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Most primary care physicians do not treat obesity, citing lack of time, resources, insurance reimbursement, and knowledge of effective interventions as significant barriers. To address this need, a 10-minute intervention delivered by the primary care physician was coupled with individual dietary counseling sessions delivered by a registered dietiti...
Context in source publication
Context 1
... guidelines developed to describe the principles of the 1-year program include the following: the role of the physician as an agent of change, determination of BMI and body composition in patient assessment, the use of meal replacements and portion-controlled meals for calorie control, the identification of high-calorie trigger foods in the diet and the management of their intake, reinforcement of the role of exercise in weight management, and guidelines for the use of pharmacotherapy, where indicated. The pro- gram is designed to be 12 months long and is outlined with recommended appointment intervals with the physician and interventions at each visit ( Table 1). The plan calls for telephone follow-up consultation with a registered dietitian at weekly intervals for the first 12 weeks and monthly for the remaining 9 months. ...
Citations
... A decrease in physical activity is associated with a relatively higher risk of CVD related to increased body fat and decreased LBM [6]. Imbalance of body composition could increase the risk of musculoskeletal disorders included LBP and arthritis [23,24]. LBP causes weakness of the erector spinae muscle and physical inactivity, resulting in decreased muscle mass and cardiovascular functions [25]. ...
Limited studies exist on the effects of exercise therapy on obese and normal-weight patients. Herein, we investigated the effect of a 12-week rehabilitation exercise program on cardiovascular risk factors, Oswestry Disability Index (ODI), and change in the cross-sectional area (CSA) of lumbar muscles in patients with obesity and normal-weight low back pain (LBP). LBP patients were allocated to the overweight LBP group (OLG; n = 15) and normal-weight LBP group (NLG; n = 15). They performed a rehabilitation exercise program three times per week for 12 weeks. Cardiovascular risk factors, ODI score, and lumbar muscle CSA were assessed pre- and post-intervention. Body composition, body weight (p < 0.001), and body mass index (p < 0.001) significantly improved after the exercise intervention in OLG. Body fat percentage significantly decreased in both groups, but OLG (p < 0.001) showed slightly greater improvement than NLG (p = 0.034). Total cholesterol (p = 0.013) and low-density lipoprotein (p = 0.002) significantly improved in OLG. ODI score improved significantly in both groups (p = 0.000). Lumbar muscle CSA showed a significant difference in the context of the time result (p = 0.008). OLG showed a significant improvement post-intervention (p = 0.003). The rehabilitation exercise program was more beneficial on cardiovascular risk factors and change in lumbar muscle CSA in OLG, suggesting an intensive exercise intervention needed for overweight patients with LBP.
... Bowerman et al. compared the effectiveness of a ten-minute primary care physician-led intervention plus dietician-led telephone counseling session versus usual care on patients' satisfaction and weight loss. They concluded that their program was effective and resulted in about 9.5% and 6.5% weight loss from baseline for women and men at 6 months follow-up, respectively, when considering the averages [15]. These studies parallel our statement that the primary care setting is a successful area to implement weight management interventions. ...
Objective The aim of this study is to examine the effectiveness of a single physician-led weight loss program in a primary care. Methods This is a retrospective analysis of 300 patients with a BMI >30 kg/m2 in an outpatient weight loss program. Weight loss interventions included lifestyle counseling and pharmacotherapy. Outcomes were assessed based on percentage weight change during a time period of two consecutive visits less than 90 days. Results We found that 57.7%, 43.3% and 16.1% patients who attended the clinic 5 or more times, 4-5 times, 2-3 times respectively achieved 5% weight loss (p < 0.0001). In regard to achieving 10% weight loss, 42.3%, 8.7% and 4.3% patients who attended the clinic 5 or more times, 4-5 times and 2-3 times did it respectively (p<0.0001). Moreover 60% of patients achieved 5% of weight loss in about 200 days, and 40% achieved 10% weight loss in 350 days. Patients who achieved 5% weight loss, their average A1c was reduced to 5.8 at their last visit from 6.4 at the first visit. Conclusions A single physician-led weight loss program is effective and can be created within a primary care setting to achieve 5-10% weight loss.
