Top

Published in:

Open Access 01-12-2021 | Obesity | Research article

Using a brief web-based 5A intervention to improve weight management in primary care: results of a cluster-randomized controlled trial

Authors: Franziska D. Welzel, Jonathan Bär, Janine Stein, Margrit Löbner, Alexander Pabst, Melanie Luppa, Thomas Grochtdreis, Anette Kersting, Matthias Blüher, Claudia Luck-Sikorski, Hans-Helmut König, Steffi G. Riedel-Heller

Published in: BMC Primary Care | Issue 1/2021

Abstract

Background

The primary health care setting is considered a major starting point in successful obesity management. However, research indicates insufficient quality of weight counseling in primary care. Aim of the present study was to implement and evaluate a 5A online tutorial aimed at improving weight management and provider-patient-interaction in primary health care. The online tutorial is a stand-alone low-threshold minimal e-health intervention for general practitioners based on the 5As guidance for obesity management by the Canadian Obesity Network.

Methods

In a cluster-randomized controlled trial, 50 primary care practices included 160 patients aged 18 to 60 years with obesity (BMI ≥ 30). The intervention practices had continuous access to the 5A online tutorial for the general practitioner. Patients of control practices were treated as usual. Primary outcome was the patients’ perspective of the doctor-patient-interaction regarding obesity management, assessed with the Patient Assessment of Chronic Illness Care before and after (6/12 months) the training. Treatment effects over time (intention-to-treat) were evaluated using mixed-effects linear regression models.

Results

More than half of the physicians (57%) wished for more training offers on obesity counseling. The 5A online tutorial was completed by 76% of the physicians in the intervention practices. Results of the mixed-effects regression analysis showed no treatment effect at 6 months and 12 months’ follow-up for the PACIC 5A sum score. Patients with obesity in the intervention group scored lower on self-stigma and readiness for weight management compared to participants in the control group at 6 months’ follow-up. However, there were no significant group differences for weight, quality of life, readiness to engage in weight management, self-stigma and depression at 12 months’ follow-up.

Conclusion

To our knowledge, the present study provides the first long-term results for a 5A-based intervention in the context of the German primary care setting. The results suggest that a stand-alone low-threshold minimal e-health intervention for general practitioners does not improve weight management in the long term. To improve weight management in primary care, more comprehensive strategies are needed. However, due to recruitment difficulties the final sample was smaller than intended. This may have contributed to the null results.

Trial registration

The study has been registered at the German Clinical Trials Register (Identifier: DRKS00009241, Registered 3 February 2016).

World Health Organization. Fact sheet: obesity and overweight. 2016. http://www.who.int/mediacentre/factsheets/fs311/en/. Accessed Feb 2017.

Mensink GBM, Schienkiewitz A, Haftenberger M, Lampert T, Ziese T, Scheidt-Nave C. Übergewicht und Adipositas in Deutschland: Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2013;56:786–94. https://doi.org/10.1007/s00103-012-1656-3.CrossRefPubMed

Kopelman PG. Obesity as a medical problem. Nature. 2000;404:635–43. https://doi.org/10.1038/35007508.CrossRefPubMed

Kopelman P. Health risks associated with overweight and obesity. Obes Rev. 2007;8(Suppl 1):13–7. https://doi.org/10.1111/j.1467-789X.2007.00311.x.CrossRefPubMed

Haslam DW, James WPT. Obesity. Lancet. 2005;366:1197–209. https://doi.org/10.1016/S0140-6736(05)67483-1.CrossRefPubMed

Simon GE, von Korff M, Saunders K, Miglioretti DL, Crane PK, van Belle G, Kessler RC. Association between obesity and psychiatric disorders in the US adult population. Arch Gen Psychiatry. 2006;63:824–30. https://doi.org/10.1001/archpsyc.63.7.824.CrossRefPubMedPubMedCentral

Puhl RM, Heuer CA. The stigma of obesity: a review and update. Obesity. 2009;17:941–64. https://doi.org/10.1038/oby.2008.636.CrossRefPubMed

Withrow D, Alter DA. The economic burden of obesity worldwide: a systematic review of the direct costs of obesity. Obes Rev. 2011;12:131–41. https://doi.org/10.1111/j.1467-789X.2009.00712.x.CrossRefPubMed

Sharma AM, Kushner RF. A proposed clinical staging system for obesity. Int J Obes (Lond). 2009;33:289–95. https://doi.org/10.1038/ijo.2009.2.CrossRef

10.

