EAL

MNT: Weight Management (2015)

Citation:

Osland EJ, Powell EE, Banks M, Jonsson JR, Hickman IJ. Obesity management in liver clinics: Translation of research into clinical practice. J Gastroenterol Hepatol. 2007; 22(4): 504-509.

PubMed ID: 17376041

Study Design:

Cost-effectiveness study

Class:

M - Click here for explanation of classification scheme.

Quality Rating:

POSITIVE: See Quality Criteria Checklist below.

Research Purpose:

To determine if a nutrition research protocol could be translated into clinical practice and meet the demand of increased referral to the service
To evaluate the effectiveness and resource implication of intensive nutrition intervention
To evaluate the effectiveness of providing alternative methods of dietetic review as an option for patients unable to participate in an intensive program.

Inclusion Criteria:

Referred to a dietitian for weight reduction from the Gastroenterology and Hepatitis management clinics at the Princess Alexandra hospital between February 2003 and March 2005
BMI of at least 25kg/m².

Exclusion Criteria:

Patients unable to participate in the intensive program were offered standard dietetic therapy for weight reduction
Patients who declined dietetic therapy entirely were offered written material summarizing the food and exercise education provided throughout the program.

Description of Study Protocol:

Recruitment

All subjects were patients in the clinic who were referred for weight reduction.

Design

This was a cost-effectiveness study of treatment provided by one dietitian in a specific clinic during the study period.

Intensive therapy consisted of weekly review for 12 weeks followed by weight maintenance program of monthly review for 12 months. Group education was introduced during the initial six weeks, with patients reviewed weekly for one hour to 1.5 hours in groups of six to eight patients using cognitive behavior therapy. During the second six weeks, patients were reviewed individually for 15 minutes to 20 minutes, with the goal to lose weight no faster than 0.5kg per week. The 12-month maintenance program involved support to prevent relapse.
Standard care provided to patients not able to participate in intensive treatment included an initial one-hour consultation with the dietitian, including individualized dietary and physical activity recommendations, and follow-up of 15-minute to 30-minute appointments when scheduled by the patient.

Intervention

A more intensive treatment plan was implemented and studied for effectiveness.

Statistical Analysis

SPSS for Windows version 11.0, statistical significance P<0.05.

Data Collection Summary:

Timing of Measurements

Measurements were recorded at each visit, which varies with treatment group over the course of the six-month study period.

Dependent Variables

Weight (kg)
Waist circumference (cm)
Height (cm)
Patient retention (completion of program)
Patient attendance (number of appointments)
Alanine aminotransferase (ALT, U/L)
Cost (Australian dollars).

Independent Variables

Sex
Age
Work status.

Control Variables

Level of therapy.

Description of Actual Data Sample:

Initial N: N=93
Attrition (final N): N=65 (30% attrition); intensive program 48 (50% male); standard therapy 17 (47% male)
Age: Intensive 51.1±1.8 years; standard 45.2±2.3 years
Other relevant demographics: Work status not statistically different between groups
Anthropometrics: Waist circumference was significantly higher in the intensive treatment group (113±1.7cm vs. 105±2.4cm, P=0.04)
Location: Queensland, Australia.

Summary of Results:

Key Findings

83% of patients in intensive treatment program achieved weight loss at six months. Only 24% of patients in standard treatment program achieved weight loss.
Intensive treatment patients significantly decreased waist circumference to 108±2cm (P<0.001).
Results of dietetic service provision for intensive intervention group at six months: Intensive intervention costs include 12 weeks of intensive intervention (six weeks of group sessions and six weeks of individual review) and monthly follow-up of three months. Costs extrapolated from total costs incurred divided by total weight balance (losses + gains) of all patients continuing in follow up at six months.

Parameter	Result
Mean weight loss (total group)	4.3kg
Number of patients achieving weight loss	26 (83%)
Cost per patient ($AU)	$87.50
Cost per kg lost ($AU)	$31.00

Other Findings

Patients who decreased weight circumference experienced significant improvement in ALT (P<0.001).

Author Conclusion:

An intensive structured dietetic program provided as part of standard clinical practice can be an effective method of weight reduction for overweight patients with liver disease and is a feasible treatment option for weight management in a clinical outpatient setting. The cost of providing an intensive weight loss intervention compares favorably to other weight loss methods involving pharmacotherapy. An outpatient-based, intensive lifestyle intervention is a feasible treatment option for weight management in overweight patients with chronic liver disease.

Funding Source:

University/Hospital:

Princess Alexandra Hospital

Reviewer Comments:

Quality Criteria Checklist: Review Articles
Relevance Questions
	1.	Will the answer if true, have a direct bearing on the health of patients?	Yes
	2.	Is the outcome or topic something that patients/clients/population groups would care about?	Yes
	3.	Is the problem addressed in the review one that is relevant to dietetics practice?	Yes
	4.	Will the information, if true, require a change in practice?	Yes

Validity Questions
	1.	Was the question for the review clearly focused and appropriate?	Yes
	2.	Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described?	N/A
	3.	Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased?	N/A
	4.	Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible?	Yes
	5.	Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined?	Yes
	6.	Was the outcome of interest clearly indicated? Were other potential harms and benefits considered?	Yes
	7.	Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described?	N/A
	8.	Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included?	Yes
	9.	Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed?	Yes
	10.	Was bias due to the review's funding or sponsorship unlikely?	Yes