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Kasher Meron M, Eizenstein S, Cukierman-Yaffe T, Oieru D. Missed diagnosis-a major barrier to patient access to obesity healthcare in the primary care setting. Int J Obes (Lond) 2024; 48:1003-1010. [PMID: 38649487 PMCID: PMC11216998 DOI: 10.1038/s41366-024-01514-6] [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: 11/10/2023] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To investigate whether individuals with an elevated BMI measurement, for whom a diagnosis of overweight or obesity (OW/OB) is not recorded, are less likely to be offered clinical care for obesity compared to those with a recorded diagnosis. SUBJECTS A retrospective cohort study using the electronic medical record database of Maccabi Healthcare Services (MHS) in Israel. Included were 200,000 adults with BMI ≥ 25 kg/m2 measurement recorded during a primary care visit between 2014 and 2020, and no prior diagnosis of OW/OB or related co-morbidities. METHODS The relationships between a recorded diagnosis of OW/OB and two composite outcomes: 1. A composite of referrals to screening tests for metabolic complications; 2. A composite of weight loss intervention and follow up, were analyzed using multivariate logistic regression models. RESULTS In only 18% of individuals, a diagnosis of OW/OB was recorded. After adjusting for multiple potential confounding factors, individuals who received a recorded diagnosis were 18% more likely to be offered an evaluation for obesity-related metabolic complication, (OR 1.18, 95% CI 1.15-1.21, p < 0.001), and almost twice as likely to be offered intervention and follow up for their excess body weight (OR 1.84, 95% CI 1.76-1.94, p < 0.001) compared to individuals with missed diagnosis. These results persisted after adjusting for inter-physician variability. In addition, male sex, older age, and Arab sector were all associated with lower rates of weight loss intervention and follow up, while young individuals were less likely to be screened for metabolic complications. CONCLUSION Beyond BMI measurement, a recorded diagnosis of OW/OB is associated with statistically and clinically significant higher rates of performance of obesity care and intervention. Undiagnosed OW/OB presents a significant clinical opportunity, as recording a diagnosis of OW/OB would predict improved patient access to obesity healthcare and improved clinical outcomes.
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Affiliation(s)
- Michal Kasher Meron
- Meir Medical Center, Clalit Health Services, Kfar Saba, Israel.
- Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel.
| | - Sapir Eizenstein
- Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Tali Cukierman-Yaffe
- Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel-HaShomer, Israel
| | - Dan Oieru
- Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
- Maccabi Healthcare Services, Tel Aviv-Yafo, Israel
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2
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Rodbard HW, Barnard-Kelly K, Pfeiffer AFH, Mauersberger C, Schnell O, Giorgino F. Practical strategies to manage obesity in type 2 diabetes. Diabetes Obes Metab 2024; 26:2029-2045. [PMID: 38514387 DOI: 10.1111/dom.15556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 03/23/2024]
Abstract
The rising phenomenon of obesity, a major risk factor for the development and progression of type 2 diabetes, is a complex and multifaceted issue that requires a comprehensive and coordinated approach to be prevented and managed. Although novel pharmacological measures to combat obesity have achieved unprecedented efficacy, a healthy lifestyle remains essential for the long-term success of any therapeutic intervention. However, this requires a high level of intrinsic motivation and continued behavioural changes in the face of multiple metabolic, psychological and environmental factors promoting weight gain, particularly in the context of type 2 diabetes. This review is intended to provide practical recommendations in the context of a holistic, person-centred approach to weight management, including evidence-based and expert recommendations addressing supportive communication, shared decision-making, as well as nutritional and pharmacological therapeutic approaches to achieve sustained weight loss.
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Affiliation(s)
| | - Katharine Barnard-Kelly
- Southern Health NHS Foundation Trust, Southampton, UK
- BHR Limited, Portsmouth, UK
- Spotlight Consultations, Fareham, UK
| | - Andreas F H Pfeiffer
- Department of Endocrinology, Diabetes and Nutrition, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Oliver Schnell
- Sciarc GmbH, Baierbrunn, Germany
- Forschergruppe Diabetes eV at the Helmholtz Centre, Munich-Neuherberg, Germany
| | - Francesco Giorgino
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, Italy
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Cuevas A, Pardo F, Alonso R, Barros E, Rendón A. Features and behaviours for weight loss in the Chilean cohort with obesity from the ACTION study. Clin Obes 2024:e12673. [PMID: 38686641 DOI: 10.1111/cob.12673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/27/2024] [Accepted: 04/11/2024] [Indexed: 05/02/2024]
Abstract
In Latin America, obesity rates are among the highest in the world. Currently, people with obesity (PWO) receive suboptimal care due to several challenges and barriers. The international ACTION-IO study aimed to identify perceptions, attitudes and behaviours of PWO and healthcare providers (HCP), and to assess potential barriers to effective obesity care. The aim of this subanalysis of the Chilean cohort was to compare their characteristics, perceptions, attitudes and behaviours according to the percentage of weight loss (lower weight loss [LWL; ≤10%] or higher weight loss [HWL; >10%] of basal weight). The ACTION-IO survey was completed by 1000 Chilean PWO and 200 HCPs. Mean age of PWO was 38 years (range 18-75); 62% were female. The majority had class I obesity. HWL subgroup represented 17.2% of all Chilean subset. Specific characteristics of patients with HWL were identified (higher educational level, lower proportion of class III obesity, preference for consulting obesity specialists, considering conversations with HCP as very helpful). HWL patients reported higher rates of favourable outcomes following HCP advice and a higher probability of attending scheduled follow-up visits. Certain demographic and behavioural variables (educational level, consultation to obesity specialists, adherence to HCP advice, follow-up scheduled visits and becoming aware of the obesity state) may identify PWO with a higher probability of a greater weight loss.
