Weight-loss counseling by nurse practitioners no more effective than usual care
MedWire News: Researchers suggest that counseling delivered by general practitioners (GPs) as part of usual care is sufficient for weight gain reduction in overweight and obese patients, after finding no additional benefits from lifestyle counseling provided by trained nurse practitioners (NPs).
Nancy ter Bogt (University Medical Center Groningen, The Netherlands) and colleagues randomly allocated 457 overweight or obese (body mass index [BMI] 25-40kg/m2) patients, with hypertension and/or dyslipidemia, to receive lifestyle counseling from a NP (n=225), or usual care from a GP, according to GP guidelines (n=232).
All participants were medically examined at baseline (between June 2005 and February 2006), and after 1 and 3 years.
The researchers found that lifestyle counseling proved effective, with 80% of participants in the NP group and 64% in the GP group losing more than 1% of their body weight or remaining at a stable weight (between >1% weight loss and 1% weight gain) in the first year.
Any difference between the NP and GP disappeared over time, however, with 60% of patients in both groups losing or maintaining weight after 3 years, a result which the researchers say was "somewhat disappointing."
There were also no significant differences in mean weight or waist circumference changes between the two groups after 3 years.
The only significant differences observed between the two groups were in mean levels of fasting glucose, which fell by 0.02 mmol/l in the NP group, but increased by 0.10 mmol/l in the GP group.
Furthermore, particularly for obese individuals (BMI ≥30 kg/m2), GP care was associated with a lower prevalence of impaired fasting glucose, at 7% compared with 22% for NP care.
In an accompanying commentary, Debra Haire-Joshu and Samuel Klein, from Washington University in St Louis, Missouri, USA, noted that primary care providers are a "critical entry point to the healthcare setting for the obese population."
They stressed that "weight loss interventions in primary care settings will be more effective if coordinated care is reimbursed and more sustainable if supported by complementary actions of multiple settings, such as worksite or community."
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By Nikki Withers