Can strategies intended to improve how care is organised or delivered to people with overweight or obesity lead to greater weight reduction?
What is the aim of this review?
To assess the effectiveness of strategies to change the behaviour of health professionals and the organisation of care to promote weight reduction in people with overweight and obesity. This is an update of a Cochrane Review.
We found little evidence for a clinically important intervention effect on weight loss, or on body mass index (BMI) change. The results suggest that a brief educational intervention provided to healthcare professionals may lead to a slight decrease in weight for their adult patients, but the results of the studies were not consistent. Evidence for all the other interventions we looked at came mostly from single studies, which is why these interventions need further investigation.
What was studied in the review?
The number of people with overweight or obesity is increasing around the world. Excessive weight is associated with many chronic diseases.
We searched the literature for studies that evaluated the effects of interventions aimed at changing the behaviour of health professionals or the way care is organised for improved weight management and weight loss.
What are the main results of this review?
We included 12 studies, eight in adults and four in children. One hundred and thirty-nine family practices were included, providing care to 89,754 people who were followed for 12 months. Seven studies evaluated the effects of various interventions directed at healthcare professionals (i.e. education, reminders, and decision support tools), and the other five evaluated different organisational interventions (i.e. changes in who delivers the health care, how and where it is delivered, etc.). The comparison intervention was standard care, or the opportunity to seek it. The main outcomes assessed were weight or weight change for adults, and how their weight compared with their peers for children.
Brief education of primary care physicians in weight management may slightly decrease the weight of their patients, .
Tailoring the education to the healthcare professional to improve how closely they follow guidelines probably led to little or no difference in obesity management or weight loss at study end.
We are uncertain whether issuing doctors with printed reminders about weight management strategies helped to reduce their patients’ weight, compared to standard care.
Two studies reported that providing doctors with a clinical decision support tool within the practice may lead to little or no difference in the BMI of children with obesity or in the weight of adults with overweight or obesity, compared to patients receiving standard care.
Two studies assessed the effect of multidisciplinary teams. Weight-loss programmes led by a dietitian or by a doctor plus a dietitian may lead to greater weight loss in adult patients than standard care. Shared care (between family practice and hospital doctors and dietitians) probably leads to little or no difference in the BMI of children with obesity, compared to standard care.
Organisational restructuring of the delivery of family practice care (i.e. introducing the chronic care model: training of the whole practice team, enhanced electronic medical record system, the paediatric nurse practitioners playing a key role in delivering the intervention) led to a slightly lower increase in the BMI of children with obesity at intervention clinics, compared to standard care.
Two studies assessed changes in the setting of service delivery. The use of both mail and phone interventions to promote weight loss probably led to little or no difference in weight loss of adults with overweight or obesity, compared to standard care. Family practice weight management programmes conducted by nurses may lead to little or no difference in BMI in children with obesity, as compared to specialist obesity hospital clinics run by consultants.
How up-to-date is this review?
The review authors searched for studies up to September 2016.