Further research is needed to identify cost effective strategies for improving management of obesity

OBJECTIVES

To determine whether health professionals' management or organization of care for overweight and obese people could be improved.

METHOD

Systematic review of randomized controlled trials; interrupted time-series studies and controlled before and after studies.

LITERATURE REVIEW

Ten electronic databases (including MEDLINE and EMBASE), full text searches of relevant print journals, and contact with content area experts. Most searches were conducted up to December 1997.

INCLUSION AND EXCLUSION CRITERIA

Studies: (a) with randomized controlled trial, interrupted time series, or controlled before and after designs AND (b) targeting any qualified health professional AND (c) employing any intervention which targeted providers' management of obesity and aimed to improve provider practice or patient outcomes AND (d) measuring professional performance or patient outcomes.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers assessed and cross-checked studies for inclusion, quality ratings and results. Characteristics, quality and results of included studies were tabulated. Meta-analysis was not performed.

RESULTS

1. Twelve studies were included. Three randomized controlled trials were identified comparing professional-oriented interventions (reminders and training) with controls. One controlled before and after study compared professional and organizational interventions of shared care to improve collaboration between a hospital clinic and general practice. Eight randomized controlled trials of organizational interventions compared either the provider of weight loss interventions or the setting of interventions.

2. Included studies were heterogeneous and generally of poor quality, making it difficult to recommend specific interventions for improving obesity management.

AUTHORS' CONCLUSIONS

Further research is needed to identify cost-effective strategies for improving the management of obesity.