Improving management of obesity in primary care: cluster randomised trial

doi:10.1136/bmj.327.7423.1085

BMJ 2003;327:1085 (8 November), doi:10.1136/bmj.327.7423.1085

Primary care

Improving management of obesity in primary care: cluster randomised trial

Helen Moore, director of Yorkshire Primary Care Research Network¹, Carolyn D Summerbell, reader in human nutrition², Darren C Greenwood, lecturer in medical statistics³, Philip Tovey, principal research fellow⁴, Jacqui Griffiths, senior community dietitian⁵, Maureen Henderson, senior community dietitian⁶, Kate Hesketh, senior community dietitian⁷, Sally Woolgar, diabetes specialist dietitian⁸, Ashley J Adamson, lecturer in human nutrition⁹

¹ Centre for Research in Primary Care, University of Leeds, Leeds LS2 9PL, ² School of Health, University of Teesside, Middlesbrough TS1 3BA, ³ Biostatistics Unit, University of Leeds, Leeds LS2 9LN, ⁴ School of Healthcare Studies, University of Leeds, Leeds LS2 9JT, ⁵ Department of Nutrition and Dietetics, Leeds Community Nutrition, St Mary's Hospital, Leeds LS12 3QE, ⁶ Department of Nutrition and Dietetics, University Hospital of North Durham, Durham DH1 5TW, ⁷ Newcastle Nutrition, Newcastle Hospitals NHS Trust, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, ⁸ Department of Nutrition and Dietetics, Scarborough, Whitby and Ryedale Primary Care Trust, Scarborough Hospital, Scarborough YO12 6QL, ⁹ Human Nutrition Research Centre, School of Clinical Medical Sciences, University of Newcastle upon Tyne, Newcastle NE1 7RU

Correspondence to: Helen Moore h.moore{at}leeds.ac.uk

Objective To evaluate a training programme intended to improvethe management of obesity, delivered to general practice teams.

Design Cluster randomised trial.

Setting Northern and Yorkshire region of England

Participants 44 general practices invited consecutively attendingobese adults to participate; 843 patients attended for collectionof baseline data and were subsequently randomised.

Intervention 4.5 hour training programme promoting an obesitymanagement model.

Main outcome measures Difference in weight between patientsin intervention and control groups at 12 months (main outcomemeasure) and at 3 months and 18 months; change in practitioners'knowledge and behaviour in obesity management consultations.

Results Twelve months after training the patients in the interventiongroup were 1 (95% confidence interval - 1.9 to 3.9) kg heavierthan controls (P = 0.5). Some evidence indicated that practitioners'knowledge had improved. Some aspects of the management model,including recording weight, target weight, and dietary targets,occurred more frequently in intervention practices after thetraining, but in absolute terms levels of implementation werelow.

Conclusion A training package promoting a brief, prescriptiveapproach to the treatment of obesity through lifestyle modification,intended to be incorporated into routine clinical practice,did not ultimately affect the weight of this motivated and atrisk cohort of patients.

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