Dutch General Practitioners’ weight management policy for overweight and obese patients

Kloek, Corelien; Tol, J.J. Heeres-van der; Veenhof, Cindy; Wulp, Ineke van der; Swinkels, I.C.S.

doi:10.1186/2052-9538-1-2

Cited by 12 publications

(8 citation statements)

References 29 publications

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“…Similar to others, we found that most of the HCPs considered dietary advisement important in obesity management [10,26] and that more educational training was desirable [11,27]. Moreover, the few (28 %) participants who received their education in dietary counselling less than one year ago felt more confident about evidence based dietary advice and were to a higher degree positive to LCD advisement, indicating that education and training influences the level of self-estimated knowledge and the attitude toward newer treatment options.…”

Section: Discussionsupporting

confidence: 83%

Low carbohydrate diet and obesity treatment in primary health care: dietary advice after the new Swedish report

2016

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Background: In 2013, the Swedish Council on Health Technology Assessment (SBU) published a report "Dietary treatment of obesity" where low carbohydrate diet (LCD) was established as one of the evidence based diet options in obesity treatment, even without diabetes. No data exists on how much the health care professionals (HCP) in primary care actually are informed of or to which extent they use the knowledge in the new report. We aimed to investigate the HCPs' current knowledge, attitudes and application of LCD in obesity treatment in primary care. Methods: All primary health care centres (PHCC) in Jönköping County Council (JCC) were invited to participate in this cross sectional descriptive study. HCPs who were working with obese patients were sent an online survey by email from January to March 2014. Data was collected about self-estimated knowledge, clinical practice of dietary advice and attitudes on LCD as well as demographic data and work related information. Chi2 and logistic regression were used to analyse associations between the independent and the outcome variables. Results: Two hundred and seventy-one HCPs completed the survey (70.7 %); 95 % gave dietary advice. Those who gave dietary advice, 49 % were uncertain about evidence based dietary advice; 28 % received education on dietary advice last year; 60 % reported patient requests for LCD; 80 % felt hesitant about LCD; 54 % stated that they have good knowledge about LCD and 47 % recommended LCD. Factors that influenced the advisement on LCD were profession (physician and diabetes nurse), patient requests for LCD (OR 0.46, 95 % CI 0.27-0.77, p = 0.003) and good knowledge (self-estimated) about LCD (OR 0.43, 95 % CI 0.26-0.71, p = 0.001). Recent education on dietary advice affected in a positive way the uncertainty about evidence based dietary advice (OR 0.19, p = 0.0001), the hesitancy about LCD (OR 0.37,, p = 0.002) and self-estimated knowledge about LCD (OR 2.67, 95 % CI 1.49-4.80, p = 0.001). Conclusions: HCPs were positive to dietary advisement but had an ambivalent attitude toward LCD as yet another dietary option. This area may be improved with continuous educational training, supposing that this is prioritized. Thus, it is reasonable to believe that LCD will gradually be more common as a tool to deal with obesity in primary care in the future.

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Section: Discussionsupporting

confidence: 83%

Low carbohydrate diet and obesity treatment in primary health care: dietary advice after the new Swedish report

2016

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“…Furthermore, in line with a recent review of similar studies of the UK primary healthcare system, our study indicates that some patients are less likely to be identified as being overweight by their GP, including younger patients and patients without a chronic condition [ 17 ]. These findings are also supported by an Australian study which showed a positive association between age and weight recording [ 10 ], and a study of Dutch GPs’ weight management policy, which showed that weight was less often discussed with patients without weight-related comorbidities [ 18 ].…”

