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Torkel S, Wang R, Norman RJ, Zhao L, Liu K, Boden D, Xu W, Moran L, Cowan S. Barriers and enablers to a healthy lifestyle in people with infertility: a mixed-methods systematic review. Hum Reprod Update 2024; 30:569-583. [PMID: 38743500 PMCID: PMC11369225 DOI: 10.1093/humupd/dmae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/20/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND While there is a recognized role of optimizing lifestyle (diet and physical activity) behaviours in the management of infertility, the best practice remains unknown and factors influencing the lifestyle of people with infertility are not well understood. OBJECTIVE AND RATIONALE This systematic review evaluated barriers and enablers to a healthy lifestyle in people with infertility, from the perspectives of people with infertility and health professionals, in order to inform optimal behavioural change strategies. SEARCH METHODS Ovid MEDLINE(R), PsycINFO, EMBASE, EBM Reviews, and CINAHL were searched from inception to 28 August 2023. Eligible studies were qualitative and quantitative primary studies that explored barriers and/or enablers to lifestyle for infertility management. Quality assessment was performed using the Centre for Evidence-Based Management Critical Appraisal of a Survey Tool and the Critical Appraisal Skills Programme Qualitative Checklist. Data were analysed by thematic analysis with themes mapped to the Capability, Opportunity, Motivation and Behaviour (COM-B) model and Theoretical Domains Framework (TDF). OUTCOMES After screening 12 326 abstracts and 99 full-texts, 27 studies were included (12 quantitative, 6 qualitative and 9 mixed-methods) with 22 studies of women with infertility (n = 2524), 11 studies of men with infertility (n = 1407), and 6 studies of health professionals (n = 372). We identified barriers and enablers relating to capability (e.g. strategies for behaviour change), opportunity (e.g. limited time, resources, and money), and motivation (e.g. interplay between lifestyle and emotional state). Based on the identified themes, suggested intervention components to integrate into lifestyle management of infertility include facilitating development of self-management skills to support lifestyle change (e.g. self-monitoring, action planning, and goal setting) and incorporating mental health strategies (e.g. providing information about the benefits of healthy lifestyle behaviours for mental health and encouraging patients to reframe healthy lifestyle behaviours as self-care strategies). WIDER IMPLICATIONS The findings have identified important factors that influence lifestyle management in people with infertility and have suggested relevant intervention components to consider when designing interventions. Given the paucity of qualitative studies identified, more research is needed to further understand the complex and interacting factors that shape lifestyle during the fertility journey.
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Affiliation(s)
- Sophia Torkel
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia
| | - Rui Wang
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Robert J Norman
- Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - Lijun Zhao
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Kai Liu
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Dana Boden
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia
| | - Wentong Xu
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia
| | - Lisa Moran
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia
| | - Stephanie Cowan
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia
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Abstract
ABSTRACT Endometrial cancer is the most common malignancy of the female reproductive system diagnosed in the United States. The most commonly cited cause is unopposed endogenous estrogen produced by excess adipose tissue. Endometrial cancer typically is diagnosed in postmenopausal women with a body mass index (BMI) of 25 kg/m2 or more. This article reviews how clinicians can use a systematic approach to fill the awkward silence when talking with patients about weight. Meaningful conversations about weight loss can be achieved using the 5 A's for obesity management with the goal of decreasing diagnosis and increasing survivorship from endometrial cancer.
