EAL

MNT: Weight Management (2015)

Citation:

Jones N, Furlanetto DLC, Jackson JA, Kinn S. An investigation of obese adults’ views of the outcomes of dietary treatment. J Hum Nutr Diet. 2007; 20 (5): 486-494. PubMed ID: 17845383

Study Design:

Trend Study

Class:

D - Click here for explanation of classification scheme.

Quality Rating:

NEUTRAL: See Quality Criteria Checklist below.

Research Purpose:

The purpose of this study was to obtain views of patients attending community dietetic clinics, on the dietetic service, the outcomes of dietary treatment in terms of lifestyle change and the impact that attending the dietitian had on their lives
By seeking the views of patients on these topics, the researchers aimed to obtain information on what should be measured in terms of outcomes in the future and also to use the findings to improve dietary treatment.

Inclusion Criteria:

Adult
BMI of 30kg/m² and over or 28kg/m² and under, with obesity-related complications.

Exclusion Criteria:

Not described.

Description of Study Protocol:

Recruitment

Participants were recruited by community dietitians at primary care dietetic clinics
All adult obese patients attending the clinics for weight management advice were asked whether they would like to participate.

Design

This qualitative study used semi-structured one-to-one interviews to collect patients’ views
Interviewers included a dietitian not involved in the treatment of patients and two health researchers
Interviews took place in the participants’ homes and involved a series of open-ended questions on the following topics: Participants’ dieting history, views on advice given, changes they were able to make, barriers that made it difficult to make changes and the impact lifestyle change had on their lives
Interviews were transcribed; participants’ views and comments were grouped and coded according to themes and sub-themes; content analysis was conducted using the constant comparison method.

Statistical Analysis
Not conducted or described.

Data Collection Summary:

Timing of measurements: Single interviews were conducted
Dependent variables: N/A
Independent variables: N/A
Control variables: Participant details such as age, level of activity, gender and reason for dietetic referral were collected.

Description of Actual Data Sample:

Initial N: 24 (six male, 18 female)
Attrition (final N): 24
Age: 10 participants were aged 20 years to 50 years; 14 participants were over 50
Ethnicity: Not described
Other relevant demographics: Not described
Anthropometrics: Not described
Location: Scotland.

Summary of Results:

Key Findings

Most interviewees had lost weight since meeting with the dietitian and had experienced improvements to their physical and mental health
Most interviewees accessed the dietetic service easily; a few commented on long waiting times
The majority of the interviewees reported mainly positive views about the dietetic service, valuing the advice and motivation
Interviewees valued an ongoing, supportive and positive relationship with their dietitian and reported links between the extent of their motivation to change their lifestyle and lose weight and both their relationship with their dietitian and the content of the appointment sessions
All interviewees valued monitoring to assess progress
Interviewees valued advice that was personalized and related directly to their own diet and lifestyle
Most interviewees recognized physical activity as the key to weight loss and were managing to incorporate more walking into their daily lives
Many interviewees felt apathetic in terms of self-efficacy, that there was no room for change or any further restrictions and that they were unable to help themselves
During periods of stress, emotional upset or negative emotion, barriers to complying with advice given were accentuated
Many interviewees expressed the importance of regular dietetic monitoring and support; a missed appointment was a reason for their perceived lack of sufficient weight loss
Many interviewees believed their diets and dieting behaviors to be equivalent or superior to those of others and therefore felt undeserved of their obesity.

Author Conclusion:

This study helped to identify the aspects of dietary treatment that are important to obese patients
Improving the knowledge of patients’ priorities in obesity treatment may inform future provision of dietetic treatment and assist in the selection of appropriate outcomes for measurement.

Funding Source:

University/Hospital:

Glasgow Caledonian University

Reviewer Comments:

Views collected cannot be generalized beyond the sample or be seen as representative of the obese population as a whole.

Small study
Participants were mostly women, over 50 years old and potentially unemployed, retired or on leave from work
A bias was introduced via recruitment methodology of interviewing current volunteers; not considered were the views of patients who had either been discharged or who had voluntarily dropped out of the service
A bias was introduced via choice of interviewers (e.g., people may feel more comfortable pointing out problems when the interviewer isn't a dietitian)
Quantified data was not provided.