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Affiliation(s)
- Ada Cuevas
- Center for Advanced Metabolic Medicine and Nutrition (CAMMYN), Santiago, Chile
| | - Fabián Pardo
- Metabolic Diseases Research Laboratory (MDRL), School of Medicine, Faculty of Medicine, San Felipe Campus, Universidad de Valparaiso, Valparaíso, Chile
- Center of Interdisciplinary Biomedical and Engineering Research for Health (MEDING), School of Medicine, Faculty of Medicine, San Felipe Campus, Universidad de Valparaiso, Valparaíso, Chile
| | - Rodrigo Alonso
- Center for Advanced Metabolic Medicine and Nutrition (CAMMYN), Santiago, Chile
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Evans TS, Drew KJ, McKenna J, Dhir P, Marwood J, Freeman C, Hill AJ, Newson L, Homer C, Matu J, Radley D, Ells LJ. Can the delivery of behavioural support be improved in the NHS England Low-Calorie Diet Programme? An observational study of behaviour change techniques. Diabet Med 2024; 41:e15245. [PMID: 37914161 DOI: 10.1111/dme.15245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/09/2023] [Accepted: 10/17/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Previous research has illustrated a drift in the fidelity of behaviour change techniques (BCTs) during the design of the pilot NHS England Low-Calorie Diet (NHS-LCD) Programme. This study evaluated a subsequent domain of fidelity, intervention delivery. Two research questions were addressed: (1) To what extent were BCTs delivered with fidelity to providers programme plans? (2) What were the observed barriers and facilitators to delivery? METHODS A mixed-methods sequential explanatory design was employed. Remote delivery of one-to-one and group-based programmes were observed. A BCT checklist was developed using the BCT Taxonomy v1; BCTs were coded as present, partially delivered, or absent during live sessions. Relational content analysis of field notes identified observed barriers and facilitators to fidelity. RESULTS Observations of 122 sessions across eight samples and two service providers were completed. Delivery of the complete NHS-LCD was observed for five samples. Fidelity ranged from 33% to 70% across samples and was higher for group-based delivery models (64%) compared with one-to-one models (46%). Barriers and facilitators included alignment with the programme's target behaviours and outcomes, session content, time availability and management, group-based remote delivery, and deviation from the session plan. CONCLUSIONS Overall, BCTs were delivered with low-to-moderate fidelity. Findings indicate a dilution in fidelity during the delivery of the NHS-LCD and variation in the fidelity of programmes delivered across England. Staff training could provide opportunities to practice the delivery of BCTs. Programme-level changes such as structured activities supported by participant materials and with sufficient allocated time, might improve the delivery of BCTs targeting self-regulation.