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3
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Verhaak AMS, Ferrand J, Puhl RM, Tishler DS, Papasavas PK, Umashanker D. Experienced weight stigma, internalized weight bias, and clinical attrition in a medical weight loss patient sample. Int J Obes (Lond) 2022; 46:1241-1243. [PMID: 35173281 PMCID: PMC8852855 DOI: 10.1038/s41366-022-01087-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 01/21/2022] [Accepted: 02/01/2022] [Indexed: 11/09/2022]
Abstract
Background Limited research has explored the relationship between weight bias and clinical attrition, despite weight bias being associated with negative health outcomes. Participants/method Experienced weight stigma (EWS), internalized weight bias (IWB), and clinical attrition were studied in a Medical Weight Loss clinic, which combines pharmacological and behavioral weight loss. Patient sociodemographic, medical, and psychological (depression) variables were measured at consultation, and clinic follow-ups were monitored for 6 months. IWB was assessed with the Weight Bias Internalization Scale Modified (WBIS-M). Results Two-thirds (66%) of study participants returned for follow-up appointments during the 6-month period (“continuers”), while 34% did not return after the initial consultation (“dropouts”). Clinic “dropouts” had higher WBIS-M scores at initial consultation than “continuers,” (χ2(1) = 4.56; p < 0.05). No other variables were related to clinical attrition. Average WBIS-M scores (4.57) were similar to other bariatric patient studies, and were associated with younger age (t = −2.27, p < 0.05), higher depression (t = 2.65, p < 0.01), and history of EWS (t = 2.14, p < 0.05). Conclusion Study findings indicate that IWB has significant associations with clinical attrition. Additional research is warranted to further explore the relationships between EWS, IWB, and medical clinic engagement.
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Affiliation(s)
- Allison M S Verhaak
- Division of Health Psychology, The Institute of Living/Hartford Hospital, Hartford, CT, USA. .,Hartford HealthCare Headache Center, Ayer Neuroscience Institute, Hartford, CT, USA.
| | - Jennifer Ferrand
- Division of Health Psychology, The Institute of Living/Hartford Hospital, Hartford, CT, USA.,Wellness Department/Medical Affairs, Hartford HealthCare, Hartford, CT, USA
| | - Rebecca M Puhl
- University of Connecticut Rudd Center for Food Policy & Health; Department of Human Development and Family Sciences, University of Connecticut, Hartford, CT, USA
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Ewens B, Kemp V, Towell-Barnard A, Whitehead L. The nursing care of people with class III obesity in an acute care setting: a scoping review. BMC Nurs 2022; 21:33. [PMID: 35090451 PMCID: PMC8796636 DOI: 10.1186/s12912-021-00760-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with Class III obesity pose unique challenges to health care staff and organisations. Care requirements of this population are unique and require specialised equipment and knowledge to meet these needs, maintain the quality of care, as well as the safety of patients and staff. AIM To synthesise the evidence on the nursing care of Class III obese patients in acute care settings. METHODS A scoping review informed by JBI. CINAHL Plus, Medline, Scopus, Proquest Central, Web of Science and Embase were searched for primary research articles about the nursing management of people classified as Class III obese in acute care. Methodological quality of included studies was assessed; data extracted and synthesised into themes. RESULTS Fourteen studies were included in the review. The synthesis generated three themes: Access to equipment, knowledge and training, patient care, and opportunities to improve care. CONCLUSIONS A paucity of high-quality evidence informs the nursing care of people with Class III obesity in acute care. Access to appropriate equipment dominated the findings of this review. Adequate provision of equipment and education on its use are required. Education to promote engagement with patients, adapting clinical practice and promotion of self-care could improve care and outcomes.
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Affiliation(s)
- Beverley Ewens
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027 Australia
| | - Vivien Kemp
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027 Australia
| | - Amanda Towell-Barnard
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027 Australia
| | - Lisa Whitehead
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027 Australia
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5
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Pearl RL, Wadden TA, Jakicic JM. Is weight stigma associated with physical activity? A systematic review. Obesity (Silver Spring) 2021; 29:1994-2012. [PMID: 34747131 PMCID: PMC8612947 DOI: 10.1002/oby.23274] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/17/2021] [Accepted: 07/26/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Weight stigma is associated with impaired health, attributed in part to reductions in health-promoting behaviors. This review analyzed evidence of the association between weight stigma and physical activity (PA) in adults and youth. METHODS Three databases were searched for terms related to weight stigma and PA. Eligible studies reported the quantitative association between at least one measure of weight stigma and one behavioral measure of PA. RESULTS A total of 38 studies met eligibility criteria. Of the 29 studies of adults, 3 used objective PA measures, and 79% used an observational, cross-sectional design. Findings of the relationship between weight stigma and PA were mixed. Everyday weight discrimination and internalizing weight stigma were associated with reduced PA in most studies. Several studies found indirect, and not direct, effects of weight stigma on PA when analyses included other individual-level factors. In the nine studies of youth, two used objective PA measures, all were observational, and only one study was longitudinal. Most youth studies found a relationship between weight-based teasing and reduced PA. CONCLUSIONS Weight teasing, everyday discrimination, and internalization were associated with reduced PA. However, associations were inconsistent and often indirect. Future studies should include objective PA measures with larger samples and longitudinal assessments.
