A computer support program that helps clinicians provide patients with metabolic syndrome tailored counseling to promote weight loss.

BACKGROUND: Physician counseling can help patients make substantial changes in diet and physical activity behaviors that can result in weight loss and a reduction in metabolic risk factors. Unfortunately, time constraints and a lack of training often make it difficult for physicians to provide effective counseling. The objective in this study was to test the effect of a computerized support tool to enhance brief physician-delivered health lifestyle counseling to patients with increased metabolic risk factors during two usual care visits. DESIGN/SETTING/PARTICIPANTS: This is a prospective controlled trial of a 12-month intervention conducted at two large community health centers serving mostly Hispanic patients. Participants (n = 279) had a body mass index (calculated as kg/m²) ≥ 25 and at least two components of the metabolic syndrome. INTERVENTION: In the intervention group, a computer program was used to help patients set tailored self-management goals for weight loss, nutrition, and physical activity. Goals were then reviewed and reinforced at clinic visits with participants' physicians at baseline and again at 6 months. The control group received care as usual. Data were collected between July 2007 and August 2008. MAIN OUTCOME MEASURES: Change in body weight was the primary outcome. Secondary measures included changes in blood glucose, blood cholesterol, blood pressure, physical activity, and energy intake. RESULTS: Significantly more patients in the intervention group lost ≥ 5% of their body weight at 12 months than controls (26.3% vs 8.5%; odds ratio = 3.86; P < 0.01). Loss of > 5% of total body weight was associated with improvements in cardiovascular risk factors, including low-density lipoprotein cholesterol (-14.0 vs -4.1 mg/dL; P = 0.04). CONCLUSIONS: A brief computer-based intervention designed to increase the dialogue between patients and clinicians about behavioral goals can lead to increased 12-month weight loss.

Clinic-based support to help overweight patients with type 2 diabetes increase physical activity and lose weight.

BACKGROUND: Our objective was to test the effect of physicians providing brief health lifestyle counseling to patients with type 2 diabetes mellitus during usual care visits. METHODS: We conducted a randomized controlled trial of a 12-month intervention at 2 large community health centers, enrolling 310 patients with a body mass index (calculated as weight in kilograms divided by height in meters squared) of 25 or greater. In the intervention group, self-management goals for nutrition and physical activity were set using a tailored computer program. Goals were then reviewed at each clinic visit by physicians. The control group received only printed health education materials. The main outcome measures included change in physical activity and body weight. RESULTS: In the intervention group, recommended levels of physical activity increased from 26% at baseline to 53% at 12 months (P< .001) compared with controls (30% to 37%; P= .27), and 32% of patients in the intervention group lost 6 or more pounds at 12 months compared with 18.9% of controls (odds ratio, 2.2; P= .006). CONCLUSION: A brief intervention to increase the dialogue between patients and health care providers about behavioral goals can lead to increased physical activity and weight loss.