Galuska DA. Are health care professionals advising obese patients to lose weight? JAMA. 1999;282:1576. https://doi.org/10.1001/jama.282.16.1576.CrossRefPubMed

11.

Foster GD, Wadden TA, Makris AP, Davidson D, Sanderson RS, Allison DB, Kessler A. Primary care physicians’ attitudes about obesity and its treatment. Obes Res. 2003;11:1168–77. https://doi.org/10.1038/oby.2003.161.CrossRefPubMed

12.

Bramlage P, Wittchen H-U, Pittrow D, Kirch W, Krause P, Lehnert H, et al. Recognition and management of overweight and obesity in primary care in Germany. Int J Obes Relat Metab Disord. 2004;28:1299–308. https://doi.org/10.1038/sj.ijo.0802752.CrossRefPubMed

13.

Thuan J-F, Avignon A. Obesity management: attitudes and practices of French general practitioners in a region of France. Int J Obes (Lond). 2005;29:1100–6. https://doi.org/10.1038/sj.ijo.0803016.CrossRef

14.

Tham M, Young D. The role of the general practitioner in weight management in primary care–a cross sectional study in general practice. BMC Fam Pract. 2008;9:66. https://doi.org/10.1186/1471-2296-9-66.CrossRefPubMedPubMedCentral

15.

Puhl RM, Brownell KD. Confronting and coping with weight stigma: an investigation of overweight and obese adults. Obesity. 2006;14:1802–15. https://doi.org/10.1038/oby.2006.208.CrossRefPubMed

16.

Lim MT, Lim YMF, Teh XR, Lee YL, Ismail SA, Sivasampu S. Patient experience on self-management support among primary care patients with diabetes and hypertension. Int J Qual Health Care. 2019;31:37–43. https://doi.org/10.1093/intqhc/mzy252.CrossRefPubMedPubMedCentral

17.

Linetzky B, Jiang D, Funnell MM, Curtis BH, Polonsky WH. Exploring the role of the patient-physician relationship on insulin adherence and clinical outcomes in type 2 diabetes: Insights from the MOSAIc study. J Diabetes. 2017;9:596–605. https://doi.org/10.1111/1753-0407.12443.CrossRefPubMed

18.

Heisler M, Bouknight RR, Hayward RA, Smith DM, Kerr EA. The relative importance of physician communication, participatory decision making, and patient understanding in diabetes self-management. J Gen Intern Med. 2002;17:243–52. https://doi.org/10.1046/j.1525-1497.2002.10905.x.CrossRefPubMedPubMedCentral

19.

Kerse N, Buetow S, Mainous AG, Young G, Coster G, Arroll B. Physician-patient relationship and medication compliance: a primary care investigation. Ann Fam Med. 2004;2:455–61. https://doi.org/10.1370/afm.139.CrossRefPubMedPubMedCentral

20.

Williams GC, Freedman ZR, Deci EL. Supporting autonomy to motivate patients with diabetes for glucose control. Diabetes Care. 1998;21:1644–51.CrossRef

21.

Panagioti M, Richardson G, Small N, Murray E, Rogers A, Kennedy A, et al. Self-management support interventions to reduce health care utilisation without compromising outcomes: a systematic review and meta-analysis. BMC Health Serv Res. 2014;14:356. https://doi.org/10.1186/1472-6963-14-356.CrossRefPubMedPubMedCentral

22.

Vallis M, Piccinini-Vallis H, Sharma AM, Freedhoff Y. Clinical review: modified 5 As: minimal intervention for obesity counseling in primary care. Can Fam Physician. 2013;59:27–31.PubMedPubMedCentral

23.

Serdula MK, Khan LK, Dietz WH. Weight loss counseling revisited. JAMA. 2003;289:1747–50. https://doi.org/10.1001/jama.289.14.1747.CrossRefPubMed

24.

