Nursing interventions with people with obesity in Primary Health Care: an integrative review

Braga, Vanessa Augusta Souza; Jesus, Maria Cristina Pinto de; Conz, Claudete Aparecida; Tavares, Renata Evangelista; Silva, Marcelo Henrique da; Merighi, Miriam Aparecida Barbosa

doi:10.1590/S1980-220X2017019203293

Brasil

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REVIEW • Rev. esc. enferm. USP 51 • 2017 • https://doi.org/10.1590/S1980-220X2017019203293 linkcopy

Nursing interventions with people with obesity in Primary Health Care: an integrative review

Intervenciones del enfermero en las personas con obesidad en la Atención Primaria de Salud: revisión integrativa

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective Identify the knowledge produced on nursing interventions with people suffering from obesity in Primary Health Care.

Method Integrative literature review of publications indexed in the databases: CINAHL, LILACS, MEDLINE, SciELO, SCOPUS and WEB OF SCIENCE, between 2011 and 2016.

Results Thirty-three articles were selected. The knowledge produced covered two themes: “Counseling aimed at weight control and promotion of healthy lifestyle habits” and “Perception of Primary Health Care nurses regarding interventions with people with obesity.”

Conclusion The results may help prompt reflections on professional training, management, and health services in terms of the relevance of nurses working with people suffering from obesity, with the support of digital technologies, motivational techniques, and nursing consultations. This could enhance their activities in the multiprofessional teams in which they participate at this healthcare level.

Obesity; Nursing Care; Primary Care Nursing; Review

Database	Search strategy
SCOPUS	Keywords – “nurses” OR “health personnel” OR “nurse practitioners” AND “primary health care” AND “obesity”
CINAHL	CINAHL terms – “nurses” OR “health personnel” OR “nurse practitioners” AND “primary health care” AND “obesity”
MEDLINE	Descriptors (MeSH) – “nurses” OR “health personnel” OR “nurse practitioners” OR “nursing” AND “obesity” AND “primary health care” OR “primary care”
LILACS	Descriptors (DeCS) – “nurses” OR “health personnel” OR “nurse practitioners” AND “primary health care” AND “obesity”
WEB OF SCIENCE	Keywords – “nurses” OR “health personnel” OR “nurse practitioners” OR “nursing” AND “primary health care” OR “primary care” AND “obesity”
SciELO	Keywords – “nurses” OR “health personnel” OR “nurse practitioners” AND “primary health care” AND “obesity”

