Background
Methods
Research question
Data sources and search
Inclusion and exclusion criteria
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focused on prevention of childhood obesity;
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were medical treatments aimed solely at weight loss, such as surgical or pharmaceutical interventions;
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described an intervention that did not take place in a health setting or if that setting was focused solely on the role of general practitioners.
Data extraction
Study (author, year, country) | Clinical focus | Intervention participants, setting duration | Main findings and limitation | 5As focus (Ask, Assess, Advise/Agree, Assist, Arrange) |
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Jackson et al., 2007 [11] United Kingdom | Health visitor (community nurse) | Specialist health visitor intervention aimed at addressing obesity 89 people with BMI > 30 Community health 1 year | - Weight, BMI, BP decreased - Self-reported diet changed (less sugar products, more fruit and vegetable) - Positive feedback from participants - Small numbers and short term follow-up | - Assess - Advise - Assist |
Davis et al. 2008 [12] USA | Medical specialists (nephrology) | Education of doctors on behaviour modification, patient education, health literacy and communication 64 patient interactions observed pre and post education of doctors working in hospital based nephrology clinic Pre and post intervention evaluation | - Doctors communication improved post intervention - Patients increased recall of weight based advice - No assessment if intervention lead to patients making changes recommended. - Small numbers, all in one clinic | - Ask - Assess - Advise |
Mustila et al. 2013 [13] Finland | Maternity- Prenatal care | Non randomised, individual and group counselling for women at risk of gestational diabetes Measures: development of gestational diabetes, gestational weight gain, newborn anthropometry, infant weight gain Interventions commenced at 1—17 weeks gestational weeks, follow up to infant 12 months | - Reduced gestational glucose intolerance, no changes to gestational weight gain, newborn anthropometry or infant weight gain - No long term follow-up to establish impact on childhood obesity or mother’s long-term weight | - Ask - Assess - Advise |
Claesson et al. 2014 [14] Sweden | Maternity- Physical activity benefits during pregnancy | Obese women kept physical activity diaries during pregnancy and answered questionnaires looking at mental health, QoL at weeks 15 and 35 plus 11 wks post 74 physical active, 79 physically inactive | - Physical activity among obese pregnant women provides better psychological well-being and improved quality of life, but does not change weight gain - Self-reported data | - Ask |
McElwaine et al. 2014 [15] Australia | Primary healthcare based nurses and allied health | Practice change intervention to increase PHC nurse and AH provision of preventive care. Non randomised two groups (intervention and control)- interviews with clients to ascertain benefit | - Increase in assessment and advice relating to risk behaviours (Ahn, Smith, & Ory, 2012), but no change in referral rates for intervention or follow-up - Highlights issues with implementation in real world settings | - Ask - Advise - Arrange (refer) |
Bartlem et al. 2016 [16] Australia | Mental health | Trial to get community MH workers to increase preventive care by assessing for risk factors and referring person for intervention 12 month intervention | - Increase in assessment for nutrition risk - No significant change in practice advice or referral | Modified 5As (2As and 1R) - Ask - Advise - Refer |
Wiggers et al. 2017 [17] Australia | Community-based preventative care | Practice change intervention with nursing and allied health community base staff delivering adult services over 12 months, aimed at increasing assessment, brief advice and referral for risk factors Interventions include developing policy and electronic medical record based tool; clinician and manager training; audit and feedback; implementation support | - Assessment enhanced but no significant change to rates of brief advice or referral | Modified 5As (2As and 1R) - Ask - Advise - Refer |
Study (type, author, year) | Clinical focus | Summary of review | Main findings and limitations | 5As focus (Ask, Assess, Advise/Agree, Assist, Arrange) |
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Review Smith et al. 2008 [18] | Adults (pregnancy) | Review of outcomes associated with maternal obesity in pregnancy 54 articles | Describes consequences of obesity in pregnancy; psychological implications (mainly descriptive); Interventions: community based (info, groups etc) inconclusive. Individualised: not significant numbers and no long term outcomes Makes recommendations re: implications for practice- quite broad | Not specifically highlighted by review |
