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Obesity: Provider Education with a Client Intervention

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What the CPSTF Found

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 8 studies (search period 1966 and June 30, 2007). The review was 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.

Summary of Results

Eight studies were included in the review.

  • All of the studies reported patient weight-related outcomes in the desired direction.
    • After 12 months, patients reduced their weight by a median of 2.5 lbs when compared with a control group (5 studies).
    • Studies without a control group showed patients reduced their weight by a median of 11 lbs (range: 6-12 months; 3 studies).
  • One study reported provider outcomes and showed that trained providers scored higher on knowledge and were significantly more likely to record a patient’s weight and discuss target weight and diet.

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

CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are 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?

Study Characteristics

  • Five studies used randomized controlled trials and three used a pre-post design.
  • Provider education varied by who conducted the education, for how long, and on what topics. Patient interventions included education and counseling.
  • Patient characteristics included diabetes, hypertension, and obesity.