What are the characteristics of overweight and obese patients who achieve weight loss and what factors are most helpful? A quantitative and qualitative study of patients and interventions in a rural general practice

Introduction and aims: Of the modifiable cardiovascular risk factors obesit y remains the most difficult to influence. Sustained weight reduction is a rare outcome in general practice. A minority of patients do, however, succe ed. This study attempts to identify characteristics of successful weight lo sers (SWL) in primary care and to identify other factors associated with su ccess. Method: The study was in two parts: (1) a case-control review of the overwe ight and obese, using the existing data on cardiovascular risk factors in t he practice collected over 8 years. The demographic and clinical characteri stics of those achieving and maintaining 10% weight loss for at least 3 mon ths were compared with the unsuccessful controls (UWL): (2) a qualitative s tudy of the small group of successful weight losers, employing semistructur ed interviews in each patient's home, looking for patient's ideas on what l ed to success. Results: One hundred and ninety-eight initially overweight (BMI > 25 kg/m(2 )) had follow up weight measurements recorded: 18 (9%) were SWLs. Success w as associated with adverse coronary heart disease (CHD) risk profile, parti cularly with initial and follow-up cholesterol levels where the association was highly significant (P < 0.0001). The qualitative study suggested a dif ferent profile of factors operating in initiation vs. maintenance of weight loss (predominant health related anxiety, in initiation, and enhanced self -image, in maintenance). Conclusions: SWLs are more likely to have modifiable CHD risk factors than UWLs. Some SWLs seem to make a global improvement in modifiable risk factor s when they lose weight. Anxiety about health, either from health professio nal advice or screening, or from life events, is the commonest reason for i nitiating successful weight loss. Doctor and nurse advice was the principal initiating factor in several instances. Sell-generated positive feelings a bout weight loss are the commonest factors in sustaining weight loss, follo wed Ly support from family and friends and support and follow-up by the Pri mary Health Care Teams.