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Welsh A, Hammad M, Piña IL, Kulinski J. Obesity and cardiovascular health. Eur J Prev Cardiol 2024; 31:1026-1035. [PMID: 38243826 PMCID: PMC11144464 DOI: 10.1093/eurjpc/zwae025] [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: 10/24/2023] [Revised: 01/06/2024] [Accepted: 01/17/2024] [Indexed: 01/22/2024]
Abstract
Obesity has risen to epidemic levels worldwide over the past few decades and has become a huge global health burden owing to its direct contribution to the development of some of the most prevalent chronic diseases including diabetes, hypertension, hyperlipidaemia, and other cardiovascular diseases. Obesity is a disease of positive energy balance resulting from complex interactions between abnormal neurohumoral responses and an individual's socioeconomic, environmental, behavioural, and genetic factors leading to a state of chronic inflammation. Understanding the complex nature of the disease is crucial in determining the best approach to combat its rising numbers. Despite recent advancements in pharmacological therapy for the treatment of obesity, reversing weight gain and maintaining weight loss is challenging due to the relapsing nature of the disease. Prevention, therefore, remains the key which needs to start in utero and continued throughout life. This review summarizes the role obesity plays in the pathophysiology of various cardiovascular diseases both by directly affecting endothelial and myocyte function and indirectly by enhancing major cardiovascular risk factors like diabetes, hypertension, and hyperlipidaemia. We highlight the importance of a holistic approach needed to prevent and treat this debilitating disease. Particularly, we analyse the effects of plant-based diet, regular exercise, and non-exercise activity thermogenesis on obesity and overall cardiorespiratory fitness. Moreover, we discuss the significance of individualizing obesity management with a multimodal approach including lifestyle modifications, pharmacotherapy, and bariatric surgery to tackle this chronic disease.
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Affiliation(s)
- Aimee Welsh
- Division of Cardiology, Medical College of Wisconsin, 8701 W. Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - Muhammad Hammad
- Division of Cardiology, Medical College of Wisconsin, 8701 W. Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - Ileana L Piña
- Division of Cardiology, Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA 19107, USA
| | - Jacquelyn Kulinski
- Division of Cardiology, Medical College of Wisconsin, 8701 W. Watertown Plank Rd, Milwaukee, WI 53226, USA
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Lichtfuss K, Franco-Arellano B, Jefferson K, Brady J, Arcand J. The implementation of non-weight focused approaches in clinical practice: A Canadian cross-sectional study among registered dietitians. J Hum Nutr Diet 2024; 37:610-621. [PMID: 38273641 DOI: 10.1111/jhn.13284] [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: 08/21/2023] [Accepted: 01/03/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND An increasing number of dietitians use non-diet approaches, referred to as non-weight focused practice approaches (NWFAs), in clinical practice when working with higher weight adult clients. However, the factors that impact dietitians' ability to successfully implement these approaches in practice are unknown. METHODS Aiming to examine how implementing NWFAs in clinical practice differs based on the extent to which a dietitian uses NWFAs with their clients, we conducted a cross-sectional online survey among Canadian registered dietitians who work with higher weight adults (May to July 2021), developed and validated following the Consolidated Framework for Implementation Research. Descriptive statistics were conducted to identify barriers and facilitators with respect to implementing NWFAs. The Kruskal-Wallis was used to test for differences in barriers and facilitators with respect to implementing NWFAs among five different practice approaches. The results showed that, among participants (n = 383; 82% white; 95% women) the most important barriers for implementation of NWFAs were clients' focus on weight as an outcome, when losing weight is a condition to access enhanced services, requiring changes to their practice philosophy, difficulty funding professional development and not having sufficient skills or knowledge to implement NWFAs in practice. Top-rated facilitators included the use of clinical guidelines, scientific publications and educational materials, which were rated with higher agreement across all implementation stages (p < 0.001). CONCLUSIONS The present study highlights important factors that may impact the effective implementation of NWFAs in dietetic practice for higher weight adult clients, which is essential to minimise barriers in practice.
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Affiliation(s)
- Kori Lichtfuss
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
| | | | | | - Jennifer Brady
- School of Nutrition and Dietetics, Acadia University, Wolfville, NS, Canada
| | - JoAnne Arcand
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
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Oikarinen AK, Kähkönen O, Kaakinen P, Kääriäinen M, Virtanen M, Paalimäki-Paakki K, Hylkilä K, Männikkö N, Kerimaa H, Kivelä K, Jansson M, Kajula O, Männistö M, Lahtinen M, Vanhanen M, Rajala M. Nurses' experiences of competence in lifestyle counselling with adult patients in healthcare settings: A qualitative systematic literature review. J Clin Nurs 2024; 33:1684-1708. [PMID: 38332566 DOI: 10.1111/jocn.17050] [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: 08/21/2023] [Revised: 01/17/2024] [Accepted: 01/23/2024] [Indexed: 02/10/2024]
Abstract
AIMS AND OBJECTIVES To identify and synthesise nurses' experiences of competence in lifestyle counselling with adult patients in healthcare settings. BACKGROUND Modifiable lifestyle risk behaviours contribute to an increased prevalence of chronic diseases worldwide. Lifestyle counselling is part of nurses' role which enables them to make a significant contribution to patients' long-term health in various healthcare contexts, but requires particular competence. DESIGN Qualitative systematic literature review and meta-aggregation. METHOD The review was guided by Joanna Briggs Institute's methodology for conducting synthesis of qualitative studies. PRISMA-checklist guided the review process. Relevant original studies were search from databases (CINAHL, PubMed, Scopus, Medic and Psych Articles, Ebscho Open Dissertations and Web of Science). After researcher consensus was reached and quality of the studies evaluated, 20 studies were subjected to meta-aggregation. RESULTS From 20 studies meeting the inclusion criteria, 75 findings were extracted and categorised into 13 groups based on their meaning, resulting in the identification of 5 synthesised findings for competence description: Supporting healthy lifestyle adherence, creating interactive and patient-centred counselling situations, acquiring competence through clinical experience and continuous self-improvement, collaborating with other professionals and patients, planning lifestyle counselling and managing work across various stages of the patient's disease care path. CONCLUSION The review provides an evidence base that can be used to support nurses' competence in lifestyle counselling when working with adult patients in healthcare settings. Lifestyle counselling competence is a complex and rather abstract phenomenon. The review identified, analysed and synthesised the evidence derived from nurses' experience which shows that lifestyle counselling competence is a multidimensional entity which relates to many other competencies within nurses' work. IMPLICATIONS FOR THE PROFESSION Recognising the competencies of nurses in lifestyle counselling for adult patients can stimulate nurses' motivation. The acquisition of these competencies can have a positive impact on patients' lives and their health. PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution. IMPACT The research may enhance nurses' competence in lifestyle counselling, leading to improved health outcomes, better adherence to recommendations and overall well-being. It may also drive the development of interventions, improving healthcare delivery in lifestyle counselling. REPORTING METHOD The review was undertaken and reported using the PRISMA guidelines. PROTOCOL REGISTRATION Blinded for the review.
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Affiliation(s)
- Anne Kaarina Oikarinen
- Research Unit of Health Science and Technology, Medical Research Centre Oulu, Faculty of Medicine, Oulu University, Oulu, Finland
- The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence Group, Helsinki, Finland
| | - Outi Kähkönen
- The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence Group, Helsinki, Finland
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Pirjo Kaakinen
- Research Unit of Health Science and Technology, Medical Research Centre Oulu, Faculty of Medicine, Oulu University, Oulu, Finland
- The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence Group, Helsinki, Finland
| | - Maria Kääriäinen
- Research Unit of Health Science and Technology, Medical Research Centre Oulu, Faculty of Medicine, Oulu University, Oulu, Finland
- The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence Group, Helsinki, Finland
| | - Mari Virtanen
- Helsinki Metropolia University of Applied Sciences, Helsinki, Finland
| | | | - Krista Hylkilä
- The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence Group, Helsinki, Finland
- Research Unit of Health Science and Technology, Faculty of Medicine, Oulu University, Oulu, Finland
| | - Niko Männikkö
- Research Unit of Health Science and Technology, Medical Research Centre Oulu, Faculty of Medicine, Oulu University, Oulu, Finland
- The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence Group, Helsinki, Finland
| | - Heli Kerimaa
- Research Unit of Health Science and Technology, Medical Research Centre Oulu, Faculty of Medicine, Oulu University, Oulu, Finland
- The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence Group, Helsinki, Finland
| | - Kirsi Kivelä
- Wellbeing Services Country of North Ostrobothnia, Oulu, Finland
| | - Miia Jansson
- Research Unit of Health Science and Technology, Medical Research Centre Oulu, Faculty of Medicine, Oulu University, Oulu, Finland
- The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence Group, Helsinki, Finland
- RMIT University, Melbourne, Australia
| | - Outi Kajula
- Oulu University of Applied Sciences, Oulu, Finland
| | - Merja Männistö
- The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence Group, Helsinki, Finland
- Master School at Diaconia University of Applied Sciences, Helsinki, Finland
| | - Minna Lahtinen
- Research Unit of Health Science and Technology, Medical Research Centre Oulu, Faculty of Medicine, Oulu University, Oulu, Finland
| | - Minna Vanhanen
- The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence Group, Helsinki, Finland
- Oulu University of Applied Sciences, Oulu, Finland
| | - Mira Rajala
- Research Unit of Health Science and Technology, Medical Research Centre Oulu, Faculty of Medicine, Oulu University, Oulu, Finland
- The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence Group, Helsinki, Finland
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Standen EC, Rothman AJ, Mann T. Consequences of receiving weight-related advice from a healthcare provider: Understanding the varied experiences of people with higher weight. Soc Sci Med 2024; 347:116784. [PMID: 38522232 DOI: 10.1016/j.socscimed.2024.116784] [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: 03/25/2023] [Revised: 01/11/2024] [Accepted: 03/11/2024] [Indexed: 03/26/2024]
Abstract
Healthcare providers regularly give weight-related advice (e.g., behavioral weight loss counseling) to patients with higher weight (BMI ≥30 kg/m2). The U.S. Preventive Services Task Force recommends this practice on the basis that behavioral weight-related advice can motivate patients to attempt weight loss; however, it is also possible that this advice has adverse consequences (e.g., negative psychological reactions). In this study, we examined people's reported reactions to a recent experience of receiving weight-related advice from a healthcare provider. U.S. adults (N = 189) with higher weight who reported having received weight-related advice completed an online survey via Prolific. They answered questions about their most recent experience of receiving weight-related advice, including the purpose of the visit, characteristics of their provider, and characteristics of the advice itself. They also provided demographic information and indicated their trust in healthcare providers and the healthcare system. 90.5% of participants (n = 171) reported having one of three types of reactions to their provider's weight-related advice. Participants (1) felt motivated to change their behaviors and weight; (2) felt bad or guilty about their behaviors and weight; or (3) felt both motivated to change and bad or guilty. Using chi-square tests of independence and one-way ANOVAs, we examined how various participant characteristics and characteristics of the visit, provider, and advice itself differed across these three groups. We found significant demographic differences across the groups and found that a disproportionate amount of people in the "motivated" group reported having requested the weight-related advice and having had a two-way discussion about weight with their provider. Whereas some people feel motivated after receiving weight-related advice from a healthcare provider, others are left feeling bad about themselves or ambivalent. Understanding these varied reactions may provide insights into how healthcare providers can deliver advice that is motivating without eliciting negative psychological reactions.
