51
|
Sherman RP, Petersen R, Guarino AJ, Crocker JB. Primary Care-Based Health Coaching Intervention for Weight Loss in Overweight/Obese Adults: A 2-Year Experience. Am J Lifestyle Med 2019; 13:405-413. [PMID: 31285724 PMCID: PMC6600613 DOI: 10.1177/1559827617715218] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 05/19/2017] [Accepted: 05/24/2017] [Indexed: 11/15/2022] Open
Abstract
Background: Obesity is a major contributor to medical comorbidity and places a large economic burden on health care. This study examined the effectiveness of primary care-integrated health coaching for weight loss in overweight/obese patients. Participants/Methods: This observational clinical study with a retrospective comparison analysis was performed at an urban academic primary care practice. A total of 271 individuals with a BMI >25 kg/m2 were recruited and followed for 2 years. A standardized health coaching intervention was used to promote weight loss. The main outcome measures were weight loss as a percentage of initial body weight and proportion of patients with weight loss ≥5% initial body weight, controlling for relevant covariates. An activity-based cost assessment of health coaching for weight loss was also performed. Results: Health coaching was associated with a mean loss of 7.24% initial weight after 12 months (95% CI = 8.68 to 5.90) and 6.77% after 24 months (95% CI = 8.78 to 4.76). Coached patients were more likely to achieve ≥5% of initial weight loss at both 12 and 24 months (P < .001). Health coaching costs were $288.54 per participant over 1 year. Conclusions: Primary care-integrated health coaching was associated with statistically significant weight loss in overweight and obese adults.
Collapse
Affiliation(s)
- Ryan P. Sherman
- Medway Public Schools, Medway, Massachusetts
(RPS)
- Azimuth Psychological, Boston, Massachusetts
(RP)
- Fulbright Specialist, Boston, Massachusetts
(AJG)
- the Department of Medicine, Massachusetts General
Hospital, and Harvard Medical School, Boston, Massachusetts (JBC)
| | - Rebecca Petersen
- Medway Public Schools, Medway, Massachusetts
(RPS)
- Azimuth Psychological, Boston, Massachusetts
(RP)
- Fulbright Specialist, Boston, Massachusetts
(AJG)
- the Department of Medicine, Massachusetts General
Hospital, and Harvard Medical School, Boston, Massachusetts (JBC)
| | - Anthony J. Guarino
- Medway Public Schools, Medway, Massachusetts
(RPS)
- Azimuth Psychological, Boston, Massachusetts
(RP)
- Fulbright Specialist, Boston, Massachusetts
(AJG)
- the Department of Medicine, Massachusetts General
Hospital, and Harvard Medical School, Boston, Massachusetts (JBC)
| | - J. Benjamin Crocker
- J. Benjamin Crocker, MD, Harvard Medical
School, 101 Merrimac Street, 10th Floor Boston, MA 02114; e-mail:
| |
Collapse
|
52
|
Clark DO, Keith N, Weiner M, Xu H. Outcomes of an RCT of videoconference vs. in-person or in-clinic nutrition and exercise in midlife adults with obesity. Obes Sci Pract 2019; 5:111-119. [PMID: 31019728 PMCID: PMC6469332 DOI: 10.1002/osp4.318] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 11/29/2018] [Accepted: 12/03/2018] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE New communication technologies have shown some promise in lifestyle weight loss interventions but may be most effective when leveraging face-to-face communications. The study reported here sought to test whether weight loss programme attendance and outcomes are greater when offered in-person at community sites or remotely via videoconference vs. in Federally Qualified Health Centers (FQHCs). In a three-arm randomized trial among 150 FQHC adults, intervention delivery in community-sites or via videoconference was tested against a clinic-based lifestyle intervention (enhanced usual care [EUC]). METHODS Twice weekly, a nutrition topic was reviewed, and exercise sessions were held in a 20-week programme delivered either in community settings or via videoconference. The primary outcome was the proportion of participants losing more than 2 kg at 6 (end of treatment) and 12 months in intent-to-treat analyses. RESULTS Mean (SD) age was 53 years, 82% were women, 65% were African-American, 50% reported $18,000 or less household income and 49% tested low in health literacy, and mean (SD) body mass index was 39 kg m-2. The proportion losing more than 2 kg of weight in the community site, videoconference and EUC groups was 33%, 34% and 24%, respectively, at 6 months and 29%, 34% and 29% at 12 months. No differences reached significance. Attendance was poor in all groups; 45% of community site, 58% of videoconference and 16% of EUC participants attended at least one session. CONCLUSION Videoconference and community-based delivery were as effective as an FQHC-based weight loss programme.
Collapse
Affiliation(s)
- D. O. Clark
- Indiana University Center for Aging ResearchIndianapolisINUSA
- Regenstrief Institute, Inc.IndianapolisINUSA
- Department of Medicine, Division of General Internal Medicine and GeriatricsIndiana University School of MedicineIndianapolisINUSA
| | - N. Keith
- Indiana University Center for Aging ResearchIndianapolisINUSA
- Regenstrief Institute, Inc.IndianapolisINUSA
- School of Health and Human SciencesIndiana University‐Purdue University IndianapolisIndianapolisINUSA
| | - M. Weiner
- William M. Tierney Center for Health Services ResearchIndiana University School of Medicine, Regenstrief Institute, Inc.IndianapolisINUSA
| | - H. Xu
- Department of BiostatisticsIndiana University School of MedicineIndianapolisINUSA
| |
Collapse
|
53
|
Moschonis G, Michalopoulou M, Tsoutsoulopoulou K, Vlachopapadopoulou E, Michalacos S, Charmandari E, Chrousos GP, Manios Y. Assessment of the Effectiveness of a Computerised Decision-Support Tool for Health Professionals for the Prevention and Treatment of Childhood Obesity. Results from a Randomised Controlled Trial. Nutrients 2019; 11:E706. [PMID: 30917561 PMCID: PMC6471646 DOI: 10.3390/nu11030706] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 03/14/2019] [Accepted: 03/22/2019] [Indexed: 02/07/2023] Open
Abstract
We examined the effectiveness of a computerised decision-support tool (DST), designed for paediatric healthcare professionals, as a means to tackle childhood obesity. A randomised controlled trial was conducted with 65 families of 6⁻12-year old overweight or obese children. Paediatricians, paediatric endocrinologists and a dietitian in two children's hospitals implemented the intervention. The intervention group (IG) received personalised meal plans and lifestyle optimisation recommendations via the DST, while families in the control group (CG) received general recommendations. After three months of intervention, the IG had a significant change in dietary fibre and sucrose intake by 4.1 and -4.6 g/day, respectively. In addition, the IG significantly reduced consumption of sweets (i.e., chocolates and cakes) and salty snacks (i.e., potato chips) by -0.1 and -0.3 portions/day, respectively. Furthermore, the CG had a significant increase of body weight and waist circumference by 1.4 kg and 2.1 cm, respectively, while Body Mass Index (BMI) decreased only in the IG by -0.4 kg/m². However, the aforementioned findings did not differ significantly between study groups. In conclusion, these findings indicate the dynamics of the DST in supporting paediatric healthcare professionals to improve the effectiveness of care in modifying obesity-related behaviours. Further research is needed to confirm these findings.
Collapse
Affiliation(s)
- George Moschonis
- Department of Dietetics, Nutrition and Sport, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia.
- Department of Nutrition and Dietetics, Harokopio University of Athens, 70 El Venizelou Avenue, Kallithea, 17671 Athens, Greece.
| | - Maria Michalopoulou
- Department of Nutrition and Dietetics, Harokopio University of Athens, 70 El Venizelou Avenue, Kallithea, 17671 Athens, Greece.
| | - Konstantina Tsoutsoulopoulou
- Department of Nutrition and Dietetics, Harokopio University of Athens, 70 El Venizelou Avenue, Kallithea, 17671 Athens, Greece.
| | - Elpis Vlachopapadopoulou
- Department of Endocrinology-Growth and Development, Children's Hospital P. A. Kyriakou, 11527 Athens, Greece.
| | - Stefanos Michalacos
- Department of Endocrinology-Growth and Development, Children's Hospital P. A. Kyriakou, 11527 Athens, Greece.
| | - Evangelia Charmandari
- Division of Endocrinology, Metabolism, and Diabetes, First Department of Pediatrics, University of Athens Medical School, Aghia Sophia Children's Hospital, 11527 Athens, Greece.
- Division of Endocrinology and Metabolism, Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, 11527 Athens, Greece.
| | - George P Chrousos
- Division of Endocrinology, Metabolism, and Diabetes, First Department of Pediatrics, University of Athens Medical School, Aghia Sophia Children's Hospital, 11527 Athens, Greece.
| | - Yannis Manios
- Department of Nutrition and Dietetics, Harokopio University of Athens, 70 El Venizelou Avenue, Kallithea, 17671 Athens, Greece.
| |
Collapse
|
54
|
Krystia O, Ambrose T, Darlington G, Ma DWL, Buchholz AC, Haines J. A randomized home-based childhood obesity prevention pilot intervention has favourable effects on parental body composition: preliminary evidence from the Guelph Family Health Study. BMC OBESITY 2019; 6:10. [PMID: 30873285 PMCID: PMC6398255 DOI: 10.1186/s40608-019-0231-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 01/31/2019] [Indexed: 12/11/2022]
Abstract
Background Home-based lifestyle behaviour interventions show promise for treating and preventing childhood obesity. According to family theories, engaging the entire family unit, including parents, to change their family behaviour and dynamics may be necessary to prevent the development of childhood obesity. However, little is known about how these interventions, which may change the family dynamics and weight-related behaviours of parents, affect weight outcomes in parents. Our objective was to examine the effect of a pilot home-based childhood obesity prevention intervention on measures of anthropometrics and body composition in Canadian parents. Methods Forty-four families with children aged 1.5–5 years were randomized to one of three groups: 4 home visits with a health educator, emails, and mailed incentives (4 HV); 2 home visits, emails, and mailed incentives (2 HV); or general health emails (control). Both the 2 HV and 4 HV intervention were conducted over a period of 6 months. Body composition and anthropometric outcomes were measured at baseline and at 6 months and 18 months from baseline. Results In parents with baseline body mass index (BMI) ≥ 25 kg/m2, the 2 HV group had significantly lower body mass and waist circumference at 6-month (CI = -5.85,-0.14 kg;-5.82,-0.30 respectively) and 18-month follow-up (CI = -7.57,-1.21 kg;-9.30,-2.50 cm respectively) when compared to control, and significantly lower BMI at 18-month follow-up when compared to control (CI = -2.59,-0.29 kg/m2). In parents with baseline BMI < 25 kg/m2, the 4 HV group had significantly lower percentage fat mass (CI = -3.94,-0.12%), while the 2 HV group had significantly lower body mass (CI = -2.56,-0.42 kg) and BMI (CI = -0.77,-0.08 kg/m2) at 6-month follow-up, both compared to control; these effects were not maintained at 18-month follow-up. Conclusions This study provides support that a home-based childhood obesity prevention intervention may improve weight outcomes among parents. Future research should explore how home-based interventions influence family behaviour and dynamics to impact weight outcomes in children and their parents. Trial registration Prospectively registered August 2014, clinical trial identifier NCT02223234.
Collapse
Affiliation(s)
- Owen Krystia
- 1Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1 Canada
| | - Tory Ambrose
- 1Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1 Canada
| | - Gerarda Darlington
- 2Department of Mathematics and Statistics, University of Guelph, Guelph, ON N1G 2W1 Canada
| | - David W L Ma
- 3Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON N1G 2W1 Canada
| | - Andrea C Buchholz
- 1Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1 Canada
| | - Jess Haines
- 1Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1 Canada
| | | |
Collapse
|
55
|
Houle-Johnson SA, Kakinami L. Do sex differences in reported weight loss intentions and behaviours persist across demographic characteristics and weight status in youth? A systematic review. BMC Public Health 2018; 18:1343. [PMID: 30514246 PMCID: PMC6280345 DOI: 10.1186/s12889-018-6179-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 11/02/2018] [Indexed: 12/18/2022] Open
Abstract
Background Evidence suggests that young females are more likely to try to lose weight than young males, however whether this sex difference persists across demographic characteristics and weight status is unclear. Further, whether females are more likely than males to try to lose weight using unhealthy weight loss strategies has never been systematically assessed. The objective of this systematic review was to examine the literature on sex differences in weight loss intentions and strategies in children and adolescent observational studies to determine whether sex differences persisted across demographic characteristics (race/ethnicity, grade level) and weight status. Methods Relevant articles published after 1990 were identified using PubMED, Web of Science, and PsycInfo. Searches were conducted in May of 2015 and again in May of 2017. Studies conducted in the US and Canada with participants 18-years old or younger who measured weight loss strategies in the context of weight loss intention were selected. Descriptive statistics were extracted from 19 studies. Results Almost two-thirds of youth reported trying to lose weight. High-school and middle-school aged females reported consistently higher prevalence of weight loss intentions compared to male counterparts, as did Caucasian, African-American, and Hispanic females. The proportion of youth using unhealthy or extreme strategies reached 44 and 13%, respectively, with a similar proportion of males and females endorsing the use of each category of weight loss strategies across studies. Native-American youth reported the highest prevalence (27%) of using extreme strategies. Conclusions Researchers should consider demographic characteristics when reporting prevalence information for weight loss intentions and behaviours, as certain groups might require more targeted public health initiatives. Across characteristics, prevalence ranges were broad for weight loss intentions and use of particular strategies, suggesting the need to standardize and refine data collection and reporting practices in this literature. Electronic supplementary material The online version of this article (10.1186/s12889-018-6179-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Stephanie A Houle-Johnson
- Department of Psychology, Concordia University, Montreal, Quebec, Canada.,School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier Private, VNR3088, Ottawa, ON, K1N 9A8, Canada
| | - Lisa Kakinami
- Department of Mathematics and Statistics, Concordia University, 1455 De Maisonneuve Blvd. W., Room S-LB 927, Montreal, QC, H3G 1M8, Canada. .,PERFORM Centre, Concordia University, Montreal, Quebec, Canada.