Section: Discussionsupporting

confidence: 59%

“…However, research from the UK suggests that GPs can feel uncomfortable talking about overweight, and may not always feel responsible for discussing weight management with their patients [ 24 ]. In the Netherlands, most GPs consider weight management to be part of their responsibility of providing care, but they face other barriers such as time constraints [ 18 ]. A solution may be for GPs to delegate some weight management tasks to practice nurses, who already play an important role in lifestyle counselling in Dutch primary healthcare [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Recording of weight in electronic health records: an observational study in general practice

et al. 2018

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BackgroundRoutine weight recording in electronic health records (EHRs) could assist general practitioners (GPs) in the identification, prevention, and management of overweight patients. However, the extent to which weight management is embedded in general practice in the Netherlands has not been investigated. The purpose of this study was to evaluate the frequency of weight recording in general practice in the Netherlands for patients who self-reported as being overweight. The specific objectives of this study were to assess whether weight recording varied according to patient characteristics, and to determine the frequency of weight recording over time for patients with and without a chronic condition related to being overweight.MethodsBaseline data from the Occupational and Environmental Health Cohort Study (2012) were combined with data from EHRs of general practices (2012–2015). Data concerned 3446 self-reported overweight patients who visited their GP in 2012, and 1516 patients who visited their GP every year between 2012 and 2015. Logistic multilevel regression analyses were performed to identify associations between patient characteristics and weight recording.ResultsIn 2012, weight was recorded in the EHRs of a quarter of patients who self-reported as being overweight. Greater age, lower education level, higher self-reported body mass index, and the presence of diabetes mellitus, chronic obstructive pulmonary disease, and/or cardiovascular disorders were associated with higher rates of weight recording. The strongest association was found for diabetes mellitus (adjusted OR = 10.3; 95% CI [7.3, 14.5]). Between 2012 and 2015, 90% of patients with diabetes mellitus had at least one weight measurement recorded in their EHR. In the group of patients without a chronic condition related to being overweight, this percentage was 33%.ConclusionsWeight was frequently recorded for overweight patients with a chronic condition, for whom regular weight measurement is recommended in clinical guidelines, and for which weight recording is a performance indicator as part of the payment system. For younger patients and those without a chronic condition related to being overweight, weight was less frequently recorded. For these patients, routine recording of weight in EHRs deserves more attention, with the aim to support early recognition and treatment of overweight.Electronic supplementary materialThe online version of this article (10.1186/s12875-018-0863-x) contains supplementary material, which is available to authorized users.

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“…Therefore, they represent a subpopulation of hypertensive patients, ones that have already been informed on the necessity to lose weight by their GPs. Over 82% of Dutch GPs considered weight management of patients as their responsibility [31]. The study from ten European countries revealed that 60% of GPs advised their overweight patients to lose weight.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Individual Nutrition Education Compared to Group Education, in Improving Anthropometric and Biochemical Indices among Hypertensive Adults with Excessive Body Weight: A Randomized Controlled Trial

et al. 2019

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Objective: The study aims to compare the effectiveness of individual and group nutrition education methods in improving key anthropometric and biochemical markers in drug-treated, overweight-obese hypertensive adults. Methods: The randomized trial included 170 patients with pharmacologically well-controlled primary hypertension and body mass index (BMI) ≥ 25 kg/m2. For six months, the patients received six sessions, either one-to-one individual nutrition education (IE, n = 89) or group education (GE, n = 81), developed by dietitians. Anthropometric measurements, body composition, and fasting measures of biochemical parameters were obtained at baseline and after six months of intervention. Results: 150 patients completed the nutrition education program. The IE group significantly improved in many parameters compared to the GE group, including weight (p < 0.001), waist circumference (p < 0.001), BMI (p < 0.001), systolic and diastolic blood pressure (BP) (p < 0.001), fasting plasma glucose (p = 0.011), oral glucose tolerance test (OGGT) (p = 0.030), and insulin resistance (homeostatic model assessment of insulin resistance, HOMA-IR) (p < 0.001). The groups did not differ in terms of total cholesterol, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) concentrations. Conclusion: Individual nutrition education is more effective than group education in terms of improving anthropometric and biochemical indices in overweight-obese hypertensive adults.

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Dutch General Practitioners’ weight management policy for overweight and obese patients

Cited by 12 publications

References 29 publications

Low carbohydrate diet and obesity treatment in primary health care: dietary advice after the new Swedish report

Low carbohydrate diet and obesity treatment in primary health care: dietary advice after the new Swedish report

Recording of weight in electronic health records: an observational study in general practice

Effectiveness of Individual Nutrition Education Compared to Group Education, in Improving Anthropometric and Biochemical Indices among Hypertensive Adults with Excessive Body Weight: A Randomized Controlled Trial

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