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Affiliation(s)
- Erin C Standen
- Department of Psychology, University of Minnesota, 75 East River Road, Minneapolis, MN, 55455, USA.
| | - Alexander J Rothman
- Department of Psychology, University of Minnesota, 75 East River Road, Minneapolis, MN, 55455, USA
| | - Traci Mann
- Department of Psychology, University of Minnesota, 75 East River Road, Minneapolis, MN, 55455, USA
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Zhang P, Zhang L, Chen W. Patients' perception of lifestyle advice as a mechanism between health shocks and health behaviours: Evidence from a longitudinal study in China. J Glob Health 2024; 14:04059. [PMID: 38515430 PMCID: PMC10958586 DOI: 10.7189/jogh.14.04059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
Background The heavy burden of non-communicable chronic diseases (NCDs) and the deficiency of health behaviours (HB) are threatening the middle- and older-aged population in China. However, little is known about the relational mechanism between health shocks (HS) and HBs, while the importance of patients' perception of lifestyle advice (PPLA) to initiate HB is insufficiently emphasised. In this study, we aimed to examine this perception as a mediator between HS and HB and the variety of mediation effects caused by the different contents of lifestyle advice. Methods We retrieved panel data from the two latest waves of a nationally representative cohort, the China Health and Retirement Longitudinal Study (CHARLS). After constructing well-balanced groups through propensity score matching, we conducted descriptive and multilevel logistic regression analyses to analyse the state of and factors influencing PPLA. We employed the Preacher's Sobel test with 1000 replications bootstrap to examine the mediating effect of PPLA. Results On a sample of 7922 respondents (post-propensity score matching), we found that HSs had a positive direct effect on HB, with observed decreases in smoking and drinking and increases in exercise. A limited and selected perception of lifestyle advice showed a gap between the advice given by providers and perceived by patients, with gender, education level, social support inside the family, self-reported health, comorbidity, treatment regimens, and utilisation of family doctors being significant influencing factors. Nevertheless, any content of lifestyle advice partially mediated the relationship in which HS increases non-addictive HB (exercise), while only the targeted and detailed content of lifestyle advice about corresponding behaviours partially mediated the effect between HS and addictive HB (smoking and drinking). Conclusions This study provides the first evidence that PPLA partially mediates the positive effect of HS on HB. Personalised chronic disease management; targeted advice and interventions; and multiple social resources COULD BE beneficial for patients with HS to initiate HB.
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Affiliation(s)
- Peng Zhang
- School of Public Health, Fudan University, Xuhui District, Shanghai, China
- School of Humanities, Shanghai Institute of Technology, Fengxian District, Shanghai, China
| | - Luying Zhang
- School of Public Health, Fudan University, Xuhui District, Shanghai, China
| | - Wen Chen
- School of Public Health, Fudan University, Xuhui District, Shanghai, China
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Carlson SR, Imam N, Seidenstein A, Klein G. Evaluation of weight loss counsel for Osteoarthritis patients: A cross-sectional analysis of NHANES 2011-2018. Osteoarthritis Cartilage 2024; 32:82-92. [PMID: 37777150 DOI: 10.1016/j.joca.2023.08.013] [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: 06/07/2023] [Revised: 08/23/2023] [Accepted: 08/29/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVE Though health care providers (HCPs) know the importance of weight loss counsel for Osteoarthritis (OA), little is known about how frequently it is practiced and even less of its effectiveness. Thus, we analyzed the prevalence and effectiveness of weight counsel receipt in overweight/obese OA patients. DESIGN Using 2011-2018 National Health and Nutrition Examination Survey data, we cross-sectionally analyzed overweight/obese patients in the United States to determine the prevalence of receipt of HCP weight counsel in those with OA and among other variables. We used multivariate logistic regression models to calculate odds ratios of being counseled and of achieving ten percent weight loss in groups with and without counsel. Mean weight losses were also compared among groups. RESULTS 39,156 patients were identified, of whom 1948 met inclusion criteria. Overall, 51.89% of overweight/obese OA patients received weight counseling. The odds of receiving counsel varied with several demographic variables. The odds of achieving 10% weight loss in those counseled was 1.84 times (95% confidence interval: 1.028, 3.299) that of those not counseled (p = 0.04). In contrast, patients counseled lost a mean of 0.49 pounds while those not counseled gained a mean of 0.03 pounds, a difference which was not statistically significant (p = 0.59). CONCLUSION Prevalence of weight counsel receipt for OA has not changed significantly between 2011 and 2018. Though counsel for weight more frequently leads to adequate weight loss in those with OA, the average weight loss is minimal regardless of counsel. Thus, refinement of this intervention may be needed to bolster weight loss.
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Affiliation(s)
- Steven R Carlson
- Hackensack Meridian School of Medicine, United States; Hackensack Meridian Health, Department of Orthopedics, United States.
| | - Nareena Imam
- Rutgers Robert Wood Johnson Medical School, United States.
| | - Ari Seidenstein
- Hackensack Meridian School of Medicine, United States; Hackensack Meridian Health, Department of Orthopedics, United States; Holy Name Medical Center, United States.
| | - Gregg Klein
- Hackensack Meridian School of Medicine, United States; Hackensack Meridian Health, Department of Orthopedics, United States; Holy Name Medical Center, United States.
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Brennan BR, Beals KA, Burns RD, Chow CJ, Locke AB, Petzold MP, Dvorak TE. Impact of Culinary Medicine Course on Confidence and Competence in Diet and Lifestyle Counseling, Interprofessional Communication, and Health Behaviors and Advocacy. Nutrients 2023; 15:4157. [PMID: 37836442 PMCID: PMC10574678 DOI: 10.3390/nu15194157] [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: 08/25/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
Most physicians report inadequate training to provide diet and lifestyle counseling to patients despite its importance to chronic disease prevention and management. To fill the nutrition training gap, elective Culinary Medicine (CM) courses have emerged as an alternative to curriculum reform. We evaluated the impact of an interprofessional CM course for medical and health professional students who experienced the hands-on cooking component in person or a in mixed-mode format (in-person and via Zoom) at the University of Utah from 2019-2023 (n = 84). A factorial ANOVA assessed differences between educational environment and changes between pre- and post-course survey responses related to diet and lifestyle counseling, interprofessional communication, and health behaviors and advocacy. Qualitative comments from post-course surveys were analyzed on a thematic level. Students rated themselves as having greater confidence and competence in diet and lifestyle counseling (p < 0.05) and increased ability to prepare eight healthy meals (p < 0.05). Additionally, a Mann-Whitney two-sample rank-sum test was used to compare data from exit survey responses from medical students who took the CM course (n = 48) and did not take the CM course (n = 297). Medical students who took CM were significantly more likely to agree that they could counsel patients about nutrition (p < 0.05) and physical activity (p < 0.05). CM courses may improve students' confidence to provide diet and lifestyle counseling.
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Affiliation(s)
- Britta Retzlaff Brennan
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT 84112, USA;
| | - Katherine A. Beals
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT 84112, USA;
| | - Ryan D. Burns
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT 84112, USA;
| | - Candace J. Chow
- Department of Internal Medicine, University of Utah, Salt Lake City, UT 84112, USA;
| | - Amy B. Locke
- Department of Family and Preventative Medicine, University of Utah, Salt Lake City, UT 84112, USA; (A.B.L.); (M.P.P.)
| | - Margaret P. Petzold
- Department of Family and Preventative Medicine, University of Utah, Salt Lake City, UT 84112, USA; (A.B.L.); (M.P.P.)
| | - Theresa E. Dvorak
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT 84112, USA;
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Repking S, Mayer K, Folkers C, Shah V, Janardhan S. An Evaluation of an Advanced Practice Provider Led Weight Intervention in Liver Disease (WILD) Pathway. Gastroenterol Nurs 2023; 46:289-295. [PMID: 37158384 DOI: 10.1097/sga.0000000000000740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 03/10/2023] [Indexed: 05/10/2023] Open
Abstract
Within the scope of their practice, advanced practice providers provide similar patient care as physicians, but in some cases have outperformed physicians in terms of health outcomes, satisfaction, and cost-effectiveness. At an academic medical center, hepatology trained advanced practice providers, who were also certified in obesity management, led an interprofessional team to develop the Weight Intervention in Liver Disease pathway. In September 2018, patients who were seen in the hepatology practice and met criteria for enrollment were referred to the Weight Intervention in Liver Disease program for comprehensive care of obesity and related metabolic disorders. A program evaluation was conducted in 2021 to identify whether the effectiveness of the advanced practice provider-led structure and process, and the Weight Intervention in Liver Disease pathway, supported weight loss goals as well as improvement in alanine aminotransferase levels, patient satisfaction, and provider satisfaction. Results found that the structure of the pathway and the implementation are resulting in positive outcomes of 100% patient satisfaction, 80% provider satisfaction, and a total average sustained weight loss of 5.05% ( SD = 7.98, p < .01). A weight loss pathway led by trained advanced practice providers proves successful in long-term weight loss goals.
