EFFICACY OF A PRIMARY CARE MANAGED WEIGHT LOSS PROGRAM IN OVERWEIGHT AND OBESE WOMEN

Context: Obesity and low vitamin D status are linked. It is not clear that weight loss through lifestyle intervention is influenced by vitamin D status. Objective: The aim of this study was to investigate the effect of baseline vitamin D status and vitamin D supplementation on weight loss and associated parameters for participants on a weight loss program in a primary care setting. Design: A retrospective analysis of clinical records of patients who underwent an individually tailored weight loss program at a single dietetic clinic in Sydney, Australia. Setting: Primary care centers. Patients: 205 overweight and obese men and women aged from 18 to 50 years. Interventions: Patients were referred to a dietetic clinic for a weight loss program. Patients with low serum 25-hydroxyvitamin D (25(OH)D) concentrations at baseline were advised to increase sun exposure and take multivitamins supplemented with 2000 IU or 4000 IU per day of vitamin D3, according to the preference of their primary care physician. Main outcome measures: Clinical parameters of weight, height, waist circumference, and serum 25(OH)D, as well as blood pressure and fasting lipid profile were collected from both baseline and three-month follow-up consultations. Results: Subjects with sufficient baseline 25(OH)D levels (≥50 nmol/L) experienced significantly greater weight loss (−7.7 ± 5.9 kg vs. −4.2 ± 3.3 kg) and reductions in BMI (−2.6 ± 1.8 kg/m2 vs. −1.5 ± 1.1 kg/m2) and waist circumference (−5.2 ± 3.5 cm vs. −3.1 ± 3.1 cm) as compared with those who were vitamin D insufficient at baseline (p < 0.001 for all). Vitamin D insufficient patients who were supplemented with daily 2000 IU or 4000 IU vitamin D experienced significantly greater decreases in weight (−5.3 ± 3.6 kg vs. −2.3 ± 1.6 kg), BMI (−1.9 ± 1.2 kg/m2 vs. −0.8 ± 0.6 kg/m2) and waist circumference (−4.2 ± 3.4 cm vs. −1.2 ± 1.3 cm) as compared with those not supplemented (p < 0.001 for all). We also observed a greater decrease in low-density lipoprotein (LDL) cholesterol (−0.4 ± 0.5 mmol/L vs. −0.2 ± 0.5 mmol/L) in subjects insufficient at baseline and supplemented as compared with those insufficient at baseline and not supplemented (p < 0.01). Conclusion: In a weight loss setting in a dietetic clinic, adequate vitamin D status at baseline, or achieved at three months through supplementation, was associated with significantly greater improvement of anthropometric measures. The study has implications for the management of vitamin D status in obese or overweight patients undergoing weight loss programs.

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Provider Views of the Feasibility and Utility of Lifestyle Obesity Treatment in Primary Care: Insights from the Think Health! Study

European Journal for Person Centered Healthcare ◽

10.5750/ejpch.v3i1.878 ◽

2015 ◽

Vol 3 (1) ◽

pp. 77 ◽

Cited By ~ 1

Author(s):

Etienne Phipps ◽

Lisa Chacko ◽

Jennifer Fassbender ◽

Kelly Allison ◽

David Sarwer ◽

...

Keyword(s):

Primary Care ◽

Weight Loss ◽

Obesity Treatment ◽

Weight Loss Program ◽

Health Study ◽

Clinical Practices ◽

Structured Interviews ◽

Practice Based Research ◽

Primary Care Clinicians ◽

Post Hoc

Rationale: Feasible approaches for providing obesity treatment in primary care settings have been difficult to identify. We assessed the views of primary care clinicians and practice staff about a simplified, lifestyle weight loss program after their participation in a randomized trial designed to evaluate the program within their clinical practices. Methods: Post-hoc interviews were conducted with 13 clinicians and 12 auxiliary staff at the 5 participating practices in the Think Health! Study of weight management in primary care. A 13-item survey was used to guide semi-structured interviews about the perceived strengths, weakness, and potential long-term utility of the program. Responses were analyzed using descriptive statistics and qualitative methods. Results: Providers unanimously endorsed the need for weight loss counseling for their patients. They supported the need for more frequent visits initially to best engage patients in a weight loss program. Additional training in counseling skills was desired. Conclusion: Clinicians participating in a practice- based trial valued having weight loss materials available to share with patients. Offering patient materials that convey key content and structure for behavior change tasks while allowing provider discretion in how materials are integrated into patient care might be a viable option for testing in future practice-based research.

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The effect of a primary care-based Medical Weight Loss Program on weight loss and anthropomorphic metrics

Family Practice ◽

10.1093/fampra/cmaa050 ◽

2020 ◽

Author(s):

Vivienne A Rose ◽

Elena N Klyushnenkova ◽

Min Zhang ◽

Verlyn O Warrington

Keyword(s):

Primary Care ◽

Weight Loss ◽

Care Setting ◽

Primary Care Practice ◽

Primary Care Setting ◽

Weight Loss Program ◽

Care Practice ◽

Control Group ◽

Baseline Weight ◽

Medical Weight Loss

Abstract Background Diet and lifestyle intervention programs have been shown to be effective in decreasing obesity/overweight and many associated comorbidities in specialty research settings. There is very little information however as to the efficacy of such programs conducted in usual/typical primary care practices. We analysed effectiveness of the Medical Weight Loss Program (MWLP) designed to specifically address overweight/obesity in the setting of an urban academic primary care practice. Objective To determine whether participation in the MWLP within a general primary care setting can result in weight loss. Methods A retrospective medical chart review of patients treated in MWLP and a control group of patients with obesity receiving regular care in the general primary care setting. From the practice database (1 April 2015–31 March 2016), 209 patients (≥18 years old) who participated in the MWLP were identified; 265 controls were selected from the remaining population based on the presence of the obesity-related diagnoses. Results MWLP patients lost on average 2.35 ± 5.88 kg in 6 months compared to their baseline weight (P < 0.0001). In contrast, the control group demonstrated a trend of gaining on average 0.37 ± 6.03 kg. Having three or more visits with the MWLP provider within 6 months after program initiation was the most important factor associated with successful loss of at least 5% of the baseline weight. Weight loss also correlated with a decrease in abdominal girth. Conclusion MWLP integrated into the general primary care practice may potentially be an effective model for managing obesity and related morbidities.

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