What are the characteristics of overweight and obese patients who achieve weight loss and what factors are most helpful? A quantitative and qualitative study of patients and interventions in a rural general practice
Abstract:Introduction and aims: Of the modifiable cardiovascular risk factors obesity remains the most difficult to influence. Sustained weight reduction is a rare outcome in general practice. A minority of patients do, however, succeed. This study attempts to identify characteristics of successful weight losers (SWL) in primary care and to identify other factors associated with success.
Method: The study was in two parts: (1) a case-control review of the overweight and obese, using the existing data on cardiovascular risk factors in the practice collected over 8 years. The demographic and clinical characteristics of those achieving and maintaining 10% weight loss for at least 3 months were compared with the unsuccessful controls (UWL); (2) a qualitative study of the small group of successful weight losers, employing semistructured interviews in each patient’s home, looking for patient’s ideas on what led to success.
Results: One hundred and ninety-eight initially overweight (BMI > 25 kg/m2) had follow up weight measurements recorded; 18 (9%) were SWLs. Success was associated with adverse coronary heart disease (CHD) risk profile, particularly with initial and follow-up cholesterol levels where the association was highly significant (P < 0.0001). The qualitative study suggested a different profile of factors operating in initiation vs. maintenance of weight loss (predominant health related anxiety, in initiation, and enhanced self-image, in maintenance).
Conclusions: SWLs are more likely to have modifiable CHD risk factors than UWLs. Some SWLs seem to make a global improvement in modifiable risk factors when they lose weight. Anxiety about health, either from health professional advice or screening, or from life events, is the commonest reason for initiating successful weight loss. Doctor and nurse advice was the principal initiating factor in several instances. Self-generated positive feelings about weight loss are the commonest factors in sustaining weight loss, followed by support from family and friends and support and follow-up by the Primary Health Care Teams.