Cochrane review Flodgren et al. 2010 [19] | Health professional change | Interventions to change the behaviour of health professionals and the organisation of care to promote weight reduction in o/o adults (RCTs) 6 RCTS- 246 health professionals and 1324 o/o pts | Limited evidence on how to organise care to include prevention None of the studies evaluated strategies aimed at changing health professionals attitudes or beliefs | N/A focused on changing health professionals behaviour |
Review of reviews Kremers et al. 2010 [20] | Adults | Lit review of interventions targeting prevention of overweight and obesity in adults Looked at 46 studies evaluating interventions aimed at preventing obesity. Interventions looked at setting and target group | More success amongst programmes targeting weight loss than at preventing CV disease or improving general health status | N/A- review focussed on service specifically designed for weight management, not process for people to get into programmes |
Synthesis review Kirk et al. 2012 [21] | Adults | Synthesis of obesity management evidence Systematic reviews and meta-analysis | - Highlights the value of multi-component interventions that are delivered over the longer term, and reinforces the role of health care professionals. - Currently, few health professionals are advising their patients about weight management in general, even as the prevalence of obesity increases. | Focussed on interventions i.e. Assist and arrange |
Review Vuori et al. 2013 [22] USA | Physical activity in health services | Literature review (2000–2013) of ‘exercise training’ counselling delivered in health services | Health benefits to physical activity but advice re: increasing is not routinely incorporated into health encounters Focuses on physical activity in isolation, not how it can link to other lifestyle changes such as diet | N/A Focussed on outcomes not process of providing advice |
Systematic review Kushner and Ryan 2014 [23] | Clinical guidelines for adults | Systematic review to describe best practice for assessment and lifestyle management of obesity | Best practice for assessment lifestyle management of obesity is - Screen all adults for overweight, with full medical history - Offer weight loss via lifestyle change support for people with BMI > 30 Does not discuss issues relating to factors such as health literacy or how to support people with reduced capacity to make lifestyle changes Does not discuss any system issues with implementation | Ask Assess (not health literacy) Advise/ agree Assist Arrange |
Cochrane review Mastellos 2014 [5] | Adults | Transtheoretical model stages of change Looking at Dietary and physical exercise modification in weight loss management for overweight and obese adults 3 RCT studies, 2971 participants | Inconclusive that this model leads to sustained weight loss. The model focuses on 5 stages of change. However, did show changes to behaviour such as improved diet and physical activity. Studies didn’t tend to focus on other outcomes e.g. QoL or rates of illness | N/A- looked at outcomes of specific interventions |
Author | Year | Country | Title | Summary |
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National Health and Medical Research Council [41] | 2013 | Australia | Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia. | - Guidelines for management of individuals who have a body mass index (BMI) greater than 25.0 kg/m2 and are at risk of comorbidities - Intended for use by clinicians including general practitioners, primary health care nurses, - follow the primary care ‘5As’ framework: |
Royal Australian College of General Practitioners [9] | 2016 | Australia | Guidelines for preventive activities in general practice. 9th edition | Aim to provide a practical approach to weight management in general practice with a focus on more intensive interventions |
National Institute for Health and Care Excellence [43] | 2006 (updated 2015) | UK | Obesity prevention Clinical guideline [CG43] | Outlines role of health services in increasing physical activity levels and supporting improvements in diet |
Moyer, V. A., 2011 [42] USA | 2012 update of 2003 recommendations | USA | Screening for and Management of obesity in Adults: U.S. Preventive Services Task Force Recommendation Statement | Recommends all adults should be screened for obesity but that how this is done will be influenced by the individual patients circumstances as well as the health setting |
Study (author, year, country) | Clinical focus | Study type | Main findings and limitation |
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Lindstrom et al., 2005 [60] Finland | Obesity and Diabetes | Description of Finnish Diabetes Prevention Study, focussing on weight management | - Obesity needs to be seen as chronic condition and focus needs to be on behaviour change - Individuals require personalised, ongoing, long-term support to make and sustain lifestyle change - Screening high risk individuals in health settings and providing obesity prevention is effective in preventing Type 2 Diabetes |
