Comparison of a Behavioral Versus an Educational Weight Management Intervention After Renal Transplantation: A Randomized Controlled Trial

Transplantation Direct. 2019;5(12):e507

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Abstract

Background: In the first year following renal transplantation, preventing weight gain to minimize overweight or obesity is particularly important. The aim of this study is to test the effect of an 8-month behavioral intervention BMI and physical activity. Methods: This randomized controlled study included 123 adult kidney or kidney-pancreas recipients. Patients were randomized to usual (1 educational session, then weight self-monitoring) and intervention care (usual care plus 7-8 counseling sessions). Alongside weight, body composition, and physical activity, satisfaction and perceptions regarding care were measured at weeks 2-6 (baseline), then at months 8 and 12. Results: Both groups reported comparably high satisfaction. The intervention group (IG) reported more chronic care-related activities. In patients with BMIs >= 18.5, mean weight gain (from baseline) was unexpectedly low in both groups: at month 8, +0.04 kg/m2 in IG patients and +0.14 kg/m2 in the control group (P = 0.590), and respectively, +0.03 kg/m2 and +0.19 kg/m2 at month 12 (P = 0.454). Both groups were physically active, walking averages of 10 807 (IG) and 11 093 (control group) steps per day at month 8 (P = 0.823), and respectively 9773 and 11 217 at month 12 (P = 0.195). Conclusions: The behavioral intervention had high patient acceptance and supported patients in maintaining their weight, but had no superior effect on a single educational session. Further research is needed to assess patient weight gain risk profiles to stratify the intervention.

CET Conclusion

Reviewer: Dr Liset Pengel, Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences University of Oxford
The randomised controlled trial tested the effect of an 8-month behavioural intervention on BMI change in adult kidney and kidney-pancreas transplant recipients who started within 6 weeks posttransplant. The sample size calculation was based on data from a pilot study and showed that 128 patients would achieve 80% power. Using envelopes, 123 patients were randomised to a behavioural intervention or usual care. Usual care consisted of one educational intervention whilst the behavioural intervention consisted of 7-8 face-to-face and telephone interventions. The difference in BMI change at 8 and 12 months was not significant between groups. There were also no significant differences in BMI change between groups regarding body composition, any of the measures of physical activity or self-report physical activity. The authors conclude that both interventions resulted in good weight management and suggest that future research should focus on investigating which patients would benefit most from complex weight control interventions.

Study details

Aims : To evaluate the effect of an 8-month behavioural intervention which aims to prevent weight gain in kidney and kidney-pancreas transplant recipients.
Interventions : Both groups received a 45-60 minute nurse delivered educational intervention. The behavioural group also received 7-8 sessions over eight months focusing on behaviour to achieve or maintain normal weight and on integrating physical activity in daily life.
Participants : 123 adult kidney and kidney –pancreas transplant recipients who received their transplant no more than 6 weeks ago.
Outcomes : The primary outcome was change in BMI between baseline and 8 months. Secondary outcomes were BMI change between baseline and 12 months, and changes in lean tissue mass, waist-hip ratio, self-reported physical activity and number of steps.
Follow up : 12 months

Metadata

Publication type : Randomised Controlled Trial
Language : English