| |
Collapse
|
56
|
Solmi M, Köhler CA, Stubbs B, Koyanagi A, Bortolato B, Monaco F, Vancampfort D, Machado MO, Maes M, Tzoulaki I, Firth J, Ioannidis JPA, Carvalho AF. Environmental risk factors and nonpharmacological and nonsurgical interventions for obesity: An umbrella review of meta-analyses of cohort studies and randomized controlled trials. Eur J Clin Invest 2018; 48:e12982. [PMID: 29923186 DOI: 10.1111/eci.12982] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 06/18/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Multiple environmental factors have been implicated in obesity, and multiple interventions, besides drugs and surgery, have been assessed in obese patients. Results are scattered across many studies and meta-analyses, and they often mix obese and overweight individuals. MATERIALS AND METHODS PubMed and Cochrane Database of Systematic Reviews were searched through 21 January 2017 for meta-analyses of cohort studies assessing environmental risk factors for obesity, and randomized controlled trials investigating nonpharmacological and nonsurgical therapeutic interventions for obesity. We excluded data on overweight participants. Evidence from observational studies was graded according to criteria that included the statistical significance of the random-effects summary estimate and of the largest study in a meta-analysis, the number of obesity cases, heterogeneity between studies, 95% prediction intervals, small-study effects and excess significance. The evidence of intervention studies for obesity was assessed with the GRADE framework. RESULTS Fifty-four articles met eligibility criteria, including 26 meta-analyses of environmental risk factors (166 studies) and 46 meta-analyses of nondrug, nonsurgical interventions (206 trials). In adults, the only risk factor with convincing evidence was depression, and childhood obesity, adolescent obesity, childhood abuse and short sleep duration had highly suggestive evidence. Infancy weight gain during the first year of life, depression and low maternal education had convincing evidence for association with paediatric obesity. All interventions had low or very-low-quality evidence with one exception of moderate-quality evidence for one comparison (no differences in efficacy between brief lifestyle primary care interventions and other interventions for paediatric obesity). Summary effect sizes were mostly small across compared interventions (maximum 5.1 kg in adults and 1.78 kg in children) and even these estimates may be inflated. CONCLUSIONS Depression, obesity in earlier age groups, short sleep duration, childhood abuse and low maternal education have the strongest support among proposed risk factors for obesity. Furthermore, there is no high-quality evidence to recommend treating obesity with a specific nonpharmacological and nonsurgical intervention among many available, and whatever benefits in terms of magnitude of weight loss appear small.
Collapse
Affiliation(s)
- Marco Solmi
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Cristiano A Köhler
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK.,Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Francesco Monaco
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Leuven, Belgium.,University Psychiatric Centre, KU Leuven, University of Leuven, Leuven-Kortenberg, Belgium
| | - Myrela O Machado
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,IMPACT Strategic Research Center, Deakin University, Geelong, Vic., Australia
| | - Ioanna Tzoulaki
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.,MRC-PHE Centre for Environment, School of Public Health, Imperial College London, London, UK.,Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - Joseph Firth
- NICM, School of Science and Health, University of Western Sydney, Sydney, NSW, Australia.,Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - John P A Ioannidis
- Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California.,Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California.,Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California.,Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, California
| | - André F Carvalho
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Centre for Addiction & Mental Health (CAMH), Toronto, ON, Canada
| |
Collapse
|
57
|
Parker SM, Stocks N, Nutbeam D, Thomas L, Denney-Wilson E, Zwar N, Karnon J, Lloyd J, Noakes M, Liaw ST, Lau A, Osborne R, Harris MF. Preventing chronic disease in patients with low health literacy using eHealth and teamwork in primary healthcare: protocol for a cluster randomised controlled trial. BMJ Open 2018; 8:e023239. [PMID: 29866737 PMCID: PMC5988137 DOI: 10.1136/bmjopen-2018-023239] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 04/20/2018] [Accepted: 05/11/2018] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Adults with lower levels of health literacy are less likely to engage in health-promoting behaviours. Our trial evaluates the impacts and outcomes of a mobile health-enhanced preventive intervention in primary care for people who are overweight or obese. METHODS AND ANALYSIS A two-arm pragmatic practice-level cluster randomised trial will be conducted in 40 practices in low socioeconomic areas in Sydney and Adelaide, Australia. Forty patients aged 40-70 years with a body mass index ≥28 kg/m2 will be enrolled per practice. The HeLP-general practitioner (GP) intervention includes a practice-level quality improvement intervention (medical record audit and feedback, staff training and practice facilitation visits) to support practices to implement the clinical intervention for patients. The clinical intervention involves a health check visit with a practice nurse based on the 5As framework (assess, advise, agree, assist and arrange), the use of a purpose-built patient-facing app, my snapp, and referral for telephone coaching. The primary outcomes are change in health literacy, lifestyle behaviours, weight, waist circumference and blood pressure. The study will also evaluate changes in quality of life and health service use to determine the cost-effectiveness of the intervention and examine the experiences of practices in implementing the programme. ETHICS AND DISSEMINATION The study has been approved by the University of New South Wales (UNSW) Human Research Ethics Committee (HC17474) and ratified by the University of Adelaide Human Research Ethics committee. There are no restrictions on publication, and findings of the study will be made available to the public via the Centre for Primary Health Care and Equity website and through conference presentations and research publications. Deidentified data and meta-data will be stored in a repository at UNSW and made available subject to ethics committee approval. TRIAL REGISTRATIONREGISTRATION NUMBER ACTRN12617001508369; Pre-results.
Collapse
Affiliation(s)
- Sharon M Parker
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Nigel Stocks
- Discipline of General Practice, University of Adelaide, Adelaide, South Australia, Australia
| | - Don Nutbeam
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Louise Thomas
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Nicholas Zwar
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Jon Karnon
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Jane Lloyd
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Manny Noakes
- Nutrition and Health Program, CSIRO Health and Biosecurity, Adelaide, South Australia, Australia
| | - Siaw-Teng Liaw
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Annie Lau
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Richard Osborne
- School of Health and Social Development, Centre for Population Health Research, Faculty of Health, Deakin University, Melbourne, Victoria, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
58
|
Bardus M, Hamadeh G, Hayek B, Al Kherfan R. A Self-Directed Mobile Intervention (WaznApp) to Promote Weight Control Among Employees at a Lebanese University: Protocol for a Feasibility Pilot Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e133. [PMID: 29769174 PMCID: PMC5981057 DOI: 10.2196/resprot.9793] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 03/18/2018] [Accepted: 03/31/2018] [Indexed: 01/04/2023] Open
Abstract
Background Overweight and obesity have become major health problems globally with more than 1.9 billion overweight adults. In Lebanon, the prevalence of obesity and overweight is 65.4% combined. Risk factors of obesity and overweight are preventable and can be addressed by modifications in the environment and in an individual’s lifestyle. Mobile technologies are increasingly used in behavioral, self-directed weight management interventions, providing users with additional opportunities to attain weight control (weight loss, weight gain prevention, etc). Mobile apps may allow for the delivery of Just-in-Time Adaptive Interventions (JITAIs), which provide support through skill building, emotional support, and instrumental support, following the participants’ progress. A few commercially available apps offer JITAI features, but no studies have tested their efficacy. Objective The primary objective of this study is to examine the feasibility of a self-directed weight loss intervention, targeting employees of an academic institution, using a virtual coaching app with JITAI features (Lark) and a self-help calorie-counting app (MyFitnessPal). The secondary objective is to estimate the effects of the intervention on main study outcomes. Methods This study is a single-center, parallel, randomized controlled trial with 2 study arms (intervention and control). Participants will be randomly allocated in equal proportions to the intervention (Lark) and control groups (MyFitnessPal). To be eligible for this study, participants must be employed full- or part-time at the university or its medical center, able to read English, have a smartphone, and be interested in controlling their weight. Recruitment strategies entail email invitations, printed posters, and social media postings. We will assess quantitative rates of recruitment, adherence, and retention, self-reported app quality using the user version of the Mobile App Rating Scale. We will also assess changes in weight-related outcomes (absolute weight and waist circumference), behavioral outcomes (physical activity and diet), and cognitive factors (motivation to participate in the trial and to manage weight). Results WaznApp was funded in June 2017, and recruitment started in March 2018. Conclusions This study will provide information as to whether the selected mobile apps offer a feasible solution for promoting weight management in an academic workplace. The results will inform a larger trial whose results might be replicated in similar workplaces in Lebanon and the Middle East and North Africa region, and will be used as a benchmark for further investigations in other settings and similar target groups. Trial Registration ClinicalTrials.gov NCT03321331; https://clinicaltrials.gov/ct2/show/NCT03321331 (Archived by WebCite at http://www.webcitation.org/6ys9NOLo5) Registered Report Identifier RR1-10.2196/9793
Collapse
Affiliation(s)
- Marco Bardus
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Ghassan Hamadeh
- Department of Family Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Bouchra Hayek
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Rawan Al Kherfan
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| |
Collapse
|
59
|
Sutcliffe K, Melendez-Torres GJ, Burchett HED, Richardson M, Rees R, Thomas J. The importance of service-users' perspectives: A systematic review of qualitative evidence reveals overlooked critical features of weight management programmes. Health Expect 2018. [PMID: 29537117 PMCID: PMC5980498 DOI: 10.1111/hex.12657] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Extensive research effort shows that weight management programmes (WMPs) targeting both diet and exercise are broadly effective. However, the critical features of WMPs remain unclear. Objective To develop a deeper understanding of WMPs critical features, we undertook a systematic review of qualitative evidence. We sought to understand from a service‐user perspective how programmes are experienced, and may be effective, on the ground. Search strategy We identified qualitative studies from existing reviews and updated the searches of one review. Inclusion criteria We included UK studies capturing the views of adult WMP users. Data extraction and synthesis Thematic analysis was used inductively to code and synthesize the evidence. Main results Service users were emphatic that supportive relationships, with service providers or WMP peers, are the most critical aspect of WMPs. Supportive relationships were described as providing an extrinsic motivator or “hook” which helped to overcome barriers such as scepticism about dietary advice or a lack confidence to engage in physical activity. Discussion and conclusions The evidence revealed that service‐users’ understandings of the critical features of WMPs differ from the focus of health promotion guidance or descriptions of evaluated programmes which largely emphasize educational or goal setting aspects of WMPs. Existing programme guidance may not therefore fully address the needs of service users. The study illustrates that the perspectives of service users can reveal unanticipated intervention mechanisms or underemphasized critical features and underscores the value of a holistic understanding about “what happens” in complex psychosocial interventions such as WMPs.
Collapse
Affiliation(s)
- Katy Sutcliffe
- EPPI-Centre, UCL Institute of Education, University College London, London, UK
| | - G J Melendez-Torres
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Helen E D Burchett
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Michelle Richardson
- EPPI-Centre, UCL Institute of Education, University College London, London, UK
| | - Rebecca Rees
- EPPI-Centre, UCL Institute of Education, University College London, London, UK
| | - James Thomas
- EPPI-Centre, UCL Institute of Education, University College London, London, UK
| |
Collapse
|
60
|
Garnett C, Crane D, Brown J, Kaner E, Beyer F, Muirhead C, Hickman M, Redmore J, de Vocht F, Beard E, Michie S. Reported Theory Use by Digital Interventions for Hazardous and Harmful Alcohol Consumption, and Association With Effectiveness: Meta-Regression. J Med Internet Res 2018; 20:e69. [PMID: 29490895 PMCID: PMC5856921 DOI: 10.2196/jmir.8807] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/16/2017] [Accepted: 11/17/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Applying theory to the design and evaluation of interventions is likely to increase effectiveness and improve the evidence base from which future interventions are developed, though few interventions report this. OBJECTIVE The aim of this paper was to assess how digital interventions to reduce hazardous and harmful alcohol consumption report the use of theory in their development and evaluation, and whether reporting of theory use is associated with intervention effectiveness. METHODS Randomized controlled trials were extracted from a Cochrane review on digital interventions for reducing hazardous and harmful alcohol consumption. Reporting of theory use within these digital interventions was investigated using the theory coding scheme (TCS). Reported theory use was analyzed by frequency counts and descriptive statistics. Associations were analyzed with meta-regression models. RESULTS Of 41 trials involving 42 comparisons, half did not mention theory (50% [21/42]), and only 38% (16/42) used theory to select or develop the intervention techniques. Significant heterogeneity existed between studies in the effect of interventions on alcohol reduction (I2=77.6%, P<.001). No significant associations were detected between reporting of theory use and intervention effectiveness in unadjusted models, though the meta-regression was underpowered to detect modest associations. CONCLUSIONS Digital interventions offer a unique opportunity to refine and develop new dynamic, temporally sensitive theories, yet none of the studies reported refining or developing theory. Clearer selection, application, and reporting of theory use is needed to accurately assess how useful theory is in this field and to advance the field of behavior change theories.
Collapse
Affiliation(s)
- Claire Garnett
- Department of Behavioural Science and Health, University College London, London, United Kingdom
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - David Crane
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Fiona Beyer
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Colin Muirhead
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Matthew Hickman
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - James Redmore
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Frank de Vocht
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Emma Beard
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| |
Collapse
|
61
|
Gorczyca AM, Washburn RA, Ptomey L, Mayo MS, Sullivan DK, Gibson CA, Lee R, Stolte S, Donnelly JE. Weight management in rural health clinics: The Midwest diet and exercise trial. Contemp Clin Trials 2018; 67:37-46. [PMID: 29454140 DOI: 10.1016/j.cct.2018.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 02/12/2018] [Accepted: 02/13/2018] [Indexed: 01/26/2023]
Abstract
Obesity prevalence is higher in rural compared to urban residents. Rural health clinics offer a potential venue for delivery of weight management. However, traditional programs require travel to attend on-site meetings which is impractical or inconvenient for rural residents. Clinic staff in most rural settings are unlikely to be trained to provide effective weight management. Remote delivery using group phone conferences (GP) or individual phone calls (IP), by staff associated with rural clinics eliminates the need for travel to attend on-site meetings. The effectiveness of these approaches will be the focus of this trial. Staff at five primary care clinics, serving primarily rural residents, will be trained to deliver GP and IP interventions and an enhanced usual care (EUC), (i.e., individual face-to-face meetings (~45 min) at clinic site, four times across 18 mos.). Two hundred overweight/obese adults (BMI ≥ 25.0-45.0 kg/m2, age ≥ 21 yrs.) will be recruited through each clinic and randomized to GP (n = 80), IP (n = 80), or EUC (n = 40) to compare weight loss (0-6 mos.), weight maintenance (7-18 mos.), and weight change during a 6 mo. no contact follow-up (19-24 mos.) between intervention arms. The GP and IP interventions will be identical in lesson plan content, diet, and physical activity. The only difference between groups will be the delivery format (group vs. individual) and session duration (GP ~45 min/session; IP ~15 min/session). Primary (body weight) and secondary outcomes (waist circumference, energy/macronutrient intake, physical activity) will be assessed at baseline, 6, 12, 18 and 24 mos. Cost and contingent valuation analyses will also be completed. NCT REGISTRATION NCT02932748.
