BMJ  2003;326:1458 (28 June), doi:10.1136/bmj.326.7404.1458-a

Letter

Increasing fruit and vegetable consumption

Brief interventions have useful long term results

EDITOR—The study by Steptoe et al on dietary change reminded me of a coronary risk reduction project that I worked for during the late 1970s.¹ My role was to deliver behavioural weight reduction courses to people from a population of 6000 who wished to attend. To my surprise, a single one hour counselling session from one of the doctors had the same long term benefit as my intensive 12 week behavioural weight loss course.

The key factor turned out to be not the treatment given but the degree of interest of the people concerned. At 22 month follow up participants who had responded quickly to the initial invitation had lost weight, whereas those who had responded slowly to that initial invitation had gained weight. The treatment given did not predict weight loss at all.

There was, however, a different pattern. Those people who responded quickly and attended the one hour session lost weight slowly over two years, whereas those same people who attended my sessions lost weight quickly and then regained a fair part of what they had lost. By the 22 month point the two groups had converged. Those who responded slowly gained weight no matter what course they attended.

My intensive courses were in an important respect a negative factor compared with one good counselling or education session. They took much more of the participant's time, and they subjected at least some of them to a cycle of weight loss and weight gain which is probably unhealthy.

That experience convinced me of the value of brief interventions. I also realised that researchers who use volunteers, get a positive result, and then say, "If only everyone could have this treatment" are kidding themselves. With behaviour change research you get the best results with the first people through the door—and the results will inevitably fade the longer you leave the door open.

Airport Health Centre, Sydney, Mascot, NSW 2020, Australia davidbrown{at}bigpond.com

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Competing interests: None declared.

References

1. Steptoe A, Perkins-Porras L, McKay C, Rink E, Hilton E, Cappuccio FP. Behavioural counselling to increase consumption of fruit and vegetables in low income adults: randomised trial. BMJ 2003;326: 855-8. (19 April.)[Abstract/Free Full Text]

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Relevant Article

Behavioural counselling to increase consumption of fruit and vegetables in low income adults: randomised trial

Andrew Steptoe, Linda Perkins-Porras, Catherine McKay, Elisabeth Rink, Sean Hilton, and Francesco P Cappuccio
BMJ 2003 326: 855. [Abstract] [Full Text] [PDF]