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Affiliation(s)
- Sarah Repking
- Sarah Repking, DNP, ACNP-BC, is a nurse practitioner and WILD provider in the department of hepatology at Rush University Medical Center, Chicago, Illinois
- Karen Mayer, PhD, RN, is an assistant professor of Rush University College of Nursing, Chicago, Illinois
- Colleen Folkers, APN-BC, is a nurse practitioner and WILD provider in the department of hepatology at Rush University Medical Center, Chicago, Illinois
- Vicki Shah, DMSc, PA-C, was a physican assistant at the department of hepatology at Rush University Medical Center, Chicago, Illinois. She currently serves as a medical science liason for Gilead Sciences
- Sujit Janardhan, PhD, MD, is a hepatologists in the department of hepatology at Rush University Medical Center, Chicago, Illinois and currently serves as the medical director of the WILD Pathway
| | - Karen Mayer
- Sarah Repking, DNP, ACNP-BC, is a nurse practitioner and WILD provider in the department of hepatology at Rush University Medical Center, Chicago, Illinois
- Karen Mayer, PhD, RN, is an assistant professor of Rush University College of Nursing, Chicago, Illinois
- Colleen Folkers, APN-BC, is a nurse practitioner and WILD provider in the department of hepatology at Rush University Medical Center, Chicago, Illinois
- Vicki Shah, DMSc, PA-C, was a physican assistant at the department of hepatology at Rush University Medical Center, Chicago, Illinois. She currently serves as a medical science liason for Gilead Sciences
- Sujit Janardhan, PhD, MD, is a hepatologists in the department of hepatology at Rush University Medical Center, Chicago, Illinois and currently serves as the medical director of the WILD Pathway
| | - Colleen Folkers
- Sarah Repking, DNP, ACNP-BC, is a nurse practitioner and WILD provider in the department of hepatology at Rush University Medical Center, Chicago, Illinois
- Karen Mayer, PhD, RN, is an assistant professor of Rush University College of Nursing, Chicago, Illinois
- Colleen Folkers, APN-BC, is a nurse practitioner and WILD provider in the department of hepatology at Rush University Medical Center, Chicago, Illinois
- Vicki Shah, DMSc, PA-C, was a physican assistant at the department of hepatology at Rush University Medical Center, Chicago, Illinois. She currently serves as a medical science liason for Gilead Sciences
- Sujit Janardhan, PhD, MD, is a hepatologists in the department of hepatology at Rush University Medical Center, Chicago, Illinois and currently serves as the medical director of the WILD Pathway
| | - Vicki Shah
- Sarah Repking, DNP, ACNP-BC, is a nurse practitioner and WILD provider in the department of hepatology at Rush University Medical Center, Chicago, Illinois
- Karen Mayer, PhD, RN, is an assistant professor of Rush University College of Nursing, Chicago, Illinois
- Colleen Folkers, APN-BC, is a nurse practitioner and WILD provider in the department of hepatology at Rush University Medical Center, Chicago, Illinois
- Vicki Shah, DMSc, PA-C, was a physican assistant at the department of hepatology at Rush University Medical Center, Chicago, Illinois. She currently serves as a medical science liason for Gilead Sciences
- Sujit Janardhan, PhD, MD, is a hepatologists in the department of hepatology at Rush University Medical Center, Chicago, Illinois and currently serves as the medical director of the WILD Pathway
| | - Sujit Janardhan
- Sarah Repking, DNP, ACNP-BC, is a nurse practitioner and WILD provider in the department of hepatology at Rush University Medical Center, Chicago, Illinois
- Karen Mayer, PhD, RN, is an assistant professor of Rush University College of Nursing, Chicago, Illinois
- Colleen Folkers, APN-BC, is a nurse practitioner and WILD provider in the department of hepatology at Rush University Medical Center, Chicago, Illinois
- Vicki Shah, DMSc, PA-C, was a physican assistant at the department of hepatology at Rush University Medical Center, Chicago, Illinois. She currently serves as a medical science liason for Gilead Sciences
- Sujit Janardhan, PhD, MD, is a hepatologists in the department of hepatology at Rush University Medical Center, Chicago, Illinois and currently serves as the medical director of the WILD Pathway
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Greaney ML, Xu F, Ward-Ritacco CL, Cohen SA, Ellis KA, Riebe D. Does Healthcare Provider Counseling for Weight Management Behaviors among Hispanic Adults Who Are Overweight/Obese Vary by Acculturation Level? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2778. [PMID: 36833475 PMCID: PMC9957032 DOI: 10.3390/ijerph20042778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 06/18/2023]
Abstract
This cross-sectional study explored differences in the receipt of health care provider (HCP) counseling to control/lose weight and adopt weight-related lifestyle behavior changes among Hispanic respondents according to acculturation level. Differences in reported action regarding HCP counseling were also examined. Data from four National Health and Nutrition Examination Survey (NHANES) cycles (2011-2018) were analyzed, with the analytic sample limited to Hispanic respondents who were overweight/obese. Respondents' acculturation levels were derived from their reported country of origin and the primary language spoken at home. Respondents who reported speaking only Spanish or more Spanish than English at home were classified as primarily speaking Spanish at home. In contrast, those who reported speaking Spanish and English equally, more English than Spanish, or only English were categorized as primarily speaking English at home. Weighted multivariate logistic regression models were utilized to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to determine if differences in acculturation levels existed regarding the likelihood of receiving HCP counseling to (1) control/lose weight, (2) increase exercise/PA, and (3) reduce fat/calorie intake. Similar analyses examined differences in reported action regarding HCP counseling according to acculturation level. The analysis found no significant differences in receiving HCP counseling according to acculturation level. However, non-US-born respondents who primarily spoke Spanish at home were less likely than US-born respondents to report acting to control/lose weight (p = 0.009) or increase exercise/PA (p = 0.048), but were more likely to report having taken action to reduce fat/calorie intake (p = 0.016). This study revealed differences between acting on recommendations of health care professionals according to acculturation level, indicating a need for interventions tailored to acculturation levels.
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Affiliation(s)
- Mary L. Greaney
- Department of Health Studies, University of Rhode Island, Kingston, RI 02881, USA
| | - Furong Xu
- School of Education, University of Rhode Island, Kingston, RI 02881, USA
| | | | - Steven A. Cohen
- Department of Health Studies, University of Rhode Island, Kingston, RI 02881, USA
| | - Kerri A. Ellis
- College of Nursing, University of Rhode Island, Kingston, RI 02881, USA
| | - Deborah Riebe
- Department of Kinesiology, University of Rhode Island, Kingston, RI 02881, USA
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LaVela SL, Burkhart E, Jones K, Pellegrini C. Health care provider views on the magnitude of overweight/obesity in spinal cord injury and awareness of evidence-based guidance for weight management. PM R 2023; 15:20-30. [PMID: 34534402 DOI: 10.1002/pmrj.12709] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/02/2021] [Accepted: 09/10/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Literature shows that large proportions of people with a spinal cord injury (SCI) continue to experience challenges and limitations in weight management (WM) efforts in the health care setting. Despite the need, evidence-based research on effective and practical WM practices for persons with SCI is inconsistent and not widely used by health care providers (HCPs). OBJECTIVE The objectives were twofold: (1) to explore HCP perspectives of the extent of the problem of overweight/obesity in individuals with SCI and (2) HCPs awareness of and beliefs about availability of literature or evidence-based guidelines that discuss WM in SCI. DESIGN Qualitative study using semistructured interviews with HCPs and thematic analysis to identify themes. PARTICIPANTS/SETTING SCI HCPs (n = 25) from Veterans Health Administration and Midwest Regional SCI Care System. INTERVENTION Not applicable. RESULTS SCI HCPs (88%) emphasized the large scope of the problem of overweight and obesity in persons with SCI. HCPs noted the multiple associated negative consequences, specifically 84% highlighted the impact on chronic conditions (cardiometabolic, respiratory) and 48% discussed the impact on secondary/associated conditions (skin, bowel, bladder, musculoskeletal). HCPs noted other impacts of excess weight as greater disability in later life (28%), challenges with mobility and function (60%), self-care (24%), and equipment safety (28%). This sample of HCPs (76%) indicated being unaware of published or available information about WM efforts that work in SCI populations. CONCLUSION Our findings indicate that HCPs believe that overweight and obesity is a significant problem in persons with SCI but that this sample of HCPs are not aware of published work and easily accessible SCI-specific WM evidence-based guidance. This suggests the need for more education and proactive efforts to improve awareness of appropriate information within interprofessional HCPs.
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Affiliation(s)
- Sherri L LaVela
- Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines, Illinois, USA.,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Elizabeth Burkhart
- Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines, Illinois, USA.,Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, Illinois, USA
| | - Kayla Jones
- Midwest Regional SCI Care System (MRSCICS), Shirley Ryan AbilityLab (SRAlab), Chicago, Illinois, USA
| | - Christine Pellegrini
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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Influence of Nutrition Training, Eating Habits, and Culinary Skills of Health Care Professionals and Its Impact in the Promotion of Healthy Eating Habits. TOP CLIN NUTR 2023. [DOI: 10.1097/tin.0000000000000307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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12
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Tate DF, Kraschnewski JL, Martinez C, Diamond M, Veldheer S, Hwang KO, Lehman EB, Sciamanna CN. A cluster-randomized controlled trial of automated internet weight-loss programs in primary care: Role of automated provider feedback. Obesity (Silver Spring) 2022; 30:2363-2375. [PMID: 36416000 PMCID: PMC9912959 DOI: 10.1002/oby.23506] [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: 10/01/2021] [Revised: 05/05/2022] [Accepted: 05/07/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Despite the high prevalence of obesity and associated health risks in the United States adult population, few primary care providers (PCPs) have time and training to provide weight-management counseling to their patients. This study aims to compare the effect of referral to a comprehensive automated digital weight-loss program, with or without provider email feedback, with usual care on weight loss in patients with overweight or obesity. METHODS A total of 550 adults (mean [SD], 51.4 [11.2] years, BMI = 35.1 [5.5] kg/m2 , 72.0% female) were enrolled through their PCPs (n = 31). Providers were randomly assigned to refer their patients to a 12-month internet weight-loss intervention only (IWL), the intervention plus semiautomated feedback from the provider (IWL + PCP), or to usual care (EUC). Weight was measured at baseline and at 3, 6, and 12 months. RESULTS Weight changes (mean [SE]) at 12 months were -0.92 (0.46), -3.68 (0.46), and -3.58 (0.48) kg in the EUC, IWL, and IWL + PCP groups, respectively. Outcomes were significantly different in EUC versus IWL and EUC versus IWL + PCP (p < 0.001), but not in IWL versus IWL + PCP. CONCLUSIONS Referral by PCPs to an automated weight-loss program holds promise for patients with obesity. Future research should explore ways to further promote accountability and adherence.
