Achievement of weight loss in patients with overweight during dietetic treatment in primary health care

Autoři: Lisa D. M. Verberne aff001;  Chantal J. Leemrijse aff001;  Markus M. J. Nielen aff001;  Roland D. Friele aff001
Působiště autorů: NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands aff001;  Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands aff002
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225065



Dietitians are the preferred primary health care professionals for nutritional care in overweight patients. Guidelines for dietitians recommend a weight reduction of ≥ 5% of initial body weight after one year of treatment. The purpose of this study was to evaluate weight change in patients with overweight who were treated by dietitians in Dutch primary health care, and to identify patient characteristics that were associated with it.

Materials and methods

This observational study data was based on real life practice data of patients with overweight during the period 2013–2017, derived from dietetic practices that participated in the Nivel Primary Care Database. Multilevel linear regression analyses were performed to investigate weight change after dietetic treatment and to explore associations with patient characteristics.


In total, data were evaluated from 56 dietetic practices and 4722 patients with a body mass index (BMI) ≥ 25 kg/m2. The mean treatment time was 3 hours within an average timeframe of 5 months. Overall, patients had a mean weight change of -3.5% (95% CI: -3.8; -3.1) of their initial body weight, and a quarter of the patients reached a weight loss of 5% or more, despite the fact that most patients did not meet the recommended treatment duration of at least one year. The mean BMI change was -1.1 kg/m2 (95% CI: -1.2; -1.0). Higher weight reductions were shown for patients with a higher initial BMI and for patients with a longer treatment time. Sex and age were not associated with weight change, and patients with other dietetic diagnoses, such as diabetes, hypertension, and hypercholesterolemia, had lower weight reductions.


This study showed that dietetic treatment in primary health care coincided with modest weight reduction in patients with overweight. The weight loss goals were not reached for most patients, which was possibly due to a low treatment adherence.

Klíčová slova:

Body Mass Index – Body weight – Diabetes diagnosis and management – Hypercholesterolemia – Hypertension – Obesity – Weight loss


1. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384:766–81. doi: 10.1016/S0140-6736(14)60460-8 24880830

2. World Health Organization. Infographic—Over 50% of people are overweight or obese. 2013. Available from: Cited 13 Nov 2018.

3. World Health Organization. Prevention and control of noncommunicable diseases in the European Region: a progress report. 2014. Available from: Cited 13 Nov 2018.

4. Kloek CJ, Tol J, Veenhof C, van der Wulp I, Swinkels IC. Dutch General Practitioners' weight management policy for overweight and obese patients. BMC Obes. 2014;1:2. doi: 10.1186/2052-9538-1-2 26217495

5. van Binsbergen JJ, Langens FN, Dapper AL, van Halteren MM, Glijsteen R, Cleyndert GA, et al. NHG-Standaard Obesitas. Huisarts Wet. 2010;53(11):609–625.

6. The Dutch Association of Dietetics. Artsenwijzer Dietetiek. 2017. Available from: Cited 13 Nov 2018.

7. Millen BE, Wolongevicz DM, Nonas CA, Lichtenstein AH. 2013 American Heart Association/American College of Cardiology/The Obesity Society guideline for the management of overweight and obesity in adults: implications and new opportunities for registered dietitian nutritionists. J Acad Nutr Diet. 2014;114(11):1730–5. doi: 10.1016/j.jand.2014.07.033 25439081

8. Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and The Obesity Society. J Am Coll Cardiol. 2014;63(25 Pt B):2985–3023.

9. Mertens IL, Van Gaal LF. Overweight, obesity, and blood pressure: the effects of modest weight reduction. Obes Res. 2000;8(3):270–8. doi: 10.1038/oby.2000.32 10832771

10. Wing RR, Lang W, Wadden TA, Safford M, Knowler WC, Bertoni AG, et al. Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. Diabetes care. 2011;34(7):1481–1486. doi: 10.2337/dc10-2415 21593294

11. Mitchell LJ, Ball LE, Ross LJ, Barnes KA, Williams LT. Effectiveness of dietetic consultations in primary health care: a systematic review of randomized controlled trials. J Acad Nutr Diet. 2017;117(12):1941–62. doi: 10.1016/j.jand.2017.06.364 28826840

12. Howatson A, Wall CR, Turner-Benny P. The contribution of dietitians to the primary health care workforce. J Prim Health Care. 2015;7(4):324–32. doi: 10.1071/hc15324 26668838

13. Lenoir L, Maillot M, Guilbot A, Ritz P. Primary care weight loss maintenance with behavioral nutrition: an observational study. Obesity (Silver Spring). 2015;23(9):1771–7.

14. Tol J, Swinkels IC, de Bakker DH, Seidell J, Veenhof C. Dietetic treatment lowers body mass index in overweight patients: an observational study in primary health care. J Hum Nutr Diet. 2014;27(5):426–33. doi: 10.1111/jhn.12175 24205956

15. van Esch TE, Brabers AE, van Dijk CE, Gusdorf L, Groenewegen PP, de Jong JD. Increased cost sharing and changes in noncompliance with specialty referrals in The Netherlands. Health Policy. 2017;121(1):180–8.

16. Verberne LD, Hendriks MR, Rutten GM, Spronk I, Savelberg HH, Veenhof C, et al. Evaluation of a combined lifestyle intervention for overweight and obese patients in primary health care: a quasi-experimental design. Fam Pract. 2016;33(6):671–7. doi: 10.1093/fampra/cmw070 27538423

17. Welty FK, Nasca MM, Lew NS, Gregoire S, Ruan Y. Effect of onsite dietitian counseling on weight loss and lipid levels in an outpatient physician office. Am J Cardiol. 2007;100(1):73–5. doi: 10.1016/j.amjcard.2007.02.056 17599444

18. Willaing I, Ladelund S, Jorgensen T, Simonsen T, Nielsen LM. Nutritional counselling in primary health care: a randomized comparison of an intervention by general practitioner or dietician. Eur J Cardiovasc Prev Rehabil. 2004;11(6):513–20. doi: 10.1097/01.hjr.0000152244.58950.5f 15580064

19. Dansinger ML, Tatsioni A, Wong JB, Chung M, Balk EM: Meta-analysis: the effect of dietary counseling for weight loss. Ann Intern Med. 2007;147(1):41–50. doi: 10.7326/0003-4819-147-1-200707030-00007 17606960

20. Finkler E, Heymsfield SB, St-Onge MP. Rate of weight loss can be predicted by patient characteristics and intervention strategies. J Acad Nutr. 2012;112(1):75–80.

21. Johnstone AM, Murison SD, Duncan JS, Rance KA, Speakman JR. Factors influencing variation in basal metabolic rate include fat-free mass, fat mass, age, and circulating thyroxine but not sex, circulating leptin, or triiodothyronine. Am J Clin Nutr. 2005;82(5):941–8. doi: 10.1093/ajcn/82.5.941 16280423

22. Phung OJ, Scholle JM, Talwar M, Coleman CI. Effect of noninsulin antidiabetic drugs added to metformin therapy on glycemic control, weight gain, and hypoglycemia in type 2 diabetes. JAMA. 2010;303(14):1410–8. doi: 10.1001/jama.2010.405 20388897

23. Pischon T, Sharma AM. Use of beta-blockers in obesity hypertension: potential role of weight gain. Obes. Rev. 2001;2(4):275–280. 12119998

Článek vyšel v časopise


2019 Číslo 11