Intermediate weight changes and follow-up of dietetic treatment in primary health care: an observational study
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RESEARCH ARTICLE
Open Access
Intermediate weight changes and follow-up of dietetic treatment in primary health care: an observational study Lisa D. M. Verberne1* , Chantal J. Leemrijse1, Markus M. J. Nielen1 and Roland D. Friele1,2
Abstract Background: Primary health care data have shown that most patients who were treated for overweight or obesity by a dietitian did not accomplish the recommended treatment period. It is hypothesised that a slow rate of weight loss might discourage patients from continuing dietetic treatment. This study evaluated intermediate weight changes during regular dietetic treatment in Dutch primary health care, and examined whether weight losses at previous consultations were associated with attendance at follow-up consultations. Methods: This observational study was based on real life practice data of overweight and obese patients during the period 2013–2017, derived from Dutch dietetic practices that participated in the Nivel Primary Care Database. Multilevel regression analyses were conducted to estimate the mean changes in body mass index (BMI) during six consecutive consultations and to calculate odds ratios for the association of weight change at previous consultations with attendance at follow-up consultations. Results: The total study population consisted of 25,588 overweight or obese patients, with a mean initial BMI of 32.7 kg/m2. The BMI decreased between consecutive consultations, with the highest weight losses between the first and second consultation. After six consultations, a mean weight loss of − 1.5 kg/m2 was estimated. Patients who lost weight between the two previous consultations were more likely to attend the next consultation than patients who did not lose weight or gained weight. Conclusions: Body mass index decreased during consecutive consultations, and intermediate weight losses were associated with a higher attendance at follow-up consultations during dietetic treatment in overweight patients. Dietitians should therefore focus on discussing intermediate weight loss expectations with their patients. Keywords: Overweight, Obesity, Weight loss, Nutritionists, Primary health care
Background In Europe, almost all primary health care systems provide services for the prevention and treatment of overweight and obesity (i.e. having a body mass index (BMI) ≥ 25 kg/ m2) [1]. In the Netherlands, general practitioners (GPs), practice nurses, and dietitians are the main healthcare * Correspondence: [email protected] 1 Nivel, Netherlands Institute for Health Services Research, P.O. Box 1568, Utrecht 3500 BN, The Netherlands Full list of author information is available at the end of the article
professionals to provide these services. Weight management tasks by GPs and practice nurses may consist of regular weight measurements and advisement on nutrition and physical activity [2, 3]. For more intensive guidance on nutritional health care, patients are advised to consult a dietitian. Dietitians are important health care professionals for providing nutritional health
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