Obesity Treatment With LCD in Primary Health Care

Patients are recruited in an ordinary primary care setting in Primary care centers in Orebro County. All Primary care centers in the area (26) are invited to take part in the study.

Patients are given brief information at ordinary visits at doctor, nurse or physiotherapists, or by written information announced at the health care center. Before going into the study they need a doctors visit to pass the inclusion and exclusion criteria. The study starts at a nurse visit where the patient gets written information about the LCD treatment and the protocol.

After 24 weeks in the study, all patients with weight loss of 7% or more are randomized into two groups.

Group 1, keep their contact with the nurse at the primary health care centre, and gets a written prescription of physical activity, which is followed by a visit at 36 weeks.

Group 2, gets a code for the internet-based CBT programme. They go into the programme at home, and follow the programme which has the goal of weight stability and contains strategies of meal plans, portion controls, physical activity planning, and cognitive strategies of thinking and goal setting. During this programme there is an opportunity to "chat" with CBT therapists via the internet, concerning the programme and its challenges. No personal meeting with therapist is included.

At 1 year in the study both groups meed with doctor at primary health care center and at 2 year there is a nurse follow up at the same center.

At baseline, 12 weeks, 24 weeks, 1 year and 2 years several validated instruments are used to follow patients wellbeing due to:

• Quality of life (Short Form -36, SF-36)
• Obesity related problems (Obesity related Problems Scale version 3 OPv3)
• Mood (Mood Adjective Chek List MACL)
• Self reported pain (Brief Pain Inventory Short form BPI-SF)
• Eating behavior (Three Factor Eating Questionnaire- Revised 21 Items TFEQ-R21)
• Fatigue (Multidimensional Fatigue Inventory MFI)

We also investigate the patients experiences of the treatment, how they manage to hold on to the diet, and how it effects their motivation for ongoing lifestyle changes. For this we use a study specific instrument.

Inclusion criteria

• BMI > 30 with health problems and willingness and motivation to make lifestyle changes.
• Access to the internet and the ability to read and understand written information in swedish.

Exclusion criteria

• BMI < 30
• Excessive eating disorder problems (screening forms are used)
• Severe heart failure (New York Heart Association (NYHA) class III-IV)
• Moderate or severe COPD (Chronic Obstructive Pulmonary Disease) (FEV% <50)
• Uncontrolled asthma (hospitalization or more than twice requiring inhalation treatment on health care site last year)
• Pregnancy and lactation
• Type 1 Diabetes
• Serious liver dysfunction (ALT value more than doubled, women> 1.5 μkat / L, men> 2.2 μkat / L)
• Former Gastric bypass surgery or other weight reducing surgery