Predictors of weight loss in young adults who are over-weight or obese and have psychosocial problems: a post hoc analysis

Jørgen Lous, Kirsten S Freund, Jørgen Lous, Kirsten S Freund

Abstract

Background: The aim of this study is in a general practice trial setting to identify predictive factors for weight loss after 1 year among young adults who are over-weight or obese and who have several psychosocial problems.

Methods: Twenty-eight general practitioners recruited 495 patients aged 20-45 years with psychosocial problems for a randomized general preventive study to increase self-efficacy to achieve a self-prioritised goal for a better life by discussions of resources and barriers for reaching the goal. The present study is a post hoc analysis of possible predictors of weight loss among all 218 patients who have over-weight or obesity. A 23-pages questionnaire was completed before and 1 year after randomization. 111 patients had a one-hour preventive health consultation with their general practitioners focused on life coaching and a follow-up consultation within 3 months, and 107 patients had no preventive consultation.

Results: Twenty-two patients stated during the preventive consultation that weight loss was a prioritised goal. They had a mean weight loss of 4.7 kgs compared with 1.6 kgs in the group without this goal and 1.6 kgs in the group without preventive consultation. In a logistic regression model, predictors of weight loss or no weight loss were a) pre-interventional consideration of weight loss within 30 days, b) having weight loss as a prioritised goal for improved quality of life, c) being female, d) being in the oldest half of participants, and e) having many psychosocial problems. In a linear regression model, the predictors together explained about 11% of the weight loss. Important predictors were: obesity (explained 4%), pre-interventional consideration of weight loss within 30 days (3%), and having a preventive health consultation with weight loss as a prioritised goal (2%).

Conclusions: Pre-interventional consideration of weight loss within 30 days and having weight loss as a prioritised goal during the health consultation were two important predictors for weight loss. By structured interventions focussing on the patients' priorities, self-chosen goals, their resources and barriers for reaching the goals, changes may be obtained; especially in participants with many problems who often do not accept participation in procedures on risks.

Clinicaltrials gov registration: NCT 01231256 , Aug. 22. 2010.

Trial registration: ClinicalTrials.gov NCT01231256.

Keywords: General practitioners; Life coaching; Motivation; Over-weight; Patient-centred; Psychosocial problems; Specific self-efficacy; Weight loss.

Figures

Fig. 1
Fig. 1
Flowchart of enrollment. Note: one participant excluded because of missing information on weight both in the group of preventive consultation and no weight loss goal and in the group of no preventive consultation and not asked for goals
Fig. 2
Fig. 2
a and b Correlation plot and “Difference versus average plot” (Bland & Altman plot) of measured and stated weight at baseline (n = 91)

