.lastname: Lucini
authors.affiliation: ASL Monza e Brianza, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Cesana
authors.affiliation: University of Milan, Department BIOMETRA, Milan, Italy; Exercise Medicine Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Vigo
authors.affiliation: University of Milan, Department BIOMETRA, Milan, Italy; Exercise Medicine Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
authors.forename: Mara
authors.initials: M
authors.lastname: Malacarne
authors.affiliation: Exercise Medicine Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Pagani
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D002908:Chronic Disease / Q000517:prevention & control; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D007388:Internal Medicine; D008019:Life Style; D008297:Male; D008875:Middle Aged; D050177:Overweight / Q000628:therapy*; D040242:Risk Reduction Behavior; D015431:Weight Loss
keywords: Cognitive behavioral therapy; Diet; Exercise; Lifestyle medicine; Prevention; Weight reduction