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Affiliation(s)
- Rebecca L. Pearl
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Thomas A. Wadden
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - John M. Jakicic
- Healthy Lifestyle Institute and Physical Activity and Weight Management Research Center, University of Pittsburgh, Pittsburgh, PA, USA
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6
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Clements JN, Albanese NP, D'Souza JJ, Misher A, Reece S(M, Trujillo J, Whitley HP. Clinical review and role of clinical pharmacists in obesity management: An opinion of the endocrine and metabolism practice and research network of the American College of Clinical Pharmacy. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Jennifer N. Clements
- Diabetes Transition Spartanburg Regional Healthcare System Spartanburg South Carolina USA
| | - Nicole P. Albanese
- University at Buffalo School of Pharmacy and Pharmaceutical Sciences Buffalo New York USA
| | - Jennifer J. D'Souza
- Midwestern University Chicago College of Pharmacy Downers Grove Illinois USA
| | - Anne Misher
- Patient Health Support Pharmacist Caromont Health Gastonia North Carolina USA
| | | | - Jennifer Trujillo
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences Aurora Colorado USA
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7
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Howes EM, Harden SM, Cox HK, Hedrick VE. Communicating About Weight in Dietetics Practice: Recommendations for Reduction of Weight Bias and Stigma. J Acad Nutr Diet 2021; 121:1669-1674. [PMID: 33589383 DOI: 10.1016/j.jand.2021.01.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 01/12/2021] [Accepted: 01/19/2021] [Indexed: 11/18/2022]
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8
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Watson D, Hughes K, Robinson E, Billette J, Bombak AE. Patient Recommendations for Providers to Avoid Stigmatizing Weight in Rural-Based Women With Low Income. J Patient Cent Res Rev 2021; 8:20-30. [PMID: 33511250 DOI: 10.17294/2330-0698.1752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose Weight stigma has become widespread within health care and disproportionately affects women, who are under greater appearance-based scrutiny than men. It is also well established that rural-based individuals with low incomes suffer greater health disparities compared with urban, higher-income counterparts, yet studies examining recommendations for nonstigmatizing health care among higher-weight women from low-income rural settings are lacking. This study examined the experiences and recommendations of higher-weight, low-income, rural women, with the aim of improving health care for similar populations. Methods In-depth, semi-structured interviews were conducted in a rural region of the Midwestern United States to explore participants' recommendations for redressing stigma within health care. All participants (n=25) self-identified as higher-weight, low-income, rural women. Results All participants experienced or were aware of weight stigma within health care. Themes identified from responses were understanding patients and their situations, offering options and supplemental information, communicating effectively, taking time, and having a positive attitude. Patient recommendations focused on correcting physician biases, rapport-building, and providing holistic care. Conclusions The findings suggest that weight stigma is prevalent within health care provided to low-income women in rural U.S. Midwest and that there are specific communication and training approaches that may reduce the prevalence of weight stigma in health care.
