A Patient-Centered Decision Rule for Referral of Patients to Weight-Loss Programs

Comparing diverse health promotion programs using overall self-rated health as a common metric

Health promotion programs may target a variety of behaviors including weight loss, exercise, stress, nutrition, or other risk factors. Comparing the outcomes of diverse programs is hampered by the absence of a common metric. Overall self-rated health has been used as a health outcome measure in population studies and in some primary care studies, but its potential use to monitor the outcomes of health programs is unexplored. The purpose of this study was to compare the outcomes of 4 health promotion programs using change in overall self-rated health as a common metric. Program-specific metrics used were weight change, change in minutes of exercise, change in stress management activities, and change in healthy nutrition practices. We found that, although all of our lifestyle interventions positively affected the program-specific metrics, only the weight loss and exercise programs showed improvement in specific metrics correlated with improvements in overall self-rated health.

Exercise and self-rated health in adult primary care patients

BACKGROUND

Clinical guidelines call for more exercise than many patients are willing to undertake. More modest goals are more acceptable but may not improve overall self-rated health (SRH) in primary care patients. Furthermore, whether exercise should be measured in minutes per week, times per week, or both is unclear.

DESIGN

A random sample of 939 primary care patients met criteria for the study. Exercise was measured in self-reported minutes and times per week. Multiple logistic regression analysis was used to test for the independent effects of minutes and times per week of exercise on SRH in primary care patients.

RESULTS

Exercising 1 to 150 minutes per week was independently related to good SRH (odds ratio = 3.41, confidence interval = 1.73-6.73) as was exercising 151 to 300 minutes per week (odds ratio = 4.13, confidence interval = 1.45-11.71). The number of exercise times per week was not significant.

CONCLUSIONS

In our sample of relatively healthy primary care patients, exercising 1 to 300 minutes per week appears to promote good SRH.

Validity of overall self-rated health as an outcome measure in small samples: a pilot study involving a case series

OBJECTIVE

A single-item measure of overall self-rated health (SRH) commonly is used in population surveys, but has not been used in small pilot projects. The purpose of this study was to assess the validity of SRH in small samples.

DESIGN

We used data from a prospective, observational weight-loss project to compare change in SRH with change in body weight and physical activity (PA) (minutes) over 30 days (n = 34). Body mass index at baseline ranged from 25.5 to 50.4 (mean = 36.1, median = 34.6). SRH was self-assessed using the following question: How would you rate your health overall? Results An increase in weight was associated with a reduction in SRH (r = 0.37, P = 0.03). An increase in PA was associated with improved SRH (r = 0.39, P = 0.02).

CONCLUSIONS

A single-item SRH measure may be an efficient method for measuring programme outcomes, and may also be useful for comparing the relative effectiveness of different programmes in pilot projects and quality improvement studies.

Obesity and pre-hypertension in family medicine: implications for quality improvement

Background.

Prevention of pre-hypertension is an important goal for primary care patients. Obesity is a risk factor for hypertension, but has not been addressed for pre-hypertension in primary care populations. The objective of this study was to assess the degree to which obesity independently is associated with risk for pre-hypertension in family medicine patients.

Methods.

This study was a retrospective analysis of information abstracted from medical records of 707 adult patients. Multivariable logistic regression was used to test the relationship between body mass index (BMI) and pre-hypertension, after adjustment for comorbidity and demographic characteristics. Pre-hypertension was defined as systolic pressure between 120 and 139 mm Hg or diastolic pressure between 80 and 89 mm Hg.

Results.

In our sample, 42.9% of patients were pre-hypertensive. Logistic regression analysis revealed that, in comparison to patients with normal body mass, patients with BMI > 35 had higher adjusted odds of being pre-hypertensive (OR = 4.5, CI 2.55–8.11, p < .01). BMI between 30 and 35 also was significant (OR = 2.7, CI 1.61–4.63, p < 0.01) as was overweight (OR = 1.8, CI 1.14–2.92, p = 0.01).

Conclusion.

In our sample of family medicine patients, elevated BMI is a risk factor for pre-hypertension, especially BMI > 35. This relationship appears to be independent of age, gender, marital status and comorbidity. Weight loss intervention for obese patients, including patient education or referral to weight loss programs, might be effective for prevention of pre-hypertension and thus should be considered as a potential quality indicator.