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 t o standard methods developed by the Cochrane Effective Practice and Organis ation of Care (EPOC) Group.(1) PARTICIPANTS: Trained health care professionals and overweight and obese pa tients. MEASUREMENTS: Objective measures of health professionals' practice and beha viours, and patient outcomes including satisfaction, behaviour, psychologic al factors, disease status, risk factors, and measures of body weight, fat, or BMI. RESULTS: Twelve studies that met all the review inclusion criteria were ide ntified. Three were randomised controlled trials of health professional-ori ented interventions (such as the use of reminders and training) and one was a controlled before and after study to improve collaboration between a hos pital clinic and GPs. A further eight randomised controlled trials were ide ntified of interventions comparing either the deliverer of weight loss inte rventions or the setting of the delivery of the intervention. The heterogen eity and generally limited quality of identified studies make it difficult to provide recommendations for improving health professionals' obesity mana gement. CONCLUSIONS: At present, decisions about improving the provision of service s for overweight and obese people must be based on the evidence from patien t interventions and good clinical judgement. Future research is required to identify cost-effective strategies for improving health professionals' man agement and the organisation of care for overweight and obese people. A full version of this review, including detailed descriptions of the inclu ded studies and data tables, is available in the Cochrane Library.(2) The C ochrane Library is a database of systematic review and other evidence on th e effects of health care, available on CD ROM from Update Software. For fur ther information see: http://www.cochrane.co.uk.