More clinic time won't stave off weight gain

NEW YORK (Reuters Health) - People who receive one-on-one counseling over multiple years are no more likely to avoid gaining weight than those who simply check in with their regular doctors once in a while, new study findings report.

Specifically, 6 out of 10 people who met with a nurse practitioner multiple times to discuss how to stay active and healthy avoided gaining weight over a 3-year period. But so did 6 out of 10 people who did not receive any individualized counseling.

Both groups were also just as likely to maintain their blood pressure and cholesterol. People who spent extra time with a nurse practitioner, however, were more likely to have lowered their fasting blood sugar levels by the end of the study.

Even though the extra intervention was largely ineffective, the findings were not disappointing, study author Nancy ter Bogt of the University Medical Center Groningen told Reuters Health - more than half of all study participants did not gain weight.

And the change in blood glucose levels is a good sign, she added. "This is very important in the prevention of diabetes and shows that lifestyle changes without (substantial) weight loss can lead to positive health effects."

The intervention may have other benefits, as well -- in a previous study with the same group, researchers found that men who met one-on-one with a nurse practitioner tended to lose more weight over one year than men who didn't have these regular meetings. Weight loss was similar among both groups of women, however.

The study, published in the Archives of Internal Medicine, included more than 400 residents in The Netherlands, all overweight or obese, who had either high blood pressure, bad cholesterol, or both.

During the study, ter Bogt and her colleagues randomly assigned 225 people to meet with a nurse, and another 232 to simply check in regularly with their doctor.

The logic, the authors note, is that doctors often have little time to counsel patients on ways to lose or not gain weight.

Those who received personalized counseling met with a nurse four times in the first year, also checking in once on the phone, and spoke again to the nurses a few more times over the following 2 years. Nurses helped participants set goals for losing weight, keep food diaries, and use pedometers to track their activity. "This leads to more awareness of a healthy lifestyle," ter Bogt noted in an e-mail.

After 1 year, people who met with nurses were more likely to have kept off extra weight. However, by the end of the study, that advantage had disappeared, and both groups were equally likely to have avoided gaining weight. And both groups lost roughly the same amount over the 3-year study period - between 0.6 and 1.2 percent of their body weight.

Encouragingly, the authors note that on average, Dutch residents gain a small amount of weight every year, which the majority of both groups of participants avoided.

"Weight gain is a steady and slow process," ter Bogt added. To keep the weight off, the best steps are also the most obvious ones. "In our opinion, the best way to prevent further weight gain is to make small adaptations in lifestyle (e.g., increase physical activity) and more awareness of a healthy lifestyle."

In an accompanying editorial, Drs. Debra Haire-Joshu and Samuel Klein at the Washington University School of Medicine in St. Louis note that other research has shown that intensive interventions can indeed help people lose weight. We can't rely on primary care doctors alone, they add, who often don't have the time and training patients need.

"Weight loss interventions in primary care settings will be more...sustainable if supported by complementary actions of multiple settings, such as worksite or community," they write.

SOURCE: bit.ly/hLmTN1 Archives of Internal Medicine, February 28, 2011.