1
|
Spreckley M, de Lange J, Seidell J, Halberstadt J. Primary care-led weight-management intervention: qualitative insights into patient experiences at one-year follow up. Int J Qual Stud Health Well-being 2023; 18:2256669. [PMID: 37703440 PMCID: PMC10501160 DOI: 10.1080/17482631.2023.2256669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 09/05/2023] [Indexed: 09/15/2023] Open
Abstract
INTRODUCTION The global prevalence of overweight and obesity is continuously increasing. Long-term weight loss results remain disappointing. This study aims to identify factors and strategies for successful long-term weight loss in a primary care-led weight-loss intervention from the perspective of participants. MATERIALS AND METHODS This qualitative interview study is the first follow-up study in a 2-year study series of participants with overweight or obesity. Methods utilized are semi-structured interviews (n = 20) with quantitative self-description. The data were transcribed from audio-taped interviews and analysed thematically. RESULTS This study found that clear, continuously evolving self-monitoring strategies facilitated by strong routines and a long-term focus enhanced successful outcomes. Challenges faced included stress, disappointment and loss of routine along with external criticism and discouragement. Benefits experienced due to weight loss included improved health, self-esteem, communal support and encouragement, which continued to fuel motivation. Receiving continuous support and encouragement from healthcare practitioners was instrumental for long-term success. CONCLUSION This study highlighted the complex, multifaceted experiences patients encounter in the pursuit of trying to achieve long-term weight loss. Personalized treatment protocols taking into account the diverse requirements and circumstances of individuals have the potential to improve treatment outcomes. Continuous, professional support may enhance long-term outcomes.
Collapse
Affiliation(s)
- Marie Spreckley
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Judith de Lange
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jaap Seidell
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jutka Halberstadt
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
2
|
Enright C, Thomas E, Saxon DR. An Updated Approach to Antiobesity Pharmacotherapy: Moving Beyond the 5% Weight Loss Goal. J Endocr Soc 2023; 7:bvac195. [PMID: 36686585 PMCID: PMC9847544 DOI: 10.1210/jendso/bvac195] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Indexed: 01/11/2023] Open
Abstract
Despite professional society guidelines recommending that obesity be treated as a chronic disease by emphasizing the use of lifestyle modification in conjunction with pharmacotherapy, antiobesity medications are uncommonly prescribed in most clinical practices. The recent Food and Drug Administration approval of semaglutide 2.4 mg weekly to treat obesity-as well as other forthcoming advancements in diabetes and antiobesity medications-highlights the potential of pharmacotherapy to significantly augment weight loss efforts. In this Expert Endocrine Consult, we review the evolving role of antiobesity pharmacotherapy in clinical practice and suggest a framework for the use of these medications.
Collapse
Affiliation(s)
- Connor Enright
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Elizabeth Thomas
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Aurora, CO 80045, USA,Endocrinology Section, Rocky Mountain Veterans Affairs Medical Center, Aurora, CO 80045, USA
| | - David R Saxon
- Correspondence: David Saxon, MD, Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, 12801 East 17th Avenue, Mail Stop: 8106, Aurora, CO 80045, USA.
| |
Collapse
|
3
|
Spreckley M, de Lange J, Seidell JC, Halberstadt J. Patient insights into the experience of trying to achieve weight-loss and future expectations upon commencement of a primary care-led weight management intervention: A qualitative, baseline exploration. PLoS One 2022; 17:e0270426. [PMID: 35767563 PMCID: PMC9242434 DOI: 10.1371/journal.pone.0270426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 06/09/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction The long-term effects of interventions aiming to achieve substantial, sustainable weight loss maintenance have been disappointing. Most people regain their lost weight over time but some seem to be able to maintain their weight loss. We are following the experiences of patients over time prospectively. This study forms the baseline to provide insights into patient experiences prior to entering a primary care-led weight management intervention and their expectations going forward. Materials and methods We recruited 21 adult male and female patients of varying ethnicity with a BMI between 27.7kg/m2 and 48.4kg/m2 from a cohort of patients entering a primary care-led weight management intervention. Patients were offered video and audio interview options during the COVID-19 lockdown. In total, twenty chose the audio option, while one chose the video option. The interview format was semi-structured with room for individual exploration. Discussion We found that participants experienced feeling unable to control their weight and encountered a multitude of internal and external barriers to weight management. Some had supportive environments, while others experienced discouraging external influences. Though personal characteristics varied, motivations, goals and expected benefits were similar across this cohort. Most participants had previously experienced transient successful weight-loss attempts with varying approaches. COVID-19 was experienced as an opportunity or barrier for change. Conclusion This study illustrates the importance of gaining comprehensive insights into the diverse experiences patients encounter when trying to achieve weight loss. Personalized support taking into account individual experiences and circumstances may enhance long-term treatment outcomes. Future research into the complexities of weight management based on individual accounts can aid in the creation of improved treatment protocols.
