Observational Study on Implementation and Effectiveness of Cognitive Behaviour Therapy Targeting Eating Behaviour for Patients with Abdominal Obesity in an Ordinary Primary Health Care Setting

Lisbeth Stahre,Ann Blomstrand,Tore Hallstrom

doi:10.21767/2471-8203.100036

Abstract

Objective: To describe the implementation of Cognitive Behavioural Therapy Targeting Eating Behaviour (CBT-TEB) and to determine the short-term effectiveness in reducing abdominal obesity and body mass index (BMI) where the therapy was provided in ordinary primary care centres. Methods: A screening questionnaire was given to consecutive patients and after that a health dialogue, blood pressure and plasma glucose check were offered. Eightythree persons aged 18-69 years consented to participate in the CBT-TEB intervention. Inclusion criteria were the combination of abdominal obesity and BMI ≥ 25. Primary outcome measures were changes from baseline to six months after end of therapy in waist circumference (WC), waist-to-hip ratio (WHR), weight, and BMI. Changes in eating behaviours: emotional eating and uncontrolled eating, obesity related psychosocial problems as well as patients´ and group leaders´ experiences of the CBT-TEB programme were also assessed. Pulse, systolic and diastolic blood pressure, total cholesterol, high-density lipoproteins (HDL-C), low-density lipoproteins (LDL-C) and triglycerides were measured. Results: Mean reductions after six months (total sample, last observation carried forward): WC 4.8 (sd 7.0) cm, WHR 0.027 (sd 0.04), weight 4.4 (sd 4.9) kg, BMI 1.6 (sd 1.8) kg/m2. Mean reductions after six months in therapy completers: WC 5.5 (7.3) cm, WHR 0.031 (0.05), weight 5.0 (5.0) kg, BMI 1.8 (1.8) kg/m2. Cognitive restraint eating increased and uncontrolled eating, emotional eating and obesity-related psychosocial problems decreased significantly during therapy. Patients´ experiences of the therapy exceeded their expectations. Group leaders´ experiences were positive. Conclusions: It was feasible to implement CBT-TEB in primary care with health educators and district nurses as group leaders after short training. The therapy was well accepted by patients and staff. The short-term effectiveness of CBT-TEB was satisfying and seems to surpass most or all published CBT-based programmes for reduction of weight and abdominal obesity in patients attending primary care.

Highlights

Overweight and weight-related conditions are important causes of cardiovascular disease, stroke and mortality
To describe the implementation of Cognitive Behavioural Therapy Targeting Eating Behaviour (CBT-TEB) and to determine the short-term effectiveness in reducing abdominal obesity and body mass index (BMI) where the therapy was provided in ordinary primary care centres
All fulfilled criteria for abdominal obesity based on waist circumference (WC) and 75 (90%) fulfilled waist-to-hip ratio (WHR)-based criteria

Summary

Introduction

Overweight and weight-related conditions are important causes of cardiovascular disease, stroke and mortality. Abdominal obesity is a stronger predictor for morbidity and mortality than body mass index (BMI) [1,2,3,4,5]. There are strong associations between abdominal obesity and metabolic risk factors such as insulin resistance, lipid disturbances and hypertension. The metabolic syndrome is increasing in many societies which is coupled to the increasing prevalence of overweight and obesity [6]. Given the magnitude of the problems, treatment of obesity and abdominal obesity should be an important prevention task in primary care. Obesity is often unrecognized in primary care and only a minority of obese primary care patients participate in weight control programmes and few receive advice from health professionals [7,8]

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Discussion

Conclusion