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Obesity management in primary care: systematic review exploring the influence of therapeutic alliance

Elizabeth A Sturgiss1, Kathleen O'Brien2, Nicholas Elmitt2

  • 1Department of General Practice, Monash University, Melbourne, Australia.

Family Practice
|April 21, 2021
PubMed
Abstract

Insights

Few obesity interventions in primary care report therapeutic alliance elements. Enhancing patient-practitioner relationships is crucial for effective obesity treatment and requires comprehensive reporting in research.

Area of Science:

  • Obesity research
  • Primary care interventions
  • Therapeutic alliance in healthcare

Background:

  • Obesity is a significant public health concern requiring effective interventions.
  • Primary care settings are pivotal for delivering obesity management strategies.
  • The therapeutic alliance, encompassing bond, goals, and tasks, is recognized for its importance in healthcare outcomes.

Purpose of the Study:

  • To investigate the influence of the therapeutic alliance on the effectiveness of obesity interventions within primary care.
  • To assess the extent to which randomized controlled trials report on therapeutic alliance components in obesity interventions.

Main Methods:

  • Systematic review of randomized controlled trials (RCTs) focusing on adult obesity interventions in primary care.
  • Searched seven databases using terms 'obesity', 'primary care', and 'intervention' from January 1998 to March 2018.
  • Narrative synthesis was employed due to high statistical heterogeneity and limited trial numbers; primary outcome was weight loss difference.

Main Results:

  • Eleven RCTs involving 3955 patients were eligible from over 10,000 studies.
  • Only one study comprehensively reported all aspects of the therapeutic alliance (bond, goals, tasks).
  • Most interventions utilized prescriptive protocols, with few incorporating collaborative goal setting or the regular primary care practitioner.

Conclusions:

  • A surprising scarcity of reported therapeutic alliance elements was found in obesity intervention trials, despite their critical role in primary care effectiveness.
  • Future interventions should be designed to optimize therapeutic relationships.
  • Research reporting on obesity interventions needs to be more comprehensive regarding relational aspects.
Keywords:
Consultationcontinuity of caredoctor–patient relationshiplifestyle modification/health behaviour changeobesityprimary care

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