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Concurrent Counseling With Dietitian, Physician Is Effective in Achieving Weight Loss

Posted: Friday, August 03, 2007

Concurrent counseling with a dietitian and a physician in an outpatient setting is effective in achieving and maintaining weight loss, according to a new study. 

"Nationally, the reported rate of physician counseling about exercise is approximately 34%," Dr. Francine K. Welty and colleagues from Beth Israel Deaconess Medical Center, Boston, write. "However, many clinicians do not routinely measure patients' weight, assess their lifestyle, or offer advice on such topics."

In the current study, the researchers advised 80 overweight or obese patients with at least one cardiovascular risk factor (86%) or coronary heart disease (14%) to exercise 30 minutes per day. The subjects were also counseled to eat a modified Dietary Approaches to Stop Hypertension (DASH) diet. Weight, body mass index, lipid levels, and blood pressure were measured at one follow-up visit with the dietitian and physician and at least one additional visit with the physician alone.  The authors note that the approach is fully reimbursable.

The average age of the patients was 55 years. The mean baseline body mass index was 30.1 kg/m squared. The average maximum weight loss was 5.6% (10.8 lb) of usual weight at a mean follow-up of 1.75 years. At a mean follow-up of 2.6 years, 64 of these patients (81%) maintained significant weight loss (average weight loss 5.3%). The subjects who maintained weight loss exercised an average of 3.8 days per week, compared with 2.6 days in those who did not (p = 0.012).

There was an average decrease in LDL cholesterol of 9.3% (from 142 to 129 mg/dL) and in triglycerides of 34% (from 297 to 196 mg/dL). The average increase in HDL cholesterol was 9.6% (from 48 to 53 mg/dL). Systolic and diastolic blood pressure was lowered from 129 to 126 mm Hg (p = 0.21) and from 79 to 75 mm Hg (p = 0.003), respectively.

"In a primary care setting, office staff can help perform anthropometric measurements including height, weight, and waist circumference, calculate body mass index from a nomogram, and prompt, coordinate, and deliver counseling and follow-up services," Dr. Welty and colleagues conclude.

They also suggest that that "primary care physicians hold an 'obesity' clinic on prespecified days and arrange for a dietitian to be available at those sessions, a situation similar to that described in this report."

Source: Diabetes In Control: Am J Cardiol 2007;100:73-75

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