Collapse
Affiliation(s)
- Marie Spreckley
- Faculty of Science, Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- * E-mail:
| | - Judith de Lange
- Faculty of Science, Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Jacob C. Seidell
- Faculty of Science, Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Jutka Halberstadt
- Faculty of Science, Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| |
Collapse
|
4
|
Spreckley M, Seidell J, Halberstadt J. Perspectives into the experience of successful, substantial long-term weight-loss maintenance: a systematic review. Int J Qual Stud Health Well-being 2021; 16:1862481. [PMID: 33455563 PMCID: PMC7833027 DOI: 10.1080/17482631.2020.1862481] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Purpose: In light of the increasing prevalence of overweight and obesity, understanding the experiences, strategies and challenges encountered when trying to achieve substantial, sustainable weight loss is an important area to investigate. We systematically evaluated qualitative studies focusing on the accounts of individuals who have achieved sustained weight loss to create a comprehensive picture of the experience of sustainable weight loss. Methods: Included studies were peer-reviewed studies that qualitatively assessed the views and experiences of adults who previously had or currently have overweight or obesity who successfully lost weight and who subsequently maintained or regained weight. The evidence was systematically synthesized, which enabled the formulation of clear themes and recommendations. Results: The 15 chosen studies included the accounts of 294 individuals. We found that continuous monitoring and goal setting, driven by sustained motivation and encouraging experiences, while resisting ever present challenges and enduring discouraging experience encapsulates the experience of sustained, substantial weight loss. Conclusions: This review aims to provide a comprehensive understanding of the experiences, strategies and challenges encountered when trying to achieve substantial, sustained weight loss. Additional research taking into account findings from this review and others of its kind will enhance the formulation of treatment protocols.
Collapse
Affiliation(s)
- Marie Spreckley
- Faculty of Science, Department of Health Sciences, Vrije Universiteit Amsterdam , Amsterdam, Netherlands
| | - Jaap Seidell
- Faculty of Science, Department of Health Sciences, Vrije Universiteit Amsterdam , Amsterdam, Netherlands
| | - Jutka Halberstadt
- Faculty of Science, Department of Health Sciences, Vrije Universiteit Amsterdam , Amsterdam, Netherlands
| |
Collapse
|
5
|
Plummer A, Walker I. Can self-regulation explain why not everyone is overweight or obese? AUSTRALIAN JOURNAL OF PSYCHOLOGY 2021. [DOI: 10.1080/00049530.2021.1883999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Ann Plummer
- Discipline of Psychology, University of Canberra, Canberra, Australia
| | - Iain Walker
- Discipline of Psychology, University of Canberra, Canberra, Australia
- Research School of Psychology, Australian National University, Australia
| |
Collapse
|
6
|
Lawlor ER, Hughes CA, Duschinsky R, Pountain GD, Hill AJ, Griffin SJ, Ahern AL. Cognitive and behavioural strategies employed to overcome "lapses" and prevent "relapse" among weight-loss maintainers and regainers: A qualitative study. Clin Obes 2020; 10:e12395. [PMID: 32767708 PMCID: PMC7116423 DOI: 10.1111/cob.12395] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/30/2020] [Accepted: 07/10/2020] [Indexed: 02/02/2023]
Abstract
While many behavioural weight management programmes are effective in the short-term, post-programme weight regain is common. Overcoming "lapses" and preventing "relapse" has been highlighted as important in weight-loss maintenance, but little is known on how this is achieved. This study aimed to compare the cognitive and behavioural strategies employed to overcome "lapses" and prevent "relapse" by people who had regained weight or maintained weight-loss after participating in a weight management programme. By investigating differences between groups, we intended to identify strategies associated with better weight-loss maintenance. Semi-structured interviews were conducted with 26 participants (58% female) recruited from the 5-year follow-up of the Weight Loss Referrals for Adults in Primary Care (WRAP) trial (evaluation of a commercial weight-loss programme). Participants who had lost ≥5% baseline weight during the active intervention were purposively sampled according to 5-year weight trajectories (n = 16 'Regainers', n = 10 'Maintainers'). Interviews were audio-recorded, transcribed verbatim, and analysed thematically. Key differences in strategies were that Maintainers continued to pay attention to their dietary intake, anticipated and planned for potential lapses in high-risk situations, and managed impulses using distraction techniques. Regainers did not report making plans, used relaxed dietary monitoring, found distraction techniques to be ineffective and appeared to have difficulty navigating food within interpersonal relationships. This study is one of the longest qualitative follow-ups of a weight loss trial to date, offering unique insights into long-term maintenance. Future programmes should emphasize strategies focusing on self-monitoring, planning and managing interpersonal relationships to help participants successfully maintain weight-loss in the longer-term.
