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Cited by 90Obesity and Health PracticesObesity, Physical Activity, DietHealth Policy Implementation Science

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

Open access
Flodgren, Gerd, Deane, Katherine, Dickinson, Heather O, Kirk, Sara, Alberti, Hugh, Beyer, Fiona R, Brown, James G, Penney, Tarra L +2 more·2010·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd000984.pub2PMC PMC4235843
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Abstract

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 STRATEGY: 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 (I(2) = 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.

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  • Interventions implemented by community-identified leaders are often more effective than those by non-leaders.

    “Yet interventions implemented by community-identified leaders are often more effective than those by non-leaders [20, 21].”

    From Social Network Analysis for Program Implementation (2015) · cites this paper as [20]

  • There is strong evidence that opinion leader and RDS interventions are effective behavior change approaches.

    “There is strong evidence that opinion leader and RDS interventions are effective behavior change approaches [20, 68].”

    From Social Network Analysis for Program Implementation (2015) · cites this paper as [20]

  • Network-identified peer opinion leaders have been used in dozens of studies to accelerate behavior change.

    “Network-identified peer opinion leaders have been used in dozens of studies to accelerate behavior change.”

    From Social Network Analysis for Program Implementation (2015) · cites this paper as [20]

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Research works printed but not linked: 6

  1. Ferstl von R Jokusch U Brengelmann JC Behaviour therapy of overweight [Die verhaltenstherapeutische behandlung des Ubergewichts] International Journal of Health Education 1975 119 36
  2. Health Education Authority Obesity in primary healthcare. A literature review 1995 HEA London
  3. Jeffery RW McGuire MT Brelje KL Pronk NP Boyle RG Hase KA Recruitment to mail and telephone interventions for obesity in a managed care environment: the weigh-to-be project The American Journal of Managed Care 2004 10 378 82 15209481
  4. National Institute for Health and Clinical Excellence National Collaborating Centre for Primary Care Obesity: the prevention, identification, assessment and management of overweight and obesity in adults and children 2006 Vol. CG43 http://www.nice.org.uk/CG43#summary 22497033
  5. Raab G Butcher I Balance in cluster randomized trials Statistics in Medicine 2001 20 351 65 11180306
  6. The Nordic Cochrane Centre The Cochrane Collaboration Review Manager 2008 The Nordic Cochrane Centre, The Cochrane Collaboration Copenhagen 5.0

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Authors
Flodgren, G., Deane, K., Dickinson, H. O., Kirk, S., Alberti, H., Beyer, F. R., Brown, J. G., Penney, T. L., Summerbell, C. D., & Eccles, M. P.
Affiliations
  • University of Oxford (GB)
  • University of East Anglia (GB)
  • Newcastle University (GB)
  • Dalhousie University (CA)
  • Linthorpe Surgery; 378 Linthorpe Road Middlesbrough UK TS5 6HA
  • University of York (GB)
  • Sowerby Centre for Health Informatics at Newcastle; NHS Clinical Knowledge Summaries; Bede House, All Saints Business Centre Newcastle upon Tyne UK NE1 2ES
  • Durham University (GB)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2010-03-17
Issue
3
Pages
CD000984-CD000984
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd000984.pub2
PMC
PMC4235843
OpenAlex
W2170008268
Cited by
90
References
117
Citations by year
2025: 1 · 2024: 1 · 2022: 4 · 2021: 4 · 2020: 3 · 2019: 7 · 2018: 7 · 2017: 5 · 2016: 9 · 2015: 13 · 2014: 8 · 2013: 9 · 2012: 10
FWCI
2.39
Type
journal article
Language
en
Update notices
new_version (2017-11-30)
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • UEA Digital Repository (University of East Anglia) (acceptedVersion)
  • Durham Research Online (Durham University) (submittedVersion, cc-by)
  • Newcastle University ePrints (Newcastle Univesity)
Topics
  • Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Keywords
obesity, overweight adults, weight loss, care organization, weight loss interventions, primary care, sex differences in weight loss, risk of bias, cost-effectiveness, quality of life
MeSH terms
Adult, Body Weight, Delivery of Health Care, Female, Humans, Male, Obesity, Patient Education as Topic, Professional Practice, Weight Loss, Randomized Controlled Trials as Topic, Controlled Clinical Trials as Topic, Overweight

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