Predictors of weight loss in young adults who are over-weight or obese and have psychosocial problems:a post hoc analysis

BACKGROUND: The aim of this study is in a general practice trial setting to identify predictive factors for weight loss after 1 year among young adults who are over-weight or obese and who have several psychosocial problems. METHODS: Twenty-eight general practitioners recruited 495 patients aged 20–45 years with psychosocial problems for a randomized general preventive study to increase self-efficacy to achieve a self-prioritised goal for a better life by discussions of resources and barriers for reaching the goal. The present study is a post hoc analysis of possible predictors of weight loss among all 218 patients who have over-weight or obesity. A 23-pages questionnaire was completed before and 1 year after randomization. 111 patients had a one-hour preventive health consultation with their general practitioners focused on life coaching and a follow-up consultation within 3 months, and 107 patients had no preventive consultation. RESULTS: Twenty-two patients stated during the preventive consultation that weight loss was a prioritised goal. They had a mean weight loss of 4.7 kgs compared with 1.6 kgs in the group without this goal and 1.6 kgs in the group without preventive consultation. In a logistic regression model, predictors of weight loss or no weight loss were a) pre-interventional consideration of weight loss within 30 days, b) having weight loss as a prioritised goal for improved quality of life, c) being female, d) being in the oldest half of participants, and e) having many psychosocial problems. In a linear regression model, the predictors together explained about 11 % of the weight loss. Important predictors were: obesity (explained 4 %), pre-interventional consideration of weight loss within 30 days (3 %), and having a preventive health consultation with weight loss as a prioritised goal (2 %). CONCLUSIONS: Pre-interventional consideration of weight loss within 30 days and having weight loss as a prioritised goal during the health consultation were two important predictors for weight loss. By structured interventions focussing on the patients’ priorities, self-chosen goals, their resources and barriers for reaching the goals, changes may be obtained; especially in participants with many problems who often do not accept participation in procedures on risks. CLINICALTRIALS GOV REGISTRATION: NCT 01231256, Aug. 22. 2010

How younger adults with psychosocial problems experienced person-centered health consultations

Much attention is focused on the social determinants of health. Family medicine is challenged with a growing number of vulnerable persons with psychosocial or lifestyle related problems. The objective of this work was to explore how vulnerable younger adults experience person-centered preventive health consultations with their general practitioner. The design and setting for this work were a secondary qualitative analysis of a randomized controlled trial (RCT) in Danish general practices. Younger adults (20-45) were consecutively invited to answer a screening questionnaire about psychosocial and lifestyle-related problems when visiting general practice (28 general practitioners (GPs)) for ordinary consultations. The 30% most vulnerable persons were invited to participate in a randomized controlled study. Intervention participants (n = 209) received a structured 1- hour ‘health consultation’ with their general practitioner focusing on resources and self-chosen goals and a 20-min follow-up after 3 months; control participants (n = 255) received usual care. At 1 year, 180 participants answered a follow-up postal questionnaire, of whom 135 answered the open-ended question: “Do you think the health consultation was worthwhile?”. This question was analyzed using qualitative content analysis. Six themes were prevalent: ‘Meeting the doctor in a different way’, ‘Supporting dialogue’, ‘Food for thought’, ‘Feeling better’, ‘Opportunity for change’, and the health consultations were ‘Not worthwhile’. Offering vulnerable younger adults a structured, person-centered preventive health consultation strengthened the doctor-patient relationship, allowed patients to reflect on their life situation, enhanced their perceived ability to cope with their problems and their belief in and ability to initiate wanted changes, thereby enhancing self-efficac