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Dietitians and weight loss

Dietitians play an effective role in weight loss programmes

This study suggests that the advantages of dietitian-provided intensive behavioural therapy extend beyond weight loss to include associated benefits for Medicare patients

Intensive behavioural therapy from dietitians may be a very effective ways for older patients to lose weight, according to researchers who examined the integration of registered dietitian nutritionist-provided intensive behavioural therapy for obesity into a primary care setting and evaluated clinic outcomes for Medicare patients. The paper, ‘Sharing the 'weight' of obesity management in primary care: integration of registered dietitian nutritionists to provide intensive behavioural therapy for obesity for Medicare patients’, was published in the journal, Family Practice.

In the US, an estimated 39.8% of the general adult population has obesity and the economic consequences of obesity are high, with estimated US$1,429 greater annual healthcare expenditures per person with obesity and US$147 billion overall per year. Obesity is also associated with increased risk of type 2 diabetes, stroke, certain cancers and cardiovascular disease.

Patients undergoing intensive behavioural therapy for obesity met with a registered dietitian once every week for the first month, and once every other week for the next six months, and then (if the patient lost weight) once a month for an additional six months to discuss challenges and lifestyle changes. The patients and the dietitians discussed behavioural health risks and factors affecting their choices. The dietitians recommended clear, specific, and personalised advice and the dietitians and the patients worked together to pick goals and methods to achieve them, and the two arranged follow up meetings to discuss progress and challenges.

This study was a retrospective chart review of therapy sessions conducted at a rural family medicine clinic in eastern North Carolina for patients between 2016 and 2019. Patients were female, had Medicare insurance, and BMI>30. A total of 2,097 female patients met the criteria for eligibility for the therapy.

Analysis showed statistically significant improvements in clinical outcomes from intensive behavioural therapy treatment. Patients in the treatment group lost, on average, 2.66 lbs, roughly 1.22 lbs per intensive behavioural therapy visit, compared to patients in the control group who gained an average of 0.5 lbs. Body Mass Index and A1C (average blood sugar) declined for intensive behavioural therapy patients and those patients also took prescription medication an average of six days less than the control group. Minorities and older respondents experienced smaller, all else constant, and annual fixed effects suggest that differentials widen over time.

This study suggests that the advantages of dietitian-provided intensive behavioural therapy extend beyond weight loss to include associated benefits for Medicare patients. The researchers involved in the study believe that the results indicate it may be time for primary care physicians to expand their use of dietitians given their proven effectiveness.

"We are excited about our findings, which demonstrated registered dietitian nutritionist delivered intensive behavioural therapy for obesity to Medicare beneficiaries is effective and beneficial for patients," said Lauren Sastre from East Carolina University, Greenville, SC, and co-author of the study. "This particularly important in light of the growing pressure on providers to track and demonstrate improved Medicare patient outcomes, which include weight status."

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