Collapse
Affiliation(s)
- Anna M Gorczyca
- Cardiovascular Research Center, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160, USA.
| | - Richard A Washburn
- Cardiovascular Research Center, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160, USA.
| | - Lauren Ptomey
- Cardiovascular Research Center, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160, USA.
| | - Matthew S Mayo
- Department of Biostatistics, The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160, USA.
| | - Debra K Sullivan
- Department of Dietetics and Nutrition, The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160, USA.
| | - Cheryl A Gibson
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160, USA.
| | - Robert Lee
- Department of Health Policy and Management, The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160, USA.
| | - Sarah Stolte
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160, USA.
| | - Joseph E Donnelly
- Cardiovascular Research Center, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160, USA.
| |
Collapse
|
62
|
McRobbie H, Hajek P, Peerbux S, Kahan BC, Eldridge S, Trépel D, Parrott S, Griffiths C, Snuggs S, Myers Smith K. Tackling obesity in areas of high social deprivation: clinical effectiveness and cost-effectiveness of a task-based weight management group programme - a randomised controlled trial and economic evaluation. Health Technol Assess 2018; 20:1-150. [PMID: 27802843 DOI: 10.3310/hta20790] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND An increasing number of people require help to manage their weight. The NHS recommends weight loss advice by general practitioners and/or a referral to a practice nurse. Although this is helpful for some, more effective approaches that can be disseminated economically on a large scale are needed. OBJECTIVE To assess whether or not a task-based weight management programme [Weight Action Programme (WAP)] has better long-term effects than a 'best practice' intervention provided in primary care by practice nurses. DESIGN Randomised controlled trial with cost-effectiveness analysis. SETTING General practices in east London, UK. PARTICIPANTS Three hundred and thirty adults with a body mass index (BMI) of ≥ 30 kg/m2 or a BMI of ≥ 28 kg/m2 plus comorbidities were recruited from local general practices and via media publicity. Those who had a BMI of > 45 kg/m2, had lost > 5% of their body weight in the previous 6 months, were currently pregnant or taking psychiatric medications were excluded. Participants were randomised (2 : 1) to the WAP or nurse arms. INTERVENTIONS The WAP intervention was delivered in eight weekly group sessions that combined dietary and physical activity, advice and self-monitoring in a group-oriented intervention. The initial course was followed by 10 monthly group maintenance sessions open to all participants in this study arm. The practice nurse intervention (best usual care) consisted of four one-to-one sessions delivered over 8 weeks, and included standard advice on diet and physical activity based on NHS 'Change4Life' materials and motivational support. MAIN OUTCOME MEASURES The primary outcome measure was weight change at 12 months. Secondary outcome measures included change in BMI, waist circumference and blood pressure, and proportion of participants losing at least 5% and 10% of baseline body weight. Staff collecting measurements at the 6- and 12-month follow-ups were blinded to treatment allocation. The primary outcome measure was analysed according to the intention-to-treat principle, and included all participants with at least one recorded outcome at either 1, 2, 6 or 12 months. The analysis employed a mixed-effects linear regression model, adjusted for baseline weight, age, sex, ethnicity, smoking status and general practice. The European Quality of Life-5 Dimensions-5 Levels questionnaire was completed and used to estimate quality-adjusted life-years (QALYs) within the cost-effectiveness analysis. RESULTS There were 330 participants (WAP arm, n = 221; nurse arm, n = 109; 72% women). A total of 291 (88%) participants (WAP arm, n = 194; nurse arm, n = 97) were included in the main analysis for the primary outcome. Weight loss at 12 months was greater in the WAP arm than in the nurse intervention arm [-4.2 kg vs. -2.3 kg; difference -1.9 kg, 95% confidence interval (CI) -3.7 to -0.1 kg; p = 0.04]. Participants in the WAP arm were more likely than participants in the nurse arm to have lost at least 5% of their baseline body weight at 12 months (41% vs. 27%; odds ratio 14.61, 95% CI 2.32 to 91.96; p = 0.004). The incremental cost-effectiveness ratio for WAP over and above the nurse arm is £7742 per QALY. CONCLUSIONS A WAP delivered in general practice better promotes weight loss over 12 months than a best usual practice nurse-led weight loss programme. LIMITATIONS The trial recruited mostly women. Research is needed into factors that would make weight loss programmes more attractive to men. TRIAL REGISTRATION Current Controlled Trials ISRCTN45820471. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 79. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Hayden McRobbie
- Health and Lifestyle Research Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Peter Hajek
- Health and Lifestyle Research Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Sarrah Peerbux
- Health and Lifestyle Research Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Brennan C Kahan
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Sandra Eldridge
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Dominic Trépel
- Department of Health Sciences, University of York, York, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | - Chris Griffiths
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Sarah Snuggs
- Health and Lifestyle Research Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Katie Myers Smith
- Health and Lifestyle Research Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| |
Collapse
|
63
|
Gonzales KL, Garcia GE, Jacob MM, Muller C, Nelson L, Manson SM. Patient-provider relationship and perceived provider weight bias among American Indians and Alaska Natives. Obes Sci Pract 2018; 4:76-84. [PMID: 29479467 PMCID: PMC5818742 DOI: 10.1002/osp4.135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 08/21/2017] [Accepted: 08/29/2017] [Indexed: 12/25/2022] Open
Abstract
Objective The objective of this study was to examine patient-provider relationships among American Indians and Alaska Native (AI/AN) patients by examining associations between patient activation, perceived provider weight bias and working alliance. Patient activation is generally defined as having the knowledge, skills and confidence to manage one's health. Methods Among a sample of 87 AI/AN adults presenting for general medical care at an urban clinic in the north-west region of the USA, ordinary least squares regression analysis was completed to examine associations. Results Better working alliance scores were associated with increased patient activation, while perceived provider weight bias was associated with reduced patient activation. In addition, those with class II obesity had decreased patient activation. Conclusion These findings point to the importance of a positive patient-provider relationship in AI/ANs. Optimal patient engagement and subsequent health outcomes warrant additional consideration of patients' perceptions of provider weight bias within the context of health promotion and interventions.
Collapse
Affiliation(s)
- K. L. Gonzales
- Oregon Health Sciences University‐Portland State University School of Public HealthPortland State UniversityPortlandORUSA
| | - G. E. Garcia
- Department of SociologyPortland State UniversityPortlandORUSA
| | - M. M. Jacob
- Department of Education Studies, College of EducationUniversity of OregonEugeneORUSA
| | - C. Muller
- Initiative for Research and Education to Advance Community HealthWashington State UniversitySeattleWAUSA
| | - L. Nelson
- Initiative for Research and Education to Advance Community HealthWashington State UniversitySeattleWAUSA
| | - S. M. Manson
- Centers for American Indian and Alaska Native HealthUniversity of Colorado DenverAuroraCOUSA
| |
Collapse
|
64
|
Bello JK, Stulberg DB, Zhou Y, Wang C. Physical Activity and Consumption Patterns of Reproductive-Aged Women by BMI Category. Matern Child Health J 2018; 22:713-724. [PMID: 29344750 DOI: 10.1007/s10995-018-2440-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objectives Obesity before and during pregnancy is associated with adverse effects for mother and child, but little is known about physical activity and consumption patterns among reproductive-aged women. The goal of this study is to identify behaviors of nonpregnant reproductive-aged women associated with normal weight, overweight, and obesity. Methods Data from the nationally representative National Eating Trends survey (2003-2011) were analyzed, comparing number of days of exercise in a 1-week period and consumption of fruits/vegetables, sugar sweetened beverages (SSB), and concentrated sweets by BMI. Behaviors were compared using analysis of variance and Chi square test across groups. Ordinal logistic regression was used to compare behaviors across groups controlling for demographic factors. Multivariable Poisson regression was used to identify demographic factors associated with behaviors among obese women. Results Among 5941 18-45-year-old women, exercise and fruit/vegetable consumption were associated with healthy weight controlling for demographic factors. Reporting any exercise or fruit/vegetable consumption was associated with decreased odds of overweight or obesity (aOR 0.73, 95% CI 0.64-0.83 and aOR 0.74, 95% CI 0.58-0.95, respectively). Consuming SSBs was associated with increasing BMI category while consuming concentrated sweets was unexpectedly associated with normal weight. Among obese women, being on any diet was associated with increased exercise frequency and fruit/vegetable consumption and decreased SSB consumption. Conclusions for Practice Physical activity and consumption behaviors are associated with weight among reproductive-aged women in ways similar to those in the general population. Promoting exercise and fruit/vegetable consumption has the potential to reduce obesity.
Collapse
Affiliation(s)
- Jennifer K Bello
- Department of Family and Community Medicine, Saint Louis University, 1402 South Grand Blvd., Saint Louis, MO, 63104, USA. .,Ambulatory Primary Care Innovations Group (APCIG), NorthShore University HealthSystem, Evanston, IL, USA.
| | - Debra B Stulberg
- Department of Family Medicine, University of Chicago, 5841 S. Maryland Ave., MC 7110, Chicago, IL, 60637, USA.,Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA.,MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL, USA
| | - Ying Zhou
- Center for Biomedical Research Informatics (CBRI), NorthShore University HealthSystem, 1001 University Place, Suite 150, Evanston, IL, 60201, USA
| | - Chi Wang
- Department of Biostatistics and Research Informatics, NorthShore University HealthSystem, 1001 University Place, Evanston, IL, 60201, USA
| |
Collapse
|
65
|
Lager CJ, Esfandiari NH, Subauste AR, Kraftson AT, Brown MB, Cassidy RB, Bellers D, Lockwood AL, Varban OA, Oral EA. Milestone Weight Loss Goals (Weight Normalization and Remission of Obesity) after Gastric Bypass Surgery: Long-Term Results from the University of Michigan. Obes Surg 2018; 27:1659-1666. [PMID: 28084587 DOI: 10.1007/s11695-016-2533-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Rates of weight normalization and obesity remission after Roux-en-Y gastric bypass (GB) are unknown. This study evaluated weight loss, rates of achieving body mass index (BMI) <25 or 30 kg/m2, recidivism, and predictors of success following GB. METHODS We retrospectively studied weight and BMI at baseline, 2 and 6 months, and annually at 1-7 years in 219 patients undergoing GB at the University of Michigan from January 2008 to November 2010. RESULTS Follow-up was excellent for a population traditionally associated with high attrition rates with data availability of 157/219, 145/219, 144/219, 134/219, 123/219, 82/161, and 29/64 patients at 1-7 years, respectively. Mean baseline BMI was 47.0 kg/m2. Weight normalization (BMI <25 kg/m2) occurred in 2.3-6.8% of patients. More importantly, 47% of patients achieved remission of obesity (BMI <30 kg/m2) at some time point and 24% (52/219) at the last observed time point. BMI <30 kg/m2 was associated with a lower initial BMI and follow-up for more than 2 years. CONCLUSIONS Rates of weight normalization are low after GB; however, a large number of patients achieved BMI <30 kg/m2. While the percent total weight loss and excess weight loss are both quite high in the entire cohort and this is likely associated with significant health benefits, our results still underscore the need to address obesity with intensive clinical attention earlier in its course.
Collapse
Affiliation(s)
- Corey J Lager
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan Health Systems, Brehm Center for Diabetes, 1000 Wall Street, Room 5313, Ann Arbor, MI, 48105, USA
| | - Nazanene H Esfandiari
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan Health Systems, Brehm Center for Diabetes, 1000 Wall Street, Room 5313, Ann Arbor, MI, 48105, USA
| | - Angela R Subauste
- Division of Endocrinology, University of Mississippi, 2500 N. State St., Jackson, MS, 39216, USA
| | - Andrew T Kraftson
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan Health Systems, Brehm Center for Diabetes, 1000 Wall Street, Room 5313, Ann Arbor, MI, 48105, USA
| | - Morton B Brown
- Department of Biostatistics, School of Public Health, University of Michigan, M4039 SPH II, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Ruth B Cassidy
- Division of Minimally Invasive Surgery, Department of General Surgery, University of Michigan, 1500 E Medical Center Dr SPC 5343, Ann Arbor, MI, 48109, USA
| | - Darlene Bellers
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan Health Systems, Brehm Center for Diabetes, 1000 Wall Street, Room 5313, Ann Arbor, MI, 48105, USA
| | - Amy L Lockwood
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan Health Systems, Brehm Center for Diabetes, 1000 Wall Street, Room 5313, Ann Arbor, MI, 48105, USA
| | - Oliver A Varban
- Division of Minimally Invasive Surgery, Department of General Surgery, University of Michigan, 1500 E Medical Center Dr SPC 5343, Ann Arbor, MI, 48109, USA
| | - Elif A Oral
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan Health Systems, Brehm Center for Diabetes, 1000 Wall Street, Room 5313, Ann Arbor, MI, 48105, USA.
| |
Collapse
|
66
|
Abstract
PURPOSE OF REVIEW Emerging adulthood (age 18-25) represents a critical period for weight control: rate of weight gain is greatest during these years and the prevalence of overweight and obesity is estimated to be at least 40% among emerging adults. Unique behavioral, psychosocial, and cognitive risk factors among this population must be specifically addressed within weight management programs. We review extant treatment approaches, including lessons learned from the nascent literature specifically targeting this population. Lastly, we provide suggestions to inform future work in this area. RECENT FINDINGS The EARLY consortium comprises seven clinical trials targeting weight control in young adults age 18-35. Though these studies encompass a broader age range, two of the trials enrolled large numbers of 18-25-year-olds. Results from these trials and other recent pilot trials provide a foundation for next steps with respect to developing weight management interventions for emerging adults. The design of targeted weight control approaches for emerging and young adults has contributed to improved outcomes for this high-risk population. However, suboptimal engagement and variability in response pose challenges. Identifying and intervening on individual-level behavioral and psychological variables may enhance the effects of these adapted treatments.
