For people trying to maintain weight after participation in a weight-loss program, support from nurses is as effective as a more expensive intensive program with dieticians and exercise specialists, found a new study by New Zealand researchers in CMAJ. It appears that regular face-to-face interaction with a supportive health professional is a key success factor.
The study, a randomized controlled trial with 200 women aged 25-70 years old, included women who had lost 5% or more of their body weight. Most participants were followed for 2 years after the initial weight loss.
In addition to nutritional counselling and materials provided to all participants, the people in the Nurse Support Program received 5-10 minute weigh-in visits with a nurse every 2 weeks for 2 years. On alternate weeks, they received a phone call from the same nurse to discuss progress. The intensive support program was based on the Finnish Diabetes Prevention Study.
"Although this and other intensive programs have been successful, the costs to implement these programs are considerable and well beyond the means of health budgets in many countries," write Dr. Jim Mann from the Edgar National Centre for Diabetes Research, Dunedin, New Zealand and coauthors.
While attendance at weigh-ins was excellent, attendance at exercise classes was poor and declined dramatically in the second year. "Many participants reported that the weigh-ins and the enthusiastic support provided by the nurse on those occasions and on the telephone were key determinants of their success," write the authors.
They conclude that nurse-led programs with weekly or bi-weekly weigh-ins could be easily introduced in many countries where general practice is the cornerstone of the health care system at a fraction of the cost of intensive-support programs.
In a related commentary, Dr. Robert Ross from Queen's University in Kingston, Ontario writes that "how and how often support is provided may be more important that who provides it" as the nurse in the study had little training in nutrition and exercise but was supportive and enthusiastic. He notes that introducing nurse-coordinated programs in countries like Canada where there is a shortage of nurses may not be feasible.
Exercise specialists and dieticians with relevant training can provide similar support for people wanting to maintain weight loss. He credits the study for demonstrating that clinically meaningful weight loss can be maintained over an extended period of time.