MNT: Weight Management (2015)
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
- 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.
- 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.
- 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.
All subjects were patients in the clinic who were referred for weight reduction.
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.
A more intensive treatment plan was implemented and studied for effectiveness.
SPSS for Windows version 11.0, statistical significance P<0.05.
Timing of Measurements
Measurements were recorded at each visit, which varies with treatment group over the course of the six-month study period.
- 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).
- Work status.
Level of therapy.
- 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.
- 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.
|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|
Patients who decreased weight circumference experienced significant improvement in ALT (P<0.001).
|University/Hospital:||Princess Alexandra Hospital|
Quality Criteria Checklist: Review Articles
|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|
|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|