Collapse
Affiliation(s)
- Autumn Lanoye
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, 830 East Main Street, Richmond, VA, 23219, USA
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street Box 842018, Richmond, VA, 23284, USA
| | - Kristal L Brown
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, 830 East Main Street, Richmond, VA, 23219, USA
| | - Jessica G LaRose
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, 830 East Main Street, Richmond, VA, 23219, USA.
| |
Collapse
|
67
|
Contreras-Rodríguez O, Vilar-López R, Andrews ZB, Navas JF, Soriano-Mas C, Verdejo-García A. Altered cross-talk between the hypothalamus and non-homeostatic regions linked to obesity and difficulty to lose weight. Sci Rep 2017; 7:9951. [PMID: 28855582 PMCID: PMC5577266 DOI: 10.1038/s41598-017-09874-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 07/31/2017] [Indexed: 12/12/2022] Open
Abstract
Interactions between the hypothalamus and non-homeostatic regions may contribute to explain the difficulty to lose weight in obesity, an assumption never tested in human longitudinal studies. We investigated whether the functional connectivity between the medial and lateral hypothalamus (MH and LH) and corticostriatal regions differs between individuals with excess weight (n = 42) and normal weight (n = 39) using a seed-based resting-state approach. In addition, we examined the longitudinal association between functional connectivity and weight loss in a 3-month follow-up diet. Results showed that participants with excess weight had increased connectivity between the MH and the striatum and subgenual anterior cingulate cortex, and decreased connectivity with the middle frontal gyrus, and the bed nucleus of the stria terminalis (BNST), as well as a decreased connectivity between the LH and the cerebellum. Decreased connectivity between the MH and the posterior part of the BNST, and between the LH and the cerebellar cortex, predicted a greater percentage of weight loss. Functional connectivity measures explained 36% of the 3-month weight change among individuals with excess weight. We conclude that altered functional connectivity between homeostatic-hypothalamic regions and non-homeostatic corticostriatal and cerebellar regions is linked to obesity and difficulty to lose weight.
Collapse
Affiliation(s)
- Oren Contreras-Rodríguez
- Psychiatry Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, and Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM-17), Barcelona, Spain
| | - Raquel Vilar-López
- Red de Trastornos Adictivos, University of Granada, Granada, Spain
- Mind, Brain and Behavior Research Center, Universidad de Granada, Granada, Spain
| | - Zane B Andrews
- Monash Biomedicine Discovery Institute, Metabolic Disease and Obesity Program, Department of Physiology, Monash University, Melbourne, Australia
| | - Juan F Navas
- Mind, Brain and Behavior Research Center, Universidad de Granada, Granada, Spain
- Department of Experimental Psychology, University of Granada, Granada, Spain
| | - Carles Soriano-Mas
- Psychiatry Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, and Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM-17), Barcelona, Spain.
- Department of Psychobiology and Methodology of Health Sciences, University Autònoma de Barcelona, Barcelona, Spain.
| | - Antonio Verdejo-García
- Red de Trastornos Adictivos, University of Granada, Granada, Spain
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia
| |
Collapse
|
68
|
Jebb SA, Astbury NM, Tearne S, Nickless A, Aveyard P. Doctor Referral of Overweight People to a Low-Energy Treatment (DROPLET) in primary care using total diet replacement products: a protocol for a randomised controlled trial. BMJ Open 2017; 7:e016709. [PMID: 28780559 PMCID: PMC5629710 DOI: 10.1136/bmjopen-2017-016709] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION The global prevalence of obesity has risen significantly in recent decades. There is a pressing need to identify effective interventions to treat established obesity that can be delivered at scale. The aim of the Doctor Referral of Overweight People to a Low-Energy Treatment (DROPLET) study is to determine the clinical effectiveness, feasibility and acceptability of referral to a low-energy total diet replacement programme compared with usual weight management interventions in primary care. METHODS AND ANALYSIS The DROPLET trial is a randomised controlled trial comparing a low-energy total diet replacement programme with usual weight management interventions delivered in primary care. Eligible patients will be recruited through primary care registers and randomised to receive a behavioural support programme delivered by their practice nurse or a referral to a commercial provider offering an initial 810 kcal/d low-energy total diet replacement programme for 8 weeks, followed by gradual food reintroduction, along with weekly behavioural support for 24 weeks. The primary outcome is weight change at 12 months. The secondary outcomes are weight change at 3 and 6 months, the proportion of participants achieving 5% and 10% weight loss at 12 months, and change in fat mass, haemoglobin A1c, low-density lipoprotein cholesterol and systolic and diastolic blood pressure at 12 months. Data will be analysed on the basis of intention to treat. Qualitative interviews on a subsample of patients and healthcare providers will assess their experiences of the weight loss programmes and identify factors affecting acceptability and adherence. ETHICS AND DISSEMINATION This study has been reviewed and approved by the National Health ServiceHealth Research Authority (HRA)Research Ethics Committee (Ref: SC/15/0337). The trial findings will be disseminated to academic and health professionals through presentations at meetings and peer-reviewed journals and to the public through the media. If the intervention is effective, the results will be communicated to policymakers and commissioners of weight management services. TRIAL REGISTRATION NUMBER ISRCTN75092026.
Collapse
Affiliation(s)
- Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford UK
| | - Nerys M Astbury
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford UK
| | - Sarah Tearne
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford UK
| | - Alecia Nickless
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford UK
| |
Collapse
|
69
|
Granara B, Laurent J. Provider attitudes and practice patterns of obesity management with pharmacotherapy. J Am Assoc Nurse Pract 2017; 29:543-550. [PMID: 28665500 DOI: 10.1002/2327-6924.12481] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 04/19/2017] [Accepted: 04/30/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE More than one third of American adults are obese. Extreme obesity is rapidly rising. Nine medications are approved for weight loss yet they remain underutilized with the focus primarily on lifestyle modifications. The objective was to determine current prescribing patterns and attitudes of weight loss medications in the management of obesity among primary care providers (PCPs). METHODS PCPs were surveyed to determine practice patterns, attitudes, barriers, and facilitators for prescribing weight loss medications. CONCLUSIONS Ninety-four surveys were analyzed. Seventy-six percent of all PCPs did not prescribe weight loss medications for long-term weight loss and 58% of PCPs had negative perceptions of pharmacotherapy. Differences existed between prescribing patterns and attitudes of advanced practice clinicians and physicians. Safety concerns were the greatest barrier. Having 2+ comorbidities and severe obesity were facilitators for prescribing weight loss medications. Underutilization of pharmacotherapy suggests that PCPs may not have sufficient knowledge about medication safety profiles and efficacy. Delaying treatment until patients have reached a high level of morbidity may be less efficacious than earlier treatment. IMPLICATIONS FOR PRACTICE Education regarding effectiveness and risks of weight loss medications for obesity management is needed and earlier interventions with pharmacotherapy may prevent significant morbidity and mortality.
Collapse
Affiliation(s)
- Brittany Granara
- Department of Nursing, College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont
| | - Jennifer Laurent
- Department of Nursing, College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont
| |
Collapse
|
70
|
Alageel S, Gulliford MC, McDermott L, Wright AJ. Multiple health behaviour change interventions for primary prevention of cardiovascular disease in primary care: systematic review and meta-analysis. BMJ Open 2017; 7:e015375. [PMID: 28619779 PMCID: PMC5734412 DOI: 10.1136/bmjopen-2016-015375] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND It is uncertain whether multiple health behaviour change (MHBC) interventions are effective for the primary prevention of cardiovascular disease (CVD) in primary care. A systematic review and a meta-analysis were performed to evaluate the effectiveness of MHBC interventions on CVD risk and CVD risk factors; the study also evaluated associations of theoretical frameworks and intervention components with intervention effectiveness. METHODS The search included randomised controlled trials of MHBC interventions aimed at reducing CVD risk in primary prevention population up to 2017. Theoretical frameworks and intervention components were evaluated using standardised methods. Meta-analysis with stratification and meta-regression were used to evaluate intervention effects. RESULTS We identified 31 trials (36 484 participants) with a minimum duration of 12 months follow-up. Pooled net change in systolic blood pressure (16 trials) was -1.86 (95% CI -3.17 to -0.55; p=0.01) mm Hg; diastolic blood pressure (15 trials), -1.53 (-2.43 to -0.62; p=0.001) mm Hg; body mass index (14 trials), -0.13 (-0.26 to -0.01; p=0.04) kg/m2; serum total cholesterol (14 trials), -0.13 (-0.19 to -0.07; p<0.001) mmol/L. There was no significant association between interventions with a reported theoretical basis and improved intervention outcomes. No association was observed between intervention intensity (number of sessions and intervention duration) and intervention outcomes. There was significant heterogeneity for some risk factor analyses, leading to uncertain validity of some pooled net changes. CONCLUSIONS MHBC interventions delivered to CVD-free participants in primary care did not appear to have quantitatively important effects on CVD risk factors. Better reporting of interventions' rationale, content and delivery is essential to understanding their effectiveness.
Collapse
Affiliation(s)
- Samah Alageel
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
| | - Martin C Gulliford
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
| | - Lisa McDermott
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
| | - Alison J Wright
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
| |
Collapse
|
71
|
Contreras-Rodríguez O, Martín-Pérez C, Vilar-López R, Verdejo-Garcia A. Ventral and Dorsal Striatum Networks in Obesity: Link to Food Craving and Weight Gain. Biol Psychiatry 2017; 81:789-796. [PMID: 26809248 DOI: 10.1016/j.biopsych.2015.11.020] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 11/15/2015] [Accepted: 11/16/2015] [Indexed: 01/15/2023]
Abstract
BACKGROUND The food addiction model proposes that obesity overlaps with addiction in terms of neurobiological alterations in the striatum and related clinical manifestations (i.e., craving and persistence of unhealthy habits). Therefore, we aimed to examine the functional connectivity of the striatum in excess-weight versus normal-weight subjects and to determine the extent of the association between striatum connectivity and individual differences in food craving and changes in body mass index (BMI). METHODS Forty-two excess-weight participants (BMI > 25) and 39 normal-weight participants enrolled in the study. Functional connectivity in the ventral and dorsal striatum was indicated by seed-based analyses on resting-state data. Food craving was indicated with subjective ratings of visual cues of high-calorie food. Changes in BMI between baseline and 12 weeks follow-up were assessed in 28 excess-weight participants. Measures of connectivity in the ventral striatum and dorsal striatum were compared between groups and correlated with craving and BMI change. RESULTS Participants with excess weight displayed increased functional connectivity between the ventral striatum and the medial prefrontal and parietal cortices and between the dorsal striatum and the somatosensory cortex. Dorsal striatum connectivity correlated with food craving and predicted BMI gains. CONCLUSIONS Obesity is linked to alterations in the functional connectivity of dorsal striatal networks relevant to food craving and weight gain. These neural alterations are associated with habit learning and thus compatible with the food addiction model of obesity.
Collapse
Affiliation(s)
- Oren Contreras-Rodríguez
- Red de Trastornos Adictivos, Universidad de Granada, Granada; Psychiatry Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, and Centro de Investigación Biomédica en Red de Salud Mental, Barcelona
| | - Cristina Martín-Pérez
- Red de Trastornos Adictivos, Universidad de Granada, Granada; Institute of Neuroscience F. Oloriz, Universidad de Granada, Granada, Spain
| | - Raquel Vilar-López
- Red de Trastornos Adictivos, Universidad de Granada, Granada; Mind, Brain and Behavior Research Center, Universidad de Granada, Granada, Spain
| | - Antonio Verdejo-Garcia
- Red de Trastornos Adictivos, Universidad de Granada, Granada; Institute of Neuroscience F. Oloriz, Universidad de Granada, Granada, Spain; School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia.
| |
Collapse
|
72
|
Peckmezian T, Hay P. A systematic review and narrative synthesis of interventions for uncomplicated obesity: weight loss, well-being and impact on eating disorders. J Eat Disord 2017; 5:15. [PMID: 28469914 PMCID: PMC5410702 DOI: 10.1186/s40337-017-0143-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 03/22/2017] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Most weight loss research focuses on weight as the primary outcome, often to the exclusion of other physiological or psychological measures. This study aims to provide a holistic evaluation of the effects from weight loss interventions for individuals with obesity by examining the physiological, psychological and eating disorders outcomes from these interventions. METHODS Databases Medline, PsycInfo and Cochrane Library (2011-2016) were searched for randomised controlled trials and systematic reviews of obesity treatments (dietary, exercise, behavioural, psychological, pharmacological or surgical). Data extracted included study features, risk of bias, study outcomes, and an assessment of treatment impacts on physical, psychological or eating disorder outcomes. RESULTS From 3628 novel records, 134 studies met all inclusion criteria and were evaluated in this review. Lifestyle interventions had the strongest evidence base as a first-line approach, with escalation to pharmacotherapy and bariatric surgery in more severe or complicated cases. Quality of life was the most common psychological outcome measure, and improved in all cases where it was assessed, across all intervention types. Behavioural, psychological and lifestyle interventions for weight loss led to improvements in cognitive restraint, control over eating and binge eating, while bariatric surgery led to improvements in eating behaviour and body image that were not sustained over the long-term. DISCUSSION Numerous treatment strategies have been trialled to assist people to lose weight and many of these are effective over the short-term. Quality of life, and to a lesser degree depression, anxiety and psychosocial function, often improve alongside weight loss. Weight loss is also associated with improvements in eating disorder psychopathology and related measures, although overall, eating disorder outcomes are rarely assessed. Further research and between-sector collaboration is required to address the significant overlap in risk factors, diagnoses and treatment outcomes between obesity and eating disorders.