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Affiliation(s)
- Tamla S Evans
- Obesity Institute and School of Health, Leeds Beckett University, Leeds, UK
| | - Kevin J Drew
- Obesity Institute and School of Health, Leeds Beckett University, Leeds, UK
| | - Jim McKenna
- Obesity Institute and Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - Pooja Dhir
- Obesity Institute and School of Health, Leeds Beckett University, Leeds, UK
| | - Jordan Marwood
- Obesity Institute and School of Health, Leeds Beckett University, Leeds, UK
| | - Charlotte Freeman
- Obesity Institute and School of Health, Leeds Beckett University, Leeds, UK
| | - Andrew J Hill
- Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Lisa Newson
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Catherine Homer
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Olympic Legacy Park, Sheffield, UK
| | - Jamie Matu
- Obesity Institute and School of Health, Leeds Beckett University, Leeds, UK
| | - Duncan Radley
- Obesity Institute and Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - Louisa J Ells
- Obesity Institute and School of Health, Leeds Beckett University, Leeds, UK
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Vilarrasa N, Salvador J, Poyato F, Rubio-Herrera MÁ. Does the Prevalence of Obesity in the Different Regions of Spain Influence the Attitudes, Perception, and Barriers to Its Treatment? Obes Facts 2024; 17:264-273. [PMID: 38493779 PMCID: PMC11149964 DOI: 10.1159/000538257] [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: 04/08/2023] [Accepted: 03/05/2024] [Indexed: 03/19/2024] Open
Abstract
INTRODUCTION The differences in the prevalence of obesity between the various regions of Spain, partly attributed to socioeconomic differences, may influence the approach to this disease. The aim of this study was to compare differences in attitudes, perception, and barriers to the treatment of obesity between people with obesity (PwO) and health care professionals (HCPs), between the different regions of Spain. METHODS Sub-analysis of the ACTION-IO Spain study, which included 1,500 PwO and 306 HCP, was performed to identify differences in PwQ and HCPs belonging to regions with high prevalence of obesity (>16%, n = 9 regions, high prevalence of obesity [HPO] group) and low prevalence of obesity (<16%, n = 8 regions, low prevalence of obesity [LPO] group) (self-reported data), according to the 2017 National Health Survey of Spain. STATISTICS comparison of proportions (χ2). RESULTS A total of 746 PwO belonged to HPO and 754 to LPO group. The PwO in HPO group were younger, had lower income, a lower level of higher education, higher unemployment rate, and fewer comorbidities. Obesity was considered a chronic disease to a higher extent in HPO compared to LPO group (62 vs. 56%), but this difference was not statistically significant. The PwO in HPO group discussed less with the HCPs about their excess weight (57 vs. 70%), did not feel motivated to lose weight in a higher percentage (26 vs. 18%), and felt less emotionally supported (16 vs. 24%). In HPO group, the preference for unhealthy food (51 vs. 36%), and the costs of healthy eating, anti-obesity drugs and bariatric surgery were perceived barriers to losing weight. A higher proportion of PwO in HPO group considered that exercise (58 vs. 40%) was more effective for achieving weight loss. In contrast, LPO group considered diet more effective (48 vs. 32%). HCPs in HPO group felt more motivated to treat obesity (83 vs. 68%) and a higher proportion (14 vs. 5%) identified the economic burden as one of the main reasons why PwO do not start conversations to lose weight. CONCLUSIONS There is less concern and conversation about excess weight in PwO in regions with a higher prevalence of obesity, with socioeconomic limitations being one of the main perceived barriers to treatment.
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Affiliation(s)
- Nuria Vilarrasa
- Department of Endocrinology, Diabetes and Nutrition, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Spain
- CIBER Diabetes and Associated Metabolic Diseases (CIBERDEM), Madrid, Spain
| | - Javier Salvador
- Faculty of Medicine, University of Navarra, Pamplona, Spain
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Madrid, Spain
| | | | - Miguel Ángel Rubio-Herrera
- Department of Endocrinology and Nutrition, San Carlos Clinical Hospital and Health Research Institute of the San Carlos Clinical Hospital (IdISSC), Madrid, Spain
- Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
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6
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Jamaly S, Lundberg CE, Adiels M, Lagergren J, Björck L, Rosengren A. Incidence of type 2 diabetes after gastric by-pass surgery in a Swedish controlled cohort study. Obes Res Clin Pract 2024; 18:15-20. [PMID: 38199930 DOI: 10.1016/j.orcp.2023.12.001] [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: 06/24/2023] [Revised: 10/18/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024]
Abstract
AIMS To assess the long-term risk of developing type 2 diabetes in patients with obesity who have undergone gastric bypass surgery compared to non-operated patients with obesity and the general population. METHODS This study included 71,495 patients aged 20-65 years with a principal diagnosis of obesity in the Swedish Patient Register in 2001-2013. Of these, 23,099 had undergone gastric bypass and 32,435 had not. Each patient was matched by age, sex and geographic region with two controls from the general population without obesity diagnosis, i.e., 44,735 controls for the gastric bypass cohort and 62,522 controls for the non-operated cohort with obesity. Operated and non-operated patients with obesity were also directly compared using Cox regression analysis, providing hazard ratios (HR) with 95% confidence intervals (CI) adjusted for age, education, and sex. RESULTS During a median follow-up of 4.3 years (interquartile range [IQR] 2.4, 7.0 years), 3792 (11.7%) non-operated patients with obesity developed type 2 diabetes (incidence rate 22.8/1000 person-years, 95% CI 22.1-23.6) compared to 394 (1.7%) among gastric bypass patients (incidence rate 4.0/1000 person-years, 95% CI 3.6-4.5). The latter incidence was comparable to population controls (3.5/1000 person-years, 95% CI 3.2-3.8). Gastric bypass patients had 85% lower risk of diabetes compared to non-operated patients with obesity during the first six years of follow-up (HR 0.15; 95% CI 0.13-0.17). CONCLUSION Gastric bypass surgery for obesity seems to reduce the risk of developing type 2 diabetes to levels similar to that of the general population during the first six years of follow-up but not thereafter.
