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Weight loss, risk factor reduction and lifestyle changes in obese individuals participating in ‘Your Choice’: a dietitian-led weight management programme

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Abstract:

Background: 

Weight loss in obese individuals can improve morbidity, mortality and lower economic costs (NICE, 2006). Current guidance recommends that lifestyle-based interventions should be used as a first-line approach and an adjunct to other weight loss strategies(NICE, 2006), although the evidence is limited and inconsistent (Harvey et al., 2001). ‘Your Choice’ is an ongoing weight management programme provided by the community nutrition service of South Manchester PCT, consisting of a group education day on healthy eating and physical activity, followed by 3-monthly individual appointments for monitoring and support. The aim of this retrospective, quantitative study was to evaluate participant outcomes and satisfaction with the ‘Your Choice’ programme. Methods: 

This study included 123 participants that were enrolled on the programme. Health-related outcomes, including body weight, body mass index (BMI), heart rate, blood pressure and percentage body fat, were analysed for 73 participants who attended the education day and at least one follow-up appointment using paired t-tests. Retrospective questionnaires were sent at the time of evaluation to all participants who had attended the education day to investigate reported lifestyle changes, self-efficacy, and quality of life as a result of the education day, satisfaction with the programme and reasons for nonattendance. The study was approved by the University of Chester Research Ethics Committee. Results: 

Mean (SD) weight and BMI were 93.8 (12.7) kg and 34.9 (5.7) kg m−2, respectively, at baseline (n = 73). Forty-one percent participants who attended the education day had not attended a follow-up appointment at the time of evaluation. At the time of evaluation, participation in the programme was in the range 3–18 months (median 9 months). Fourteen percent of participants lost ≥5% body weight [−8.8 (4.1) kg], 48% lost 0–4.9% [−2.3 (1.3) kg] body weight, whereas 38% gained weight [2.1 (1.7) kg]. Significant reductions in weight and BMI compared to baseline were observed for participants after two [−1.5 (4.5) kg; n =50] and three [−1.9 (4.6) kg; n =31] follow-up appointments (P 0.05). Reductions in systolic blood pressure were observed at each follow up (P 0.05), but no significant changes were observed for diastolic blood pressure or heart rate. Questionnaire response rate was 51% (n = 63). Participants reported a better understanding of food groups (89%), portion sizes (92%), food labelling (78%) and healthy food choices (81%); 93% reported making positive changes to food choices and 70% reported increasing physical activity. Nighty-five percent were satisfied with the education day overall. Reasons for nonattendance included inconvenient clinic times or locations and changing personal circumstances. Discussion: 

Attending ‘Your Choice’ was associated with significant reductions in weight, BMI and systolic blood pressure, although the magnitude of weight lost was below current recommendations to achieve health benefits. Participant satisfaction was rated highly, and many individuals reported making positive changes to their lifestyles as a result of the education day. The questionnaire highlighted reasons for attrition and the participants’ views of the service. Further strategies need to be identified to allow a greater number of participants to achieve and maintain weight loss in line with current recommendations. Conclusions: 

This study demonstrated the effectiveness of ‘Your Choice’ in terms of weight loss, lifestyle changes and participant satisfaction. Recommendations included measuring waist circumference, providing evening or weekend services and including more frequent follow up, such as support groups or drop-in clinics. The study findings can be used to improve this programme and help develop effective weight management strategies in other UK community settings in the future. References

National Institute of Health and Clinical Excellence (2006) Obesity: The Prevention, Identification, Assessment and Management of Overweight and Obesity in Adults and Children. London: The Stationery Office.

Harvey, E.L., Glenny, A.M., Kirk, S.F.L. & Summerbell, C.D. (2001) Improving health professionals’ management and the organisation of care for overweight and obese people. Cochrane Database Syst. Rev. 2, Article No.: CD000984.

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1365-277X.2009.00952_3.x

Affiliations: 1: Department of Nutrition and Dietetics, Countess of Chester Hospital NHS Foundation Trust, Chester, UK 2: Queensland University of Technology, Brisbane, Australia 3: Manchester PCT, Wythenshawe Health Care Centre, Sharston, Manchester, UK, Email: gaynor_karen@yahoo.ie

Publication date: June 1, 2009

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