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Worcester Area Trial for Counseling in Hyperlipidemia (WATCH)

Ira S. Ockene, MD; James R. Hebert, ScD; Judith K. Ockene, PhD; Gordon M. Saperia, MD; Ed Stanek, PhD; Robert Nicolosi, PhD; Philip A. Merriam, MSPH; Thomas G. Hurley, MS

Arch Intern Med. 1999;159:725-731.

Objective  To evaluate the effectiveness of a training program for physician-delivered nutrition counseling, alone and in combination with an office-support program, on dietary fat intake, weight, and blood low-density lipoprotein cholesterol levels in patients with hyperlipidemia.

Participants and Methods  Forty-five primary care internists at the Fallon Community Health Plan, a central Massachusetts health maintenance organization, were randomized by site into 3 groups: (1) usual care; (2) physician nutrition counseling training; and (3) physician nutrition counseling training plus an office-support program. Eleven hundred sixty-two of their patients with blood total cholesterol levels in the highest 25th percentile, having previously scheduled physician visits, were recruited. Physicians in groups 2 and 3 attended a 3-hour training program on the use of brief patient-centered interactive counseling and the use of an office-support program that included in-office prompts, algorithms, and simple dietary assessment tools. Primary outcome measures included change at 1-year of follow-up in percentage of energy intake from saturated fat; weight; and blood low-density lipoprotein cholesterol levels.

Results  Improvement was seen in all 3 primary outcome measures, but was limited to patients in group 3. Compared with group 1, patients in group 3 had average reductions of 1.1 percentage points in percent of energy from saturated fat (a 10.3% decrease) (P = .01); a reduction in weight of 2.3 kg (P<.001); and a decrease of 0.10 mmol/L (3.8 mg/dL) in low-density lipoprotein cholesterol level (P = .10). Average time for the initial counseling intervention in group 3 was 8.2 minutes, 5.5 minutes more than in the control group.

Conclusion  Brief supported physician nutrition counseling can produce beneficial changes in diet, weight, and blood lipids.

From the Department of Medicine, University of Massachusetts Medical School (Drs I. S. Ockene, Hebert, and J. K. Ockene, and Messrs Merriam and Hurley); Fallon Clinic/Fallon Community Health Plan (Dr Saperia), Worcester, Mass; the Department of Biostatistics, University of Massachusetts at Amherst (Dr Stanek); and the Department of Health and Clinical Science, University of Massachusetts at Lowell (Dr Nicolosi).

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