Lutfiyya et al. 2008 [24] USA | Medical services for adults | Analysis of 2003 Behavioural Risk factor Surveillance Survey to ascertain whether healthy weight patients receive primary obesity prevention advice | - Only a very small proportion of healthy-weight adults received primary prevention |
Ma et al. 2009 [61] USA | Medical services for adults | Analysis of data from National Ambulatory Medical Care Survey- all patient visits in 2 year period Review of data for doctor visits to look at measurements for obesity plus rates of counselling | - Highlighted number of records that had data on weight and BMI missing plus low rates of intervention for people recorded as being overweight - Data based on one visit- not possible to track if individual received advice on other visits |
Aronne 2009 [62] USA | Adults- assessment and treatment of obesity | Outlines assessment and treatment of obese individuals. | - Recommends long-term behavioural therapy to achieve the lasting benefits of weight loss interventions. |
Kemper 2010 [25] USA | Adults CVD risk/ BMI and need for weight loss counselling | Reviewed records from nursing lead centre against NHLBI guidelines as to whether people were told to lose weight and how appropriate this advice was. | - Small numbers, but only 12% counselled to lose weight and those that did receive advice, it wasn’t within guidelines - Patients in programme self-selected so not reflective of broader society; self-reported risk factors |
Phelan 2010 [26] USA | Maternity- weight gain during pregnancy | Discusses negatives of excessive weight gain in pregnancy and interventions | - Interventions quite broad, doesn’t highlight definite solutions but does give good summary of reasons to act during pregnancy |
Heslehurst 2011 [27] UK | Maternity | Broad description of shortcomings of maternity guidelines and potential issues in UK | - Recommends further research into effectiveness of intervention to support women before, during and after pregnancy |
Post et al 2011 [28] USA | Medical physicians or other community based health professionals | Analysis of survey (2005–08) which included record of BMI and question re: being told about weight status by GP or other health professional and questions re self-identifying as overweight and desire to lose weight | - People told they were overweight more likely to recognise they were overweight and express desire to lose weight - Half of overweight and third of obese not told overweight - Based on self-reported recall of being provided weight advice |
Ahn, Smith et al. 2012 [29] USA | Older adults (≥65 years) | Telephone and postal survey evaluating if a doctor or nurse had asked or given advice about weight, healthy diet, or physical activity Study aimed to investigate the correlates of health professional–patient discussions about body weight, healthy diet, and physical activity. | - Being moderately or severely obese, more chronic conditions, and more frequent physician visits increased the likelihood of being recognized as overweight or obese and reporting lifestyle discussions. - Based on self-reported recall of being provided weight advice |
Hernandez- Boussard et al. 2012 [63] USA | Community based medical practices | Analysis of data from National Ambulatory Medical Care Survey- all patient visits in 2 year period that recorded height and weight to ascertain whether obese patients receive same preventive care as non-obese | - Obese patients received significantly less preventative exams (e.g. mammogram, pap smear etc.); less tobacco and injury prevention advice and less psychological referrals but more diet, exercise and weight reduction education. - Data based on one visit- not possible to track if individual received advice on other visits |
Oken et al. 2013 [30] USA | Maternity | Interviews regarding gestational weight gain and the use of electronic medical records to support clinical decision making Obstetric clinicians from one practice Duration N/A | - Advice regarding gestational weight gain variable, may be enhanced by having clinical decision supports in electronic medical records - Small number of participants, all from one practice |
Miller et al. 2014 [31] Australia | Maternity | A general discussion of reasons for including weight management in pregnancy services and reasons why this is not happening | - A very general summary - references selective research. Gives a good overview of issues but not a definitive solution. Touches on social issues but not in great detail |
Study (author, year, country) | Clinical focus | Study type | Main findings and limitation |
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Brown, Stride et al. 2007 [51] UK | Primary care nurses | Patterns of clinical practice, beliefs and attitudes of primary care nurses in relation to obesity management Self-completed postal questionnaire. 4 PCTs 544 staff- 398 responses (72%) | Majority of nurses agreed -Obesity causes health problems -Patients not motivated to change but not due to lack of self-control - empathy towards patients, rewarding to work with obese -saw weight management as part of role -did not find it awkward or sensitive issue to raise but patients perceived awkwardness. Nurses did not feel effective in role -nurses with higher BMI less likely to have negative view towards obesity - Obesity an issue of lifestyle choice -very few have specific training and didn’t think had organisational support |