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Affiliation(s)
- Deborah F. Tate
- Departments of Health Behavior and Nutrition, Gillings School of Global Public Health; Lineberger Comprehensive Cancer Center, School of Medicine; University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jennifer L. Kraschnewski
- Departments of Medicine, Pediatrics and Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA, United States
| | - Caitlin Martinez
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Molly Diamond
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Susan Veldheer
- Department of Family and Community Medicine, Pennsylvania State University, College of Medicine, Hershey, PA; Department of Public Health Sciences, Pennsylvania State University, College of Medicine, Hershey, PA, United States
| | - Kevin O. Hwang
- University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Erik B. Lehman
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Christopher N. Sciamanna
- Department of Public Health Sciences, Pennsylvania State University, College of Medicine, Hershey, PA; Department of General Internal Medicine, Pennsylvania State University, College of Medicine, Hershey, PA United States
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13
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Dhungana RR, Pedisic Z, de Courten M. Implementation of non-pharmacological interventions for the treatment of hypertension in primary care: a narrative review of effectiveness, cost-effectiveness, barriers, and facilitators. BMC PRIMARY CARE 2022; 23:298. [PMID: 36418958 PMCID: PMC9686020 DOI: 10.1186/s12875-022-01884-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The current guidelines for the prevention, detection, evaluation, and management of hypertension recommend six types of non-pharmacological interventions: alcohol reduction, salt intake reduction, increased potassium intake, physical activity, weight loss, and heart-healthy diets. However, the non-pharmacological interventions are still not widely used in primary care. In this paper, we, therefore, reviewed and summarised the evidence on the effectiveness, cost-effectiveness, barriers, and facilitators of non-pharmacological interventions for the treatment of hypertension in primary care. METHODS A thorough literature search was conducted in Embase, Google Scholar, and PubMed databases, to identify the most recent reviews or, in their absence, primary studies on alcohol reduction, salt intake reduction, potassium supplementation, physical activity, weight reduction, heart-healthy diets, and other non-pharmacological interventions for the treatment of hypertension in primary care. RESULTS Alcohol reduction is a non-pharmacological intervention for the treatment of hypertension in primary care with proven effectiveness, feasibility, and acceptability. Interventions for sodium intake reduction, physical activity, and weight reduction are effective but there is insufficient evidence regarding their feasibility and acceptability in primary care settings. Evidence on the effectiveness of potassium intake and heart-healthy diets is limited and inconsistent. There is a lack of evidence on the cost-effectiveness of non-pharmacological interventions in the treatment of hypertension. The most common barriers to deliver such interventions related to healthcare providers include a lack of time, knowledge, self-confidence, resources, clear guidelines, and financial incentives. The most common barriers related to patients include a lack of motivation and educational resources. Less evidence is available on facilitators of implementing non-pharmacological interventions in primary care. Besides, facilitators differed by different types of interventions. CONCLUSIONS Available evidence suggests that more pragmatic, clinically feasible, and logistically simple interventions are required for sodium intake reduction, physical activity, and weight reduction in primary care settings. Future studies should provide further evidence on the effectiveness of weight control, potassium intake, and heart-healthy diets. More research is also needed on cost-effectiveness and facilitators of all types of effective non-pharmacological interventions for the treatment of hypertension in primary care.
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Affiliation(s)
- Raja Ram Dhungana
- Institute for Health and Sport, Victoria University, Melbourne, Australia.
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | - Zeljko Pedisic
- Institute for Health and Sport, Victoria University, Melbourne, Australia
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14
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Odgers KR, Jurado LFM, Kamienski M. Nurse Practitioner-Led Ketogenic Diet for Adults With Overweight/Obesity. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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15
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Kurz D, McCrea-Robertson S, Nelson-Brantley H, Befort C. Rural engagement in primary care for optimizing weight reduction (REPOWER): A mixed methods study of patient perceptions. PATIENT EDUCATION AND COUNSELING 2022; 105:2371-2381. [PMID: 34865892 DOI: 10.1016/j.pec.2021.11.028] [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: 06/17/2021] [Revised: 11/10/2021] [Accepted: 11/27/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To report on patients' satisfaction and experience of care across three different modes of weight loss counseling. METHODS 1407 patients with obesity in the rural Midwest were enrolled to a 2-year weight management trial through their primary care practice and assigned to one of three treatment conditions: in-clinic individual, in-clinic group, phone group counseling. Patients completed surveys assessing seven domains of satisfaction and experience of care at 6 and 24-months. Post-treatment interviews were conducted to add context to survey responses. RESULTS 1295 (92.0%) and 1230 (87.4%) completed surveys at 6 and 24-months, respectively. Patients in phone group counseling reported lower satisfaction than patients who received in-clinic group or in-clinic individual counseling across all domains at 6-months and five out of seven domains at 24-months. Interviews revealed that patients were more satisfied when they received face-to-face counseling and had meaningful interactions with their primary care provider (PCP) about their weight. CONCLUSION Rural patients with obesity have higher satisfaction and experience of care when weight loss counseling is delivered in a face-to-face environment and when their PCP is involved with their treatment. PRACTICE IMPLICATIONS Primary care practices looking to offer weight loss treatment should consider incorporating some level of face-to-face treatment plans that involves meaningful interaction with the PCP.
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Affiliation(s)
- Daniel Kurz
- University of Kansas School of Medicine, Department of Population Health, Kansas City, KS USA.
| | - Stacy McCrea-Robertson
- University of Kansas School of Medicine, Department of Population Health, Kansas City, KS USA
| | | | - Christie Befort
- University of Kansas School of Medicine, Department of Population Health, Kansas City, KS USA
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16
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Karabukayeva A, Anderson JL, Hall AG, Feldman SS, Mehta T. Exploring a Need for a Cardiometabolic Disease Staging System as a Computerized Clinical Decision Support Tool: Qualitative Study. JMIR Form Res 2022; 6:e37456. [PMID: 35776499 PMCID: PMC9288101 DOI: 10.2196/37456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/02/2022] [Accepted: 06/16/2022] [Indexed: 12/05/2022] Open
Abstract
Background Although cardiometabolic diseases are leading causes of morbidity and mortality in the United States, computerized tools for risk assessment of cardiometabolic disease are rarely integral components of primary care practice. Embedding cardiometabolic disease staging systems (CMDS) into computerized clinical decision support systems (CDSS) may assist with identifying and treating patients at greatest risk for developing cardiometabolic disease. Objective This study aimed to explore the current approach to medical management of obesity and the need for CMDS designed to aid medical management of people living with obesity, at risk of being obese, or diabetic at the point of care. Methods Using a general inductive approach, this qualitative research study was guided by an interpretive epistemology. The method included semistructured, in-depth interviews with primary care providers (PCPs) from university-based community health clinics. The literature informed the interview protocol and included questions on PCPs’ experiences and the need for a tool to improve their ability to manage and prevent complications from overweight and obesity. Results PCPs (N=10) described their current approaches and emphasized behavioral treatments consisting of combined diet, physical activity, and behavior therapy as the first line of treatment for people who were overweight or obese. Results suggest that beneficial features of CDSS include (1) clinically relevant and customizable support, (2) provision of a comprehensive medical summary with trends, (3) availability of patient education materials and community resources, and (4) simplicity and ease of navigation. Conclusions Implementation of a CMDS via a CDSS could enable PCPs to conduct comprehensive cardiometabolic disease risk assessments, supporting clinical management of overweight, obesity, and diabetes. Results from this study provide unique insights to developers and researchers by identifying areas for design optimization, improved end user experience, and successful adoption of the CDSS.
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Affiliation(s)
- Aizhan Karabukayeva
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jami L Anderson
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Allyson G Hall
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Sue S Feldman
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
- Department of Graduate Medical Education, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Tapan Mehta
- Department of Family and Community Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
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17
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Laguerre E, Matthews T. Association between Nutrition Behavior and Colorectal Cancer Diet Recommendation. J Cancer Prev 2022; 27:79-88. [PMID: 35864857 PMCID: PMC9271404 DOI: 10.15430/jcp.2022.27.2.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 03/30/2022] [Accepted: 05/20/2022] [Indexed: 11/16/2022] Open
Abstract
The incidence of colorectal cancer has considerably increased worldwide, particularly among adults aged 50 and older. Despite numerous nutrition initiatives, colorectal cancer (CRC) remains a public health burden that affects younger adults in the United States. Understanding the potential factors contributing to non-adherence to nutrition recommendations can be helpful to develop effective nutrition initiatives to prevent CRC. This study aimed to determine differences in nutrition knowledge, attitudes, and beliefs (KAB); examine their associations on diet characteristics and weight status; and identify factors influencing eating patterns among ethnically diverse populations at risk for CRC and living in urban areas. The study used a quantitative descriptive and correlational research design in which data were collected through an online cross-sectional survey. A total of 377 participants responded to the survey. The study revealed a few significant differences in KAB levels between males and females. KAB levels were not associated with weight status but with meat recommendations among overweight or obese males. Ultimately, the study identified perceived barriers and facilitators as factors influencing participants’ diets. Differences in KAB among males and females were inconsistent with the diet characteristics and weight status variables. This study suggests acknowledging these differences and inconsistencies when designing nutrition initiatives focusing on colorectal cancer prevention.