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Affiliation(s)
- Shabbar Jamaly
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden
| | - Christina E Lundberg
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden
| | - Martin Adiels
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Medicine Geriatrics and Emergency Medicine/Östra, Gothenburg, Sweden
| | - Jesper Lagergren
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute, Karolinska University Hospital, Sweden; School of Cancer and Pharmaceutical Sciences, King's College London, United Kingdom
| | - Lena Björck
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Medicine Geriatrics and Emergency Medicine/Östra, Gothenburg, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Medicine Geriatrics and Emergency Medicine/Östra, Gothenburg, Sweden.
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Beyeler M, Légeret C, Kiwitz F, van der Horst K. Usability and Overall Perception of a Health Bot for Nutrition-Related Questions for Patients Receiving Bariatric Care: Mixed Methods Study. JMIR Hum Factors 2023; 10:e47913. [PMID: 37938894 PMCID: PMC10666014 DOI: 10.2196/47913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/09/2023] [Accepted: 09/02/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Currently, over 4000 bariatric procedures are performed annually in Switzerland. To improve outcomes, patients need to have good knowledge regarding postoperative nutrition. To potentially provide them with knowledge between dietetic consultations, a health bot (HB) was created. The HB can answer bariatric nutrition questions in writing based on artificial intelligence. OBJECTIVE This study aims to evaluate the usability and perception of the HB among patients receiving bariatric care. METHODS Patients before or after bariatric surgery tested the HB. A mixed methods approach was used, which consisted of a questionnaire and qualitative interviews before and after testing the HB. The dimensions usability of, usefulness of, satisfaction with, and ease of use of the HB, among others, were measured. Data were analyzed using R Studio (R Studio Inc) and Excel (Microsoft Corp). The interviews were transcribed and a summary inductive content analysis was performed. RESULTS A total of 12 patients (female: n=8, 67%; male: n=4, 33%) were included. The results showed excellent usability with a mean usability score of 87 (SD 12.5; range 57.5-100) out of 100. Other dimensions of acceptability included usefulness (mean 5.28, SD 2.02 out of 7), satisfaction (mean 5.75, SD 1.68 out of 7), and learnability (mean 6.26, SD 1.5 out of 7). The concept of the HB and availability of reliable nutrition information were perceived as desirable (mean 5.5, SD 1.64 out of 7). Weaknesses were identified in the response accuracy, limited knowledge, and design of the HB. CONCLUSIONS The HB's ease of use and usability were evaluated to be positive; response accuracy, topic selection, and design should be optimized in a next step. The perceptions of nutrition professionals and the impact on patient care and the nutrition knowledge of participants need to be examined in further studies.
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Affiliation(s)
- Marina Beyeler
- Nutrition and Dietetics, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
- Oviva AG, Altendorf, Switzerland
| | | | - Fabian Kiwitz
- Business Information Technology, Zürich University of Applied Sciences, Zürich, Switzerland
- KIRATIK GmbH, Sigmaringen, Germany
| | - Klazine van der Horst
- Nutrition and Dietetics, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
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Binsaeed B, Aljohani FG, Alsobiai FF, Alraddadi M, Alrehaili AA, Alnahdi BS, Almotairi FS, Jumah MA, Alrehaili AT. Barriers and Motivators to Weight Loss in People With Obesity. Cureus 2023; 15:e49040. [PMID: 38116343 PMCID: PMC10729542 DOI: 10.7759/cureus.49040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION Obesity has become a global public health challenge with associated health risks. Effective weight-loss interventions are crucial to mitigating these risks and improving overall well-being. However, individuals with obesity often encounter various barriers that hinder their weight loss efforts, while specific motivators can drive them towards successful outcomes. This systematic review aimed to explore the barriers and motivators to weight loss in people with obesity. METHODS A literature search was conducted using relevant keywords in electronic databases such as PubMed, Medline, PsycINFO, and Google Scholar. Studies published in peer-reviewed journals during the last 10 years were considered for inclusion. We included studies investigating both barriers and/or motivators to weight loss published in English. RESULTS The findings showed that motivators for weight loss include health concerns, body satisfaction, family support, normalcy restoration, emotional encouragement, self-determination, and mindful food choices. Motivators involve exercise facilities, balanced diets, and assistance from healthcare providers, peers, friends, or family. Gender influences healthcare providers' influence on weight loss, with women trusting providers more while men lean towards medication options. Healthcare providers play a role in impacting weight loss through discussions and educating patients. Age also influences motivators; adolescents emphasize health, self-esteem, and bullying avoidance, while young women focus on lifestyle influence, resources, and joy. Barriers include insufficient self-control, physical pain, time constraints, dietary restrictions, and a lack of support. Logistical issues, patient readiness, healthcare providers' views, resource scarcity, and social dynamics are also barriers. Dietary barriers involve triggers, emotional states, and limited healthy options. School-aged children with obesity face curriculum challenges and resource scarcity. CONCLUSION These findings show the intricate interplay between motivators and barriers, underscoring the multifaceted nature of weight loss in people with obesity. Targeted interventions that address these factors holistically are essential for successful weight management.
