Can certified health professionals treat obesity in a community-based programme? A quasi-experimental study

Objective: To test the effectiveness of a nonpharmaceutical programme for obese participants in a rural Eastern Canadian Province using certified health professionals. Design: A prospective quasi-experimental design with repeated premeasure and postmeasure. Participants: 146 participants with obesity (body mass index >30 kg/m²) from rural and urban communities in an Eastern Canadian Province were divided into four groups. Intervention: A 6-month intensive active communitybased lifestyle intervention (InI) delivered by Certified Exercise Physiologists, Certified Personal Trainers and Registered Dietitians, followed by 6 months of selfmanagement. A second intervention (InII) was nested in InI and consisted of group-mediated cognitive- behavioral intervention (GMCBI) delivered by an exercise psychologist to two of the four InI groups. Outcomes: (1) Improving health outcomes among the participants' preactive and postactive 6-month intervention and self-management period, (2) Documenting the impact of InII (GMCBI) and location of the intervention (urban vs rural). Results: The 6-month active InI significantly improved cardiovascular health for participants who completed the intervention. InII (GMCBI) significantly lowered the attrition rate among the participants. The selfmanagement period was challenging for the participants and they did not make further gains; however, most were able to maintain the gains achieved during the active intervention. The location of the intervention, urban or rural, had little impact on outcomes. Conclusions: A community-based programme utilising healthcare professionals other than physicians to treat obese patients was effective based on premeasure and postmeasure. During the self-management phase, the participants were able to maintain the gains. Psychological support is essential to participant retention.