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Affiliation(s)
- Emmanuelle Laguerre
- Department of Health Science, College of Graduate Health Studies, A.T. Still University, Mesa, AZ, USA
| | - Tracy Matthews
- Department of Health Science, College of Graduate Health Studies, A.T. Still University, Mesa, AZ, USA
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18
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Chen JN, Dennis JA, St. John JA, Shen CL. Self-Reported Patient Compliance With Physician Advised Lifestyle Behavior Changes Among Adults With Musculoskeletal Conditions. Front Public Health 2022; 10:821150. [PMID: 35284362 PMCID: PMC8907563 DOI: 10.3389/fpubh.2022.821150] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Approximately half of adult Americans suffer from musculoskeletal disorders (MSD). Significant risk factors for musculoskeletal disorders include poor diet, obesity, and insufficient physical activity. Studies show that lifestyle change education and interventions reduce MSD risk factors. However, little is known about the relationship between physician advice for behavior change and reported behavior change by MSD patients. This study explored the association between physician advice for lifestyle change and reported change in MSD patients, as well as the effects that patient education levels have on compliance. Methods This study used data from the 2017 National Health Interview Survey, a nationally representative cross-sectional survey of non-institutionalized US adults. The research team limited analysis to adults who reported a limitation due to musculoskeletal problems (n = 2,672). Outcomes included physician recommendations to increase physical activity, reduce fat/calories, or lose weight, and whether they enacted these behavioral changes. Adjusted logistic regression models examined whether compliance with doctor's instructions differed by education level. Results Adjusted models show patients advised to change physical activity, diet, and weight were more likely to report attempted behavior change. Education was positively associated with likelihood of complying with physician advice to increase physical activity. Among patients not advised to change behaviors by a physician, education was positively associated with current behavior change attempts. Conclusion This study suggests that physician recommendations are relevant predictors of reported behavior change in individuals with MSD. Although education plays an important role in this association, the relationship is complex and multifaceted. Future studies should explore how compliance may be impacted by other factors, such as physician message type.
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Affiliation(s)
- Jason N. Chen
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, United States
- *Correspondence: Jason N. Chen
| | - Jeff A. Dennis
- Julia Jones Matthews Department of Public Health, Graduate School of Biomedical Sciences, Texas Tech University Health Sciences Center, Lubbock, TX, United States
| | - Julie A. St. John
- Center of Excellence for Integrative Health, Lubbock, TX, United States
- Julia Jones Matthews Department of Public Health, Graduate School of Biomedical Sciences, Texas Tech University Health Sciences Center, Abilene, TX, United States
| | - Chwan-Li Shen
- Center of Excellence for Integrative Health, Lubbock, TX, United States
- Center of Excellence for Translational Neuroscience and Therapeutics, Lubbock, TX, United States
- Department of Pathology, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, United States
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Taylor PC, Van de Laar M, Laster A, Fakhouri W, Quebe A, de la Torre I, Jain S. Call for action: incorporating wellness practices into a holistic management plan for rheumatoid arthritis-going beyond treat to target. RMD Open 2021; 7:e001959. [PMID: 34893537 PMCID: PMC8666892 DOI: 10.1136/rmdopen-2021-001959] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/23/2021] [Indexed: 01/07/2023] Open
Abstract
This expert opinion article explores the strategy of adopting a holistic approach to the management of rheumatoid arthritis (RA) by incorporating the wellness practices of exercise, optimised sleep, optimised nutrition, mindfulness, social connectedness and positive emotions into the management plan. The aim is to attain optimal health for each patient beyond that achievable by limiting disease management to pharmacological treatment to attain the lowest achievable composite scores of disease activity, as recommended with the current treat-to-target approach, and addressing the recent recognition of pain control as a key patient-reported outcome. Incorporating wellness practices into a busy clinical setting requires creativity and customisation based on the individual practice setting and the individual needs of each patient. Such practices can help people living with RA to achieve optimum wellness through the introduction of measures-according to individual need-designed to improve the aspects of life most impacted for that person, thereby complementing treat-to-target and pain control strategies with pharmacological agents. Clinicians must consider wellness practices in addition to treat-to-target pharmacological agents for the holistic management of people with RA.
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Affiliation(s)
- Peter C Taylor
- Botnar Research Centre, NDORMS, University of Oxford, Oxford, UK
| | - Mart Van de Laar
- Transparency in Healthcare B.V, University of Twente, Hengelo, The Netherlands
| | - Andrew Laster
- Arthritis & Osteoporosis Consultants of the Carolinas, Charlotte, North Carolina, USA
| | | | - Amanda Quebe
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | - Saundra Jain
- School of Nursing, The University of Texas at Austin, Austin, Texas, USA
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20
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Ockene JK, Pbert L, Crawford S, Frisard CF, Pendharkar JA, Sadasivam RS, Faro J, Okuliar C, Eno C, Margo K, Shaw MA, Soleymani T, Stadler DD, Warrier S, White K, Geller AC. Teaching Medical Students to Help Patients Manage Their Weight: Outcomes of an Eight-School Randomized Controlled Trial. J Gen Intern Med 2021; 36:3000-3007. [PMID: 33835315 PMCID: PMC8034040 DOI: 10.1007/s11606-020-06571-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/29/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Given the rising rates of obesity there is a pressing need for medical schools to better prepare students for intervening with patients who have overweight or obesity and for prevention efforts. OBJECTIVE To assess the effect of a multi-modal weight management curriculum on counseling skills for health behavior change. DESIGN A pair-matched, group-randomized controlled trial (2015-2020) included students enrolled in eight U.S. medical schools randomized to receive either multi-modal weight management education (MME) or traditional weight management education (TE). SETTING/PARTICIPANTS Students from the class of 2020 (N=1305) were asked to participate in an objective structured clinical examination (OSCE) focused on weight management counseling and complete pre and post surveys. A total of 70.1% of eligible students (N=915) completed the OSCE and 69.3% (N=904) completed both surveys. INTERVENTIONS The MME implemented over three years included a web-based course, a role-play classroom exercise, a web-patient encounter with feedback, and an enhanced clerkship experience with preceptors trained in weight management counseling (WMC). Counseling focused on the 5As (Ask, Advise, Assess, Assist, Arrange) and patient-centeredness. MEASUREMENTS The outcome was student 5As WMC skills assessed using an objective measure, an OSCE, scored using a behavior checklist, and a subjective measure, student self-reported skills for performing the 5As. RESULTS Among MME students who completed two of three WMC components compared to those who completed none, exposure was significantly associated with higher OSCE scores and self-reported 5A skills. LIMITATIONS Variability in medical schools requiring participation in the WMC curriculum. CONCLUSIONS This trial revealed that medical students struggle with delivering weight management counseling to their patients who have overweight or obesity. Medical schools, though restrained in adding curricula, should incorporate should incorporate multiple WMC curricula components early in medical student education to provide knowledge and build confidence for supporting patients in developing individualized plans for weight management. NIH TRIAL REGISTRY NUMBER R01-194787.
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Affiliation(s)
- Judith K Ockene
- Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.
| | - Lori Pbert
- Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Sybil Crawford
- Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Christine F Frisard
- Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Jyothi A Pendharkar
- Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Rajani S Sadasivam
- Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Jamie Faro
- Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | | | - Cassie Eno
- Creighton University School of Medicine, Omaha, NE, USA
| | - Katherine Margo
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Monica Ann Shaw
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Taraneh Soleymani
- Previously at the University of Alabama, Birmingham, AL and now at Penn State Health, Middletown, PA, USA
| | | | | | | | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Cambridge, MA, USA
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21
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Joseph CLM, Alexander GL, Lu M, Leatherwood SL, Kado R, Olden H, Melkonian C, Miree CA, Johnson CC. Pilot study of a brief provider and EMR-based intervention for overweight teens with asthma. Pilot Feasibility Stud 2021; 7:167. [PMID: 34462008 PMCID: PMC8404363 DOI: 10.1186/s40814-021-00848-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 04/28/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Asthma-related morbidity is increased in overweight patients, yet providers are given little guidance on how to discuss weight and asthma management with overweight teens. OBJECTIVE We piloted an electronic medical record (EMR)-based tailored discussion guide (TDG) and a brief provider training, to address weight management in overweight teens with asthma. The primary outcome was intervention impact on patient-reported asthma outcomes (e.g., asthma control and morbidity). Secondary outcomes included change in BMI, patient-centeredness, and change in healthy behaviors. METHODS Teens aged 13-18 years with persistent asthma and a body mass index ≥ 85th percentile for their age and sex were eligible. Parents of eligible teens were contacted before an upcoming appointment to allow teen enrollment during the clinic visit. Providers reviewed Motivational Interviewing (MI) concepts and were trained in the TDG for support of conversations around weight and asthma management. Measures included asthma outcomes retrieved from the EMR at 6- and 12-month post-baseline, teen impressions of patient-provider communication at 6-week post-enrollment, and teen report of healthy behaviors at 6- and 12-month post-baseline. RESULTS Of 44 teens enrolled (77% African-American, 63% female), mean BMI for intervention (n=25) and control groups (n=19) at baseline were similar. Thirty participants (68%) completed a 6-week questionnaire. Compared to controls, at 6 months, intervention teens reported fewer days of limited activity and "uncontrolled asthma," but at 12 months, only restricted activity remained lower, and BMI was not reduced. Intervention teens reported clinic visits that were more patient-centered than controls, including discussion of asthma treatment options with provider, feeling ready to follow an asthma treatment routine, and receiving helpful tips about reaching a healthy weight. The healthy behavior "dinner with family" showed improvement for intervention teens at 6 and 12 months. The feasibility study also revealed a need to improve recruitment strategies and to streamline intervention delivery. CONCLUSION Modest improvements in patient-reported asthma outcomes and health behaviors were observed. There was strong evidence that the TDG supports provider discussion of weight and asthma to create a more patient-centered conversation from the perspective of participating teens. Challenges to recruitment and clinic adaptation must be addressed before advancing to a full-scale trial. TRIAL REGISTRATION NCT02575326 Teen Asthma Control Encouraging a Healthier Lifestyle, www.cllinicaltrials.gov.
