Obesity: Multicomponent Provider Interventions with Client Interventions

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Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) finds insufficient evidence to determine the effectiveness of the combination of multicomponent provider-oriented interventions with client interventions to prevent and control obesity among child, adolescent, or adult clients based on the lack of any data on provider behavior change and moderate effects on patient weight.

The full CPSTF Finding and Rationale Statement and supporting documents for Obesity Prevention and Control: Multicomponent Provider Interventions with Client Interventions are available in The Community Guide Collection on CDC Stacks.

Intervention

Multicomponent interventions are designed to increase knowledge and change attitudes and practices of healthcare providers in addressing overweight and obesity among clients. These interventions use more than one of the following strategies: education, feedback, reminders, or office systems and support mechanisms. The interventions in this review also include components directed at clients themselves (e.g., lifestyle education, behavioral interventions).

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to obesity prevention and control.

Study Characteristics

Study Characteristics not available because CPSTF did not have enough information to determine if the intervention works.

Summary of Results

Interventions for providers with adult patients:

  • Three studies qualified for the review.
  • No studies reported outcomes related to provider behavior.
  • Patient outcomes:
    • Weight: median decrease of 5.72 lbs (3 studies)
    • Blood pressure: one study reported a decrease
    • Blood lipid measures: one study reported improvements
    • No behavior change outcomes reported

Interventions for providers with child and adolescent patients:

  • The single study identified for the review found small and inconsistent effects on BMI, physical activity, and nutrition outcomes.

Summary of Economic Evidence

An economic review of this intervention was not conducted because CPSTF did not have enough information to determine if the intervention works.

Applicability

Applicability of this intervention across different settings and populations was not assessed because CPSTF did not have enough information to determine if the intervention works.

Evidence Gaps

The following outlines evidence gaps from reviews of provider-oriented interventions to prevent and control obesity: provider education, provider feedback, provider reminders, provider education with a client intervention, multicomponent provider interventions, and multicomponent provider interventions with client interventions.

Future studies should measure changes in provider behavior and patient weight-related outcomes. Studies should be conducted over a clinically meaningful duration, report outcomes with statistical precision, and use a study design and sample size that allows sufficient power to detect a meaningful difference. Following are questions that remain to be answered.

Effectiveness on provider outcomes:

  • What effect do education, reminders, and feedback have on providers’ knowledge, attitudes, skills, and behavior?
  • Do these interventions have an additional benefit on the provider’s own weight?
  • Which characteristics of these interventions contribute to increased or decreased effectiveness?
  • Does the method of delivery to providers matter?
  • What frequency, duration, or format of provider education contributes to increased or decreased effectiveness?
  • Are provider-based interventions more effective at either preventing weight gain, preventing weight re-gain, or promoting weight loss?

Effectiveness on patient outcomes:

  • If the provider interventions change their knowledge, attitudes, and skills, does this have an effect on patient knowledge, attitudes, and skills?
  • Do provider-level interventions have an effect on patient biological outcomes (such as weight-related outcomes, objectively measured)?
  • What are intervention effects on various subgroups/sub-populations?

Implementation and adoption:

  • Are provider-level interventions more effective when integrated within clinical systems than when offered on a referral basis?
  • Do specific potential benefits from an intervention enhance its acceptability? For example, does training providers on obesity counseling assist with other types of counseling?
  • Are there other harms from an intervention, such as taking time away from other tasks that might be more effective?
  • What is the cost effectiveness of these interventions?
  • How broadly applicable is the intervention; to what types of patients does it appeal?
  • What resources (e.g., time, money, staffing, computer capabilities) constrain these interventions?
  • What are the barriers and enabling factors to adoption and implementation of provider-level interventions? In what ways can they be integrated into institutional or other systems-level interventions?
  • Does effectiveness differ based on the level of scale in which interventions are delivered or on type of provider?

Implementation Considerations and Resources

CPSTF did not have enough evidence to determine whether the intervention is or is not effective. This does not mean that the intervention does not work, but rather that additional research is needed to determine whether or not the intervention is effective.