Collapse
Affiliation(s)
| | - Phillipa Hay
- Foundation Chair of Mental Health and Centre for Health Research, School of Medicine, Western Sydney University, Parramatta, Australia
| |
Collapse
|
73
|
Affiliation(s)
- Helen P Booth
- Department of Primary Care and Public Health Sciences, King's College London, London SE1 1UL, UK.
| | - Martin C Gulliford
- Department of Primary Care and Public Health Sciences, King's College London, London SE1 1UL, UK
| |
Collapse
|
74
|
Gulliford MC, Charlton J, Prevost T, Booth H, Fildes A, Ashworth M, Littlejohns P, Reddy M, Khan O, Rudisill C. Costs and Outcomes of Increasing Access to Bariatric Surgery: Cohort Study and Cost-Effectiveness Analysis Using Electronic Health Records. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:85-92. [PMID: 28212974 PMCID: PMC5338873 DOI: 10.1016/j.jval.2016.08.734] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 07/06/2016] [Accepted: 08/27/2016] [Indexed: 05/25/2023]
Abstract
OBJECTIVES To estimate costs and outcomes of increasing access to bariatric surgery in obese adults and in population subgroups of age, sex, deprivation, comorbidity, and obesity category. METHODS A cohort study was conducted using primary care electronic health records, with linked hospital utilization data, for 3,045 participants who underwent bariatric surgery and 247,537 participants who did not undergo bariatric surgery. Epidemiological analyses informed a probabilistic Markov model to compare bariatric surgery, including equal proportions with adjustable gastric banding, gastric bypass, and sleeve gastrectomy, with standard nonsurgical management of obesity. Outcomes were quality-adjusted life-years (QALYs) and net monetary benefits at a threshold of £30,000 per QALY. RESULTS In a UK population of 250,000 adults, there may be 7,163 people with morbid obesity including 1,406 with diabetes. The immediate cost of 1,000 bariatric surgical procedures is £9.16 million, with incremental discounted lifetime health care costs of £15.26 million (95% confidence interval £15.18-£15.36 million). Patient-years with diabetes mellitus will decrease by 8,320 (range 8,123-8,502). Incremental QALYs will increase by 2,142 (range 2,032-2,256). The estimated cost per QALY gained is £7,129 (range £6,775-£7,506). Net monetary benefits will be £49.02 million (range £45.72-£52.41 million). Estimates are similar for subgroups of age, sex, and deprivation. Bariatric surgery remains cost-effective if the procedure is twice as costly, or if intervention effect declines over time. CONCLUSIONS Diverse obese individuals may benefit from bariatric surgery at acceptable cost. Bariatric surgery is not cost-saving, but increased health care costs are exceeded by health benefits to obese individuals.
Collapse
Affiliation(s)
- Martin C Gulliford
- Department of Primary Care and Public Health Sciences, King's College London, London, UK; National Institutes for Health Research Biomedical Research Centre at Guy's and St Thomas' National Health Service Foundation Trust, London, UK.
| | - Judith Charlton
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Toby Prevost
- Department of Primary Care and Public Health Sciences, King's College London, London, UK; National Institutes for Health Research Biomedical Research Centre at Guy's and St Thomas' National Health Service Foundation Trust, London, UK
| | - Helen Booth
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Alison Fildes
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Mark Ashworth
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Peter Littlejohns
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Marcus Reddy
- Department of Surgery, St George's University Hospital National Health Service Foundation Trust, London, UK
| | - Omar Khan
- Department of Surgery, St George's University Hospital National Health Service Foundation Trust, London, UK
| | - Caroline Rudisill
- Department of Social Policy, London School of Economics and Political Science, London, UK
| |
Collapse
|
75
|
Figura A, Rose M, Ordemann J, Klapp BF, Ahnis A. Improvement in self-reported eating-related psychopathology and physical health-related quality of life after laparoscopic sleeve gastrectomy: A pre-post analysis and comparison with conservatively treated patients with obesity. Eat Behav 2017; 24:17-25. [PMID: 27951428 DOI: 10.1016/j.eatbeh.2016.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 11/21/2016] [Accepted: 11/30/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The present study examined the effects of laparoscopic sleeve gastrectomy (LSG) on self-reported eating-related psychopathology and health-related quality of life (HRQoL). Outcomes of the LSG group were compared with a group of conservatively treated (CT) patients, who underwent a 1-year multimodal weight reduction group program that included dietary advice, physical exercise, psychoeducation, cognitive-behavioral therapy, training in Jacobson's progressive muscle relaxation, and social group support. The setting was a multidisciplinary obesity center. METHOD A sample of 103 patients with obesity were investigated using the Eating Disorder Inventory and the Short Form Health Survey before and, on average, 19 (±5) months after weight loss intervention. Thereof, 63 patients (age 45.6±10.9years, 71.4% females) underwent LSG, and 40 patients (age 50.6±11.3years, 77.5% females) underwent the CT program. Patients were assigned to either the surgical or the nonsurgical intervention group following clinical guidelines and patient preference. RESULTS In the LSG group, excess weight loss (%EWL) was 53.0±24.0%, and body mass index (BMI) decreased from 51.5±8.1 to 38.0±7.7kg/m2. In the CT group, %EWL was 13.9±27.1%, and BMI decreased from 40.3±6.7 to 38.0±7.2kg/m2. Significant improvements in eating-related psychopathology were observed in both groups. Although both groups had a similar BMI after the respective interventions, LSG patients reported significantly greater body satisfaction and substantial improvement in perceived physical health from a lower baseline level than CT patients. DISCUSSION In the second follow-up year, LSG was associated with greater weight loss from a higher baseline weight, and greater improvements in self-reported eating-related psychopathology and physical HRQoL compared with conservative treatment.
Collapse
Affiliation(s)
- Andrea Figura
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin 10117, Germany.
| | - Matthias Rose
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin 10117, Germany; Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Jürgen Ordemann
- Center for Obesity and Metabolic Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin 10117, Germany
| | - Burghard F Klapp
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin 10117, Germany
| | - Anne Ahnis
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin 10117, Germany
| |
Collapse
|
76
|
Moreno B, Crujeiras AB, Bellido D, Sajoux I, Casanueva FF. Obesity treatment by very low-calorie-ketogenic diet at two years: reduction in visceral fat and on the burden of disease. Endocrine 2016; 54:681-690. [PMID: 27623967 DOI: 10.1007/s12020-016-1050-2] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 07/04/2016] [Indexed: 02/06/2023]
Abstract
The long-term effect of therapeutic diets in obesity treatment is a challenge at present. The current study aimed to evaluate the long-term effect of a very low-calorie-ketogenic (VLCK) diet on excess adiposity. Especial focus was set on visceral fat mass, and the impact on the individual burden of disease. A group of obese patients (n = 45) were randomly allocated in two groups: either the very low-calorie-ketogenic diet group (n = 22), or a standard low-calorie diet group; (n = 23). Both groups received external support. Adiposity parameters and the cumulative number of months of successful weight loss (5 or 10 %) over a 24-month period were quantified. The very low-calorie-ketogenic diet induced less than 2 months of mild ketosis and significant effects on body weight at 6, 12, and 24 months. At 24 months, a trend to regress to baseline levels was observed; however, the very low-calorie-ketogenic diet induced a greater reduction in body weight (-12.5 kg), waist circumference (-11.6 cm), and body fat mass (-8.8 kg) than the low-calorie diet (-4.4 kg, -4.1 cm, and -3.8 kg, respectively; p < 0.001). Interestingly, a selective reduction in visceral fat measured by a specific software of dual-energy x-ray absorptiometry (DEXA)-scan (-600 g vs. -202 g; p < 0.001) was observed. Moreover, the very low-calorie-ketogenic diet group experienced a reduction in the individual burden of obesity because reduction in disease duration. Very low-calorie-ketogenic diet patients were 500 months with 5 % weight lost vs. the low-calorie diet group (350 months; p < 0.001). In conclusion, a very low-calorie-ketogenic diet was effective 24 months later, with a decrease in visceral adipose tissue and a reduction in the individual burden of disease.
Collapse
Affiliation(s)
- Basilio Moreno
- Division of Endocrinology and Nutrition, Hospital G Universitario Gregorio Marañon, Madrid, Spain
| | - Ana B Crujeiras
- Laboratory of Molecular and Cellular Endocrinology, Instituto de Investigación Sanitaria (IDIS), Complejo Hospitalario Universitario de Santiago (CHUS), Santiago de Compostela University (USC), Santiago de Compostela, Spain
- CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Santiago de Compostela, Spain
| | - Diego Bellido
- Division of Endocrinology, Complejo Hospitalario Universitario de Ferrol and Coruña University, Ferrol, Spain
| | - Ignacio Sajoux
- Medical Department Pronokal, Protein Supplies SL, Barcelona, Spain
| | - Felipe F Casanueva
- CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Santiago de Compostela, Spain.
- Division of Endocrinology, Department of Medicine, Complejo Hospitalario Universitario de Santiago (CHUS), Santiago de Compostela University, Santiago de Compostela, Spain.
| |
Collapse
|
77
|
Jain P, Røstbjerg AS, Haase CL, Rhee NA. Weight loss experiences and willingness to intervention with pharmacotherapy among obese and very obese Danish people. PHYSICIAN SPORTSMED 2016; 44:201-7. [PMID: 27254773 DOI: 10.1080/00913847.2016.1193425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Obesity is a growing issue with increasing impact on healthcare budgets, yet very little is known about weight loss experiences of people with body mass index (BMI)≥30kg/m(2) and their willingness to try and pay for weight loss interventions (WLI). The objective of this survey was to gather knowledge about weight loss experiences among obese and severely obese people. METHODS 1,003 Danish people >18 years of age with BMI≥30 who wanted to lose weight completed an online survey. Data included demographics, experience with WLI, awareness of anti-obesity medication (AOM), and willingness to try and pay for WLI including AOM. RESULTS Respondents had been trying to lose weight for several years (medium [25% percentile;75% percentile]);5.1[2.0;10.3] years (BMI 30-35) and 10.0 [5.0;20.0] (very obese (BMI>35) with co-morbidities (OWC). The desired weight loss was 20.0 [15.0;25.0] kg (BMI 30-35) and 35.0 [28.0;47.5] kg (OWC). Independent of educational level and gender, health concern was the main incentive for weight loss. Several WLI had been tried repeatedly, yet 60% of respondents with BMI 30-35 and 50% of the OWC were unaware of AOM. Among those who had tried AOM, side effects and lack of effectiveness were the main reasons to stop. 50-73% were willing to try AOM dependent on expected weight loss. Willingness to try and pay for new AOM was strongest for the OWC. CONCLUSION Respondents had made repeated attempts for up to a decade to lose weight, yet remained far from their ideal weight. They had spent a substantial amount of money on WLI, had limited information of AOM, and indicated a desire for increased professional support.
Collapse
Affiliation(s)
- Pavika Jain
- a Novo Nordisk Scandinavia AB , Copenhagen , Denmark
| | | | | | | |
Collapse
|
78
|
Kulendran M, King D, Schmidtke KA, Curtis C, Gately P, Darzi A, Vlaev I. The use of commitment techniques to support weight loss maintenance in obese adolescents. Psychol Health 2016; 31:1332-41. [PMID: 27406781 DOI: 10.1080/08870446.2016.1204452] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Obesity is a rising problem in adolescents related to unhealthy behaviours. Commitment devises are one type of behavioural intervention that may help people change their behaviours. The current pilot trial tests whether commitment devices delivered via text message help adolescents maintain their recent weight loss. METHODS During a 12-week pilot trial, adolescents who attended a weight loss camp were randomly assigned to either received text messages that contained only information, i.e. advice, about weight loss management (n = 13) or asked for them to commit to following the same advise (n = 14). RESULTS The BMI of the adolescents in the commitment group did not change. In contrast, the BMI of adolescents in the information group increased. A linear regression revealed that group was a significant predictor of BMI change. A logistic regression revealed that adolescents in the information group were nearly eight times more likely to regain weight than those in the commitment group. CONCLUSIONS This is the first study with adolescents to show weight maintenance using a commitment device. The results suggest that commitment devices can help adolescents maintain their recent weight loss.