Collapse
Affiliation(s)
- Emma R Lawlor
- MRC Epidemiology Unit, University of Cambridge, Cambridge, England
| | - Carly A Hughes
- Fakenham Medical Practice, Norfolk, United Kingdom
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Robbie Duschinsky
- Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, England
| | | | - Andrew J Hill
- Division of Psychological & Social Medicine, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Simon J Griffin
- MRC Epidemiology Unit, University of Cambridge, Cambridge, England
- Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, England
| | - Amy L Ahern
- MRC Epidemiology Unit, University of Cambridge, Cambridge, England
| |
Collapse
|
7
|
Pacanowski CR, Levitsky DA. Self-Weighing and Visual Feedback Facilitates Self-Directed Learning in Adults Who Are Overweight and Obese. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2020; 52:369-376. [PMID: 31561967 DOI: 10.1016/j.jneb.2019.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 08/16/2019] [Accepted: 08/22/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Understanding how and why self-weighing works for some individuals but not others in weight management is vital. This study investigated how self-weighing and tracking of weight using a Web site facilitated a self-directed learning process in overweight or obese adults interested in losing weight. DESIGN Semistructured interviews with study completers (n = 47) and voluntary withdrawals (n = 10) about their experience after 6 and 12 months of using the program or when they withdrew. ANALYSIS Qualitative, guided by self-directed learning theory. RESULTS Although both completers and those who withdrew engaged in self-directed learning, often exemplifying the same concepts (eg, instrumental learning), experiences described a positive sense of control over weight in completers and a lack of sense of control in those who withdrew. CONCLUSIONS AND IMPLICATIONS Overall, it seemed that frequent self-weighing and visual feedback of body weight over time facilitated a self-directed learning process in both completers and those who withdrew. This research provides a rich understanding of how adults use self-weighing to facilitate self-directed learning for weight loss. Future studies assessing how self-weighing and visual displays of weight facilitate a self-directed learning process in diverse populations and age groups are necessary to better understand how self-weighing works and for whom self-weighing is beneficial.
Collapse
Affiliation(s)
- Carly R Pacanowski
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE.
| | - David A Levitsky
- Division of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, NY
| |
Collapse
|
8
|
Temporal patterns of self-weighing behavior and weight changes assessed by consumer purchased scales in the Health eHeart Study. J Behav Med 2019; 42:873-882. [PMID: 30649648 PMCID: PMC6635083 DOI: 10.1007/s10865-018-00006-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 12/13/2018] [Indexed: 10/27/2022]
Abstract
Self-weighing may promote attainment and maintenance of healthy weight; however, the natural temporal patterns and factors associated with self-weighing behavior are unclear. The aims of this secondary analysis were to (1) identify distinct temporal patterns of self-weighing behaviors; (2) explore factors associated with temporal self-weighing patterns; and (3) examine differences in percent weight changes by patterns of self-weighing over time. We analyzed electronically collected self-weighing data from the Health eHeart Study, an ongoing longitudinal research study coordinated by the University of California, San Francisco. We selected participants with at least 12 months of data since the day of first use of a WiFi- or Bluetooth-enabled digital scale. The sample (N = 1041) was predominantly male (77.5%) and White (89.9%), with a mean age of 46.5 ± 12.3 years and a mean BMI of 28.3 ± 5.9 kg/m2 at entry. Using group-based trajectory modeling, six distinct temporal patterns of self-weighing were identified: non-users (n = 120, 11.5%), weekly users (n = 189, 18.2%), rapid decliners (n = 109, 10.5%), increasing users (n = 160, 15.4%), slow decliners (n = 182, 17.5%), and persistent daily users (n = 281, 27.0%). Individuals who were older, female, or self-weighed 6-7 days/week at week 1 were more likely to follow the self-weighing pattern of persistent daily users. Predicted self-weighing trajectory group membership was significantly associated with weight change over time (p < .001). In conclusion, we identified six distinct patterns of self-weighing behavior over the 12-month period. Persistent daily users lost more weight compared with groups with less frequent patterns of scale use.