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Affiliation(s)
| | | | | | | | - Alya A Alrehaili
- College of Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Bushra S Alnahdi
- College of Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
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Lindberg CS, Sandbaek A, Jensen SD, Meldgaard Bruun J, Andreassen P. Communication about weight-related issues with adult patients with obesity in general practice: A scoping review. Obes Sci Pract 2023; 9:548-570. [PMID: 37810526 PMCID: PMC10551109 DOI: 10.1002/osp4.669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 02/28/2023] [Accepted: 03/18/2023] [Indexed: 03/30/2023] Open
Abstract
Background Primary care providers see patients with obesity in general practice every day but may be challenged regarding communication about obesity. The research question of this study is: how do general practitioners and general practice staff and adult patients with obesity communicate about weight-related issues? Methods A scoping review approach was used, searching PubMed, Scopus and CINAHL for peer-reviewed studies - of both quantitative and/or qualitative study designs, and published between 2001 and 2021. Results Twenty articles were included. The weight-related issues discussed were by far physical issues, and only one study mentioned psychosocial issues. Most of the included studies contained information on who initiates the communication, how the weight-related issues are addressed and handled, and also obstacles and challenges in relation to the communication. The studies lacked information of when the weight-related issues are addressed and differences in views and experiences when discussing weight-related issues in general practice. Conclusion Studies with the main focus communication about obesity and overall health in general practice are needed. Findings also indicate, that non-stigmatizing communication tools and guidelines are needed on this area to promote these types of conservations.
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Affiliation(s)
- Cecilie Sonne Lindberg
- Steno Diabetes Center AarhusAarhus University HospitalAarhusDenmark
- Research Unit for General PracticeAarhusDenmark
- Danish National Center for ObesityAarhusDenmark
| | - Annelli Sandbaek
- Steno Diabetes Center AarhusAarhus University HospitalAarhusDenmark
- Research Unit for General PracticeAarhusDenmark
- Department of Public HealthUniversity of AarhusAarhusDenmark
| | - Sissel Due Jensen
- Steno Diabetes Center AarhusAarhus University HospitalAarhusDenmark
- Department of Public HealthUniversity of AarhusAarhusDenmark
| | - Jens Meldgaard Bruun
- Steno Diabetes Center AarhusAarhus University HospitalAarhusDenmark
- Danish National Center for ObesityAarhusDenmark
- Department of Clinical MedicineUniversity of AarhusAarhusDenmark
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Dobbie LJ, Coelho C, Crane J, McGowan B. Clinical evaluation of patients living with obesity. Intern Emerg Med 2023; 18:1273-1285. [PMID: 37119384 PMCID: PMC10412477 DOI: 10.1007/s11739-023-03263-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/11/2023] [Indexed: 05/01/2023]
Abstract
Obesity is a significant public health concern which is implicated in cardiometabolic disease, mechanical complications and psychiatric sequelae. BMI is currently used for diagnosis; however, it has limited sensitivity for adiposity in certain circumstances. This has led to the development of risk stratification tools like the Edmonton Staging criteria and the Kings Obesity Staging Criteria: these facilitate and guide comprehensive obesity-related complication assessment. Healthcare professionals working within obesity clinics should adopt evidence-based communication strategies, including shared decision-making, motivational interviewing, and realistic goal setting. It is also vital to avoid weight-stigmatising terminology in all aspects of care, as this can negatively impact patients. Primary care plays an essential part in obesity care and should work to promptly identify cases, initiate treatment and forward on to specialist services where appropriate. Clinical evaluation of the patient living with obesity should take a holistic approach and involve input from bariatric physicians, dietitians, psychologists, and bariatric surgeons, wider members of the multi-disciplinary team should be involved where needed. Clinicians should take a detailed history, examination and order laboratory tests to investigate for complications. Overall, with appropriate evaluation, these assessments can guide patient management and facilitate long-term improvement in health.
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Affiliation(s)
| | | | - James Crane
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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Abstract
Obesity research is advancing swiftly, but the increase in obesity prevalence is faster. Over the past three decades, researchers have found that biopsychosocial factors determine weight gain much more than personal choices and responsibility. Various genes have found to predispose people to obesity by interacting with our obesogenic environment. In this review, we discuss the impact of physical inactivity, excessive caloric intake, intrauterine environment, postnatal influences, insufficient sleep, drugs, medical conditions, socioeconomic status, ethnicity, psychosocial stress, endocrine disrupting chemicals and the gastrointestinal microbiome, on the occurrence of obesity.