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Affiliation(s)
- Declan Watson
- Department of Psychology, University of New Brunswick, Fredericton, Canada
| | - Katherine Hughes
- School of Health Sciences, Central Michigan University, Mount Pleasant, MI
| | - Emma Robinson
- Department of Sociology, University of New Brunswick, Fredericton, Canada
| | | | - Andrea E Bombak
- Department of Sociology, University of New Brunswick, Fredericton, Canada
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9
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Croghan IT, Ebbert JO, Njeru JW, Rajjo TI, Lynch BA, DeJesus RS, Jensen MD, Fischer KM, Phelan S, Kaufman TK, Schroeder DR, Rutten LJF, Crane SJ, Tulledge-Scheitel SM. Identifying Opportunities for Advancing Weight Management in Primary Care. J Prim Care Community Health 2020; 10:2150132719870879. [PMID: 31496342 PMCID: PMC6734618 DOI: 10.1177/2150132719870879] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: Much has been written about the patients' perspective concerning weight management in health care. The purpose of this survey study was to assess perspectives of primary care providers (PCPs) and nurses toward patient weight management and identify possible areas of growth. Patients and Methods: We emailed a weight management-focused survey to 674 eligible participants (437 [64.8%] nurses and 237 [35.2%] PCPs) located in 5 outpatient primary care clinics. The survey focused on opportunities, practices, knowledge, confidence, attitudes, and beliefs. A total of 219 surveys were returned (137 [62.6%] from nurses and 82 [34.4%] from PCPs). Results: Among 219 responders, 85.8% were female and 93.6% were white non-Hispanic. In this study, PCPs and nurses believed obesity to be a major health problem. While PCPs felt more equipped than nurses to address weight management (P < .001) and reported receiving more training than nurses (50.0% vs 17.6%, respectively), both felt the need for more training on obesity (73.8% and 79.4%, respectively). Although, PCPs also spent more patient contact time providing weight management services versus nurses (P < .001), the opportunity/practices score was lower for PCPs than nurses (-0.35 ± 0.44 vs -0.17 ± 0.41, P < .001) with PCPs more likely to say they lacked the time to discuss weight and they worried it would cause a poor patient-PCP relationship. The knowledge/confidence score also differed significantly between the groups, with nurses feeling less equipped to deal with weight management issues than PCPs (-0.42 ± 0.43 vs -0.03 ± 0.55, P < .001). Neither group seemed very confident, with those in the PCP group only answering with an average score of neutral. Conclusion: By asking nurses and PCP general questions about experiences, attitudes, knowledge, and opinions concerning weight management in clinical care, this survey has identified areas for growth in obesity management. Both PCPs and nurses would benefit from additional educational training on weight management.
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10
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Puhl RM. What words should we use to talk about weight? A systematic review of quantitative and qualitative studies examining preferences for weight-related terminology. Obes Rev 2020; 21:e13008. [PMID: 32048465 DOI: 10.1111/obr.13008] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/06/2020] [Accepted: 01/27/2020] [Indexed: 12/18/2022]
Abstract
Evidence of weight stigma and its harmful consequences have led to increased attention to the words that are used to talk about obesity and body weight, including calls for efforts to carefully consider weight-related terminology and promote respectful language in the obesity and medical fields. Despite increased research studies examining people's preferences for specific words that describe body weight, there has been no systematic review to synthesize existing evidence on perceptions of and preferences for weight-related terminology. To address this gap, the current systematic review identified 33 studies (23 quantitative, 10 qualitative) that examined people's preferences for weight-related terminology in the current research literature (from 1999 to 2019). Across studies, findings generally suggest that neutral terminology (eg, "weight" or "unhealthy weight") is preferred and that words like "obese" and "fat" are least acceptable, particularly in provider-patient conversations about weight. However, individual variation in language preferences is evident across demographic characteristics like race/ethnicity, gender, and weight status. Of priority is future research that can improve upon the limited diversity of the existing literature, both with respect to sample diversity and the use of culturally relevant weight-related terminology, which is currently lacking in measurement. Implications for patient-provider communication and public health communication are discussed.