Anczak JD, Nogler RA. Tobacco cessation in primary care: maximizing intervention strategies. Clin Med Res. 2003;1:201–16. https://doi.org/10.3121/cmr.1.3.201.CrossRefPubMedPubMedCentral

25.

Conroy MB, Majchrzak NE, Regan S, Silverman CB, Schneider LI, Rigotti NA. The association between patient-reported receipt of tobacco intervention at a primary care visit and smokers’ satisfaction with their health care. Nicotine Tob Res. 2005;7(Suppl 1):S29-34. https://doi.org/10.1080/14622200500078063.CrossRefPubMed

26.

Larzelere MM, Williams DE. Promoting smoking cessation. Am Fam Physician. 2012;85:591–8. PubMed-ID: 22534270.PubMed

27.

Alexander SC, Cox ME, Turner CLB, Lyna P, Ostbye T, Tulsky JA, et al. Do the five A’s work when physicians counsel about weight loss? Fam Med. 2011;43:179–84. PubMed-ID: 21380950.PubMedPubMedCentral

28.

Canadian Obesity Network. 5As of obesity management. 2013. http://www.obesitynetwork.ca/5As.

29.

Lau DCW, Douketis JD, Morrison KM, Hramiak IM, Sharma AM, Ur E. 2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children summary. CMAJ. 2007;176:S1-13. https://doi.org/10.1503/cmaj.061409.CrossRefPubMedPubMedCentral

30.

Flegal KM, Graubard BI, Williamson DF, Gail MH. Cause-specific excess deaths associated with underweight, overweight, and obesity. JAMA. 2007;298:2028–37. https://doi.org/10.1001/jama.298.17.2028.CrossRefPubMed

31.

Rueda-Clausen CF, Benterud E, Bond T, Olszowka R, Vallis MT, Sharma AM. Effect of implementing the 5As of obesity management framework on provider-patient interactions in primary care. Clin Obes. 2013;4:39–44. https://doi.org/10.1111/cob.12038.CrossRefPubMed

32.

Unrod M, Smith M, Spring B, DePue J, Redd W, Winkel G. Randomized controlled trial of a computer-based, tailored intervention to increase smoking cessation counseling by primary care physicians. J Gen Intern Med. 2007;22:478–84. https://doi.org/10.1007/s11606-006-0069-0.CrossRefPubMedPubMedCentral

33.

Jay M, Schlair S, Caldwell R, Kalet A, Sherman S, Gillespie C. From the patient’s perspective: the impact of training on resident physician’s obesity counseling. J Gen Intern Med. 2010;25:415–22. https://doi.org/10.1007/s11606-010-1299-8.

34.

Carroll JK, Flocke SA, Sanders MR, Lowenstein L, Fiscella K, Epstein RM. Effectiveness of a clinician intervention to improve physical activity discussions in underserved adults. Fam Pract. 2016;33:488–91. https://doi.org/10.1093/fampra/cmw036.CrossRefPubMedPubMedCentral

35.

Jay MR, Gillespie CC, Schlair SL, Savarimuthu SM, Sherman SE, Zabar SR, Kalet AL. The impact of primary care resident physician training on patient weight loss at 12 months. Obesity (Silver Spring). 2013;21:45–50. https://doi.org/10.1002/oby.20237.CrossRef

36.

Yarnall KSH, Pollak KI, Østbye T, Krause KM, Michener JL. Primary care: is there enough time for prevention? Am J Public Health. 2003;93:635–41. https://doi.org/10.2105/AJPH.93.4.635.CrossRefPubMedPubMedCentral

37.

Chernof BA, Sherman SE, Lanto AB, Lee ML, Yano EM, Rubenstein LV. Health habit counseling amidst competing demands: effects of patient health habits and visit characteristics. Med Care. 1999;37(8):738–47CrossRef

38.

World Medical Association. World medical association declaration of Helsinki: ethical principles for medical research involving human subjects. J Postgrad Med. 2002;48(3):206–8.

39.

Efron B. Forcing a sequential experiment to be balanced. Biometrika. 1971;58:403. https://doi.org/10.2307/2334377.CrossRef

40.