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12
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Huijbers JCJ, Coenen P, Burchell GLB, Coppieters MW, Steenhuis IHM, Van Dieën JH, Koes BW, Kempen DHR, Anema JR, Kingma I, Voogt L, Williams CM, Van Dongen JM, Van der Ploeg HP, Ostelo RWJG, Scholten-Peeters GGM. The (cost-)effectiveness of combined lifestyle interventions for people with persistent low-back pain who are overweight or obese: A systematic review. Musculoskelet Sci Pract 2023; 65:102770. [PMID: 37167807 DOI: 10.1016/j.msksp.2023.102770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 04/21/2023] [Accepted: 04/27/2023] [Indexed: 05/13/2023]
Abstract
INTRODUCTION Lifestyle factors are expected to contribute to the persistence and burden of low-back pain (LBP). However, there are no systematic reviews on the (cost-)effectiveness of combined lifestyle interventions for overweight or obese people with LBP. AIM To assess whether combined lifestyle interventions are (cost-)effective for people with persistent LBP who are overweight or obese, based on a systematic review. DESIGN Systematic review METHOD: PubMed, Cochrane, Embase, CINAHL, PsycINFO and the Wiley/Cochrane Library were searched from database inception till January 6th 2023. Two independent reviewers performed study selection, data-extraction and risk of bias scoring using the Cochrane RoB tool 2 and/or the Consensus Health Economic Criteria list. GRADE was used to assess the level of certainty of the evidence. RESULTS In total 2510 records were screened, and 4 studies on 3 original RCTs with 216 participants were included. Low certainty evidence (1 study) showed that combined lifestyle interventions were not superior to usual care for physical functioning, pain and lifestyle outcomes. Compared to usual care, moderate certainty evidence showed that healthcare (-$292, 95%CI: 872; -33), medication (-$30, 95% CI -65; -4) and absenteeism costs (-$1000, 95%CI: 3573; -210) were lower for the combined lifestyle interventions. CONCLUSION There is low certainty evidence from 3 studies with predominantly small sample sizes, short follow-up and low intervention adherence that combined lifestyle interventions are not superior to physical functioning, pain and lifestyle outcomes compared to usual care, but are likely to be cost-effective.
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Affiliation(s)
- J C J Huijbers
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Program Musculoskeletal Health, the Netherlands
| | - P Coenen
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Amsterdam, the Netherlands.
| | - G L B Burchell
- Medical Library, Vrije Universiteit Amsterdam, the Netherlands
| | - M W Coppieters
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Program Musculoskeletal Health, the Netherlands; Menzies Health Institute Queensland, Griffith University, Brisbane & Gold Coast, Australia
| | - I H M Steenhuis
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Program Musculoskeletal Health, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - J H Van Dieën
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Program Musculoskeletal Health, the Netherlands
| | - B W Koes
- Erasmus Medical Center, University Medical Center Rotterdam, Department of General Practice, the Netherlands
| | - D H R Kempen
- Department of Orthopedic Surgery, Joint Research, OLVG Amsterdam, Amsterdam, the Netherlands
| | - J R Anema
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam, the Netherlands
| | - I Kingma
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Program Musculoskeletal Health, the Netherlands
| | - L Voogt
- NVVR, Dutch Society of Back Pain, the Netherlands
| | - C M Williams
- School of Health Sciences, University of Sydney, Australia; Research and Knowledge Translation Directorate, Mid-North Coast Local Health District, Australia
| | - J M Van Dongen
- Faculty of Science and the Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Faculty of Science and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - H P Van der Ploeg
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam, the Netherlands
| | - R W J G Ostelo
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - G G M Scholten-Peeters
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Program Musculoskeletal Health, the Netherlands
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Vela-Vásquez DA, Sifuentes-Rincón AM, Delgado-Enciso I, Ordaz-Pichardo C, Arellano-Vera W, Treviño-Alvarado V. Effect of Consuming Beef with Varying Fatty Acid Compositions as a Major Source of Protein in Volunteers under a Personalized Nutritional Program. Nutrients 2022; 14:nu14183711. [PMID: 36145087 PMCID: PMC9501318 DOI: 10.3390/nu14183711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 09/03/2022] [Accepted: 09/05/2022] [Indexed: 11/16/2022] Open
Abstract
Beef is an excellent source of nutrients; unfortunately, most nutritional recommendations suggest limiting or even avoiding it. Studies have shown that the fatty acid composition of meat influences weight loss. This randomized controlled clinical trial evaluated the anthropometric and serum lipid changes after a food intervention that included frequent beef consumption (120 g consumed four days/week for four weeks). Volunteers were randomly assigned to the commercial or Wagyu-Cross beef groups, with the latter beef possessing higher fat and MUFA contents. Both groups exhibited reductions in body measurements and lipid profiles; however, the Wagyu-Cross group exhibited greater changes in weight (−3.75 vs. −2.90 kg) and BMI (−1.49 vs. −1.03) than the commercial group, without a significant difference between them. No significant group differences in lipid profiles were observed; however, the Wagyu-Cross group exhibited a more favorable change in decreasing the TC concentration (−7.00 mg/dL) and LDL-C concentration (−12.5 mg/dL). We suggest that high MUFA beef could be included in weight-loss programs since it does not affect weight loss and hasn’t a negative influence on lipid metabolism.