Quality Criteria Checklist: Primary Research
Relevance Questions
	1.	Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies)	Yes
	2.	Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about?	Yes
	3.	Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice?	Yes
	4.	Is the intervention or procedure feasible? (NA for some epidemiological studies)	Yes

Validity Questions
1.	Was the research question clearly stated?		Yes
	1.1.	Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified?	Yes
	1.2.	Was (were) the outcome(s) [dependent variable(s)] clearly indicated?	Yes
	1.3.	Were the target population and setting specified?	Yes
2.	Was the selection of study subjects/patients free from bias?		No
	2.1.	Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study?	Yes
	2.2.	Were criteria applied equally to all study groups?	No
	2.3.	Were health, demographics, and other characteristics of subjects described?	No
	2.4.	Were the subjects/patients a representative sample of the relevant population?	No
3.	Were study groups comparable?		N/A
	3.1.	Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT)	N/A
	3.2.	Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline?	N/A
	3.3.	Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.)	N/A
	3.4.	If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis?	N/A
	3.5.	If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.)	N/A
	3.6.	If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")?	N/A
4.	Was method of handling withdrawals described?		N/A
	4.1.	Were follow-up methods described and the same for all groups?	N/A
	4.2.	Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.)	N/A
	4.3.	Were all enrolled subjects/patients (in the original sample) accounted for?	N/A
	4.4.	Were reasons for withdrawals similar across groups?	N/A
	4.5.	If diagnostic test, was decision to perform reference test not dependent on results of test under study?	N/A
5.	Was blinding used to prevent introduction of bias?		No
	5.1.	In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate?	N/A
	5.2.	Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.)	No
	5.3.	In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded?	N/A
	5.4.	In case control study, was case definition explicit and case ascertainment not influenced by exposure status?	N/A
	5.5.	In diagnostic study, were test results blinded to patient history and other test results?	N/A
6.	Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described?		N/A
	6.1.	In RCT or other intervention trial, were protocols described for all regimens studied?	N/A
	6.2.	In observational study, were interventions, study settings, and clinicians/provider described?	N/A
	6.3.	Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect?	N/A
	6.4.	Was the amount of exposure and, if relevant, subject/patient compliance measured?	N/A
	6.5.	Were co-interventions (e.g., ancillary treatments, other therapies) described?	N/A
	6.6.	Were extra or unplanned treatments described?	N/A
	6.7.	Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups?	N/A
	6.8.	In diagnostic study, were details of test administration and replication sufficient?	N/A
7.	Were outcomes clearly defined and the measurements valid and reliable?		Yes
	7.1.	Were primary and secondary endpoints described and relevant to the question?	Yes
	7.2.	Were nutrition measures appropriate to question and outcomes of concern?	Yes
	7.3.	Was the period of follow-up long enough for important outcome(s) to occur?	Yes
	7.4.	Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures?	???
	7.5.	Was the measurement of effect at an appropriate level of precision?	N/A
	7.6.	Were other factors accounted for (measured) that could affect outcomes?	No
	7.7.	Were the measurements conducted consistently across groups?	???
8.	Was the statistical analysis appropriate for the study design and type of outcome indicators?		N/A
	8.1.	Were statistical analyses adequately described and the results reported appropriately?	N/A
	8.2.	Were correct statistical tests used and assumptions of test not violated?	N/A
	8.3.	Were statistics reported with levels of significance and/or confidence intervals?	N/A
	8.4.	Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)?	N/A
	8.5.	Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)?	N/A
	8.6.	Was clinical significance as well as statistical significance reported?	N/A
	8.7.	If negative findings, was a power calculation reported to address type 2 error?	N/A
9.	Are conclusions supported by results with biases and limitations taken into consideration?		Yes
	9.1.	Is there a discussion of findings?	Yes
	9.2.	Are biases and study limitations identified and discussed?	Yes
10.	Is bias due to study's funding or sponsorship unlikely?		Yes
	10.1.	Were sources of funding and investigators' affiliations described?	Yes
	10.2.	Was the study free from apparent conflict of interest?	Yes