Simple Nurse Follow-Up Can Help Sustain Weight LossTuesday, May 12, 2009
As anyone who has ever tried to manage their weight is only too well aware, the real challenge in obesity treatment is not so much in losing weight as it is in keeping it off. As no interventions actually “cure” obesity, all patients who have lost weight need continued follow-up to reinforce and help them maintain their weight loss.
But how should intensely should these patients be followed?
In a paper, published this week in the Canadian Medical Association Journal, Kelly Dale and colleagues from the University of Otago, Dunedin, New Zealand, find that an inexpensive low-intensity but regular nursing follow up is as effective in helping patients maintain weight loss as a much more comprehensive interdisciplinary program.
Dale and colleagues randomized 200 women aged 25–70 years (initial average BMI ~32) who had intentionally lost at least 5% of their initial body weight in the previous 6 months and have or have had a body mass index (BMI) of 27 or greater to one of two levels of support:
In the less intense nurse-support program participants received weigh-in visits (5–10 minutes) with the research nurse every 2 weeks for the duration of the study (2 years). In addition, each participant was paired with a “buddy” (support person) who was in the same group and whose role was to provide additional encouragement.
The intensive-support program was based on the program used in the Finnish Diabetes Prevention Study and involved 11 individualized one-on-one sessions (about 35 minutes) with a nutritionist and exercise trainer at 2 and 6 weeks and 3, 4, 6, 9, 12, 15, 18, 21 and 24 months. Participants were also encouraged to attend at least 2 supervised circuit-type resistance-training sessions at a private gym each week for the duration of the study.
Of the 200 participants, 180 (90%) were followed-up at 1 year and 174 (87%) at 2 years with no differences in weight maintenance between the groups.
The authors conclude that the low-intensity/low-cost intervention was as effective for weight-loss maintenance as the more intensive and substantially more expensive interdisciplinary follow up.
In a commentary to the article, Robert Ross (Queens University, Kingston, Ontario), suggests that exercise specialists or dietitians, who have the relevant training and are no more expensive than nurses, would perhaps be as effective.
Of course, the findings need to replicated in an actual primary care practice, but surely they support the notion that minimal but regular follow-up can provide a cost-effective strategy to help patients maintain weight loss.