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Affiliation(s)
- Christine L M Joseph
- Department of Public Health Sciences, Henry Ford Health System, 1 Ford Place, 3E, Detroit, MI, 48202, USA.
| | - Gwen L Alexander
- Department of Public Health Sciences, Henry Ford Health System, 1 Ford Place, 3E, Detroit, MI, 48202, USA
| | - Mei Lu
- Department of Public Health Sciences, Henry Ford Health System, 1 Ford Place, 3E, Detroit, MI, 48202, USA
| | | | - Rachel Kado
- Division of Allergy and Immunology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Heather Olden
- Department of Public Health Sciences, Henry Ford Health System, 1 Ford Place, 3E, Detroit, MI, 48202, USA
| | - Christina Melkonian
- Department of Public Health Sciences, Henry Ford Health System, 1 Ford Place, 3E, Detroit, MI, 48202, USA
| | - Cheryl A Miree
- Department of Public Health Sciences, Henry Ford Health System, 1 Ford Place, 3E, Detroit, MI, 48202, USA
| | - Christine Cole Johnson
- Department of Public Health Sciences, Henry Ford Health System, 1 Ford Place, 3E, Detroit, MI, 48202, USA
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Zoltick D, Scribani MB, Krupa N, Kern M, Vaccaro E, Jenkins P. Healthy Lifestyle Counseling by Healthcare Practitioners: A Time to Event Analysis. J Prim Care Community Health 2021; 12:21501327211024427. [PMID: 34142610 PMCID: PMC8216346 DOI: 10.1177/21501327211024427] [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] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Medical societies have heavily prioritized preventive care, as evidenced by numerous best practice guidelines supporting counseling patients on lifestyle factors. This report examines preventive counseling by healthcare providers in a rural healthcare system. We utilized electronic medical records to determine whether patient characteristics and chronic conditions were predictors of preventive counseling, and what the average time-interval was before a patient received this counseling. METHODS Medical records from a cohort of 395 subjects participating in the 1999 Bassett Health Census Survey were reviewed for documented counseling with respect to smoking cessation, weight management, physical activity, and health condition-related diets (anti-hypertensive and diabetic diets). RESULTS Our analyses revealed extensive delays in counseling for smoking cessation among smokers (median time to counseling = 4.2 years), for weight management among the obese (median time = 4.8 years), and for physical activity for all subjects (median time = 10.9 years). For those with diabetes, a median time of 7.5 years passed before being counseled on a diabetic diet. Hypertensive diet counseling did not occur for more than 50% of hypertensives. CONCLUSION In this population, we did not find documentation of lifestyle counseling that was in compliance with current guidelines for any of the lifestyle factors. The measurement of actual delay times provides further support for the position that preventive efforts of health care providers need to be improved.
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Affiliation(s)
- David Zoltick
- University of Rochester, Rochester, NY, USA.,Bassett Healthcare Network, Cooperstown, NY, USA
| | | | - Nicole Krupa
- Bassett Healthcare Network, Cooperstown, NY, USA
| | - Megan Kern
- Bassett Healthcare Network, Cooperstown, NY, USA
| | | | - Paul Jenkins
- Bassett Healthcare Network, Cooperstown, NY, USA
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Surgeon Decision-Making for Individuals With Obesity When Indicating Total Joint Arthroplasty. J Arthroplasty 2021; 36:2708-2715.e1. [PMID: 33865649 DOI: 10.1016/j.arth.2021.02.078] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/22/2021] [Accepted: 02/27/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Obesity is a risk factor for complications after total joint arthroplasty (TJA). This study analyzed the impact of individual surgeon demographics, financial concerns, and other factors in determining patient candidacy for TJA based on body mass index (BMI). METHODS A 21-question survey was approved by the American Association of Hip and Knee Surgeons Research Committee for distribution to its membership. Objective questions asked about surgeon or hospital BMI thresholds for offering TJA. Subjective questions asked about physician comfort discussing topics including obesity, bariatric surgery, and weight loss before TJA, as well as insurance and age considerations. RESULTS For TJA procedures, 49.9% of surgeons had a BMI cutoff at 40, 24.5% at 45, and 8.3% at 50. At a BMI cutoff of 40, 23.8% of surgeons felt their patient volume would be adversely affected, whereas at a BMI cutoff of 35, 50% of surgeons felt their patient volume would be adversely affected. Surgeons were more likely to not perform total hip arthroplasty on patients with morbid obesity than total knee arthroplasty (P = .037). Significantly more academic surgeons did not have cutoffs for total hip arthroplasty (P = .003) or total knee arthroplasty (P < .001) compared with all other practice settings. CONCLUSION There are myriad factors that affect surgeon BMI thresholds for offering elective TJA including poor outcomes, hospital thresholds, financial considerations, and the well being of the patient. Further work should be performed to minimize the risks associated with TJA while providing the best possible care to patients with morbid obesity.
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Reading JM, Snell LM, LaRose JG. A systematic review of weight-related communication trainings for physicians. Transl Behav Med 2021; 10:1110-1119. [PMID: 33044535 DOI: 10.1093/tbm/ibaa014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Obesity is a leading cause of preventable death in the USA. Given the high number of adults seeking routine health care services, physicians have an opportunity to address weight loss during routine clinical encounters. It's often reported that physicians lack the training to address weight. Training programs are implemented in medical settings to prepare physicians to have conversations with patients. Yet, the degree of consistency among training programs and factors associated with better outcomes is unclear. The purpose of this study is to systematically review literature in physician communication trainings related to weight-to compare the content, outcomes, and implementation of existing studies examining weight-related communication training programs for physicians and determine factors associated with physician and patient outcomes. Articles were extracted from PubMed, Proquest, and Embase. Search terms included: health communication, physician training, weight, and obesity. Studies implementing a training program addressing weight among physicians were included. Trainings using either motivational interviewing (MI) or 5 As (Ask, Advise, Assess, Assist, and Arrange) framework found improvements in physicians' communication skills. A small number of trainings including experiential components were also associated with improvements in positive physician outcomes. Findings suggest trainings based in MI or 5 As framework improve physicians' communication skills, but few programs affected patient outcomes. Gaps remain with trainings that can demonstrate weight loss in patients. While work is needed to enhance the effects of these trainings on patient outcomes, data suggest that trainings should be longer in duration and include an experiential component.
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Affiliation(s)
- Jean M Reading
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - L Morgan Snell
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Jessica Gokee LaRose
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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Suissa K, Schneeweiss S, Kim DW, Patorno E. Prescribing trends and clinical characteristics of patients starting antiobesity drugs in the United States. Diabetes Obes Metab 2021; 23:1542-1551. [PMID: 33651454 DOI: 10.1111/dom.14367] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 12/24/2022]
Abstract
AIM To assess the trends in the prescribing of antiobesity medications and the characteristics of patients recently initiating antiobesity drugs. MATERIALS AND METHODS We conducted a population-based cohort study using claims data from commercial health insurances in the United States. Patients initiating an antiobesity drug between January 2004 and December 2018 were included. Trends in the utilization of antiobesity medications were plotted by year, as a proportion of any antiobesity treatment, and as initiation rates per 100 000. Descriptive statistics were used to summarize the characteristics of antiobesity initiators. RESULTS From 2004 to 2018, 626 216 patients started an antiobesity medication (two per 100 000). Phentermine was the most frequently prescribed (50% in 2018). In recent years (2015-2018), among 227 692 patients who initiated an antiobesity drug, 51% started phentermine, 19% naltrexone-bupropion, and 13% liraglutide 3.0 mg. Compared to other agents, the use of liraglutide 3.0 mg increased between 2015 and 2018. The average age of initiators was 45 years, 81% of initiators were female, 32% had hypertension, 25% had dyslipidaemia, and 6% had type 2 diabetes. Time on treatment was generally short (mean 81 days). CONCLUSION The overall use of antiobesity medications remained low over the past 15 years and phentermine was the preferred antiobesity agent. Although the use of potentially safer antiobesity agents, for example, liraglutide 3.0 mg, has increased in recent years, phentermine remained the most frequently prescribed agent among middle-aged adults with a moderate burden of comorbidities.
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Affiliation(s)
- Karine Suissa
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sebastian Schneeweiss
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Dong Wook Kim
- School of Medicine, Boston University, Boston, Massachusetts, USA
| | - Elisabetta Patorno
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Johnston EA, Arcot A, Meengs J, Dreibelbis TD, Kris-Etherton PM, Wiedemer JP. Culinary Medicine for Family Medicine Residents. MEDICAL SCIENCE EDUCATOR 2021; 31:1015-1018. [PMID: 34457944 PMCID: PMC8368964 DOI: 10.1007/s40670-021-01283-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 06/02/2023]
Abstract
BACKGROUND Physicians are inadequately trained to effectively provide lifestyle counseling to manage the obesity epidemic. ACTIVITY Family and community medicine residents participated in a culinary medicine course taught by two Registered Dietitian Nutritionists (RDNs) in University Park, PA, in March 2020. RESULTS All residents (n = 13) reported increased knowledge, 92% (n = 12) reported increased confidence, and 84.6% (n = 11) reported they intended to make changes to their practice based on the class. Most participating residents (85%, n = 11) would attend follow-up classes. DISCUSSION Residents recognized the importance of nutrition in clinical care and found the information to be applicable to practice.
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Affiliation(s)
- Emily A. Johnston
- Department of Nutritional Sciences, Penn State University, University Park, PA USA
| | - Amrita Arcot
- Department of Nutritional Sciences, Penn State University, University Park, PA USA
| | - Jennifer Meengs
- Department of Nutritional Sciences, Penn State University, University Park, PA USA
| | | | | | - Joseph P. Wiedemer
- Penn State Family and Community Medicine Residency at Mount Nittany Medical Center, State College, PA USA
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Improving Care for Childhood Obesity: A Quality Improvement Initiative. Pediatr Qual Saf 2021; 6:e412. [PMID: 34046541 PMCID: PMC8143745 DOI: 10.1097/pq9.0000000000000412] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 12/04/2020] [Indexed: 11/29/2022] Open
Abstract
Obesity affected 13.7 million children in the United States in 2015. The American Academy of Pediatrics (AAP) offers an evidence-based approach to obesity management, but adherence to recommendations is suboptimal. Our objective was to improve provider adherence to the AAP recommendations for care of patients with obesity by making systematic changes in our practice for patients of ages > 2 and younger than 19 years with a BMI > 95th percentile.