References

    1. Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet. 2011;377:557–67. doi: 10.1016/S0140-6736(10)62037-5.
    1. Rössner S. Obesity: the disease of the twenty-first century. Int J Obesity. 2002;26(Suppl4):s2–4.
    1. Flegal KM, Kit BK, Orpana H, Graubard BL. Association of all-cause mortality with overweight and obesity using standard body mass index categories; a systematic review and meta-analysis. JAMA. 2013;309:71–82. doi: 10.1001/jama.2012.113905.
    1. Azimi A, Charlot MG, Torp-Pedersen C, Gislason GH, Køber L, Jensen LO, et al. Moderate overweight is beneficial and severe obesity detrimental for patients with documented atherosclerotic heart disease. Heart. 2013;99:655–60. doi: 10.1136/heartjnl-2012-303066.
    1. Thomsen M, Nordestgaard BG. Myocardial Infarction and ischemic heart disease in overweight and obesity with and without metabolic syndrome. JAMA Intern Med. 2014;174:15–22. doi: 10.1001/jamainternmed.2013.10522.
    1. Ross R, Dagmone D, Jones PJ, Smith H, Paddags A, Hudson R, et al. Reduction in obesity and related comorbid conditions after diet-induced weight loss or exercise-induced weight loss in men; a randomized controlled trial. Ann Intern Med. 2000;133:92–103. doi: 10.7326/0003-4819-133-2-200007180-00008.
    1. Blissmer B, Riebe D, Dye G, Ruggiero L, Greene G, Caldwell M. Health-related quality of life following a clinical weight loss intervention among overweight and obese adults: intervention and 24 month follow-up effects. Health Qual Life Outcomes. 2006 Jul 17;4:43.
    1. Yamaoka K, Tango T. Efficacy of lifestyle education to prevent type 2 diabetes; a meta-analysis of randomized controlled trials. Diabetes Care. 2005;28:2780–6. doi: 10.2337/diacare.28.11.2780.
    1. Heitmann BL. Ten-year trends in overweight and obesity among Danish men and women aged 30–60 years. Int J Obesity. 2000;24:1347–52. doi: 10.1038/sj.ijo.0801388.
    1. Wildenschild C, Kjøller M, Sabroe S, Erlandsen M, Heitmann BL. Change in the prevalence of obesity and use of health care in Denmark: an observational study. Clin Epidem. 2011;3:31–41. doi: 10.2147/CLEP.S15230.
    1. Pedersen KM, Andersen JS, Søndergaard J. General practice and primary health care in Denmark. JABFM. 2012;25(Suppl1):S34–8.
    1. Le Chatelier E, Nielsen T, Qin J, Prifti E, Hildebrand F, Falony G, et al. Richness of human gut microbiome correlates with metabolic markers. Nature. 2013;500:541–6. doi: 10.1038/nature12506.
    1. Hill JO, Wyatt H. Outpatient management of obesity: a primary care perspective. Obesity Res. 2002;10(suppl 2):124S–130S. doi: 10.1038/oby.2002.205.
    1. Flodgren G, Deane K Dickinson HO, Kirk S, Alberti H, Beyer FR et al. Interventions to change the behavior of health professionals and the organization of care to promote weight reduction in overweight and obese adults (Review). Cochrane Database of Systematic Reviews 2010, Issue 3. .: CD000984. Doi: 10.1002/14651858.CD000984.pub2.
    1. Butler CC, Simpson SA, Hood K, Cohen D, Pickles T, Spanou C, et al. Training to deliver oppotunistic multiple behaviour change counselling in primary care: a cluster randomized trial. BMJ. 2013;346:f1191. doi: 10.1136/bmj.f1191.
    1. Clark MM, Abrams DB, Niaura RS, Eaton CA, Rossi JS. Self-efficacy in weight management. J Consult Clin Psychol. 1991;59:739–44. doi: 10.1037/0022-006X.59.5.739.
    1. Karl JP, Cheatham RA, Das SK, Hyatt RR, Gilhooly CH, Pittas AG, et al. Effect of glycemic load on eating behavior self-efficacy during weight loss. Appetite. 2014;80:204–11. doi: 10.1016/j.appet.2014.05.017.
    1. Bartels SJ, Pratt SI, Achbrenner KA, Barre LK, Naslund JA, Wolfe R, et al. Pragmatic replication trial of health promotion coaching for obesity in serous mental illness and maintenance of outcomes. Am J Psychiatry. 2015;172(4):344–52. doi: 10.1176/appi.ajp.2014.14030357.
    1. Fagermoen MS, Hamilton G, Lerrdal A. Morbid obese adults increased their sense of coherence one year after a patient education course: a longitudinal study. J Multidiscip Health. 2015 Mar 27;8:157–65. doi:10.2147/JMDH.S77763.
    1. Freund KS, Lous J. The effect of preventive consultations on young adults with psychosocial problems: a randomized trial. Health Educ Res. 2012;27:927–45. doi: 10.1093/her/cys048.