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Affiliation(s)
- Rebecca M Puhl
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT.,Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT
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11
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12
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Fruh SM, Golden A, Graves RJ, Hall HR, Minchew LA, Williams S. Advanced Practice Nursing student knowledge in obesity management: A mixed methods research study. NURSE EDUCATION TODAY 2019; 77:59-64. [PMID: 30954857 PMCID: PMC6564685 DOI: 10.1016/j.nedt.2019.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 02/06/2019] [Accepted: 03/27/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Obesity, the most prevalent chronic disease affecting multiple systems, is associated with increased mortality and a decreased life expectancy. OBJECTIVES The purpose of this study was to identify Advanced Practice Nursing (APN) students' confidence of obesity management as well as satisfaction of APN curriculum on and curricular recommendations regarding obesity management. DESIGN Modified convergent mixed-methods design. SETTING A university-based college of nursing in the Deep South. PARTICIPANTS Graduate APN Students. METHODS An exploratory mixed methods online survey was administered to APN students. The survey included demographics; confidence in obesity management; knowledge of pharmacological treatment; self-reported height and weight; experiences and challenges related to obesity management; and suggestions of curricular content changes for the treatment of obesity that would increase student expertise and confidence. RESULTS Ninety-nine surveys were completed by 94 female and five male APN students aged 26 to 61 years. The majority (70.7%) were white with BMIs ranging from 19.57 to 51.37 (x̅=27.81). Areas where students were least comfortable were prescribing anti-obesity medications and accurately billing for obesity management. Fourteen percent of APN students reported feeling that their graduate nursing education program did not prepare them well in obesity management, 25.3% reported feeling slightly well prepared, 32% reported feeling moderately well prepared, and 27.8% reported feeling very well or extremely well prepared. Qualitative responses accentuated insecurity in areas such as initiating a discussion on obesity management with patients who have obesity. CONCLUSIONS Overall, APN students requested that their curriculum incorporate more instruction on how to begin the discussion of weight loss and provide clear evidence-based guidelines that include diet, exercise, and medication options. An efficient way to affect the management and treatment of obesity is to ensure that the next generation of providers is thoroughly prepared to implement the best evidence-based obesity management for patients.
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Affiliation(s)
- Sharon M Fruh
- University of South Alabama, College of Nursing, 5721 USA Drive North Room 4080, Mobile, AL 36688, United States of America.
| | - Angela Golden
- 940 Pinewood Boulevard, Munds Park, AZ 86017, United States of America
| | - Rebecca J Graves
- University of South Alabama, College of Nursing, 5721 USA Drive North, Mobile, AL 36688, United States of America.
| | - Heather R Hall
- University of South Alabama, College of Nursing, 5721 USA Drive North, Mobile, AL 36688, United States of America.
| | - Leigh A Minchew
- University of South Alabama, College of Nursing, 5721 USA Drive North, Mobile, AL 36688, United States of America.
| | - Susan Williams
- University of South Alabama, College of Nursing, 5721 USA Drive North, Mobile, AL 36688, United States of America.
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13
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Stewart SJF, Ogden J. The Role of BMI Group on the Impact of Weight Bias Versus Body Positivity Terminology on Behavioral Intentions and Beliefs: An Experimental Study. Front Psychol 2019; 10:634. [PMID: 30967821 PMCID: PMC6439336 DOI: 10.3389/fpsyg.2019.00634] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 03/07/2019] [Indexed: 11/13/2022] Open
Abstract
This experimental study investigated the role of BMI on the impact of weight bias vs body positivity terminology on behavioral intentions and beliefs about obesity. Participants (n = 332) were randomly allocated to two conditions to receive a vignette depicting an image of a person with obesity using either weight bias (n = 164) or body positivity (n = 168) terminology. Participants were divided into three groups based upon their BMI category (normal weight n = 173; overweight n = 92; obese n = 64). They then completed measures of behavioral intentions, obesity illness beliefs, and fat phobia. Although there were several differences in beliefs by BMI group, the results showed no differences between weight bias or body positivity terminology on any measures. There were, however, significant BMI group by condition interactions for beliefs about obesity relating to personal control and treatment control. Post hoc tests showed that weight bias resulted in reduced personal control in the obese BMI group compared to other participants. Weight bias also resulted in higher personal control over obesity in normal weight individuals compared to body positivity. People with obesity reported higher treatment control when exposed to weight bias compared to overweight participants, whereas normal weight participants reported greater treatment control when exposed to body positivity compared to both other groups. To conclude, the impact of weight bias and body positivity information is not universal and varies according to the BMI of the audience and the outcome being measured; whereas people of normal weight may benefit from weight bias there is no evidence that obese people benefit from body positivity. Implications for the prevention and treatment of obesity are discussed.