Durant et al. 2009 [32] USA | Community health | Survey to look at patient perception of health impact of weight. Analysis looked at ethnicity 1467 surveyed | - Large disparities on racial/ethnic grounds as to whether weight seen as negative for health - Those people whose health care provider had discussed weight had better understanding of health issues |
Heslehurst et al. 2011 [33] | Maternity based health professionals | Qualitative interviews with staff working in maternity services on their views of maternity services role in caring for obese women | - Health and safety issues of working with obese women has improved but more needs to be done to address psychosocial issues, to provide clinical guidelines on weight management in pregnancy and population health initiatives to prevent obesity in pregnancy. |
Smith et al. 2011 [34] (UK) | Maternal obesity | Semi-structured interviews and focus groups evaluating understanding of community based maternal obesity initiatives; community service providers views on maternal obesity services and their role in prevention and management of obesity | - Current public health and community service provision lacks structured maternal obesity objectives |
Gunther et al. 2012 [35] United Kingdom | Doctors and nurses in primary healthcare | Barriers and enablers of managing obesity in GP Qualitative interviews Thematic analysis 7 GPs; 7 practice nurses; 9 O/O pts | - Barriers- stigma, cost of private services, previous patient experience, health professionals not wanting to take responsibility for obesity management; lack of consistency, lack of skills, lack of NHS services i.e. found lots of barriers - Highlighted that preventative measures that concentrate on attitudes, behaviour and short-term goals can be associated with significant health benefits. |
Nahm 2012 [50] USA | Nurses | Preventive health care behaviours of USA based nurses Online study asked about diet, exercise, weight, stress and preferred preventive health status | - Nurses were aware of appropriate preventive health measures but did not translate into their own self care |
Leslie et al. 2013 [36] | Maternity- Gestational weight gain | Views of socially disadvantaged, O/O newly pregnant women on GWG and resources to help with this Survey at 12 week visit | - Lack of awareness of excessive GWG |
Robson et al. 2013 [37] United Kingdom | Mental health- nursing role | Postal questionnaire to 585 mental health nurses to examine attitudes to physical health care | - Mental health nurses do feel they have role in giving advice on diet and exercise but not cancer screening or smoking cessation. - More positive attitudes amongst nurses who has received physical health training post registration |
Schauer et al. 2014 [38] | Primary healthcare- doctors and nurses | Semi-structured interviews with 30 doctors, doctor assistants and nurses 3 | - Clinicians report addressing weight with those who have weight-related chronic conditions, are established patients, or have a change in weight since the previous visit. - Most clinicians address weight in the context of managing or preventing chronic conditions. - Many clinicians base advice on their own experiences with weight. |
Tol 2014 [46] Holland | Overweight or obese adults | Readiness to change and intentions round how to make change On-line questionnaire for adults overweight or obese | - Found that adults who are medically in need of weight-related care are ready to lose weight, only a few intend to use weight related care. |
Kable et Al 2015 [39] Australia | Nurses | Nurses perceptions, practices and knowledge with regard to providing healthy lifestyle advice to pts. O/O 676 surveys sent, 99 returned, 79 usable (15% response rate) | - Small numbers - 68% considered healthy lifestyle advice within scope; 28% calculated body mass, 44% mentioned physical activity solutions, 25% focused on reducing calories - Knowledge about weight management was variable |
McElwaine et al. 2013 [8] | Community Health | Telephone survey of people accessing community health services regarding what preventive advice they received regarding risk factors (smoking, alcohol consumption, fruit and vegetable intake and physical activity) | - Generally preventive are not opportunistically provided. - Highest rates for smoking, lowest for fruit and vegetable consumption. - Favourable view towards receiving preventive advice |
Bartlem et al. 2015 [40] Australia | Mental health | Telephone interviews with community mental health service clients re: engagement in smoking, fruit and vegetable consumption, alcohol consumption and physical activity | - High prevalence of risk behaviours plus high rate of people wanting to change behaviour |