Rosemann T, Laux G, Droesemeyer S, Gensichen J, Szecsenyi J. Evaluation of a culturally adapted German version of the Patient Assessment of Chronic Illness Care (PACIC 5A) questionnaire in a sample of osteoarthritis patients. J Eval Clin Pract. 2007;13:806–13. https://doi.org/10.1111/j.1365-2753.2007.00786.x.CrossRefPubMed

41.

Glasgow RE, Wagner EH, Schaefer J, Mahoney LD, Reid RJ, Greene SM. Development and validation of the Patient Assessment of Chronic Illness Care (PACIC). Med Care. 2005;43:436–44.CrossRef

42.

Drewes HW, de Jong-van Til JT, Struijs JN, Baan CA, Tekle FB, Meijboom BR, Westert GP. Measuring chronic care management experience of patients with diabetes: PACIC and PACIC+ validation. Int J Integr Care. 2012;12:e194. https://doi.org/10.5334/ijic.862.CrossRefPubMedPubMedCentral

43.

Vrijhoef HJM, Berbee R, Wagner EH, Steuten LMG. Quality of integrated chronic care measured by patient survey: identification, selection and application of most appropriate instruments. Health Expect. 2009;12:417–29. https://doi.org/10.1111/j.1369-7625.2009.00557.x.CrossRefPubMedPubMedCentral

44.

Malliarou M, Desikou C, Lahana E, Kotrotsiou S, Paralikas T, Nikolentzos A, et al. Diabetic patient assessment of chronic illness care using PACIC. BMC Health Serv Res. 2020;20:543. https://doi.org/10.1186/s12913-020-05400-5.CrossRefPubMedPubMedCentral

45.

Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011;20:1727–36. https://doi.org/10.1007/s11136-011-9903-x.CrossRefPubMedPubMedCentral

46.

Hinz A, Kohlmann T, Stöbel-Richter Y, Zenger M, Brähler E. The quality of life questionnaire EQ-5D-5L: psychometric properties and normative values for the general German population. Qual Life Res. 2014;23:443–7. https://doi.org/10.1007/s11136-013-0498-2.CrossRefPubMed

47.

Zimmerman GL, Olsen CG, Bosworth MF. A ‘stages of change’ approach to helping patients change behavior. Am Fam Physician. 2000;61:1409–16. PubMed-ID: 10735346.PubMed

48.

Stott NCH, Rollnick S, Rees, Pill RM. Innovation in clinical method: diabetes care and negotiating skills. Fam Pract. 1995;12:413–8. https://doi.org/10.1093/fampra/12.4.413.

49.

Gräfe K, Zipfel S, Herzog W, Löwe B. Screening psychischer Störungen mit dem “Gesundheitsfragebogen für Patienten (PHQ-D)“. Diagnostica. 2004;50:171–81. https://doi.org/10.1026/0012-1924.50.4.171.CrossRef

50.

Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–13.CrossRef

51.

Durso LE, Latner JD. Understanding self-directed stigma: development of the weight bias internalization scale. Obesity. 2008;16(Suppl 2):S80–6. https://doi.org/10.1038/oby.2008.448.CrossRefPubMed

52.

Hilbert A, Baldofski S, Zenger M, Lowe B, Kersting A, Braehler E. Weight bias internalization scale: psychometric properties and population norms. PLoS One. 2014;9:e86303. https://doi.org/10.1371/journal.pone.0086303.CrossRefPubMedPubMedCentral

53.

DiClemente CC, Prochaska JO, Fairhurst SK, Velicer WF, Velasquez MM, Rossi JS. The process of smoking cessation: an analysis of precontemplation, contemplation, and preparation stages of change. J Consult Clin Psychol. 1991;59:295–304. https://doi.org/10.1037/0022-006X.59.2.295.CrossRefPubMed

54.

Prochaska JO, Velicer WF, Rossi JS, Goldstein MG, Marcus BH, Rakowski W, et al. Stages of change and decisional balance for 12 problem behaviors. Health Psychol. 1994;13:39–46. https://doi.org/10.1037/0278-6133.13.1.39.CrossRefPubMed

55.