... However, there was no significant association between excessive body weight and occurrence of LBP. This finding is in line with the common trend in literature and it agrees with the finding of Bowerman et al. (37) and Tsuritani et al. (38) who, in their separate study reported no association between obesity and occurrence of LBP. This may, on one hand be because the low back is structurally the most mobile part of the back bone and the part that is mostly exposed to occcupational factors particularly during the assumption of awkward postures at work and rest i.e. prolonged sitting (33). ...
... Despite record rates of non-physician supervised dieting and the availability of numerous weight loss programs, the problem is not abating (37) . Complicating this, is that most primary care physicians do not treat obesity, citing a lack of time, resources, insurance reimbursement, and knowledge of effective interventions as significant barriers (38) . Musculoskeletal disorders including LBP represent a considerable public health problem and a common diagnosis creating absenteeism and the need for disability pensions (39) . ...
Low back pain a major causes of morbidity throughout the world and it is a most debilitating condition ,and can lead to decreased physical function ,compromised quality of life, and psychological distress.
Obesity is nowadays a pandemic condition. Obese subjects are commonly characterized by musculoskeletal disorders and particularly by non-specific LBP. However, the relationship between obesity and LBP remain to date unsupported by objective measurements of mechanical behavior of spine and it is morphology in obese subjects.
Key words: obesity, low back pain
... It would also be beneficial for physicians to work alongside and collaborate with other health professionals who may have more expertise in helping their obese patients, such as dieticians, kinesiologists, and eating disorder specialists. In fact, Bowerman et al. (2001) found that when physicians and dieticians collaborate to provide a treatment program to obese patients, involving short meetings with their physician in-person and nutrition counselling with a dietician over the phone, their patients lost weight. Physicians also reported that these interprofessional team approaches reduced the amount of time with each patient to a sustainable level. ...
With rates of obesity among adults and youth rising in Canada, it is clear that the current approaches currently used to reduce the prevalence of obesity, with an emphasis on individual weight management interventions focused on restrictive dieting, are not proving successful at a population level. Given that obesity is associated with poor physical and mental health outcomes, is placing a multi-billion-dollar economic burden on Canada and disproportionately affects disadvantaged groups, such as Aboriginal Canadians and women of low socioeconomic status, it is a health and social issue that must be addressed immediately by social workers and policy makers. This article discusses the benefits of implementing a multifaceted population-level intervention that is health centered, evidence based, antistigmatizing to obese individuals, and accessible to all Canadians. The proposed intervention includes increased education for primary care physicians, the development of walkable neighborhoods, taxation of junk food, financial incentives, clear nutrition labelling, public awareness campaigns, regulation of food advertising (especially targeted to children), and school-based health promotion initiatives. This article also discusses the unique role that social workers must play in leading the charge against the stigmatization of obese individuals, while also championing policies to effectively reduce the prevalence of obesity in Canada.
... Weight related stigma is the unfair treatment of people living with obesity and is a universal phenomenon in developed countries. [51][52][53] Outcomes of this stigma include poor experiences during interactions with healthcare providers, reduced job and promotion opportunities, verbal harassment and bullying, and even physical assault. 54,55 The effects of this in healthcare have included patients avoiding health visits due to fear of being lectured or shamed. ...