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Greaney ML, Cohen SA, Xu F, Ward-Ritacco CL, Riebe D. Healthcare provider counselling for weight management behaviours among adults with overweight or obesity: a cross-sectional analysis of National Health and Nutrition Examination Survey, 2011-2018. BMJ Open 2020; 10:e039295. [PMID: 33234635 PMCID: PMC7684803 DOI: 10.1136/bmjopen-2020-039295] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To determine if adults with overweight or obesity received counselling from their healthcare providers (HCPs) to lose weight and/or adopt healthful behaviours associated with weight loss, and whether they took action on their HCPs' recommendations. DESIGN Cross-sectional analysis of 2011-2018 National Health and Nutrition Examination Survey (NHANES) data. SAMPLE NHANES respondents aged 18+ who were overweight/obese and had seen an HCP in the previous 12 months (n=13 158). METHODS Respondents reported if their HCPs recommended they control/lose weight, increase exercise/physical activity (PA) and/or reduce fat/calorie intake, and if they adopted the offered recommendation(s). Weighted logistic regression models examined receipt of HCP counselling by sex, age, race/ethnicity, and weight status accounting for demographic characteristics and complex sampling. Similar analyses examined reported adoption of HCPs' recommendations. RESULTS The sample was 53.1% women, 45.0% were overweight and 55.0% had obesity. In total, 40.4% received counselling to control/lose weight, 49.5% to increase exercise/PA and 38.9% to reduce fat/calorie intake. The following groups were less likely (p<0.001) to receive counselling: men; younger adults (aged 18-39) versus middle-aged (aged 40-64) and older adults (aged 65+); White versus Black and Hispanic respondents; overweight respondents versus respondents with obesity. Approximately half of those advised to make changes reported doing so (53.6% controlled/lost weight, 57.3% increased exercise/PA, 51.8% reduced fat/calorie intake). Differences in the adoption of recommendations were identified by sex, age group, race/ethnicity and weight status (all p<0.05); women, middle-aged and older adults, Black and Hispanic respondents and individuals with obesity were more likely to adopt one or more recommendations. CONCLUSION Most respondents did not receive HCP counselling, and approximately half of those who received counselling reported taking action. HCPs may need training to provide counselling and to offer recommendations tailored to the social contexts of populations less likely to adopt weight control related recommendations.
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Affiliation(s)
- Mary L Greaney
- Department of Health Studies, University of Rhode Island, Kingston, Rhode Island, USA
| | - Steven A Cohen
- Department of Health Studies, University of Rhode Island, Kingston, Rhode Island, USA
| | - Furong Xu
- Kinesiology Department, University of Rhode Island, Kingston, Rhode Island, USA
| | | | - Deborah Riebe
- Kinesiology Department, University of Rhode Island, Kingston, Rhode Island, USA
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Young DR, Sidell MA, Fitzpatrick S, Koebnick C, Nau CL, Oshiro C, Horberg M. Characteristics of adults with overweight and obesity who have not attempted weight loss in the prior 12 months. Obes Res Clin Pract 2020; 14:449-455. [PMID: 32847735 DOI: 10.1016/j.orcp.2020.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 07/24/2020] [Accepted: 08/03/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine weight-related characteristics of adults with overweight or obesity who had not attempted weight loss in the prior 12 months. METHODS Adults from the obesity cohort of the PORTAL clinical data research network were randomly selected to complete a survey in 2015. It included topics of experiences with health care providers, weight history, and health-promoting behaviors. RESULTS A total of 2811 adults completed the survey, of whom 24% reported not attempting weight loss in the previous 12 months. Controlling for sociodemographic characteristics and body mass index, respondents who reported that their health care provider never talked about weight were more likely to not attempt weight loss in the previous 12 months compared with respondents who reported providers frequently brought up weight (OR: 0.45; 95% CI: 0.24, 0.66). Respondents who perceived themselves as normal weight or underweight were 4.22 times more likely (95% CI: 3.53, 5.05) to not attempt weight loss compared with respondents who perceived themselves as overweight. Respondents who reported that they never tried to lose at least 10 lbs, ate 0-2 servings of fruits and vegetables daily, or engaged in 0-29 min of physical activity weekly were less likely to attempt weight loss. CONCLUSIONS Receiving advice on weight loss from health care providers to improve awareness of overweight and obesity status may be important factors for a person's weight management. Provider discussions about weight may be a strategy to motivate weight loss attempts.
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Affiliation(s)
- Deborah Rohm Young
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave., Pasadena, CA, USA.
| | - Margo A Sidell
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave., Pasadena, CA, USA
| | - Stephanie Fitzpatrick
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, USA
| | - Corinna Koebnick
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave., Pasadena, CA, USA
| | - Claudia L Nau
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave., Pasadena, CA, USA
| | - Caryn Oshiro
- Center for Health Research, Kaiser Permanente Hawaii, 501 Alakawa Street, Suite 201, Honolulu, HI, USA
| | - Michael Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, 2101 East Jefferson Street, 3 West, Rockville, MD, USA
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Hodsdon A, Smith NA, Story DA. Preoperative communication between anaesthetists and patients with obesity regarding perioperative risks and weight management: a structured narrative review. Perioper Med (Lond) 2020; 9:24. [PMID: 32817786 PMCID: PMC7425592 DOI: 10.1186/s13741-020-00154-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 06/11/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Individuals with obesity frequently present for anaesthesia and surgery. Good communication during the preoperative consultation can optimise the provision of relevant health information and guide improvement of health status preoperatively. METHODS We planned a systematic literature review to assess existing guidelines and evidence of effectiveness for how anaesthetists should communicate with patients who have obesity in the preoperative period about perioperative risks and weight management. Database searches used keywords related to perioperative weight loss conversations. We found no papers that directly addressed our aim. The literature identified as most relevant was analysed in the form of a narrative review. RESULTS The majority of suggestions for weight loss conversations came from primary care. Four primary themes potentially relevant to anaesthetists were identified: barriers to such conversations, communication tools, language and communication and specific recommendations. Identified barriers included lack of skills, training, poor remuneration, pessimism and time constraints for clinicians. Established discussion tools including the '5A's' approach (Assess, Advise, Agree, Assist, Arrange) and motivational interviewing may hold promise to improve preoperative conversations. The papers highlighted a need for empathetic language, including use of patient-specific language where possible. CONCLUSIONS There are currently no published guidelines for how anaesthetists could most effectively discuss weight in the perioperative period with patients who have obesity. Much of the literature for obesity communication is based on the primary care setting. The perioperative period may represent an increased time of receptiveness for patients. Guidelines for discussions about weight management and associated perioperative risk are suggested.
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Affiliation(s)
- Anthony Hodsdon
- Department of Anaesthetics, Wollongong Hospital, Loftus St., Wollongong, NSW 2500 Australia
| | - Natalie Anne Smith
- Department of Anaesthetics, Wollongong Hospital, Loftus St., Wollongong, NSW 2500 Australia
| | - David A. Story
- Centre for Integrated Critical Care, Department of Medicine & Radiology, Melbourne Medical School, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, 151 Barry Street, Parkville, VIC 3010 Australia
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Pawar AS, Nagpal S, Pawar N, Lerman LO, Eirin A. General Public's Information-Seeking Patterns of Topics Related to Obesity: Google Trends Analysis. JMIR Public Health Surveill 2020; 6:e20923. [PMID: 32633725 PMCID: PMC7448178 DOI: 10.2196/20923] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/25/2020] [Accepted: 07/07/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Obesity is a major public health challenge, and recent literature sheds light on the concept of "normalization" of obesity. OBJECTIVE We aimed to study the worldwide pattern of web-based information seeking by public on obesity and on its related terms and topics using Google Trends. METHODS We compared the relative frequency of obesity-related search terms and topics between 2004 and 2019 on Google Trends. The mean relative interest scores for these terms over the 4-year quartiles were compared. RESULTS The mean relative interest score of the search term "obesity" consistently decreased with time in all four quartiles (2004-2019), whereas the relative interest scores of the search topics "weight loss" and "abdominal obesity" increased. The topic "weight loss" was popular during the month of January, and its median relative interest score for January was higher than that for other months for the entire study period (P<.001). The relative interest score for the search term "obese" decreased over time, whereas those scores for the terms "body positivity" and "self-love" increased after 2013. CONCLUSIONS Despite a worldwide increase in the prevalence of obesity, its popularity as an internet search term diminished over time. The reason for peaks in months should be explored and applied to the awareness campaigns for better effectiveness. These patterns suggest normalization of obesity in society and a rise of public curiosity about image-related obesity rather than its medical implications and harm.
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Affiliation(s)
- Aditya S Pawar
- Division of Nephrology, Mayo Clinic, Rochester, MN, United States
| | - Sajan Nagpal
- Divison of Gastroenterology, University of Chicago, Chicago, IL, United States
| | - Neha Pawar
- Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Lilach O Lerman
- Division of Nephrology, Mayo Clinic, Rochester, MN, United States
| | - Alfonso Eirin
- Division of Nephrology, Mayo Clinic, Rochester, MN, United States
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Pourat N, Chen X, Lu C, Zhou W, Daniel M, Hoang H, Sripipatana A. Racial/ethnic variations in weight management among patients with overweight and obesity status who are served by health centres. Clin Obes 2020; 10:e12372. [PMID: 32447835 DOI: 10.1111/cob.12372] [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: 09/30/2019] [Revised: 04/09/2020] [Accepted: 04/28/2020] [Indexed: 11/28/2022]
Abstract
This study sought to examine racial/ethnic variations in receipt of provider recommendations on weight loss, patient adherence, perception of weight, attempts at weight loss and actual weight loss among patients with overweight/obesity status at Health Resources and Services Administration-funded health centres (HC). We used a 2014 nationally representative survey of adult HC patients with overweight/obesity status (PwOW/OB) last year and reported the HC was their usual source of care (n = 3517). We used logistic regression models to assess the interaction of race/ethnicity and having obesity in (1) provider recommendations of diet or (2) exercise, (3) patient adherence to diet or (4) exercise, (5) perceptions of weight and (6) weight loss attempts. We used a multinomial regression model to examine (7) weight loss or gain vs no change and a linear regression model to evaluate (8) percent weight change. We found Black PwOW/OB (OR = 1.65) experienced greater odds of receiving diet recommendations than Whites. We found limited racial/ethnic disparities in adherence. Black (OR = 0.41), Hispanic/Latino (OR = 0.45), and American Indian/Alaska Native (OR = 0.41) PwOW/OB had lower odds of perceiving themselves as overweight. Black (OR = 1.68) and Hispanic (OR = 1.98) PwOW/OB had a greater odds of reporting weight gain, and Asian PwOW/OB (OR = 0.42) had lower odds of reporting weight loss than Whites. Disparities in provider diet recommendations among Blacks and Hispanics indicated the importance of personalized weight management recommendations. Understanding underlying reasons for discordance between self-perception and observed weight among different groups is needed. Overall increase in weight, despite current interventions, should be addressed through targeted racially/ethnically appropriate approaches.
