Effectiveness of an Interdisciplinary Program Performed on Obese People Regarding Nutritional Habits and Metabolic Comorbidity: A Randomized Controlled Clinical Trial.

International journal of environmental research and public health. 2020;17(1)
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Obesity is a major health issue and research has shown that programs based on a number of different interventions, including diet, exercise and behavioural components, tend to be more successful than just focussing on one lifestyle habit. The aim of this randomised trial was to determine the effectiveness of a multidisciplinary program based on healthy eating, exercise, cognitive-behavioural therapy, and health education in improving metabolic abnormalities, body mass index (BMI), and nutritional habits among obese adults. The intervention group received monthly group education sessions, four weekly exercise sessions including stretching and moderate aerobic training, monthly cognitive behavioural therapy sessions and monthly clinical and nutritional assessments for 1 year. The control group received standard care. The intervention group lost an average of 2.6 and 2.7 BMI points at the end of the 12 month intervention and at a further 12 months follow-up, respectively, whilst the average BMI of the control group did not change significantly. At baseline hardly any of the participants were considered to have adequate dietary habits. After 12 and 24 months there was a significant improvement in dietary habits in the intervention group only, with an increased intake of fruit, vegetables and fortified foods and a decreased intake in sweets, fats and oils. Both groups saw decreases in blood pressure, but the intervention group improved significantly more than the control group. Other metabolic markers, including blood sugar and lipid metabolism and liver function tests only improved in the intervention group. The authors conclude that a multidisciplinary team supported by community resources and led by nurses is able to achieve significant improvements in dietary habits and health outcomes in obese adults.

Abstract

Obesity is an important public health problem. The combined use of different therapies performed by an interdisciplinary group can improve the management of this health issue. The main goal of this research is to determine the effectiveness of a multidisciplinary program based on healthy eating, exercise, cognitive-behavioral therapy, and health education in improving metabolic comorbidity, Body Mass Index (BMI), and nutritional habits among obese adults, at short (12 months) and long term (24 months). A randomized controlled clinical trial was conducted at a community care center between February 2014 and February 2016. A random sampling was done (299), total population (3262). A sample of 74 subjects diagnosed with obesity (experimental group, n = 37 and control group, n = 37) was conducted. Inclusion criteria: obese people (BMI: >30 kg/m2) with metabolic comorbidity and bad nutritional habits. Exclusion criteria: other comorbidities. A 12-month interdisciplinary program (with pre-test, 12 months and 24 months of follow-up) was applied. Intervention is based on healthy eating, exercise, and cognitive behavioral therapy. The intervention had a positive effect on nutritional habits (F2;144 = 115.305; p < 0.001). The experimental group increased fruit and vegetable intake (F2;144 = 39.604, p < 0.001), as well as fortified foods (F2;144 = 10,076, p < 0.001) and reduced fats, oils, and sweets F2;144 = 24,086, p < 0.001). In the experimental group, a BMI reduction of 2.6 to 24 months was observed. At follow-up, no participant had inadequate nutritional habits, compared to 35.1% of the control group (χ22 = 33,398; p < 0.001). There was also a positive response of metabolic comorbidities in the intervention group. The interdisciplinary program improved all participants' metabolic parameters, BMI, and nutritional habits while maintaining the long-term effects (24 months).

Lifestyle medicine

Fundamental Clinical Imbalances : Hormonal
Patient Centred Factors : Mediators/Obesity/metabolic syndrome
Environmental Inputs : Diet ; Nutrients ; Physical exercise
Personal Lifestyle Factors : Nutrition ; Exercise and movement
Functional Laboratory Testing : Blood

Methodological quality

Jadad score : 3
Allocation concealment : Not applicable

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