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Obesity: Multicomponent Provider Interventions with Patient Interventions

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What the CPSTF Found

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 4 studies (search period 1966 to June 30, 2007).

The review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to obesity prevention and control.

Summary of Results

Detailed results from the systematic review are available in the CPSTF finding pdf icon [PDF - 390 KB].

Four studies were included in the review.

Adult Populations (3 studies)

  • All 3 studies reported reductions in patients’ weight with a median weight loss of 5.7 pounds.
  • One study showed significant weight loss, decreases in triglycerides, and improvement in blood lipid measures.
  • One study reported a decrease in blood pressure.

Children (1 study)

  • Patients’ nutrition score increased significantly after 15 months.

Summary of Economic Evidence

An economic review of this intervention was not conducted because the CPSTF did not have enough information to determine if the intervention works.

Applicability

Applicability of this intervention across different settings and populations was not assessed because the CPSTF did not have enough information to determine if the intervention works.

Evidence Gaps

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

Effectiveness on provider outcomes:

  • What effect do interventions have on providers' knowledge, attitudes, skills, and behavior?
  • Do interventions have an additional benefit on the provider's own weight?
  • Which characteristics of the interventions contribute to increased or decreased effectiveness?
  • Do different methods of delivery to providers produce different results?
  • What frequency, duration, or format of provider education contributes to increased or decreased effectiveness?
  • Are provider-based interventions more effective at preventing weight gain, preventing weight re-gain, or promoting weight loss?

Effectiveness on patient outcomes:

  • If the provider interventions change their knowledge, attitudes, and skills, does this have an effect on patient knowledge, attitudes, and skills?
  • Do provider-level interventions have an effect on patient biological outcomes (such as weight-related outcomes, objectively measured)?
  • Do intervention effects vary when delivered to subgroups or sub-populations?

Implementation and adoption:

  • Are provider-level interventions more effective when used within clinical systems than when patients are referred to providers outside the system?
  • Do specific benefits of an intervention enhance its acceptability? For example, will training providers on obesity counseling assist with other types of counseling?
  • Are there other harms from an intervention, such as taking provider time away from other tasks that might be more effective?
  • What is the cost effectiveness of these interventions?
  • How broadly applicable is the intervention; to what types of patients does it apply?
  • What resources (e.g., time, money, staffing, computer capabilities) constrain these interventions?
  • In what ways can interventions be integrated into institutional or other system-level interventions?
  • Does effectiveness differ by the type of provider?
  • Does the level of scale affect whether interventions work?

Study Characteristics

  • Of the adult studies, 2 were randomized controlled trials and 1 used a time series design.
    • Core elements of the patient interventions were diabetes education led by healthcare professionals, goal setting, home-based plan of care, physician-led counseling, and referral to nurses who delivered lifestyle interventions.
    • Patients had diabetes, hypertension, or obesity.
  • The study with children was a 15-month randomized controlled trial with 163 children.