|Author:||Yeung, Yuk-mei Mimi|
|Title:||Dietitian-led intervention on weight loss and quality of life of overweight and obese patients in primary care|
Hong Kong Polytechnic University -- Dissertations
|Department:||Faculty of Health and Social Sciences|
|Pages:||xxii, 283 leaves : illustrations ; 30 cm|
|Abstract:||Background: Obesity, a risk factor for non-communicable diseases, has reached epidemic proportion globally, creating immense economic and health problems. Overweight and obese individuals also reported impaired health-related quality of life (HRQOL). Aim and objectives: This was the first study to evaluate the efficacy of dietitian-led intervention of overweight/obese patients, in the self-financed private sector of primary care in Hong Kong. Methods: A total of 100 Chinese aged 18-65 years, with a BMI≧23, were recruited. Fifty patients in the dietitian-led intervention group (DLG) received one-on-one individualized medium-intensity diet counseling (60-minute session at first visit, 30-minute or less at follow-up sessions). Another fifty patients in a doctor’s clinic acted as control (UCG). All self-administered generic SF-36v2 and obesity-specific IWQOL-Lite HRQOL questionnaires, with dietary energy intake and anthropometric measurements assessed on sites. Dietitian-led intervention was also conducted in 20 overweight (BMI≧25) multi-ethnic non-Chinese English-speaking patients (ESG) to observe ethnical differences. Results: At the end of 8 weeks, 71 Chinese patients (39 in DLG, 32 in UCG), plus 15 multi-ethnic ESG patients, completed the study. The drop-out rate in DLG was 22% , ESG 25% and UCG at 34%. Clinically meaningful improvement in weight loss ≧5% (-6.39±3.25%; -4.92±3.33 kg) was observed in DLG, with a significant drop in daily energy intake (-691.4±321kcal), but insignificant changes in exercise habit. The percentages of weight loss were greater in a continuous fashion, with -4.20%, -6.36% and -7.90% in BMI-I(23-24.9), BMI-II(25-29.9) and BMI-III(≧30) groups respectively ; plus corresponding anthropometric improvements in body weight, BMI, 7-skinfold-sum, and body fat. The control UCG failed to lose weight as a group, with a slight mean weight gain of 0.10±1.42 kg (0.11±1.99 %) of original weight. Efficacy for weight loss intervention was equally as effective in the multi-ethnic ESG group; with a mean -4.96 ± 2.22% (-4.45±2.22kg) of initial body weight at 8-week. The 100 overweight/obese Chinese patients at beginning of study had significantly lower SF-36v2 scores in all domains, when compared to the population norm (p<0.05). Males scored significantly lower in social function and mental component score (MCS). Subjects in the higher BMI-category reported worse HRQOL scores. The completers in DLG had an overall improvement in HRQOL scores, with significant improvements in physical component scores (PCS) SF-36v2, and total score IWQOL-Lite. A clinically meaningful improvement of SF-36v2 PCS (4.82±8.23), MCS (6.32±9.85); and IWQOL-Lite total score (7.18±12.4) was observed. Weight intervention seemed to have benefited the heavier BMI-III (≧30) group more in HRQOL. The UCG had exhibited insignificant improvement in HRQOL. The ESG had improvements in HRQOL measures, though less significantly, when compared to the Chinese. Conclusion: The result suggested that an 8-week dietitian-led weight loss intervention in the private sector of primary care could result in clinically significant improvements in weight and HRQOL in the overweight/obese patients. Sample size and duration of the study was constrained by the self-financed nature of the counseling service. Long-term efficacy and the barriers for inclusion of the dietitian as a member of the integrated-care team in primary care for weight loss need to be investigated further.|
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