Authorship/Country	Design / Participants	Interventions	Outcome
Dillen et al., 2014⁽¹⁰⁾ Holland	Observational, descriptive n=100	Analysis of the content of advice given to people with obesity during nursing consultations.	The main categories for each type of advice were: lose weight, eat less fat and be physically active.
Laws et al., 2015⁽¹¹⁾ Australia	Observational, mixed methods n=56	Survey and semi-structured interviews with nurses on advice for obesity given during routine nursing consultations with children from 0 to 5 years old.	The nurses never/rarely used growth graphs to identify children at risk of overweight/obesity. Most gave advised on nutrition, and less than half promoted physical activity and routinely discussed sedentary behavior.
Bogt et al., 2011⁽¹²⁾ Holland	Clinical trial, randomized, controlled n=457	Interventions carried out by nurses to prevent weight regain in adults, through guidelines via software, compared with conventional guidelines given by physicians, over a period of three years.	There was no significant weight change difference in the two groups. In both, 60% of the participants were able to maintain the weight after three years. There was a significant difference in blood glucose reduction in the group guided by nurses, but not for blood pressure and lipid levels.
Barte et al., 2012⁽¹³⁾ Holland	Quasi- experimental, intervention in the community n=214	The participants in the intervention group (adults) received a structured questionnaire seven months after the end of the intervention for lifestyle changes. Four nursing consultations and one phone call took place.	The overall satisfaction of the participants was high, especially among those with low levels of education. Nurses were viewed as motivators for learning about and maintaining a healthy lifestyle.
Dillen et al., 2015⁽⁴⁾ Holland	Observational, descriptive n=100	The quality of counsel given in nursing consultations about weight loss was assessed.	Nurses focused on the behavior of people with obesity, using motivational communication. They rarely tackled obstacles and ensured weight control support.
Riiser et al., 2014⁽¹⁴⁾ Norway	Clinical trial, randomized, controlled n=120	Participants were aged 13 to 15 years. The intervention group received a 12-week access to an online program that provided advice on exercise based on the theory of self-determination and motivational interviews. The control group received standard follow-up from the nurses.	The intervention had a slight impact on cardiorespiratory fitness and a moderate impact on quality of life. The intervention group had a significantly lower increase in body mass index (BMI) in relation to the control group.
Isma et al., 2013⁽¹⁵⁾ Sweden	Observational, phenomenological n=18	Open interviews with nurses to understand their views on preventive approaches to overweight and obesity in childhood.	The nurses viewed their work as difficult due to lack of standardization in guidelines for obesity and overweight prevention and management. The organization and management of the services were also deficient.
Teixeira et al., 2015⁽¹⁶⁾ Portugal	Observational, descriptive n=44	Semi-structured interviews with nurses, physicians, and nutritionists regarding the discourse of health professionals when faced with obesity.	The professionals had negative beliefs and attitudes in relation to people with obesity. Nutritionists and nurses felt they were able to influence the motivation of these people.
Robinson et al., 2013⁽¹⁷⁾ Australia	Observational, descriptive n=59	Questionnaire and semi-structured interviews to understand the practices and attitudes of nurses in relation to child obesity prevention.	The nurses described prevention work as pleasant. Seventy percent were interested in getting more involved in children’s health tests, and 85% expressed interest in receiving training in child obesity prevention.
Tucker et al., 2013⁽¹⁸⁾ USA	Quasi-experimental, intervention in the community n=130	Intervention through motivational interviews carried out by nurses to reduce excess pediatric weight compared to standard clinical care.	The effects of the intervention included increased daily consumption of fruits/vegetables, more physical activity and fewer hours watching television.
Jarl et al., 2014⁽¹⁹⁾ USA	Quasi-experimental, pre- and post-intervention time series n=45	Actions implemented during two months with people suffering from obesity associated with hypertension. These actions included addressing dietary issues and lifestyle changes. The nursing intervention consisted of three in-person group meetings and two phone calls for personal counseling.	The participants made statistically significant improvements in their diets and lifestyle scores, in addition to losing a significant amount of weight (mean of 1.6 kg lost) during the two-month intervention.
Karnon et al., 2013⁽²⁰⁾ Australia	Observational, descriptive n=175	Analysis of clinical data and outcomes (weight, BMI, obesity-related complications) and use of resources (primary, pharmaceutical and hospital care) to assess the cost-effectiveness of actions by nurses with people suffering from obesity.	Low involvement of nursing professionals in clinical activities with patients with obesity was identified. When nurses were involved, care costs were lower and more people lost weight.
Nolan et al., 2012⁽²¹⁾ England	Observational, descriptive n=22	Semi-structured interviews with nurses regarding the response to problems of people with obesity and the legitimacy of the work of these professionals.	In terms of positive factors, the nurses listed links with patients, participation in training, and support for investing in obesity management. The negative factors included lack of priority in obesity management, time and clarity in relation to protocols and their work in practice.
Blackburn et al., 2015⁽²²⁾ England	Observational, descriptive n=34	Semi-structured interviews to explore points of view, opinions, and experiences of nurses for initiating discussions on weight control.	The following barriers were identified: limited understanding of obesity care, concern with the negative consequences of excess weight, and lack of time and resources to propose an effective alternative.
Yardley et al., 2014⁽²³⁾ England	Clinical trial, randomized, controlled n=179	The adult patients were divided into four intervention groups: normal care (n=43); a group that received regular nursing support (n=47); a group with web-based intervention only (n=45); and a group with web-based intervention and basic nursing support (n=44).	At 12 months, the mean weight loss was 2.44 kg in the normal care group; 2.5 kg in the group that received regular nursing support; 2.3 kg in the group with web-based intervention only; and 4.31 kg in the group with web-based intervention and basic nursing support group.
Döring et al., 2014⁽²⁴⁾ Sweden	Clinical trial, randomized n=43	Nursing intervention program with parents to prevent child obesity, starting when the child is 9-10 months old and ending at 4 years of age.	The BMI and waist measurement of the children at 4 years old were significantly reduced. The secondary results showed improvements in eating habits and physical activity of children and mothers.