Collapse
|
9
|
Rohde P, Arigo D, Shaw H, Stice E. Relation of self-weighing to future weight gain and onset of disordered eating symptoms. J Consult Clin Psychol 2019; 86:677-687. [PMID: 30035584 DOI: 10.1037/ccp0000325] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Frequent self-weighing is recommended in weight loss interventions and may prevent weight gain. However, concerns regarding the associations between self-weighing and eating disorders have been expressed and the relations between self-weighing and weight gain/eating pathology have not been examined prospectively. We tested whether (a) frequency of baseline self-weighing in college students with weight concerns predicted weight change over 2-year follow-up, (b) this relation was moderated by eating disorder symptoms, and (c) self-weighing predicted future eating disorder symptoms. METHOD Data were merged from two trials evaluating obesity/eating disorder prevention programs in 762 students (Mage = 18.7; 86% women). Participants reported how often they weighed themselves at baseline; body mass index (BMI) and eating disorder symptoms were assessed over 2-year follow-up. RESULTS Baseline self-weighing predicted weight gain, with more frequent weighers experiencing greater gains (i.e., +0.8 of BMI) over follow-up. This relation was moderated by the frequency of binge eating but not weight/shape concerns or compensatory behaviors; the combination of more frequent self-weighing and binge eating was associated with greatest weight gain (+1.6 of BMI). More frequent weighers also reported higher onset of compensatory behaviors, relative to non-self-weighers (odds ratio = 3.90, 95% confidence interval [1.76, 8.75]). CONCLUSIONS Young adults who weighed themselves more frequently had greater weight gain than those who self-weighed less frequently, especially those who engaged in binge eating, and were at risk for future unhealthy compensatory behaviors. Findings suggest that frequent self-weighing may have negative effects for some young adults, and that relations between self-weighing and weight control outcomes require further investigation. (PsycINFO Database Record
Collapse
|
10
|
Kaveh O, Peyrovi H. Exploring the Experiences of Iranian Women Regarding Obesity Self-Management: A Qualitative Study. Open Access Maced J Med Sci 2019; 7:2377-2383. [PMID: 31592042 PMCID: PMC6765089 DOI: 10.3889/oamjms.2019.632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 07/27/2019] [Accepted: 07/28/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Despite the high and growing prevalence of obesity in Iran and a variety of interventions by the healthcare providers control the problem, and it is still a prevalent health problem among Iranian women. AIM The aim of this study is to explore the perspective of obese Iranian women in the process of self-management regarding the facilitating factor in self-management of obesity. METHODS In a qualitative study, the participants were selected through purposeful sampling, and the data were collected using semi-structured interviews and focus group (n = 25) between July 2017 and September 2018. All the interviews were transcribed verbatim and the data were analysed using constant comparative method. RESULTS Supporting the umbrella was the main category found in the present study. The participating obese individuals found "support" as the main factor with an outstanding effect on motivating, incentivising and keeping diet in long-term. This category contains subcategories: self-help; family, friends, and peers' support; and medical team's support. CONCLUSION The findings suggested the critical role of support in obesity self-management process. This critical factor improves our perception of the multi-aspect and complicated nature of obesity self-management. Moreover, policymakers and providers of health services can utilise this finding in the design of care plans with higher chance of success.
Collapse
Affiliation(s)
- Omolhoda Kaveh
- International Campus, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Peyrovi
- Nursing Care Research Centre, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
11
|
Lindsay S. Five Approaches to Qualitative Comparison Groups in Health Research: A Scoping Review. QUALITATIVE HEALTH RESEARCH 2019; 29:455-468. [PMID: 30501574 DOI: 10.1177/1049732318807208] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Qualitative researchers have much to gain by using comparison groups. Although their use within qualitative health research is increasing, the guidelines surrounding them are lacking. The purpose of this article is to explore the extent to which qualitative comparison groups are being used within health research and to outline the lessons learned in using this type of methodology. Through conducting a scoping review, 31 articles were identified that demonstrated five different types of qualitative comparison groups. I highlight the key benefits and challenges in using this approach.
Collapse
Affiliation(s)
- Sally Lindsay
- 1 Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| |
Collapse
|