Primary care-based, targeted screening programme to promote sustained weight management

Abstract

Objective. To identify overweight and obese subjects at increased cardiovascular risk in the community, and provide them with lifestyle counselling that is possible to implement in real life. Design. Longitudinal cohort study. Setting. The communities of Harjavalta and Kokemäki in south-western Finland. Subjects. A tape for measurement of waist and a risk factor questionnaire was mailed to home-dwelling inhabitants aged 45–70 years (n = 6013). Of the 4421 respondents, 2752 with at least one cardiovascular risk factor were examined by a public health nurse. For the subjects with high cardiovascular risk (n = 1950), an appointment with a physician was scheduled. The main goal of lifestyle counselling for the 1608 high-risk subjects with BMI ≥ 25 kg/m2 was weight reduction of at least 5%. Among these, 906 had completed self-administrated questionnaires at baseline and form the present study population. Main outcome measure. Success in weight management. Results. At the three-year follow-up visit, 18% of subjects had lost ≥ 5% of their initial weight and 70% had stabilized their weight, while 12% had gained weight ≥ 5%. Newly diagnosed glucose disorder (OR 1.37 [95% CI 1.02–1.84]) predicted success in weight management, whereas depressive symptoms (OR 0.61 [95% CI 0.42–0.90]), excess alcohol use (OR 0.63 [95% CI 0.44–0.90]), and number of drugs used (OR 0.91 [95% CI 0.83–0.99]) at baseline predicted poor outcome. Conclusions. A primary care screening programme to identify overweight or obese individuals can promote sustained weight management. Psychological factors, especially depressive symptoms, are a critical component to consider before attempts to change the lifestyle of an individual.