Hansson et al., 2011⁽²⁵⁾ Sweden	Observational, phenomenological n=20	Semi-structured interviews to understand the views of physicians and nurses in relation to the care of people with obesity.	The general view of the team was that obesity should be prioritized in PHC, but they did not consider it the responsibility of this level of care, since they did not consider it to be a disease. Nevertheless, the team felt it was important for patients to receive personalized guidelines.
Phillips et al., 2014⁽²⁶⁾ Wales	Observational, descriptive n=18	Semi-structured interviews with nurses about good practices and barriers perceived by these professionals when dealing with obesity in PHC.	Nurses provided regular care to people suffering from obesity associated with other comorbidities. They had mixed opinions on how to approach the subject of obesity with people considered to be healthy.
Gorin et al., 2014⁽²⁷⁾ USA	Clinical trial, n=150	Families with children from 2 to 4 years of age, that received brief counseling by physicians and nurses for 12 months (Group 1); monthly counseling and phone calls (Group 2); monthly counseling and home visits (Group 3).	The interventions led to a reduction in the percentile of children, with better results when the families received counseling and home visits.
Marcos et al., 2014⁽²⁸⁾ Spain	Multicenter trial, randomized n=696	A group of adults with obesity received counseling regarding change of habits in order to lose weight, from nurses with the support of a psychologist; the other group received routine monitoring.	The mean weight loss percentage was 1% for the control group and 2.5% in the intervention group; 18.1% of the control group reduced their weight by more than 5%, compared to 26.9% in the intervention group. After two years, the mean BMI of the control group dropped 0.9 kg/m², as opposed to 2.4 kg/m² in the intervention group.
Redsell et al., 2011⁽²⁹⁾ England	Observational, mixed methods n=8	Semi-structured interviews with 12 physicians and six nurses to identify knowledge, beliefs, and practices in relation to child obesity.	The physicians were less confident to give advice on children’s nutrition than nurses, but they were more knowledgeable about the health risks of obesity.
Thabault et al., 2016⁽³⁰⁾ USA	Observational, descriptive n=38	Motivational interventions carried out by nurses with adults with obesity in relation to changes in eating habits and encouragement to exercise.	The interventions of the nurses resulted in actual weight loss (3.03 kg after four visits and 4.85 kg after eight visits); 39% of the adults lost 5% or more weight at the end of 12 weeks.
Derksen et al., 2012⁽³¹⁾ Holland	Observational, descriptive n=29 professionals n=24 users	Three focus groups with adults were created with semi-structured interviews with health professionals to understand experiences related to obesity prevention, diagnosis, treatment and relapse prevention.	The users felt that the professionals offered contradictory advice and recommendations which did not meet their needs, and did not provide support. Professionals felt lack of qualification to support and motivate adults since they did not consider obesity to be a chronic disease.
Isma et al., 2012⁽³²⁾ Sweden	Observational, phenomenological n=18	Semi-structured interviews with nurses to identify their views on child overweight and obesity.	Overweight in younger children was overlooked by professionals and viewed as a consequence of their parents’ lifestyle, with not much importance attached to it in the preschool period.
Kelishadi et al., 2012⁽³³⁾ Iran	Non-randomized clinical trial n=457	Interventions carried out by physicians and nurses with children and adolescents suffering from obesity associated with other comorbidities.	There was a significant decrease in the anthropometric and cardiometabolic risk measurements, as well as an increase in HDL-C. The prevalence of metabolic syndrome decreased by 20.8%.
Korhonen et al., 2014⁽³⁴⁾ Finland	Longitudinal cohort study n=906	Assessment of interventions based on lifestyle advice given by a nurse over a period of three years, with people between 45 and 70 years of age with overweight and comorbidities.	Around 18% of the individuals lost at least 5% of their starting weight and managed to maintain the results for three years; 70% were able to stabilize their weight after the intervention.
Engström et al., 2013⁽³⁵⁾ Sweden	Observational, descriptive n=247	Questionnaires with nurses for describing self-reported clinical activities, opinions, and attitudes in relation to obesity management.	The nurses gave advice on physical activities (40.1%) and lifestyle changes (34.8%); 25% rarely/never carried out these activities, and 78.1% BMI or abdominal circumference assessments.
Ritten et al., 2016⁽³⁶⁾ USA	Observational, descriptive n=16	Adults received five home visits from a nurse every two weeks for three months, with behavioral interventions.	It was noted that the participants took greater responsibility for their health, physical activities, nutrition, spiritual growth, stress management and motivation to live healthily. Systemic blood pressure and BMI decreased significantly.
Gunther et al., 2012⁽³⁷⁾ England	Observational, descriptive n=23	Semi-structured interviews with seven physicians, seven nurses and nine overweight adults to describe difficulties and ease in implementing obesity management recommendations.	The difficulties included stigma, previous treatment experiences, professionals not wanting to assume responsibility for obesity management, lack of care consistency, and limited skills of the professionals. Trust in the professional-patient relationship was considered to be easy.
Sousa et al., 2015⁽³⁸⁾ Brazil	Observational, descriptive n=10	Semi-structured interviews with ten primary care nurses to obtain their views on child obesity.	The nurses had knowledge about changes in the nutritional profile of children, as well as the causes and consequences of obesity. They reported encouraging physical activities, moderate use of technologies, and nutritional education.
Ware et al., 2012⁽³⁹⁾ England	Observational, descriptive n=36	Focus groups to assess interventions by physicians, nurses and nursing aides over a period of six months, using in-person meetings, email or telephone calls to change behaviors.	Although considered an additional workload, the web program was viewed by the health professionals as a possibility for providing continuity of care.
Findholt et al., 2013⁽⁴⁰⁾ USA	Observational, descriptive n=13	Semi-structured interviews with eight physicians and five nurses to understand the problems that affect child obesity management in a rural community.	They indicated the following barriers: time restrictions, limited knowledge, and lack of specialists and multidisciplinary care services. The professionals expressed interest in receiving training.
Little et al., 2016⁽⁴¹⁾ England	Controlled trial, randomized n=818	Online intervention with 24 web-based sessions, over a period of six months, on weight control associated with brief nursing support and phone calls.	The control group lost almost 3 kg in 12 months and 21% maintained a 5% weight reduction in the 12^th month. In the intervention group, there was an additional weight reduction of 1.5 kg and 29% maintained the weight in the 12^th month.

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