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Affiliation(s)
- Diana A. Vela-Vásquez
- Animal Biotechnology Laboratory, Center for Genomic Biotechnology, Instituto Politécnico Nacional, Reynosa 88710, Mexico
| | - Ana M. Sifuentes-Rincón
- Animal Biotechnology Laboratory, Center for Genomic Biotechnology, Instituto Politécnico Nacional, Reynosa 88710, Mexico
- Correspondence:
| | - Iván Delgado-Enciso
- Faculty of Medicine, University of Colima, Colima 28040, Mexico
- State Institute of Cancerology of the Health Services of the State of Colima, Colima 28085, Mexico
| | - Cynthia Ordaz-Pichardo
- National School of Medicine and Homeopathy, Instituto Politécnico Nacional, Mexico City 07320, Mexico
| | - Williams Arellano-Vera
- Animal Biotechnology Laboratory, Center for Genomic Biotechnology, Instituto Politécnico Nacional, Reynosa 88710, Mexico
| | - Víctor Treviño-Alvarado
- School of Medicine, Tecnológico de Monterrey, Monterrey 64710, Mexico
- The Institute for Obesity Research, Tecnológico de Monterrey, Monterrey 64710, Mexico
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Bays HE, Golden A, Tondt J. Thirty Obesity Myths, Misunderstandings, and/or Oversimplifications: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022. OBESITY PILLARS (ONLINE) 2022; 3:100034. [PMID: 37990730 PMCID: PMC10661978 DOI: 10.1016/j.obpill.2022.100034] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/03/2022] [Indexed: 11/23/2023]
Abstract
Background This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) is intended to provide clinicians an overview of 30 common obesity myths, misunderstandings, and/or oversimplifications. Methods The scientific support for this CPS is based upon published citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership. Results This CPS discusses 30 common obesity myths, misunderstandings, and/or oversimplifications, utilizing referenced scientific publications such as the integrative use of other published OMA CPSs to help explain the applicable physiology/pathophysiology. Conclusions This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) on 30 common obesity myths, misunderstandings, and/or oversimplifications is one of a series of OMA CPSs designed to assist clinicians in the care of patients with the disease of obesity. Knowledge of the underlying science may assist the obesity medicine clinician improve the care of patients with obesity.
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Affiliation(s)
- Harold Edward Bays
- Louisville Metabolic and Atherosclerosis Research Center, University of Louisville School of Medicine, 3288, Illinois Avenue, Louisville, KY, 40213, USA
| | - Angela Golden
- NP Obesity Treatment Clinic, Flagstaff, AZ, 86001, USA
| | - Justin Tondt
- Department of Family and Community Medicine, Penn State Health, Penn State College of Medicine, 700 HMC Crescent Rd Hershey, PA, 17033, USA
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Motivation and Limiting Factors for Adherence to Weight Loss Interventions among Patients with Obesity in Primary Care. Nutrients 2022; 14:nu14142928. [PMID: 35889885 PMCID: PMC9316956 DOI: 10.3390/nu14142928] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/11/2022] [Accepted: 07/14/2022] [Indexed: 02/04/2023] Open
Abstract
The cornerstones of obesity management are diet, physical activity and behavioral change. However, there is considerable scientific evidence that lifestyle interventions to treat obesity are rarely implemented in primary care. The aim of this study is to analyze motivation to lose weight among patients with obesity, the resources implemented by primary care centers to promote behavioral change and the limiting factors reported by the patients themselves when attempting to lose weight. A total of 209 patients diagnosed with obesity were interviewed. The variables were obtained from both electronic clinical records (sex, age, BMI, diagnosis of metabolic syndrome and records of activities prescribed to promote behavioral change) and a self-administered personal questionnaire. A total of 67.5% of the respondents reported not having sufficient motivation to adhere to a weight loss program. Records of behavioral change activities were identified in only 3% of the clinical records reviewed. The barriers to adherence to diet and exercise plans most frequently mentioned by patients were not having a prescribed diet (27.8%), joint pain (17.7%), getting tired or bored of dieting (14.8%) and laziness (11.5%). Both the high percentage of patients reporting insufficient motivation to lose weight and the barriers to weight loss identified suggest that patients feel the need to improve their motivation, which should be promoted through primary care.