Collapse
Affiliation(s)
| | | | | | - Claire Curtis
- c School of Sport, Leeds Beckett University , Leeds , UK
| | - Paul Gately
- c School of Sport, Leeds Beckett University , Leeds , UK
| | - Ara Darzi
- a Imperial College London , London , UK
| | - Ivo Vlaev
- b Warwick Business School, University of Warwick , Coventry , UK
| |
Collapse
|
79
|
Keyserling TC, Samuel-Hodge CD, Pitts SJ, Garcia BA, Johnston LF, Gizlice Z, Miller CL, Braxton DF, Evenson KR, Smith JC, Davis GB, Quenum EL, Elliott NTM, Gross MD, Donahue KE, Halladay JR, Ammerman AS. A community-based lifestyle and weight loss intervention promoting a Mediterranean-style diet pattern evaluated in the stroke belt of North Carolina: the Heart Healthy Lenoir Project. BMC Public Health 2016; 16:732. [PMID: 27495295 PMCID: PMC4975883 DOI: 10.1186/s12889-016-3370-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 07/23/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Because residents of the southeastern United States experience disproportionally high rates of cardiovascular disease (CVD), it is important to develop effective lifestyle interventions for this population. METHODS The primary objective was to develop and evaluate a dietary, physical activity (PA) and weight loss intervention for residents of the southeastern US. The intervention, given in eastern North Carolina, was evaluated in a 2 year prospective cohort study with an embedded randomized controlled trial (RCT) of a weight loss maintenance intervention. The intervention included: Phase I (months 1-6), individually-tailored intervention promoting a Mediterranean-style dietary pattern and increased walking; Phase II (months 7-12), option of a 16-week weight loss intervention for those with BMI ≥ 25 kg/m(2) offered in 2 formats (16 weekly group sessions or 5 group sessions and 10 phone calls) or a lifestyle maintenance intervention; and Phase III (months 13-24), weight loss maintenance RCT for those losing ≥ 8 lb with all other participants receiving a lifestyle maintenance intervention. Change in diet and PA behaviors, CVD risk factors, and weight were assessed at 6, 12, and 24 month follow-up. RESULTS Baseline characteristics (N = 339) were: 260 (77 %) females, 219 (65 %) African Americans, mean age 56 years, and mean body mass index 36 kg/m(2). In Phase I, among 251 (74 %) that returned for 6 month follow-up, there were substantial improvements in diet score (4.3 units [95 % CI 3.7 to 5.0]), walking (64 min/week [19 to 109]), and systolic blood pressure (-6.4 mmHg [-8.7 to -4.1]) that were generally maintained through 24 month follow-up. In Phase II, 138 (57 group only, 81 group/phone) chose the weight loss intervention and at 12 months, weight change was: -3.1 kg (-4.9 to -1.3) for group (N = 50) and -2.1 kg (-3.2 to -1.0) for group/phone combination (N = 75). In Phase III, 27 participants took part in the RCT. At 24 months, weight loss was -2.1 kg (-4.3 to 0.0) for group (N = 51) and -1.1 kg (-2.7 to 0.4) for combination (N = 72). Outcomes for African American and whites were similar. CONCLUSIONS The intervention yielded substantial improvement in diet, PA, and blood pressure, but weight loss was modest. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01433484.
Collapse
Affiliation(s)
- Thomas C. Keyserling
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, School of Medicine, CB 7110, University of North Carolina, 5039 Old Clinic Building, Chapel Hill, NC 27599 USA
- Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Carmen D. Samuel-Hodge
- Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC 27599 USA
- Department of Nutrition, Gillings School of Global Public Health, CB 7461, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Stephanie Jilcott Pitts
- Department of Public Health, Brody School of Medicine, East Carolina University, Lakeside Annex 8, 600 Moye Blvd, MS 660, Greenville, NC 27834 USA
| | - Beverly A. Garcia
- Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Larry F. Johnston
- Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Ziya Gizlice
- Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Cassandra L. Miller
- Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Danielle F. Braxton
- Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC 27599 USA
- Department of Nutrition, Gillings School of Global Public Health, CB 7461, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Kelly R. Evenson
- Department of Epidemiology, Gillings School of Global Public Health, CB 8050, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Janice C. Smith
- Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Gwen B. Davis
- Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Emmanuelle L. Quenum
- Greene County Health Department, 225 Kingold Blvd, Suite B, Snow Hill, North Carolina 28580 USA
| | - Nadya T. Majette Elliott
- Student Health Services, East Carolina University, 1000 East 5th St, MS 408, Greenville, NC 27858 USA
| | - Myron D. Gross
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN 55455 USA
| | - Katrina E. Donahue
- Department of Family Medicine, School of Medicine, CB 7595, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Jacqueline R. Halladay
- Department of Family Medicine, School of Medicine, CB 7595, University of North Carolina, Chapel Hill, NC 27599 USA
- Cecil G. Sheps Center for Health Services Research, School of Medicine, CB 7590, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Alice S. Ammerman
- Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC 27599 USA
- Department of Nutrition, Gillings School of Global Public Health, CB 7461, University of North Carolina, Chapel Hill, NC 27599 USA
| |
Collapse
|
80
|
Holdsworth E, Thorogood N, Sorhaindo A, Nanchahal K. A Qualitative Study of Participant Engagement With a Weight Loss Intervention. Health Promot Pract 2016; 18:245-252. [PMID: 27466266 DOI: 10.1177/1524839916659847] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Overweight and obesity are major public health problems and an increasing global challenge. In lieu of wider policy changes to tackle the obesogenic environment in which we presently reside, improving the design of individual-level weight loss interventions is important. AIM To identify which aspects of the Camden Weight Loss randomized controlled trial weight loss intervention participants engaged with, with the aim of improving the design of future studies and maximizing retention. METHOD A qualitative study comprising semistructured interviews ( n = 18) and a focus group ( n = 5) with intervention participants. RESULTS Two important aspects of participant engagement with the intervention consistently emerged from interviews and focus group: the advisor-participant relationship and the program structure. Some materials used during the program sessions were important in supporting the intervention; however, others were not well received by participants. CONCLUSION An individual-level weight loss intervention should be acceptable from the patient perspective in order to ensure participants are engaged with the program for as long as possible to maximize favorable results. Providing ongoing support in a long-term program with a trained empathetic advisor may be effective at engaging with people trying to lose weight in a weight loss intervention.
Collapse
|
81
|
de Vos BC, Runhaar J, van Middelkoop M, Krul M, Bierma-Zeinstra SM. Long-term effects of a randomized, controlled, tailor-made weight-loss intervention in primary care on the health and lifestyle of overweight and obese women. Am J Clin Nutr 2016; 104:33-40. [PMID: 27305950 DOI: 10.3945/ajcn.116.133512] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 05/12/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Maintenance of weight loss after a diet and exercise intervention is often low. Moreover, short follow-up periods and high attrition rates often impede translation of study results to clinical practice. OBJECTIVE The present study evaluated the long-term effectiveness of a randomized, tailor-made lifestyle intervention, consisting of diet and exercise, on the health and lifestyle of overweight, middle-aged women in primary care. DESIGN The intervention was part of a randomized controlled trial on the prevention of knee osteoarthritis [PROOF (PRevention of knee Osteoarthritis in Overweight Females) study]. The intervention lasted 2.5 y and consisted of visits to the dietitian and participation in physical activity classes, supervised by a physiotherapist. The outcome of main interest of the present study was weight change (in kg) 6-7 y after randomization. Additionally, the intervention's effect on change in physical activity was investigated. RESULTS After 6 mo, weight loss was significantly higher in the intervention group (adjusted difference: 1.34 kg; 95% CI: 0.46, 2.22 kg). Over time, this difference decreased and became nonsignificant after 24 mo. Per-protocol analyses showed similar results. After 6 mo, change in physical activity was significantly higher in the intervention group (15.2%; 95% CI: 28.6%, 1.7%). Over time, this difference increased up to 29.8% (95% CI: 2.3%, 57.2%) after 6.6 y of follow-up. Per-protocol analyses showed no significant differences in change in physical activity. CONCLUSIONS A long-lasting intervention effect on change in physical activity was found, which increased over time. For weight change, smaller differences were found, which decreased over time. In future research, greater intervention effects on weight change are expected when higher compliance rates can be reached. The present study provides important recommendations for future research. The PROOF study was registered at http://www.isrctn.com as ISRCTN42823086.
Collapse
Affiliation(s)
| | | | | | | | - Sita Ma Bierma-Zeinstra
- Departments of General Practice and Orthopaedics, Erasmus University Medical Centre Rotterdam, Rotterdam, Netherlands
| |
Collapse
|
82
|
Affiliation(s)
- Mayer B Davidson
- Charles R. Drew University (M.B.D.), Los Angeles, California 90059; and University of North Carolina School of Medicine (R.A.K.), Chapel Hill, North Carolina 27599
| | - Richard A Kahn
- Charles R. Drew University (M.B.D.), Los Angeles, California 90059; and University of North Carolina School of Medicine (R.A.K.), Chapel Hill, North Carolina 27599
| |
Collapse
|
83
|
Nield L, Kelly S. Outcomes of a community-based weight management programme for morbidly obese populations. J Hum Nutr Diet 2016; 29:669-676. [PMID: 27357098 DOI: 10.1111/jhn.12392] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Morbid obesity is an ongoing concern worldwide. There is a paucity of research reporting primary care outcomes focussed on complex and morbidly obese populations. The National Institute for Health and Care Excellence (NICE) recommends a specialist, multidisciplinary weight management team for the successful management of such populations. This is the first service evaluation reporting both primary (weight change) and secondary [body mass index (BMI), waist circumference, physical activity levels, fruit and vegetable intake, Rosenberg self-esteem score] outcomes in these patients. METHODS The present study comprised a prospective observational study of a cohort data set for patients (n = 288) attending their 3-month and 6-month (n = 115) assessment appointments at a specialist community weight management programme. RESULTS Patients had a mean (SD) initial BMI of 45.5 (6.6) kg m- ²; 66% were females. Over 80% of patients attending the service lost some weight by 3 months. Average absolute weight loss was 4.11 (4.95) kg at 3 months and 6.30 (8.41) kg at 6 months, equating to 3.28% (3.82%) and 4.90% (6.26%), respectively, demonstrating a statistically significant weight change at both time points (P < 0.001). This meets NICE best practice guidelines for the commissioning of services leading to a minimum of 3% average weight loss, with at least 30% of patients losing at ≥5% of their initial weight. Waist measurement and BMI were reduced significantly at 3 months. Improvements were also seen in physical activity levels, fruit and vegetable consumption, and self-esteem levels (P < 0.001). CONCLUSIONS This service was successful in aiding weight loss in morbidly obese populations. The findings of the present study support the view that weight-loss targets of 3% are realistic.
Collapse
Affiliation(s)
- L Nield
- Sheffield Business School, Sheffield Hallam University, Sheffield, UK
| | - S Kelly
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| |
Collapse
|
84
|
Tate DF, Lytle LA, Sherwood NE, Haire-Joshu D, Matheson D, Moore SM, Loria CM, Pratt C, Ward DS, Belle SH, Michie S. Deconstructing interventions: approaches to studying behavior change techniques across obesity interventions. Transl Behav Med 2016; 6:236-43. [PMID: 27356994 PMCID: PMC4927444 DOI: 10.1007/s13142-015-0369-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Deconstructing interventions into the specific techniques that are used to change behavior represents a new frontier in behavioral intervention research. This paper considers opportunities and challenges in employing the Behavior Change Techniques Taxonomy (BCTTv1) developed by Michie and colleagues, to code the behavior change techniques (BCTs) across multiple interventions addressing obesity and capture dose received at the technique level. Numerous advantages were recognized for using a shared framework for intervention description. Coding interventions at levels of the social ecological framework beyond the individual level, separate coding for behavior change initiation vs. maintenance, fidelity of BCT delivery, accounting for BCTs mode of delivery, and tailoring BCTs, present both challenges and opportunities. Deconstructing interventions and identifying the dose required to positively impact health-related outcomes could enable important gains in intervention science.
Collapse
Affiliation(s)
- Deborah F Tate
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Leslie A Lytle
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nancy E Sherwood
- HealthPartners Institute for Education and Research, Bloomington, MN, USA
| | | | - Donna Matheson
- Department of Pediatrics & Stanford Prevention Research Center, Stanford University, Stanford, CA, USA
| | - Shirley M Moore
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | | | - Charlotte Pratt
- National Heart, Lung and Blood Institute, NIH, Bethesda, MD, USA
| | - Dianne S Ward
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Steven H Belle
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Susan Michie
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, London, UK
| |
Collapse
|
85
|
Rudisill C, Charlton J, Booth HP, Gulliford MC. Are healthcare costs from obesity associated with body mass index, comorbidity or depression? Cohort study using electronic health records. Clin Obes 2016; 6:225-31. [PMID: 27097821 PMCID: PMC5074251 DOI: 10.1111/cob.12144] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 02/11/2016] [Accepted: 03/20/2016] [Indexed: 01/20/2023]
Abstract
The objective of this study was to evaluate the association between body mass index (BMI) and healthcare costs in relation to obesity-related comorbidity and depression. A population-based cohort study was undertaken in the UK Clinical Practice Research Datalink (CPRD). A stratified random sample was taken of participants registered with general practices in England in 2008 and 2013. Person time was classified by BMI category and morbidity status using first diagnosis of diabetes (T2DM), coronary heart disease (CHD), stroke or malignant neoplasms. Participants were classified annually as depressed or not depressed. Costs of healthcare utilization were calculated from primary care records with linked hospital episode statistics. A two-part model estimated predicted mean annual costs by age, gender and morbidity status. Linear regression was used to estimate the effects of BMI category, comorbidity and depression on healthcare costs. The analysis included 873 809 person-years (62% female) from 250 046 participants. Annual healthcare costs increased with BMI, to a mean of £456 (95% CI 344-568) higher for BMI ≥40 kg m(-2) than for normal weight based on a general linear model. After adjusting for BMI, the additional cost of comorbidity was £1366 (£1269-£1463) and depression £1044 (£973-£1115). There was evidence of interaction so that as the BMI category increased, additional costs of comorbidity (£199, £74-£325) or depression (£116, £16-£216) were greater. High healthcare costs in obesity may be driven by the presence of comorbidity and depression. Prioritizing primary prevention of cardiovascular disease and diabetes in the obese population may contribute to reducing obesity-related healthcare costs.
Collapse
Affiliation(s)
- C Rudisill
- Department of Social Policy, London School of Economics and Political Science, London, UK
| | - J Charlton
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - H P Booth
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - M C Gulliford
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
- NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, UK
| |
Collapse
|
86
|
Jansen S, Desbrow B, Ball L. Obesity management by general practitioners: the unavoidable necessity. Aust J Prim Health 2016; 21:366-8. [PMID: 26349423 DOI: 10.1071/py15018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 05/01/2015] [Indexed: 11/23/2022]
Abstract
Nearly 62% of primary care patients are overweight or obese, and obesity is now a National Health Priority Area. Weight management interventions in primary care currently generate little more than 1 kg of weight loss per patient over a 2-year period. Consequently, further strategies are required to improve the effectiveness of weight management in primary care. The National Health and Medical Research Council (NHMRC) have released updated guidelines for the management of overweight and obese patients in primary care. However, there is some disconnect between establishment of guidelines and their implementation in practice. Barriers to GPs using guidelines for the management of obesity include low self-efficacy, perceived insufficient time in consultations and the challenge of raising the topic of a patient's weight. Nonetheless, patients prefer to receive weight management support from GPs rather than other health professionals, suggesting that the demand on GPs to support patients in weight management will continue. GPs cannot afford to side-line obesity management, as obesity is likely to be the most prevalent modifiable risk factor associated with patients' long-term health. Without further strategies to support GPs in their management of patients' weight, obesity will continue to be an expensive and long-term public health issue.