Rammstedt B, John OP. Measuring personality in one minute or less: a 10-item short version of the Big Five Inventory in English and German. J Res Pers. 2007;41:203–12. https://doi.org/10.1016/j.jrp.2006.02.001.CrossRef

56.

Bacon JG, Scheltema KE, Robinson BE. Fat phobia scale revisited: the short form. Int J Obes Relat Metab Disord. 2001;25:252–7. https://doi.org/10.1038/sj.ijo.0801537.CrossRefPubMed

57.

Stein J, Luppa M, Ruzanska U, Sikorski C, König H-H, Riedel-Heller SG. Measuring negative attitudes towards overweight and obesity in the German population - psychometric properties and reference values for the German short version of the Fat Phobia Scale (FPS). PLoS One. 2014;9:e114641. https://doi.org/10.1371/journal.pone.0114641.CrossRefPubMedPubMedCentral

58.

Welzel FD, Stein J, Pabst A, Luppa M, Kersting A, Blüher M, et al. Five A’s counseling in weight management of obese patients in primary care: a cluster-randomized controlled trial (INTERACT). BMC Fam Pract. 2018;19:97. https://doi.org/10.1186/s12875-018-0785-7.CrossRefPubMedPubMedCentral

59.

Hall JA, Dornan MC. Patient sociodemographic characteristics as predictors of satisfaction with medical care: a meta-analysis. Soc Sci Med. 1990;30:811–8. https://doi.org/10.1016/0277-9536(90)90205-7.CrossRefPubMed

60.

Butler D, Oswald SL, Turner DE. The effects of demographics on determinants of perceived health-care service quality. The case of users and observers. J Manag Med. 1996;10:8–20. doi:https://doi.org/10.1108/02689239610146508.

61.

Hekkert KD, Cihangir S, Kleefstra SM, van den Berg B, Kool RB. Patient satisfaction revisited: a multilevel approach. Soc Sci Med. 2009;69:68–75. https://doi.org/10.1016/j.socscimed.2009.04.016.CrossRefPubMed

62.

Larsson G, Wilde-Larsson B. Quality of care and patient satisfaction: a new theoretical and methodological approach. Int J Health Care Qual Assur. 2010.

63.

Quintana JM, González N, Bilbao A, Aizpuru F, Escobar A, Esteban C, et al. Predictors of patient satisfaction with hospital health care. BMC Health Serv Res. 2006;6:102. https://doi.org/10.1186/1472-6963-6-102.CrossRefPubMedPubMedCentral

64.

Xiao H, Barber JP. The effect of perceived health status on patient satisfaction. Value Health. 2008;11:719–25. https://doi.org/10.1111/j.1524-4733.2007.00294.x.CrossRefPubMed

65.

Olivo G, Gour S, Schiöth HB. Low neuroticism and cognitive performance are differently associated to overweight and obesity: a cross-sectional and longitudinal UK Biobank study. Psychoneuroendocrinology. 2019;101:167–74. https://doi.org/10.1016/j.psyneuen.2018.11.014.CrossRefPubMed

66.

Atherton OE, Robins RW, Rentfrow PJ, Lamb ME. Personality correlates of risky health outcomes: findings from a large internet study. J Res Pers. 2014;50:56–60. https://doi.org/10.1016/j.jrp.2014.03.002.CrossRefPubMedPubMedCentral

67.

Magnus K, Diener E, Fujita F, Pavot W. Extraversion and neuroticism as predictors of objective life events: a longitudinal analysis. J Pers Soc Psychol. 1993;65:1046–53. https://doi.org/10.1037/0022-3514.65.5.1046.CrossRefPubMed

68.

Scheier MF, Carver CS. Effects of optimism on psychological and physical well-being: theoretical overview and empirical update. Cogn Ther Res. 1992;16:201–28. https://doi.org/10.1007/BF01173489.CrossRef

69.

Ellington L, Wiebe DJ. Neuroticism, symptom presentation, and medical decision making. Health Psychol. 1999;18:634–43. https://doi.org/10.1037/0278-6133.18.6.634.CrossRefPubMed

70.

