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A cluster randomised controlled trial of vascular risk factor management in general practice

In reply: The Health Improvement and Prevention Study (HIPS) and the Greater Green Triangle study are not comparable. HIPS was a cluster randomised controlled trial of a pragmatic intervention that was delivered by general practitioners (through Divisions of General Practice) and was analysed on an intention-to-treat (ITT) basis.1 The Greater Green Triangle study was a pre–post study of patients recruited in GP waiting rooms who completed a program delivered by study staff (ie, it was not analysed on an ITT basis).2

Dietary measures of fruit and vegetable consumption were chosen for HIPS because use of weighed food records (which are required to measure polyunsaturated : saturated fat ratio and salt intake) would have reduced participation. Participants in the intervention group self-monitored diet and physical activity, and they received individual feedback from allied health professionals and further feedback in group sessions.

The Counterweight program, on which HIPS was based, produced 5% weight loss3 and did so cost-effectively.4 It has been adopted in Scotland and England. Weight loss of this magnitude…