Exploring the role of goal setting in weight loss for adults recently diagnosed with pre-diabetes

Abstract

Background: The management of prediabetes in the community setting is a global priority. We evaluated the feasibility of a 6-month multilevel practice nurse-led prediabetes dietary intervention which involved goal setting. The aim of this paper is to explore the weight loss goals and strategies reported by participants to achieve their weight loss goals as recorded by practice nurses, and report on factors that influenced dietary behaviours. Methods: This study used a convergent mixed-methods design. A six-month pragmatic non-randomised pilot study with a qualitative process evaluation was conducted in two neighbouring provincial cities in New Zealand. A structured dietary intervention delivered by practice nurses was implemented in four practices in 2014-2016. Content analysis of the text and descriptive statistics were used to analyse the data. Results: One hundred and fifty seven people with prediabetes were enrolled (85 intervention, 72 control). The intervention group lost a mean 1.3 kg more than the control group (p < .0.001). The majority of the intervention group indicated either a high level of readiness (n = 42, 53%) or some readiness (n = 31, 39%) to make food changes. The majority of weight loss goals aligned with clinical guidelines (between 5 and 10% of body weight). While just over half (n = 47, 55%) demonstrated weight loss at the end of the six month period, the majority of participants did not achieve their predetermined weight loss goal (n = 78, 83%). Gender, ethnicity and budget were not related to weight loss at six months. Readiness to change and reported challenges to making dietary changes were related to weight loss at six months. Negative factors or setbacks included sporadic adherence to diet due to other health problems, change in context or environment and coping with ill health, most notably stress and low mood. Conclusions: The data relating to weight loss and dietary goals provided insight into the challenges that people faced in making dietary changes for weight loss across a six month period. Simplifying goal setting to those goals with the greatest potential clinical impact or the greatest significance to the person, in a socially supportive environment, may increase the success of goal achievement.

The effectiveness of goal setting on glycaemic control for people with type 2 diabetes and prediabetes: A systematic review and meta‐analysis

“…Streamlining the goal‐setting process to include only those goals with the potential to generate the greatest clinical impact or of the highest significance to the individual may improve the achievement of goals (Whitehead et al, 2020). Process evaluations to further understanding of how interventions are perceived, and facilitators and barriers to uptake would make valuable contributions (Abel & Coppell, 2018; Whitehead et al, 2017a,2017b).…”

Impact of a Community-Based Weight Management Program in a North Carolina Health Care System

“…18 Providers used motivational interviewing techniques to encourage patient-centered SMART goals for dietary choices, physical activity, stress management, and sleep improvement. 21,22 The obesity-certified PCPs were involved in every followup visit. Visits were 20 minutes in duration.…”

Uncertainty and certainty: perceptions and experiences of prediabetes in New Zealand primary care – a qualitative study

“…45 Not being told the diagnosis means peoples' illness perception of prediabetes is not being elicited, particularly how social, emotional, cultural and health literacy factors impact on understanding. 46 Similarly, the goal-setting process, which is said to be a 'central strategy for changing health behaviour' 44 and which others 33,47 have found important for motivating prediabetes lifestyle change, does not appear to be routinely undertaken.…”