Campbell MK, Piaggio G, Elbourne DR, Altman DG. Consort 2010 statement: extension to cluster randomised trials. BMJ. 2012;345:e5661. https://doi.org/10.1136/bmj.e5661.CrossRefPubMed

71.

Brauns H, Steinmann S. Educational reform in France, West-Germany and the United Kingdom: updating the CASMIN educational classification. ZUMA Nachrichten. 1999;23:7–44.

72.

Quadros LG de, Neto MG, Marchesini JC, Teixeira A, Grecco E, Junior RLK, et al. Endoscopic argon plasma coagulation vs. multidisciplinary evaluation in the management of weight regain after gastric bypass surgery: a randomized controlled trial with SHAM group. Obes Surg. 2020;30:1904–16. https://doi.org/10.1007/s11695-020-04414-6.

73.

Campbell-Scherer DL, Asselin J, Osunlana AM, Fielding S, Anderson R, Rueda-Clausen CF, et al. Implementation and evaluation of the 5As framework of obesity management in primary care: design of the 5As Team (5AsT) randomized control trial. Implement Sci. 2014;9:78. https://doi.org/10.1186/1748-5908-9-78.CrossRefPubMedPubMedCentral

74.

McDonough C, Dunkley AJ, Aujla N, Morris D, Davies MJ, Khunti K. The association between body mass index and health-related quality of life: influence of ethnicity on this relationship. Diabetes Obes Metab. 2013;15:342–8.CrossRef

75.

Jagielski AC, Brown A, Hosseini-Araghi M, Thomas GN, Taheri S. The association between adiposity, mental well-being, and quality of life in extreme obesity. PLoS One. 2014;9:e92859. https://doi.org/10.1371/journal.pone.0092859.CrossRefPubMedPubMedCentral

76.

Prochaska JO, DiClemente CC. Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol. 1983;51:390–5. https://doi.org/10.1037/0022-006X.51.3.390.CrossRefPubMed

77.

Prochaska JO, DiClemente CC, Norcross JC. In search of how people change: applications to addictive behaviors. Am Psychol. 1992;47:1102–14. https://doi.org/10.1037/0003-066X.47.9.1102.CrossRefPubMed

78.

Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Health Promot. 1997;12:38–48. https://doi.org/10.4278/0890-1171-12.1.38.CrossRefPubMed

79.

Rossi SR, Rossi JS, Rossi-DelPrete LM, Prochaska JO, Banspach SW, Carleton RA. A processes of change model for weight control for participants in community-based weight loss programs. Int J Addict. 1994;29:161–77. https://doi.org/10.3109/10826089409047375.CrossRefPubMed

80.

Kremer G, Schulz M. Motivierende Gesprächsführung in der Psychiatrie. 2016.

81.

Petrocelli JV. Processes and stages of change: counseling with the transtheoretical model of change. J Couns Dev. 2002;80:22–30. https://doi.org/10.1002/j.1556-6678.2002.tb00162.x.CrossRef

82.

Cook DA, Levinson AJ, Garside S, Dupras DM, Erwin PJ, Montori VM. Internet-based learning in the health professions: a meta-analysis. JAMA. 2008;300:1181–96. https://doi.org/10.1001/jama.300.10.1181.CrossRefPubMed

83.

Ruf D, Berner MM, Kriston L, Härter M. E-Learning–eine wichtige Unterstützung in der medizinischen Aus-, Fort- und Weiterbildung? Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2008;51:1061–9. https://doi.org/10.1007/s00103-008-0635-1.CrossRefPubMed

84.

Vollmar HC, Rieger MA, Butzlaff ME, Ostermann T. General practitioners’ preferences and use of educational media: a German perspective. BMC Health Serv Res. 2009;9:31. https://doi.org/10.1186/1472-6963-9-31.CrossRefPubMedPubMedCentral

85.

Friedman KE, Ashmore JA, Applegate KL. Recent experiences of weight-based stigmatization in a weight loss surgery population: psychological and behavioral correlates. Obesity. 2008;16(Suppl 2):S69-74. https://doi.org/10.1038/oby.2008.457.CrossRefPubMed

86.