As obesity prevalence continues to rise, approximately one third of patients seen by Australian general practitioners (GPs) are living with obesity. General practice is the cornerstone of primary care in Australia with 85% of the population seeing a GP at least annually. The current role of the GP in obesity management focuses on care co-ordination with guidelines encouraging the referral of patients to allied health services, including dietitians and exercise physiologists. But multidisciplinary team care is not always available due to factors such as location and cost, or patients may have a preference for working more closely with their GP. Currently there are no weight management programs where care is delivered by a GP. This doctoral work explores the current role of the GP in obesity management in Australia, outlines an intervention development study for a GPdelivered weight management program, and presents the findings of a feasibility trial of the program. Following the UK Medical Research Council’s Guidelines for the Development of a Complex Intervention, a GP-delivered weight management program was developed. The draft program was based on Australian evidence-based guidelines for obesity management and used a qualitative approach to engage stakeholders to refine the program materials. Following this intervention development, a six-month feasibility trial was undertaken in five general practices involving 11 GPs and 23 patients. Guided by Normalisation Process Theory, both quantitative and qualitative data were collected. Both GPs and patients reported high rates of acceptability and feasibility, and there was a low dropout rate with only three patients withdrawing. Based on the theoretical framework of Bordin, patients and GPs with a strong therapeutic alliance had better program retention and there was a trend to improvement in some health outcomes. Social cognitive theory suggests that “performance mastery” is the most effective way to develop self-efficacy. This was demonstrated in the feasibility trial with both qualitative and quantitative data showing the GPs improved self-efficacy for obesity management. Based on the findings in the feasibility trial, a modified approach to obesity management in primary care is suggested with a greater emphasis on therapeutic relationship, person-centredness, and the explicit recognition that care occurs over time and not within one consultation. A GP-delivered weight management program in Australia was demonstrated to be feasible and acceptable to both patients and their GPs. Future research will focus on a pseudo-cluster randomised controlled trial for effectiveness, alongside further development of a measure for therapeutic alliance in general practice for research, teaching, and clinical purposes.
... Family physicians have access to wide segments of the population [13] offering key information [14] and are a trusted source of advice [15] so are well placed to address weight [10,16]. The National Institute for Health and Care Excellence (NICE) recognise the important role health care professionals (HCPs) can play in preventing disease [7,[9][10][11]3] seeing obese patients before they develop further complications [12] and recommend they explore barriers to weight management during routine consultations [8]. ...
Objective:
To systematically search and synthesise qualitative studies of physicians' views and experiences of discussing weight management within a routine consultation.
Methods:
A systematic search of four electronic databases identified 11,169 articles of which 16 studies met inclusion criteria. Quality was appraised using the Critical Appraisal Skills Programme tool and a thematic synthesis conducted of extracted data.
Results:
Four analytical themes were found: (1) physicians' pessimism about patients' weight loss success (2) physicians' feel hopeless and frustrated (3) the dual nature of the physician-patient relationship (4) who should take responsibility for weight management.
Conclusion:
Despite clinical recommendations barriers remain during consultations between physicians and patients about weight management. Many of these barriers are potentially modifiable.
Practice implications:
Improving training, providing clearer guidelines and placing a greater emphasis on collaboration within and between clinicians will help reduce barriers for both physicians and patients. In particular, there is an urgent need for more specialised training for physicians about weight management to promote knowledge and skills in behaviour change techniques and ways to broach sensitive topics without damaging patient relationships.
... While the majority of studies provided follow-up via individual sessions, group meetings were included in most studies lasting one year and longer [16,17,21,24,25,29,35,55]. Subjects in all of these studies managed to maintain weight loss at ≥ 5% and this success could be attributed to the social support provided by group meetings [17,23,29]. Several studies provided lifestyle education and counselling through telephone calls [16,33,63]. Educational materials either in printed or electronic format were given when there was no healthcare provider follow-up [28,34,50,51]. ...
... Dietary sessions centered on restriction of energy intake. Dietary advice was individualized to subject's lifestyle [12,17,24,38,39], and included topics such as portion control [12,17,27,63], food exchanges [38,57,60], eating out, and cooking [22,53]. Structure was reinforced with provision of meal plans, recipes, food shopping guides [12,23,34,39,58], and a list of recommended foods to eat [23,40]. ...
... Cognitive behavioral support was provided by psychologists or behavioral therapists in studies with healthcare providers from these disciplines [16,24]. One study used a subject-completed worksheet that allowed the physician to assess patient readiness for behavior change [63]. ...
