Intervention Review

Interventions to change the behaviour of health professionals and the organisation of care to promote weight reduction in overweight and obese adults

  1. Gerd Flodgren2,
  2. Katherine Deane3,
  3. Heather O Dickinson1,
  4. Sara Kirk4,
  5. Hugh Alberti5,
  6. Fiona R Beyer6,
  7. James G Brown7,
  8. Tarra L Penney8,
  9. Carolyn D Summerbell9,
  10. Martin P Eccles1,*

Editorial Group: Cochrane Effective Practice and Organisation of Care Group

Published Online: 14 APR 2010

Assessed as up-to-date: 14 JUN 2009

DOI: 10.1002/14651858.CD000984.pub2

Database Title

Additional Information

How to Cite

Flodgren G, Deane K, Dickinson HO, Kirk S, Alberti H, Beyer FR, Brown JG, Penney TL, Summerbell CD, Eccles MP. Interventions to change the behaviour of health professionals and the organisation of care to promote weight reduction in overweight and obese adults. Cochrane Database of Systematic Reviews 2010, Issue 3. Art. No.: CD000984. DOI: 10.1002/14651858.CD000984.pub2.

Author Information

  1. 1

    Newcastle University, Institute of Health and Society, Newcastle upon Tyne, UK

  2. 2

    University of Oxford, Department of Public Health, Headington, Oxford, UK

  3. 3

    University of East Anglia, Edith Cavell Building, Norwich, UK

  4. 4

    Dalhousie University, School of Health Administration, Halifax, Nova Scotia, Canada

  5. 5

    Linthorpe Surgery, Middlesbrough, UK

  6. 6

    University of York, Centre for Reviews and Dissemination, York, UK

  7. 7

    Sowerby Centre for Health Informatics at Newcastle, NHS Clinical Knowledge Summaries, Newcastle upon Tyne, UK

  8. 8

    Dalhousie University, Applied Research Collaborations for Health, Health Administration, Halifax, Nova Scotia, Canada

  9. 9

    Queen's Campus, Durham University, School of Medicine and Health, Wolfson Research Institute, Stockton-on-Tees, UK

*Martin P Eccles, Institute of Health and Society, Newcastle University, Badiley Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK. Martin.Eccles@newcastle.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions), comment added to review
  2. Published Online: 14 APR 2010

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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.

Objectives

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.

Search 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.

Selection criteria

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.

Data collection and analysis

Two reviewers independently extracted data and assessed study quality.

Main 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 (I2 = 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.

Authors' 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.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Interventions to change the behaviour of health professionals and the organisation of care to promote weight reduction in overweight and obese adults

Although obesity used to be confined largely to high income countries, the proportion of people who are overweight or obese is now increasing globally. Obesity is a major risk factor for a number of chronic diseases, which have negative consequences for individuals, populations, and health service costs.

We searched the scientific literature for randomised controlled trials that compared routine care with interventions that aimed to change either the way health professionals worked to achieve weight loss in overweight and obese people or interventions that aimed to change the organisation of care for them. We examined the effects of interventions targeting the behaviour of health professionals or the way care is organised, with the aim of improving the management of overweight and obese people in primary care, outpatient and community settings. Our review found six relevant trials, assessing more than 246 health professionals and 1324 patients. One of these trials reported that issuing doctors with reminders about weight management strategies helped to reduce their patients' weight; one trial found that dietitian or doctor plus dietitian led weight-loss programmes were more efficient than routine care. One trial found no evidence that either mail or phone interventions were better than standard care in reducing patients' weight.Three trials looked at brief training packages for doctors, but their findings were not consistent. All the included studies varied in terms of participants, interventions, outcomes, and settings. Consequently, we cannot draw any firm conclusions about the effectiveness of these interventions.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

改變健康專家行為與照護組織以改善過重與肥胖人口減重的介入措施

肥胖的盛行率在全球逐漸增加中，若不加以控制將對民眾健康及健康服務成本產生重要的影響。

目標

評估改變健康專家行為與照護組織以改善過重與肥胖人口減重之策略的效果。

搜尋策略

我們使用下列資料庫來更新初步研究的檢索結果，全部都從以前(第2版)檢索的日期至2009年5月進行審查：The Cochrane Central Register of Controlled Trials (其同時整合所有的EPOC Specialised Register資料)(考科藍圖書館，2009年，第1期)，MEDLINE (Ovid)，EMBASE (Ovid)，CINAHL (EBSCO)，與PsycINFO (Ovid)。我們從納入研究的參考文獻中進一步確定可能相關的研究。

選擇標準

比較常規照護與目標為改善健康照護專家行為與照護組織以改善過重或肥胖成人減重之介入措施的隨機對照試驗(Randomised controlled trials(RCTs))。

資料收集與分析

兩名回顧者分別摘錄資料並評估研究品質。

主要結論

我們納入六篇隨機對照研究，包含超過246名健康專家與1324名過重或肥胖病患。其中四篇試驗是針對專家，而兩篇是針對照護組織。大部分的研究有方法學或報告的缺點，其指出有偏差風險。三篇試驗的統合分析評估針對家庭醫師的教育介入措施，結果認為相較於標準照護，一年後這種介入措施的病患其平均體重有減少(1.2 kg，95% CI為−0.4至2.8 kg)；然而，研究結果之間有中度無法解釋的異質性(I2 = 41%)。一篇試驗發現提醒者可以改變醫師的做法，造成男性的體重顯著減少(11.2 kg，95% CI為1.7至20.7 kg)，但女性則沒有(體重減少1.3 kg，95% CI為−4.1至6.7 kg)。一篇試驗發現相較於標準照護，如果由營養師(5.6 kg，95% CI為4.8至6.4 kg)，或由醫師與營養師組成的團隊(6 kg，95% CI為5至7 kg)提供照護，一年後病患也許可以減少更多的體重。一篇試驗發現標準照護與郵寄或電訪兩者的介入措施之間對於減少病患體重沒有顯著差異。

作者結論

大部分納入的試驗有方法學或報告的缺點，且研究對象，介入措施，結果，與機構皆具有異質性，因此我們無法推斷任何有關介入措施效果的肯定的結論。在建議這些介入措施作為有效的策略之前，所有評估的介入措施需要進一步的研究。

翻譯人

本摘要由高雄榮民總醫院金沁琳翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

改變健康專家行為與照護組織以改善過重與肥胖人口減重的介入措施： 雖然肥胖過去主要常見於高收入國家，但過重或肥胖的人口比例在全球正逐漸增加中。肥胖是許多慢性疾病主要的危險因子，對於個人，族群，與健康服務成本有負面結果。我們檢索科學文獻以搜尋隨機對照試驗，其比較常規照護與針對改變健康專家的工作方法以達成過重與肥胖人口減少體重，或針對改變減重照護組織的介入措施。我們評估針對健康專家行為或組織照護方法的介入措施，且目的為改善基層照護，門診與社區機構中過重與肥胖人口的管理。我們的回顧發現六篇相關的試驗，評估超過246名健康專家與1324名病患。其中一篇試驗報告有提醒者之體重管理策略的醫師有助於減少他們病患的體重；一篇試驗發現營養師或醫師連同營養師指導減重計畫比常規照護更有效。一篇試驗沒有發現郵寄或電訪介入措施對於減少病患體重比常規照護有效的證據。三篇試驗觀察醫師的簡要訓練套裝計畫，但它們的結果不一致。所有納入的研究其研究對象，介入措施，結果與機構各不相同。因此，我門無法推斷任何關於這些介入措施效果的肯定的結論。

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