Jung, Franziska UCE, Luck-Sikorski C, Konig H-H, Riedel-Heller SG. Stigma and knowledge as determinants of recommendation and referral behavior of general practitioners and internists. Obes Surg. 2016;26:2393–401. https://doi.org/10.1007/s11695-016-2104-5.

87.

Maukonen M, Männistö S, Tolonen H. A comparison of measured versus self-reported anthropometrics for assessing obesity in adults: a literature review. Scand J Public Health. 2018:565–79. https://doi.org/10.1177/1403494818761971.

88.

Hodge JM, Shah R, McCullough ML, Gapstur SM, Patel AV. Validation of self-reported height and weight in a large, nationwide cohort of U.S. adults. PLoS One. 2020:e0231229. https://doi.org/10.1371/journal.pone.0231229.

89.

Beleigoli AM, Andrade AQ, Fátima H Diniz M de, Alvares RS, Ferreira MH, Silva LA, et al. Accuracy of self-reported weight collected through a web-based platform in a weight loss trial: validation study of the POEmaS clinical trial. Stud Health Technol Inform. 2019;264:1637–8. doi:https://doi.org/10.3233/SHTI190572.

90.

Wojzischke J, Diekmann R, Bauer JM. Adipositas im Alter und ihre Bedeutung für Funktionalität und Frailty. Z Gerontol Geriatr. 2016;49:573–80. https://doi.org/10.1007/s00391-016-1133-y.CrossRefPubMed

91.

Porter Starr KN, Bales CW. Excessive body weight in older adults. Clin Geriatr Med. 2015;31:311–26. https://doi.org/10.1016/j.cger.2015.04.001.CrossRefPubMedPubMedCentral

92.

Miller SL, Wolfe RR. The danger of weight loss in the elderly. J Nutr Health Aging. 2008;12:487–91. https://doi.org/10.1007/BF02982710.CrossRefPubMed

93.

Peck BM. Age-related differences in doctor-patient interaction and patient satisfaction. Curr Gerontol Geriatr Res. 2011;2011:137492. https://doi.org/10.1155/2011/137492.CrossRefPubMedPubMedCentral

94.

Adelman RD, Greene MG, Ory MG. Communication between older patients and their physicians. Clin Geriatr Med. 2000;16(1–24):vii. https://doi.org/10.1016/s0749-0690(05)70004-5.CrossRef

95.

Daba-Buzoianu C, Cârtița-Buzoianu C, Amalancei BM. Exploring physician-older patient communication. A qualitative analysis of communication between older patients and general practitioners. Romanian J Commun Public Relat. 2018;20:47–56.CrossRef

Title: Using a brief web-based 5A intervention to improve weight management in primary care: results of a cluster-randomized controlled trial
Authors: Franziska D. Welzel
Jonathan Bär
Janine Stein
Margrit Löbner
Alexander Pabst
Melanie Luppa
Thomas Grochtdreis
Anette Kersting
Matthias Blüher
Claudia Luck-Sikorski
Hans-Helmut König
Steffi G. Riedel-Heller
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Obesity
Obesity
Care
Published in: BMC Primary Care / Issue 1/2021
Electronic ISSN: 2731-4553
DOI: https://doi.org/10.1186/s12875-021-01404-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Using a brief web-based 5A intervention to improve weight management in primary care: results of a cluster-randomized controlled trial

Abstract

Background

Methods

Results

Conclusion

Trial registration

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Trial registration

Please log in to get access to this content

Other articles of this Issue 1/2021

A pharmacist health coaching trial evaluating behavioural changes in participants with poorly controlled hypertension

Shared decision making and patient-centeredness for patients with poorly controlled type 2 diabetes mellitus in primary care—results of the cluster-randomised controlled DEBATE trial

Long term clinical outcomes of patients with ischemic stroke in primary care – a 9-year retrospective study

Willingness of patients with chronic disease in rural China to contract with family doctors: implication for targeting characteristics

Implementation outcomes of Humanwide: integrated precision health in team-based family practice primary care

A mixed-methods study describing behavioral factors that influenced general practitioners’ experiences using triage during the COVID-19 pandemic