Collapse
|
87
|
Ashman F, Sturgiss E, Haesler E. Exploring Self-Efficacy in Australian General Practitioners Managing Patient Obesity: A Qualitative Survey Study. INTERNATIONAL JOURNAL OF FAMILY MEDICINE 2016; 2016:8212837. [PMID: 27274872 PMCID: PMC4870354 DOI: 10.1155/2016/8212837] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 04/05/2016] [Accepted: 04/14/2016] [Indexed: 06/06/2023]
Abstract
Background. Obesity is a leading cause of morbidity and mortality in the Australian community, and general practitioners (GPs) are commonly approached by patients for assistance in losing weight. Previous studies have shown that GPs have low self-efficacy and low outcome expectation when it comes to managing overweight and obese patients, which affects their willingness to initiate and continue with weight counselling. This qualitative survey study aimed to explore the factors influencing confidence and behaviour in obesity management in GPs. Method. Twelve GPs recruited to deliver a pilot of an obesity management program participated in semistructured interviews, and interpretive analysis underpinned by social cognitive theory was performed on the transcripts. Results. Analysis identified five main themes: (1) perceived knowledge and skills, (2) structure to management approach, (3) the GP-patient relationship, (4) acknowledged barriers to weight loss and lifestyle change, and (5) prior experience and outcome expectation. Conclusions. GPs are likely to welcome tools which provide a more structured approach to obesity management. Shifting away from weight and BMI as sole yardsticks for success or failure and emphasising positive lifestyle changes for their own sake may improve GP self-efficacy and allow for a more authentic GP-patient interaction.
Collapse
Affiliation(s)
- Freya Ashman
- Australian National University Medical School, Academic Unit of General Practice, P.O. Box 11, Woden, ACT 2606, Australia
| | - Elizabeth Sturgiss
- Australian National University Medical School, Academic Unit of General Practice, P.O. Box 11, Woden, ACT 2606, Australia
| | - Emily Haesler
- Australian National University Medical School, Academic Unit of General Practice, P.O. Box 11, Woden, ACT 2606, Australia
| |
Collapse
|
88
|
Gulliford MC, Charlton J, Booth HP, Fildes A, Khan O, Reddy M, Ashworth M, Littlejohns P, Prevost AT, Rudisill C. Costs and outcomes of increasing access to bariatric surgery for obesity: cohort study and cost-effectiveness analysis using electronic health records. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04170] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BackgroundBariatric surgery is known to be an effective treatment for extreme obesity but access to these procedures is currently limited.ObjectiveThis study aimed to evaluate the costs and outcomes of increasing access to bariatric surgery for severe and morbid obesity.Design and methodsPrimary care electronic health records from the UK Clinical Practice Research Datalink were analysed for 3045 participants who received bariatric surgery and 247,537 general population controls. The cost-effectiveness of bariatric surgery was evaluated in severe and morbid obesity through a probabilistic Markov model populated with empirical data from electronic health records.ResultsIn participants who did not undergo bariatric surgery, the probability of participants with morbid obesity attaining normal body weight was 1 in 1290 annually for men and 1 in 677 for women. Costs of health-care utilisation increased with body mass index category but obesity-related physical and psychological comorbidities were the main drivers of health-care costs. In a cohort of 3045 adult obese patients with first bariatric surgery procedures between 2002 and 2014, bariatric surgery procedure rates were greatest among those aged 35–54 years, with a peak of 37 procedures per 100,000 population per year in women and 10 per 100,000 per year in men. During 7 years of follow-up, the incidence of diabetes diagnosis was 28.2 [95% confidence interval (CI) 24.4 to 32.7] per 1000 person-years in controls and 5.7 (95% CI 4.2 to 7.8) per 1000 person-years in bariatric surgery patients (adjusted hazard ratio was 0.20, 95% CI 0.13 to 0.30;p < 0.0001). In 826 obese participants with type 2 diabetes mellitus who received bariatric surgery, the relative rate of diabetes remission, compared with controls, was 5.97 (95% CI 4.86 to 7.33;p < 0.001). There was a slight reduction in depression in the first 3 years following bariatric surgery that was not maintained. Incremental lifetime costs associated with bariatric surgery were £15,258 (95% CI £15,184 to £15,330), including costs associated with bariatric surgical procedures of £9164 per participant. Incremental quality-adjusted life-years (QALYs) were 2.142 (95% CI 2.031 to 2.256) per participant. The estimated cost per QALY gained was £7129 (95% CI £6775 to £7506). Estimates were similar across gender, age and deprivation subgroups.LimitationsIntervention effects were derived from a randomised trial with generally short follow-up and non-randomised studies of longer duration.ConclusionsBariatric surgery is associated with increased immediate and long-term health-care costs but these are exceeded by expected health benefits to obese individuals with reduced onset of new diabetes, remission of existing diabetes and lower mortality. Diverse obese individuals have clear capacity to benefit from bariatric surgery at acceptable cost.Future workFuture research should evaluate longer-term outcomes of currently used procedures, and ways of delivering these more efficiently and safely.FundingThe National Institute for Health Research (NIHR) Health Services and Delivery Research programme. Martin C Gulliford and A Toby Prevost were supported by the NIHR Biomedical Research Centre at Guy’s and St Thomas’ Hospitals. Peter Littlejohns was supported by the South London Collaboration for Leadership in Applied Health Research and Care. The funders did not engage in the design, conduct or reporting of the research.
Collapse
Affiliation(s)
- Martin C Gulliford
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Judith Charlton
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
| | - Helen P Booth
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
| | - Alison Fildes
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
| | - Omar Khan
- Department of Surgery, St George’s University Hospital NHS Foundation Trust, London, UK
| | - Marcus Reddy
- Department of Surgery, St George’s University Hospital NHS Foundation Trust, London, UK
| | - Mark Ashworth
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
| | - Peter Littlejohns
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
| | - A Toby Prevost
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Caroline Rudisill
- Department of Social Policy, London School of Economics and Political Science, London, UK
| |
Collapse
|
89
|
Sturgiss EA, Douglas K. A collaborative process for developing a weight management toolkit for general practitioners in Australia-an intervention development study using the Knowledge To Action framework. Pilot Feasibility Stud 2016; 2:20. [PMID: 27965840 PMCID: PMC5154117 DOI: 10.1186/s40814-016-0060-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 04/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obesity is commonly seen in the Australian general practice population; however, few resources are specifically targeted at GPs working with these patients. The National Health and Medical Research Council (Australia) guideline for managing patients who are overweight and obese supports the involvement of a regular health professional. As 85 % of the population visit a GP annually, resources to support GPs working with this patient population are needed. This study describes the collaborative process used to develop an obesity management programme based on current Australian guidelines for GPs and their patients to be used in primary care. The Knowledge To Action framework was applied to develop a weight management toolkit for GPs based on current Australian guidelines. This draft was then reviewed by clinical GPs, GP registrars, consumer representatives and allied health professionals using focus groups and interviews. The participants gave feedback on the content, layout and acceptability of the documents. The feedback from the stakeholder groups was evaluated, and changes were incorporated into the final documents. A graphic designer was contracted to assist with the layout to improve useability and attractiveness of the documents. RESULTS A total of 38 participants gave feedback on the draft weight management programme, and the research team amalgamated their responses to further improve the documents. The general response from GPs and consumer representatives was positive with most conveying their wish to try the programme themselves. CONCLUSIONS "The Change Program" is a practical tool for Australian GPs to use with their patients who are overweight or obese. It was developed in collaboration with GPs, allied health professionals and consumer stakeholders based on current Australian guidelines. It is currently being piloted in five general practices.
Collapse
Affiliation(s)
- Elizabeth Ann Sturgiss
- Academic Unit of General Practice, Australian National University Medical School, Canberra, Australia
| | - Kirsty Douglas
- Academic Unit of General Practice, Australian National University Medical School, Canberra, Australia
| |
Collapse
|
90
|
Bédard A, Corneau L, Dodin S, Lemieux S. Sex Differences in the Effects of Repeated Taste Exposure to the Mediterranean Diet: A 6-month Follow-up Study. CAN J DIET PRACT RES 2016; 77:125-32. [PMID: 26916988 DOI: 10.3148/cjdpr-2015-052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
PURPOSE To determine whether an intervention based mainly on exposure to the Mediterranean diet (MedDiet), along with recommendations and tools for encouraging healthy eating, lead to different effects on dietary adherence and body weight management six months post-intervention in Canadian men and women. METHODS Thirty-eight males and 32 premenopausal females (all aged 24-53 years) were exposed to the same 4-week experimental MedDiet during which all foods were provided to participants. Participants also received some recommendations and tools to adhere to a healthy way of eating, with no other contact until the 6-month follow-up visit. RESULTS Compared with baseline, the Mediterranean score (MedScore) increased at the end of the 6-month follow-up (time effect P = 0.003), with no sex difference (sex-by-time interaction P = 0.97). With regard to MedScore components, sex differences were observed with males reporting changes in more dietary food groups than females. Although the intervention was not focused on body weight management, compared with baseline, BMI decreased during the intervention in both males and females; however, only females maintained the lower BMI 6 months after the intervention. CONCLUSIONS Exposure to the MedDiet for a short duration promotes the adherence to this food pattern in both sexes and helps in the management of body weight, especially in females.
Collapse
Affiliation(s)
- Alexandra Bédard
- a Institut sur la nutrition et les aliments fonctionnels (INAF), 2440 boulevard Hochelaga, Université Laval, QC G1V 0A6.,b École de Nutrition, Pavillon Paul-Comtois, 2425 rue de l'Agriculture, Université Laval, QC G1V 0A6
| | - Louise Corneau
- a Institut sur la nutrition et les aliments fonctionnels (INAF), 2440 boulevard Hochelaga, Université Laval, QC G1V 0A6
| | - Sylvie Dodin
- a Institut sur la nutrition et les aliments fonctionnels (INAF), 2440 boulevard Hochelaga, Université Laval, QC G1V 0A6.,c Département d'obstétrique et de gynécologie, Pavillon Ferdinand-Vandry, 1050 Avenue de la médecine, Université Laval, QC G1V 0A6
| | - Simone Lemieux
- a Institut sur la nutrition et les aliments fonctionnels (INAF), 2440 boulevard Hochelaga, Université Laval, QC G1V 0A6.,b École de Nutrition, Pavillon Paul-Comtois, 2425 rue de l'Agriculture, Université Laval, QC G1V 0A6
| |
Collapse
|
91
|
A comparison of a behavioral weight loss program to a stress management program: A pilot randomized controlled trial. Nutrition 2016; 32:904-9. [PMID: 27138110 DOI: 10.1016/j.nut.2016.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 01/07/2016] [Accepted: 01/09/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVES This study compared a behavioral weight loss program (BWL) with a stress management-based program, Emotional Brain Training (EBT), on weight loss, blood pressure, depression, perceived stress, diet, and physical activity. METHODS Subjects with a body mass index (BMI) of >28 and <45 kg/m(2) were recruited in Lexington, Kentucky in January 2014 and randomized to BWL or EBT for a 20-week intervention. Of those recruited, 49 participants were randomized to EBT or BWL. Randomization and allocation to group were performed using SPSS software. Weight, blood pressure, depression, perceived stress, dietary intake, and physical activity were measured at baseline, 10 week, and 20 week. Linear models for change over time were fit to calculate 95% confidence intervals of intervention effects. RESULTS BWL produced greater changes in BMI than EBT at both 10 (P = 0.02) and 20 wk (P = 0.03). At 10 wk, both EBT and BWL improved BMI, systolic blood pressure, depression and perceived stress (P < 0.05). BWL also improved diastolic blood pressure (P = 0.005). At 20 wk, EBT maintained improvements in BMI, systolic blood pressure, depression, and perceived stress while BWL maintained improvements only in BMI and depression (P < 0.05). CONCLUSIONS BWL produced greater weight loss than EBT; however, EBT produced sustained improvements in stress, depression, and systolic blood pressure. A combination of the two approaches should be explored.
Collapse
|
92
|
Ball LE, Leveritt MD. Development of a validated questionnaire to measure the self-perceived competence of primary health professionals in providing nutrition care to patients with chronic disease. Fam Pract 2015; 32:706-10. [PMID: 26415817 DOI: 10.1093/fampra/cmv073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Nutrition is an important aspect of chronic disease prevention and management by primary health professionals, including GPs, dietitians, practice nurses, diabetes educators and exercise professionals. In order to better understand how to improve the delivery of nutrition care, it is important to have valid and reliable tools to measure self-perceived competence. OBJECTIVE This study aimed to develop a valid, structured, questionnaire that measures the self-perceived competence of primary health professionals to provide nutrition care to patients with chronic disease. METHODS The development of the questionnaire was carried out in four stages (1): preparation of scope and structure, through a literature review and consultation with an expert reference group (2); development of questionnaire items, which were refined through feedback from the reference group and 18 primary health professionals (3); investigation of internal consistency and concurrent validity through a pilot study on 118 primary health professionals (4) and investigation of test-retest reliability through a pilot study on 33 primary health professionals who completed the questionnaire twice, 2-3 weeks apart. RESULTS Stages 1 and 2 resulted in four constructs and 35 questions in the questionnaire. Stage 3 confirmed internal consistency, with Cronbach's α ranging from 0.88 to 0.98 for each construct and 0.98 for all items combined. Dietitians scored significantly higher than speech pathologists (P < 0.05) in each construct, confirming concurrent validity. Stage 4 confirmed test-retest reliability, with correlation coefficients ranging from 0.89 to 0.94 for each construct and 0.95 for all items combined. CONCLUSION The NUTrition COMPetence (NUTCOMP) questionnaire is a valid, reliable and suitable tool that can be used to directly inform professional development and identify opportunities to support safe and effective practice.