    1. Freund KS, Lous J. [Potentially marginalized 20–44 year-olds in general practice. Who are they? Result from a screening questionnaire]. English summery. Ugeskr Laeger. 2002;164:5367–72.
    1. Ammentoep J, Uhrenfeldt L, Angel F, Ehrensvärd M, Carlsen EB, Kofoed P. Can life coaching improve health outcomes? – A systematic review of intervention studies. BMC Health Serv Res. 2013;13:428. doi: 10.1186/1472-6963-13-428.
    1. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1(8476):307–10. doi: 10.1016/S0140-6736(86)90837-8.
    1. Harvey-Berrino J, Krukowski RA, Buzzell P, Ogden D, Skelly J, West DS. The accuracy of weight reported in a web-based obesity treatment program. Telemed J E Health. 2011;17:696–9. doi: 10.1089/tmj.2011.0032.
    1. Mutsaerts MAQ, Kuchenbecker WKH, Mol BW, Land JA, Hoek A. Dropout is a problem in lifestyle intervention programs for overweight and obese infertile women: a systematic review. Hum Reprod. 2013;28:979–86. doi: 10.1093/humrep/det026.
    1. Deci EL, Ryan RM. The “What” and “Why” of goal pursuits: Human needs and self-determination of behavior. Psychological Inquiry. 2000;11:227–68. doi: 10.1207/S15327965PLI1104_01.
    1. Hansen E, Fonager K, Freund KS, Lous J. The impact of non-responders on health and lifestyle outcomes in an intervention study. BMC Res Notes. 2014;7:632–40. doi: 10.1186/1756-0500-7-632.
    1. Bramlage P, Wittchen H-U, Pittrow D, Kirch W, Krause P, Lehnert H, et al. Recognition and management of overweight and obesity in primary care in Germany. Int J Obes Relat Metab Disord. 2004;28:1299–1308. doi: 10.1038/sj.ijo.0802752.
    1. Wadden TA, Volger S, Sarwer DB, Vetter ML, Tsaiu AG, Berkowitz RI, et al. A two-year randomized trial of obesity treatment in primary care practice. N Engl J Med. 2011;365:1969–79. doi: 10.1056/NEJMoa1109220.
    1. Dansinger ML, Tatsioni A, Wong JB, Chung M, Balk EM. Meta-analysis: the effect of dietary counseling for weight loss. Ann Intern Med. 2007;147:41–50. doi: 10.7326/0003-4819-147-1-200707030-00007.
    1. Hemmingsson E, Johansson K, Eriksson J, Sundstrom J, Neovius M, Marcus C. Weight loss and dropout during a commercial weight-loss program including a very-low-calorie diet, a low-calorie diet, or restricted normal food: observational cohort study. Am J Clin Nur. 2012;96:953–61. doi: 10.3945/ajcn.112.038265.
    1. Shikany JM, Thomas AS, Beasley TM, Lewis CE, Allison DB. Randomized controlled trial of the medifast 5&1 plan for weight loss. Int J Obesity (Lond) 2013;37:1571–8. doi: 10.1038/ijo.2013.43.
    1. Appel LJ, Clark JM, Yeh H, Wang N, Coughlin JW, Daumit G, et al. Comparative effectiveness of weight-loss interventions in clinical practice. N Engl J Med. 2011;365:1959–68. doi: 10.1056/NEJMoa1108660.
    1. Pollak KI, Coffman CJ, Alexander SC, Tulsky JA, Lyna P, Dolor RJ, et al. Can physicians accurately predict which patients will lose weight, improve nutrition and increase physical activity? Fam Pract. 2012;29:553–60. doi: 10.1093/fampra/cms004.
    1. Wadden TA, Anderson DA, Foster GD, Bennett A, Steinberg C, Sarwer DB. Obese women’s perceptions of their physicians’ weight management attitudes and practices. Arch Fam Med. 2000;9:854–60. doi: 10.1001/archfami.9.9.854.
    1. Leverence RR, Williams RL, Sussman A, Crabtree BF, Net Clinicians RIOS. Obesity counseling and guidelines in primary care; a qualitative study. Am J Prev Med. 2007;32:334–9. doi: 10.1016/j.amepre.2006.12.008.
    1. Elfhag K, Rössner S. Initial weight loss is the best predictor for success in obesity treatment and sociodemographic liabilities increase risk for drop-out. Patient Educ Couns. 2010;79:361–6. doi: 10.1016/j.pec.2010.02.006.
    1. Dombrowski SU, Knittle K, Aveneell A, Araujo-Soares V, Sniehotta FF. Long term maintenance of weight loss with non-surgical interventions in obese adults: systematic review and meta-analyses of randomized controlled trials. BMJ. 2014;348:g2648. doi: 10.1136/bmj.g2646.
    1. Karlsen T, Søhagen M, Hjemesæth J. Predictors for weight loss after an intensive lifestyle intervention program in obese patients: a 1-year prospective cohort study. Health and Quality of Life Outcomes. 2013;11:165. doi: 10.1186/1477-7525-11-165.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