Objective: To identify overweight and obese subjects at increased cardiovascular risk in the community, and provide them with lifestyle counselling that is possible to implement in real life.
Design: Longitudinal cohort study.
Setting: The communities of Harjavalta and Kokemäki in south-western Finland.
Subjects: A tape for measurement of waist and a risk factor questionnaire was mailed to home-dwelling inhabitants aged 45-70 years (n = 6013). Of the 4421 respondents, 2752 with at least one cardiovascular risk factor were examined by a public health nurse. For the subjects with high cardiovascular risk (n = 1950), an appointment with a physician was scheduled. The main goal of lifestyle counselling for the 1608 high-risk subjects with BMI ≥ 25 kg/m(2) was weight reduction of at least 5%. Among these, 906 had completed self-administrated questionnaires at baseline and form the present study population.
Main outcome measure: Success in weight management.
Results: At the three-year follow-up visit, 18% of subjects had lost ≥ 5% of their initial weight and 70% had stabilized their weight, while 12% had gained weight ≥ 5%. Newly diagnosed glucose disorder (OR 1.37 [95% CI 1.02-1.84]) predicted success in weight management, whereas depressive symptoms (OR 0.61 [95% CI 0.42-0.90]), excess alcohol use (OR 0.63 [95% CI 0.44-0.90]), and number of drugs used (OR 0.91 [95% CI 0.83-0.99]) at baseline predicted poor outcome.
Conclusions: A primary care screening programme to identify overweight or obese individuals can promote sustained weight management. Psychological factors, especially depressive symptoms, are a critical component to consider before attempts to change the lifestyle of an individual.