[GP's intervention in changing lifestyle behavior of adipose patients].

BACKGROUND: Obesity and physical inactivity (silent epidemic) are the dominant causes of insulin resistance. Obesity is a major public health concern, associated with high morbidity and mortality. The disease is the result of an increased energy intake in relation to its expenditure. Lifestyle modification is the main goal of primary and secondary prevention of chronic diseases including obesity. Although changing an individual's lifestyle may be perceived difficult, evidence suggests that intensive and repeated counseling by general practitioners (GP) can stimulate patients to become more physically active and to switch to healthy diet. According to WHO data, 300 million people with body mass index (BMI) 30 were recorded in the world in 2005.

AIM: To investigate the efficiency of GP intervention for lifestyle modification in adipose patients from the respective catchment population.

METHOD: During the 2001-2004 period, 135 obese patients (BMI 30) from a GP practice attended educational program for lifestyle modification. The program lasted for 6 months, was based on a small group work and used behaviorism as a key element in therapy for obesity. Each group session took about one hour, started with a short physician's lecture on healthy lifestyle, and continued with group discussion in which every participant showed his/her own dietary and physical activity diary for the last week and received advice on how to improve and achieve better results. At the end of the session, every participant set his/her own priorities for the next week. Outpatient control of the parameters of BMI, waist circumference, nutrition and physical activity personal records was performed on a weekly basis.

RESULTS: There were 135 patients, 94 (70%) women and 41 (30%) men, mean age was 48 years. The heaviest man had 160 kg and lost 18 kg during the intervention period. The heaviest woman had 129 kg and lost 15 kg during the intervention period. BMI decreased in men by 9% (from 34.6 kg/m2 to 31.7 kg/m2; p < 0.001), and in women by 8.1% (from 34.9 kg/m2 to 32.1 kg/m2; p < 0.001). Thus, 42. 2% of the extreme obesity group (BMI > 40) and obesity group subjects switched to a lower group. Waist circumference decreased by 7.5 cm in men and by 8.4 cm in women (p < 0.001). The highest cholesterol level was 8.8 mmol/L in men and 8.6 mmol/L in women. Cholesterol decreased by 0.8 mmol/L in both men and women. Fasting blood glucose was 8.3 mmol/L in men and 8.6 mmol/L in women, and decreased by 1.4 mmol/L in men and by 0.5 mmol/L (p < 0.001) in women.

CONCLUSION: GPs are familiar with their patients and have a critical role in the assessment and advising of an appropriate lifestyle. GP recommendations can be a valuable source of motivation for the patient. Small group work coordinated by GP is more effective in changing lifestyle. Lifestyle modification program is a suitable therapeutic choice in the GP management of obesity. Medically based education in the form of small group work based on behaviorism proved its efficiency in treating obese patients in a GP practice.