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Affiliation(s)
| | - Jane Ogden
- School of Psychology, University of Surrey, Guildford, United Kingdom
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14
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Croghan IT, Phelan SM, Bradley DP, Bauer KW, Seung-Young-Han, Bradley SM, Casey BA, Mundi MS, Hurt RT, Schroeder DR, Finney Rutten LJ. Needs Assessment for Weight Management: The Learning Health System Network Experience. Mayo Clin Proc Innov Qual Outcomes 2018; 2:324-335. [PMID: 30560234 PMCID: PMC6260476 DOI: 10.1016/j.mayocpiqo.2018.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 08/09/2018] [Accepted: 08/13/2018] [Indexed: 01/26/2023] Open
Abstract
Objective To assess patients' weight management needs and experiences across multiple sites within the Learning Health System Network. Patients and Methods A total of 19,964 surveys were sent to patients identified with overweight or obesity through medical record query at 5 health care systems throughout 11 states. The survey collected patients' experiences with and opinions about weight management in clinical care from October 27, 2017, through March 1, 2018. Results Among the 2380 responders, being younger, female, nonwhite, and single and having some college education or less were all significantly associated with higher body mass index (BMI). The most frequent weight loss barriers included food cravings (30.7%-49.9%) and having a medical condition limiting physical activity (17.7%-47.1%) (P<.001). Higher BMI was associated with a higher frequency of comorbidities and lower health status (P<.001). Higher BMI was also associated with a higher belief that primary care providers (PCPs) should be involved in weight loss management (P=.01) but lower belief that the PCP had the necessary skills and knowledge to help (P<.001). Responders with a higher BMI were more likely to feel judged (P<.001) and not always respected (P<.001) by their PCP. In addition, those with a higher BMI more frequently reported avoiding health care visits because of weight gain, not wanting to undress or be weighed, and not wanting to discuss their weight with their PCP (P<.001). Conclusion Physician involvement in weight management is important to patients whose needs and experiences differ by BMI. These data may inform clinical weight management efforts and create greater alignment with patient expectations.
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Affiliation(s)
- Ivana T Croghan
- Department of Medicine, Mayo Clinic, Rochester, MN.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.,Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Sean M Phelan
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.,Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - David P Bradley
- Diabetes and Metabolism Research Center, Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Katherine W Bauer
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI
| | - Seung-Young-Han
- Mayo Clinic-ASU Obesity Solutions, Arizona State University, Tempe, AZ
| | - Steven M Bradley
- Center for Healthcare Delivery Innovation, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN
| | - Beret A Casey
- Department of Diabetes and Endocrinology, Essentia Health - Ashland Clinic, Ashland, WI
| | | | - Ryan T Hurt
- Department of Medicine, Mayo Clinic, Rochester, MN
| | | | - Lila J Finney Rutten
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.,Department of Health Sciences Research, Mayo Clinic, Rochester, MN
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15
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Hudgel DW, Patel SR, Ahasic AM, Bartlett SJ, Bessesen DH, Coaker MA, Fiander PM, Grunstein RR, Gurubhagavatula I, Kapur VK, Lettieri CJ, Naughton MT, Owens RL, Pepin JLD, Tuomilehto H, Wilson KC. The Role of Weight Management in the Treatment of Adult Obstructive Sleep Apnea. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2018; 198:e70-e87. [DOI: 10.1164/rccm.201807-1326st] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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16
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Pearl RL, Puhl RM. Weight bias internalization and health: a systematic review. Obes Rev 2018; 19:1141-1163. [PMID: 29788533 PMCID: PMC6103811 DOI: 10.1111/obr.12701] [Citation(s) in RCA: 286] [Impact Index Per Article: 47.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/23/2018] [Accepted: 03/29/2018] [Indexed: 01/31/2023]
Abstract
A robust literature has documented the negative health effects of being the target of weight bias. Weight bias internalization (WBI) occurs when individuals apply negative weight stereotypes to themselves and self-derogate because of their body weight. Compared with experiences of weight bias, less is known about the relationship between WBI and mental and physical health, although more literature on this topic has emerged in recent years. The current systematic review identified 74 studies assessing the relationship between WBI and health and interventions designed to reduce WBI and improve health. Over half of identified studies were published from 2016 to 2017. Results showed strong, negative relationships between WBI and mental health outcomes. Fewer studies have examined the relationship between WBI and physical health, and results were less consistent. Key directions for future research are highlighted, including the need for prospective and experimental studies with greater sample diversity.