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Munro AK, Keep M, Hunter EC, Hossain SZ. Confidence to manage menstruation among university students in Australia: Evidence from a cross-sectional survey. WOMEN'S HEALTH 2022; 18:17455065211070666. [PMID: 35001743 PMCID: PMC8744198 DOI: 10.1177/17455065211070666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: There has been increased attention to university students’ experiences of menstrual disorders, and access to menstrual products, in high-income countries. Less attention has been directed to other aspects of their menstrual experience, including confidence for menstrual management. This study aimed to understand the factors affecting university students’ confidence to manage menstruation at university. Methods: An online survey was completed by 410 participants (age range: 16–46 years, mean = 20.1 years) who menstruate and study at an Australian university. Participants reported demographic characteristics, confidence to manage menstruation at university, and personal, physical and environmental factors. A Mann–Whitney U-test analysed differences in confidence between groups of students. Pearson’s correlation coefficient and bivariate linear regressions determined associations between factors and confidence. Statistically significant associations were inputted into a multiple linear regression model. P-values less than 0.05 were considered significant. Results: A minority of students (16.2%) felt completely confident to manage their menstruation at university. Menstrual knowledge, positive perceptions of menstruation and comfort to discuss menstruation with others positively predicted confidence. Physical menstrual symptoms, negative perceptions of menstruation, perceived stigma and using a menstrual cup or period underwear predicted lower confidence. In multiple regression, private and clean and sanitary university bathroom facilities, changing menstrual products at university, perceived stigma and negative perceptions of menstruation remained significant predictors. Conclusion: Most students did not have complete confidence to manage their menstruation at university. Several personal, physical and environmental factors were related to students’ confidence to manage menstruation. Assessment of these factors in future research with university students is recommended to enable a comprehensive understanding of their menstrual needs, and inform interventions aimed at improving their menstrual management confidence at university.
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Affiliation(s)
- Alana K Munro
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Melanie Keep
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Erin C Hunter
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Syeda Z Hossain
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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17
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Kondo M, Okitsu T, Waki K, Yamauchi T, Nangaku M, Ohe K. Effect of ICT-Based Self-Management System DialBeticsLite on Treating Abdominal Obesity in the Specific Health Guidance in Japan: Randomized Controlled Trial. (Preprint). JMIR Form Res 2021; 6:e33852. [PMID: 35323122 PMCID: PMC8990341 DOI: 10.2196/33852] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/23/2021] [Accepted: 03/08/2022] [Indexed: 01/19/2023] Open
Abstract
Background Mobile health (mHealth) interventions, a more cost-effective approach compared with traditional methods of delivering lifestyle coaching in person, have been shown to improve physical parameters and lifestyle behavior among overweight populations. In Japan, the Specific Health Checkups and Specific Health Guidance (SHG) started in 2008 to treat obesity and abdominal obesity. However, the effectiveness of SHG is limited owing to its in-person counseling. The effect of mHealth on SHG has yet to be demonstrated. Objective This study aims to determine whether a mobile self-management app (DialBeticsLite) could make the SHG more beneficial among patients with abdominal obesity to achieve a reduction in visceral fat area (VFA). Methods This study was an open-label, 2-arm, parallel-design randomized controlled trial. We recruited 122 people in September 2017 and randomly assigned them into either the intervention or control group. All participants attended an educational group session that delivered information regarding diet and exercise. In addition, participants in the intervention group were asked to use DialBeticsLite for 3 months. DialBeticsLite facilitated the daily recording of several physical parameters and lifestyle behavior and provided feedback to encourage an improvement in behavior. The primary outcome was the change in VFA from baseline to the 3-month follow-up. Secondary outcomes included changes in both physical and metabolic parameters from baseline to the 3-month follow-up. The Welch 2-tailed t test was conducted to analyze the effects of DialBeticsLite on both the primary and secondary outcomes. Results Of the 122 participants recruited, 75 (61.5%) were analyzed because 47 (38.5%) were excluded: 37 (30.3%) because of ineligibility and 10 (8.2%) because of withdrawal of consent. The mean age was 49.3 (SD 6.1) years in the intervention group (41/75, 55%) and 48.5 (SD 5.3) years in the control group (34/75, 45%), and all participants were men, although unintentionally. The baseline characteristics did not differ significantly between the intervention and control groups, except for VFA. The average change of VFA was −23.5 (SD 20.6) cm2 in the intervention group and +1.9 (SD 16.2) cm2 in the control group (P<.001). Statistically significant differences were also found for the change of body weight, BMI, and waist circumference. These findings did not change after adjusting for VFA at the baseline. The intervention had no significant effect on any of the metabolic parameters. An exploratory analysis showed significant associations between the change in VFA and steps per day and between the change in VFA and calorie intake per day within the intervention group. Conclusions Our findings indicate that an mHealth intervention facilitating the daily monitoring of several physical parameters and lifestyle behavior can be highly effective in inducing visceral fat loss and weight loss among adults eligible for SHG. Trial Registration UMIN Clinical Trials Registry UMIN000042045; https://tinyurl.com/4vat3v53
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Affiliation(s)
- Masahiro Kondo
- Department of Planning, Information and Management, University of Tokyo Hospital, Tokyo, Japan
- Graduate School of Interdisciplinary Information Studies, The University of Tokyo, Tokyo, Japan
| | - Teru Okitsu
- Institute of Industrial Science, The University of Tokyo, Tokyo, Japan
| | - Kayo Waki
- Department of Biomedical Informatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuhiko Ohe
- Department of Planning, Information and Management, University of Tokyo Hospital, Tokyo, Japan
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Salas XR. Closing obesity care gaps and achieving health equity for people living with obesity. Eur J Intern Med 2021; 91:1-2. [PMID: 34226117 DOI: 10.1016/j.ejim.2021.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 11/24/2022]
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