A systematic review of interventions to improve health professionals management of obesity

OBJECTIVE: To determine the existence and effectiveness of interventions to improve health professionals' management of obesity or the organisation of care for overweight and obese people. DESIGN: A systematic review of intervention studies, undertaken according to standard methods developed by the Cochrane Effective Practice and Organisation of Care (EPOC) Group.(1) PARTICIPANTS: Trained health care professionals and overweight and obese patients. MEASUREMENTS: Objective measures of health professionals' practice and behaviours, and patient outcomes including satisfaction, behaviour, psychological factors, disease status, risk factors, and measures of body weight, fat, or BMI. RESULTS: Twelve studies that met all the review inclusion criteria were identified. Three were randomised controlled trials of health professional-oriented interventions (such as the use of reminders and training) and one was a controlled before and after study to improve collaboration between a hospital clinic and GPs. A further eight randomised controlled trials were identified of interventions comparing either the deliverer of weight loss interventions or the setting of the delivery of the intervention. The heterogeneity and generally limited quality of identified studies make it difficult to provide recommendations for improving health professionals' obesity management. CONCLUSIONS: At present, decisions about improving the provision of services for overweight and obese people must be based on the evidence from patient interventions and good clinical judgement. Future research is required to identify cost-effective strategies for improving health professionals' management and the organisation of care for overweight and obese people. A full version of this review, including detailed descriptions of the included studies and data tables, is available in the Cochrane Library.(2) The Cochrane Library is a database of systematic review and other evidence on the effects of health care, available on CD ROM from Update Software. For further information see: http://www.cochrane.co.uk.