Meal replacements have been shown to be effective in assisting weight loss in many clinical trials; however,
adherence is a major determinant of the reported success. Characterizing how meal replacements were used for weight loss in clinical studies can assist healthcare providers to replicate efficacy and improve adherence to achieve successful weight loss. This narrative review characterizes the treatment conditions that support meal replacements use for weight loss from 45 clinical trials. From these studies, the key treatment conditions that support the successful use of meal replacements include contact with healthcare providers; structured education and counseling sessions; and close monitoring of progress. Weekly contacts with healthcare providers that included a physician with dietitian/nutritionist team for at least three months were needed in the initial phase of using meal replacements. Education and counseling sessions should be conducted at individual and group level to provide structured diet plans which included healthy eating, exercise plan and incorporation of cognitive/psychological motivation components. Frequent monitoring of progress included weekly to monthly weight monitoring, the use of food and exercise records, and self-monitoring of blood glucose in subjects with diabetes. In conclusion, similar with other lifestyle interventions, intensive follow ups and monitoring are required to ensure the success of using meal replacements for weight loss in everyday clinical practice.
... A review of weight loss interventions in primary care shows that while evidence of the effectiveness of weight loss interventions delivered by primary care physicians is limited, [9][10][11][12][13][14][15][16] primary care physicians can play a critical role in diagnosing obesity, evaluating changes in weight-related comorbid conditions, and referring patients to trained interventionists. 17 Primary care physicians are in a unique position to refer patients because they reach most segments of the population, and their expertise is highly regarded. ...
Purpose:
The aim of the study was to test a tailored lifestyle intervention for helping obese primary care patients achieve weight loss and increase physical activity.
Methods:
We conducted a 24-month randomized clinical trial in Rhode Island. Primary care physicians identified obese, sedentary patients motivated to lose weight and increase their moderate to vigorous physical activity. These patients were randomized to 1 of 2 experimental groups: enhanced intervention (EI) or standard intervention (SI). Both groups received 3 face-to-face weight loss meetings. The enhanced intervention group also received telephone counseling calls, individually tailored print materials, and DVDs focused on diet and physical activity. Active intervention occurred in year 1 with a tapered maintenance phase in year 2.
Results:
Two hundred eleven obese, sedentary patients were recruited from 24 primary care practices. Participants were 79% women and 16% minorities. They averaged 48.6 years of age, with a mean body mass index (BMI) of 37.8 kg/m(2), and 21.2 minutes/week of moderate to vigorous physical activity. Significantly more EI participants lost 5% of their baseline weight than SI participants (group by visit, P <.001). The difference was significant during active treatment at 6 months (37.2% EI vs 12.9% SI) and 12 months (47.8% vs 11.6%), but was no longer significant during the maintenance phase at 18 months (31.4% vs 26.7%,) or 24 months (33.3% vs 24.6%). The EI group reported significantly more minutes of moderate to vigorous physical activity over time than the SI group (group by visit, P = 0.04). The differences in minutes per week at 6 months was 95.7 for the EI group vs 68.3 minutes for the SI group; at 12 months, it was 126.1 vs 73.7; at 18 months, 103.7 vs 63.7, and at 24 months, 101.3 vs 75.4. Similar trends were found for absolute weight loss and the percentage reaching national guidelines for physical activity.
Conclusion:
A home-based tailored lifestyle intervention in obese, sedentary primary care patients was effective in promoting weight loss and increasing moderate to vigorous physical activity, with the effects peaking at 12 months but waning at 24 months.
... Family physicians have access to wide segments of the population [13] offering key information [14] and are a trusted source of advice [15] so are well placed to address weight [10,16]. The National Institute for Health and Care Excellence (NICE) recognise the important role health care professionals (HCPs) can play in preventing disease [7,[9][10][11]3] seeing obese patients before they develop further complications [12] and recommend they explore barriers to weight management during routine consultations [8]. ...