Collapse
Affiliation(s)
- Lauren E Ball
- Menzies Health Institute Queensland, Griffith University, Gold Coast and
| | - Michael D Leveritt
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
| |
Collapse
|
93
|
Ball L, Leveritt M, Cass S, Chaboyer W. Effect of nutrition care provided by primary health professionals on adults' dietary behaviours: a systematic review. Fam Pract 2015; 32:605-17. [PMID: 26289046 DOI: 10.1093/fampra/cmv067] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND 'Nutrition care' refers to any practice conducted by a health professional to support a patient to improve their dietary behaviours. Better understanding about the effectiveness of nutrition care is required to identify ways to enhance success of future interventions. OBJECTIVE Systematically review literature that investigated the effect of nutrition care provided by primary health professionals on adult patients' dietary behaviours. METHODS The systematic review included all studies published between January 2000 and January 2015 that involved nutrition care by one or more primary health professionals to adult patients and incorporated at least one quantified food-related outcome measure (e.g. daily intake of vegetables in grams, weekly servings of lean meats). After data extraction, the methodological quality of each study was appraised using the Mixed Methods Appraisal Tool. RESULTS Twenty-one studies, totalling 12497 participants were included. The design, intensity, theoretical underpinning and follow-up period of interventions were diverse. Twelve studies found significant improvements in participants' dietary behaviours, such as increased daily consumption of fruit, vegetables, high-fibre bread and fish. However, seven studies did not identify any improvement in dietary behaviours; one observed equal improvements among participants in the intervention and control groups and one found a reduction in participants' daily fruit and vegetable intake. CONCLUSION Interventions involving nutrition care provided by primary health professionals have the potential to improve patients' dietary behaviours. However, the consistency and clinical significance of intervention outcomes are unclear. Further consideration of factors that may influence the effectiveness of interventions, but not traditionally measured, are required.
Collapse
Affiliation(s)
- Lauren Ball
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland and
| | - Michael Leveritt
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Sarah Cass
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland and
| | - Wendy Chaboyer
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland and
| |
Collapse
|
94
|
Prestwich A, Webb TL, Conner M. Using theory to develop and test interventions to promote changes in health behaviour: evidence, issues, and recommendations. Curr Opin Psychol 2015. [DOI: 10.1016/j.copsyc.2015.02.011] [Citation(s) in RCA: 165] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
95
|
Read S, Logue J. Variations in weight management services in Scotland: a national survey of weight management provision. J Public Health (Oxf) 2015; 38:e325-e335. [DOI: 10.1093/pubmed/fdv132] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
|
96
|
Fildes A, Charlton J, Rudisill C, Littlejohns P, Prevost AT, Gulliford MC. Probability of an Obese Person Attaining Normal Body Weight: Cohort Study Using Electronic Health Records. Am J Public Health 2015; 105:e54-9. [PMID: 26180980 DOI: 10.2105/ajph.2015.302773] [Citation(s) in RCA: 210] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES We examined the probability of an obese person attaining normal body weight. METHODS We drew a sample of individuals aged 20 years and older from the United Kingdom's Clinical Practice Research Datalink from 2004 to 2014. We analyzed data for 76,704 obese men and 99,791 obese women. We excluded participants who received bariatric surgery. We estimated the probability of attaining normal weight or 5% reduction in body weight. RESULTS During a maximum of 9 years' follow-up, 1283 men and 2245 women attained normal body weight. In simple obesity (body mass index = 30.0-34.9 kg/m(2)), the annual probability of attaining normal weight was 1 in 210 for men and 1 in 124 for women, increasing to 1 in 1290 for men and 1 in 677 for women with morbid obesity (body mass index = 40.0-44.9 kg/m(2)). The annual probability of achieving a 5% weight reduction was 1 in 8 for men and 1 in 7 for women with morbid obesity. CONCLUSIONS The probability of attaining normal weight or maintaining weight loss is low. Obesity treatment frameworks grounded in community-based weight management programs may be ineffective.
Collapse
Affiliation(s)
- Alison Fildes
- Alison Fildes, Judith Charlton, Peter Littlejohns, A. Toby Prevost, and Martin C. Gulliford are with the Department of Primary Care and Public Health Sciences, King's College London, London, UK. Caroline Rudisill is with the Department of Social Policy, London School of Economics and Political Science, London
| | - Judith Charlton
- Alison Fildes, Judith Charlton, Peter Littlejohns, A. Toby Prevost, and Martin C. Gulliford are with the Department of Primary Care and Public Health Sciences, King's College London, London, UK. Caroline Rudisill is with the Department of Social Policy, London School of Economics and Political Science, London
| | - Caroline Rudisill
- Alison Fildes, Judith Charlton, Peter Littlejohns, A. Toby Prevost, and Martin C. Gulliford are with the Department of Primary Care and Public Health Sciences, King's College London, London, UK. Caroline Rudisill is with the Department of Social Policy, London School of Economics and Political Science, London
| | - Peter Littlejohns
- Alison Fildes, Judith Charlton, Peter Littlejohns, A. Toby Prevost, and Martin C. Gulliford are with the Department of Primary Care and Public Health Sciences, King's College London, London, UK. Caroline Rudisill is with the Department of Social Policy, London School of Economics and Political Science, London
| | - A Toby Prevost
- Alison Fildes, Judith Charlton, Peter Littlejohns, A. Toby Prevost, and Martin C. Gulliford are with the Department of Primary Care and Public Health Sciences, King's College London, London, UK. Caroline Rudisill is with the Department of Social Policy, London School of Economics and Political Science, London
| | - Martin C Gulliford
- Alison Fildes, Judith Charlton, Peter Littlejohns, A. Toby Prevost, and Martin C. Gulliford are with the Department of Primary Care and Public Health Sciences, King's College London, London, UK. Caroline Rudisill is with the Department of Social Policy, London School of Economics and Political Science, London
| |
Collapse
|
97
|
Severity of obesity and management of hypertension, hypercholesterolaemia and smoking in primary care: population-based cohort study. J Hum Hypertens 2015; 30:40-5. [PMID: 25810065 PMCID: PMC5399150 DOI: 10.1038/jhh.2015.23] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 02/11/2015] [Accepted: 02/17/2015] [Indexed: 01/20/2023]
Abstract
Obesity and obesity-associated cardiovascular risk are increasing worldwide. This study aimed to determine how different levels of obesity are associated with the management of smoking, hypertension and hypercholesterolaemia in primary care. We conducted a cohort study of adults aged 30–100 years in England, sampled from the primary care electronic health records in the Clinical Practice Research Datalink. Prevalence, treatment and control were estimated for each risk factor by body mass index (BMI) category. Adjusted odds ratios (AOR) were estimated, allowing for age, gender, comorbidity and socioeconomic status, with normal weight as reference category. Data were analysed for 247 653 patients including 153 308 (62%) with BMI recorded, of whom 46 149 (30%) were obese. Participants were classified into simple (29 257), severe (11 059) and morbid obesity (5833) categories. Smoking declined with the increasing BMI category, but smoking cessation treatment increased. Age-standardised hypertension prevalence was twice as high in morbid obesity (men 78.6% women 66.0%) compared with normal weight (men 37.3% women 29.4%). Hypertension treatment was more frequent (AOR 1.75, 1.59–1.92) but hypertension control less frequent (AOR 0.63, 0.59–0.69) in morbid obesity, with similar findings for severe obesity. Hypercholesterolaemia was more frequent in morbid obesity (men 48.2% women 36.3%) than normal weight (men 25.0% women 20.0%). Lipid lowering therapy was more frequent in morbid obesity (AOR 1.83, 1.61–2.07) as was cholesterol control (AOR 1.19, 1.06–1.34). Increasing obesity category is associated with elevated risks from hypertension and hypercholesterolaemia. Inadequate hypertension control in obesity emerges as an important target for future interventions.
Collapse
|
98
|
Pbert L, Wang ML, Druker S, Jackson EA, Rosal MC. Designing and Testing the Feasibility of a Multi-level Intervention to Treat Adolescent Obesity in the Pediatric Primary Care Setting. JOURNAL OF CHILD AND ADOLESCENT BEHAVIOR 2015; 3:2. [PMID: 30364825 PMCID: PMC6198822 DOI: 10.4172/2375-4494.1000196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To describe the development steps and feasibility test of a multi-level adolescent obesity intervention for delivery in pediatric primary care settings. METHOD To understand the target setting and population (i.e., perceptions of and receptivity to various intervention components), focus groups were conducted with clinicians, adolescents, and parents (N=58). Findings informed the development of a multi-level intervention (i.e., office support systems, brief clinician-delivered counseling, and nutritionist-led adolescent group sessions) targeting overweight and obese adolescents (N=22). The intervention was pilot-tested for feasibility using a single group pre- and post-test comparison. RESULTS Families and clinicians agreed on the importance of developing approaches to address adolescent obesity in the pediatric primary care setting, and favored family involvement. The pilot-study showed that it was feasible to implement office system changes to support obesity treatment. All but one component of the clinician- delivered counseling algorithm were feasible. Adolescents participating in the intervention reported dietary improvements and movement toward the action stage for decreasing sedentary behavior. CONCLUSION Multi-level interventions for adolescent obesity in the pediatric primary care setting are feasible. Research to test the effectiveness of such interventions is warranted.
Collapse
Affiliation(s)
- Lori Pbert
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Monica L Wang
- Department of Community Health Sciences, Boston University School of Public Health 801 Massachusetts Avenue, Boston, MA 02115, USA
| | - Susan Druker
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Elizabeth A Jackson
- Department of Internal Medicine, University of Michigan Health System 1500 E. Medical Center Drive, Ann Arbor, 48109, USA
| | - Milagros C Rosal
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| |
Collapse
|
99
|
Booth HP, Prevost AT, Gulliford MC. Access to weight reduction interventions for overweight and obese patients in UK primary care: population-based cohort study. BMJ Open 2015; 5:e006642. [PMID: 25586371 PMCID: PMC4316417 DOI: 10.1136/bmjopen-2014-006642] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES To investigate access to weight management interventions for overweight and obese patients in primary care. SETTING UK primary care electronic health records. PARTICIPANTS A cohort of 91 413 overweight and obese patients aged 30-100 years was sampled from the Clinical Practice Research Datalink (CPRD). Patients with body mass index (BMI) values ≥25 kg/m(2) recorded between 2005 and 2012 were included. BMI values were categorised using WHO criteria. INTERVENTIONS Interventions for body weight management, including advice, referrals and prescription of antiobesity drugs, were evaluated. PRIMARY AND SECONDARY OUTCOME MEASURES The rate of body weight management interventions and time to intervention were the main outcomes. RESULTS Data were analysed for 91 413 patients, mean age 56 years, including 55 094 (60%) overweight and 36 319 (40%) obese, including 4099 (5%) with morbid obesity. During the study period, 90% of overweight patients had no weight management intervention recorded. Intervention was more frequent among obese patients, but 59% of patients with morbid obesity had no intervention recorded. Rates of intervention increased with BMI category. In morbid obesity, rates of intervention per 1000 patient years were: advice, 60.2 (95% CI 51.8 to 70.4); referral, 75.7 (95% CI 69.5 to 82.6) and antiobesity drugs 89.9 (95% CI 85.0 to 95.2). Weight management interventions were more often accessed by women, older patients, those with comorbidity and those in deprivation. Follow-up of body weight subsequent to interventions was infrequent. CONCLUSIONS Limited evidence of weight management interventions in primary care electronic health records may result from poor recording of advice given, but may indicate a lack of patient access to appropriate body weight management interventions in primary care.
Collapse
Affiliation(s)
- Helen P Booth
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - A Toby Prevost
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Martin C Gulliford
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| |
Collapse
|
100
|
Zandian M, Bergh C, Ioakimidis I, Esfandiari M, Shield J, Lightman S, Leon M, Södersten P. Control of Body Weight by Eating Behavior in Children. Front Pediatr 2015; 3:89. [PMID: 26539422 PMCID: PMC4609845 DOI: 10.3389/fped.2015.00089] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 10/05/2015] [Indexed: 01/07/2023] Open
Abstract
Diet, exercise, and pharmacological interventions have limited effects in counteracting the worldwide increase in pediatric body weight. Moreover, the promise that individualized drug design will work to induce weight loss appears to be exaggerated. We suggest that the reason for this limited success is that the cause of obesity has been misunderstood. Body weight is mainly under external control; our brain permits us to eat under most circumstances, and unless the financial or physical cost of food is high, eating and body weight increase by default. When energy-rich, inexpensive foods are continually available, people need external support to maintain a healthy body weight. Weight loss can thereby be achieved by continuous feedback on how much and how fast to eat on a computer screen.
Collapse
Affiliation(s)
- Modjtaba Zandian
- Section of Applied Neuroendocrinology, Karolinska Institutet, Mandometer Clinic Novum , Huddinge , Sweden
| | - Cecilia Bergh
- Section of Applied Neuroendocrinology, Karolinska Institutet, Mandometer Clinic Novum , Huddinge , Sweden
| | - Ioannis Ioakimidis
- Section of Applied Neuroendocrinology, Karolinska Institutet, Mandometer Clinic Novum , Huddinge , Sweden
| | - Maryam Esfandiari
- Section of Applied Neuroendocrinology, Karolinska Institutet, Mandometer Clinic Novum , Huddinge , Sweden
| | - Julian Shield
- Department of Paediatric Endocrinology, School of Clinical Sciences, University of Bristol , Bristol , UK ; Department of Diabetes, School of Clinical Sciences, University of Bristol , Bristol , UK ; Department of Metabolic Endocrinology, School of Clinical Sciences, University of Bristol , Bristol , UK
| | - Stafford Lightman
- Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, Department of Medicine, University of Bristol , Bristol , UK
| | - Michael Leon
- Section of Applied Neuroendocrinology, Karolinska Institutet, Mandometer Clinic Novum , Huddinge , Sweden
| | - Per Södersten
- Section of Applied Neuroendocrinology, Karolinska Institutet, Mandometer Clinic Novum , Huddinge , Sweden
| |
Collapse
|