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Affiliation(s)
- R L Pearl
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - R M Puhl
- Rudd Center for Food Policy and Obesity, Department of Human Development & Family Studies, University of Connecticut, Hartford, CT, USA
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17
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Smigelski-Theiss R, Gampong M, Kurasaki J. Weight Bias and Psychosocial Implications for Acute Care of Patients With Obesity. AACN Adv Crit Care 2018; 28:254-262. [PMID: 28847860 DOI: 10.4037/aacnacc2017446] [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: 11/01/2022]
Abstract
Obesity is a complex medical condition that has psychosocial and physiological implications for those suffering from the disease. Factors contributing to obesity such as depression, childhood experiences, and the physical environment should be recognized and addressed. Weight bias and stigmatization by health care providers and bedside clinicians negatively affect patients with obesity, hindering those patients from receiving appropriate care. To provide optimal care of patients with obesity or adiposity, health care providers must understand the physiological needs and requirements of this population while recognizing and addressing their own biases. The authors describe psychosocial and environmental factors that contribute to obesity, discuss health care providers' weight biases, and highlight implications for acute care of patients suffering from obesity.
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Affiliation(s)
- Rachel Smigelski-Theiss
- Rachel Smigelski-Theiss is Clinical Nurse Specialist, Queen's Medical Center, 1301 Punchbowl Street, Honolulu, HI 96813 . Malisa Gampong is Nurse Manager, Queen's Medical Center, Honolulu, Hawaii. Jill Kurasaki is Nurse Manager, Queen's Medical Center, Honolulu, Hawaii
| | - Malisa Gampong
- Rachel Smigelski-Theiss is Clinical Nurse Specialist, Queen's Medical Center, 1301 Punchbowl Street, Honolulu, HI 96813 . Malisa Gampong is Nurse Manager, Queen's Medical Center, Honolulu, Hawaii. Jill Kurasaki is Nurse Manager, Queen's Medical Center, Honolulu, Hawaii
| | - Jill Kurasaki
- Rachel Smigelski-Theiss is Clinical Nurse Specialist, Queen's Medical Center, 1301 Punchbowl Street, Honolulu, HI 96813 . Malisa Gampong is Nurse Manager, Queen's Medical Center, Honolulu, Hawaii. Jill Kurasaki is Nurse Manager, Queen's Medical Center, Honolulu, Hawaii
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18
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Turner M, Jannah N, Kahan S, Gallagher C, Dietz W. Current Knowledge of Obesity Treatment Guidelines by Health Care Professionals. Obesity (Silver Spring) 2018; 26:665-671. [PMID: 29570250 DOI: 10.1002/oby.22142] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The objective of this study was to assess health care professionals' knowledge of evidence-based guidelines for the nonsurgical treatment of obesity. METHODS A nationally representative sample of internists, family practitioners, obstetricians/gynecologists, and nurse practitioners completed a web-based survey between June 9 and July 1, 2016 (n = 1,506). RESULTS Only 16% of respondents indicated that obesity counseling should be provided approximately twice monthly in an individual or group setting for at least 6 months, in accordance with United States Preventive Services Task Force and Centers for Medicare and Medicaid Services guidelines. Only 15% of respondents identified BMI ≥ 27 kg/m2 with an obesity-associated comorbid condition as the appropriate indication to prescribe pharmacotherapy for patients. Two-thirds of respondents indicated that it is appropriate to continue long-term pharmacotherapy under conditions inconsistent with evidence-based guidelines, with nearly one-quarter indicating that obesity medications should never be prescribed beyond 3 months regardless of weight loss. CONCLUSIONS These findings suggest that provider understanding of appropriate clinical care for obesity is inconsistent with evidence-based recommendations. As coverage for behavioral counseling services and pharmacotherapy expands, it is imperative that health care professionals understand how to effectively leverage these treatment modalities to optimize health outcomes for patients with obesity.
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Affiliation(s)
- Monique Turner
- Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Nichole Jannah
- Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Scott Kahan
- Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Christine Gallagher
- Milken Institute School of Public Health, George Washington University, Washington, DC
| | - William Dietz
- Milken Institute School of Public Health, George Washington University, Washington, DC
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