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Affiliation(s)
- Nadereh Pourat
- UCLA Center for Health Policy Research, UCLA Fielding School of Public Health, Los Angeles, California, USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Xiao Chen
- UCLA Center for Health Policy Research, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Connie Lu
- UCLA Center for Health Policy Research, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Weihao Zhou
- UCLA Center for Health Policy Research, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Marlon Daniel
- Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, Maryland, USA
| | - Hank Hoang
- Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, Maryland, USA
| | - Alek Sripipatana
- Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, Maryland, USA
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Boykin A, Demirci J, Miller E. Investigating the Relationship Between Fatherhood and Provider Weight-Related Practices and Counseling in Clinical Settings. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2020; 52:713-718. [PMID: 32646598 PMCID: PMC7369002 DOI: 10.1016/j.jneb.2020.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/23/2020] [Accepted: 03/09/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To assess whether weight-related practices and counseling between men and their medical providers are associated with the patient's fatherhood status. METHODS Using the 2015-2017 National Survey of Family Growth, logistic regression models were constructed to examine the odds of men being weighed, told a weight status, or referred for nutrition/exercise counseling during a medical visit in the previous year. RESULTS The sample included 2,562 men and 1,272 fathers. Overall, 90%, 76%, and 49% of fathers were weighed by a provider, told their weight status, and referred for nutrition/exercise counseling, respectively. There were no associations between fatherhood status and being weighed or provider weight status communication. Fathers were more likely to be referred for nutrition/exercise counseling compared with those without children during a medical (adjusted odds ratio, 1.61; 95% confidence interval, 1.003-2.583) or routine visit (adjusted odds ratio, 1.81; 95% confidence interval, 1.04-3.16). CONCLUSIONS AND IMPLICATIONS The increased likelihood of nutrition or exercise counseling referrals among fathers presents an opportunity to address obesity within families.
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Affiliation(s)
- Alicia Boykin
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA.
| | - Jill Demirci
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, PA
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
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Telehealth Use among Community Health Centers and Cardio-Metabolic Health Outcomes. Healthcare (Basel) 2020; 8:healthcare8020165. [PMID: 32532120 PMCID: PMC7348805 DOI: 10.3390/healthcare8020165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 01/10/2023] Open
Abstract
Public health interventions to manage the cardio-metabolic syndrome (CMS) have had modest success, necessitating the expansion of telehealth services to where people live. This effort analyzes the association between telehealth provision and the management of CMS-related quality measures (hypertension, diabetes, weight assessment and related counseling, lipid therapy for coronary artery disease, and antiplatelet therapy for ischemic vascular disease) using the Uniform Data System administrative database during the period 2016–2018. A total of 523, 600, and 586 community health centers (CHCs) were documented using telehealth, out of the 1367, 1373, and 1362 total CHCs, in the respective three years. Our primary analysis showed that there was no association between telehealth use and the outcomes. A difference in difference approach that compared the CHCs which transitioned from not using it to using it with those that did not use telehealth in two consecutive years also produced null results. However, among rural areas, the odds of better managing the outcomes were greater for certain outcomes. Our study provides limited support that the adoption of telehealth is potentially beneficial in improving certain outcomes in the CHCs setting that are based in rural areas. More specificity in data regarding the nature of telehealth implementation in the CHC setting could bring clarity in these associations.
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Wernz C, S Mkuu R, Leal N, Stegall R, Wekullo C, Woldu D, Shevon Harvey I. Prevalence and predictors of receipt of weight loss advice among a nationally representative sample of overweight and obese Kenyans. Afr Health Sci 2020; 20:903-911. [PMID: 33163058 PMCID: PMC7609077 DOI: 10.4314/ahs.v20i2.45] [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] [Indexed: 11/24/2022] Open
Abstract
Background: As Kenya continues to experience rapid development and urbanization, growing evidence shows an increasing prevalence of non-communicable diseases (NCDs) and overweight and obese citizens. Objectives: This study sought to explore the extent to which Kenyan overweight and obese participants reported receiving advice from physicians or health care providers to lose weight and to identify demographic characteristics associated with receipt of weight loss advice. Methods: Descriptive statistics analyzed sociodemographic characteristics and weight loss advice from the 2015 Kenya WHO STEPwise survey (n = 1335). A bivariate logistic regression model estimated the association between socio-demographic characteristics and weight loss advice reported from a physician or health care provider. Results: The prevalence of weight loss advice from health professionals among overweight and obese participants was 19%. Model results indicated that obese individuals [odds ratio (OR) = 2.11, 95% confidence interval (CI) (1.36, 3.26)], individuals with higher than a secondary education [OR = 2.26, 95% CI (1.39, 3.68)], urban dwellers [OR = 2.38, 95% CI (1.29, 4.39)], and women [OR = 3.13, 95% CI (1.60, 6.12)] were significantly more likely to receive weight loss advice from their physician or health care provider. Conclusion: This study found low levels of report of physician or health care provider advice for weight loss among overweight individuals. Advice was primarily reported by obese patients. Weight loss advice differed significantly based on educational attainment, geographical location, and gender thus calling for targeted interventions to increase equitable NCD prevention services from physicians.
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Hansen AR, Rustin C, Opoku ST, Shevatekar G, Jones J, Zhang J. Trends in US adults with overweight and obesity reporting being notified by doctors about body weight status, 1999-2016. Nutr Metab Cardiovasc Dis 2020; 30:608-615. [PMID: 32131986 DOI: 10.1016/j.numecd.2020.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 01/10/2020] [Accepted: 01/13/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIMS Engaging healthcare providers (HCPs) is critical for early identification of overweight and obesity. The aim of this study is to describe the trend in clinicians' adherence to clinical recommendations to discuss body weight status with adults with overweight and obesity. METHODS AND RESULTS We analyzed the data of adults aged 20 and older with overweight or obesity from the National Health and Nutrition Examination Surveys, 1999 to 2016 with a 2-year data-release cycle. The question of interest was "Has a doctor or other health professionals ever told you that you were overweight?" Adjusted biennial percentage ratio (abPR) of being notified was estimated. We observed a significant increasing trend of notification in adults with overweight [abPR = 1.04 (95% confidence interval: 1.03, 1.06), about 4% increase for every two-years] and obesity [1.01 (1.00, 1.02)]. The highest increase occurred in adults with overweight aged 20-34 [1.12 (1.08, 1.16)], however, young adults with overweight remained the group with the lowest percentage (24%, 2015-2016 survey) of notification compared to others in recent survey. Notification in adults with obesity demonstrated similar trends. In 2015-2016, among adults with obesity who visited HCPs last year, 80% of these aged 50-64 and 78% of these aged 65 and older were notified. More than 80% of adults with overweight or obesity visited HCPs at least once last year. CONCLUSIONS There was an improvement in informing patients of overweight/obesity status. However, less than a quarter of young adults with overweight were notified in recent surveys, compromising the opportunities of preventing overweight from becoming obesity in early adulthood.
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Affiliation(s)
- Andrew R Hansen
- Department of Community Health Behavior and Education, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - Christopher Rustin
- Georgia Department of Public Health, Division of Health Protection, Atlanta, GA, USA
| | - Samuel T Opoku
- Department of Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - Gauri Shevatekar
- Department of Community Health Behavior and Education, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - Jeffery Jones
- Department of Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - Jian Zhang
- Department of Epidemiology, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA.
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McCafferty BJ, Hill JO, Gunn AJ. Obesity: Scope, Lifestyle Interventions, and Medical Management. Tech Vasc Interv Radiol 2020; 23:100653. [DOI: 10.1016/j.tvir.2020.100653] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Yannitsos D, Murphy RA, Pollock P, Di Sebastiano KM. Facilitators and barriers to participation in lifestyle modification for men with prostate cancer: A scoping review. Eur J Cancer Care (Engl) 2019; 29:e13193. [PMID: 31797478 DOI: 10.1111/ecc.13193] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/23/2019] [Accepted: 11/12/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE Diet and physical activity changes have been shown to improve quality of life and health outcomes for prostate cancer (PC) survivors; however, few survivors make lifestyle changes. We aimed to identify PC-specific facilitators and barriers to dietary and physical activity changes and participation in survivorship-based lifestyle management programmes. METHODS A scoping review investigating facilitators and barriers of PC survivor's participation in lifestyle management programmes was conducted in June 2018. A total of 454 studies were identified, 45 studies were assessed in full, and 16 were included in the scoping review. RESULTS Barriers to lifestyle change included perceived lack of evidence for lifestyle guidelines, treatment side effects, perception of change as unnecessary, time pressure and age. Facilitators for lifestyle change included advice from health professionals, support systems (family and peer), diagnosis as a time for change, lifestyle as a coping strategy to manage side effects and improve well-being. CONCLUSIONS Health professionals, peers and family have a significant role in lifestyle management for PC survivors to facilitate engagement. Specific and clear messaging of the benefits of lifestyle management is warranted. Treatment-related side effects, time pressure, current health perception and age should be considered when developing lifestyle management programmes for PC survivors.
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Affiliation(s)
- Demetra Yannitsos
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Rachel A Murphy
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Phil Pollock
- Prostate Cancer Supportive Care Clinic, Vancouver Prostate Centre, Vancouver General Hospital, Diamond Healthcare Centre, Vancouver, BC, Canada.,BC Cancer - Victoria, Victoria, BC, Canada
| | - Katie M Di Sebastiano
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.,School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
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Davis JP, Henry ZH, Argo CK, Northup PG. Relationship of Physician Counseling to Weight Loss Among Patients With Nonalcoholic Fatty Liver Disease: An Observational Cohort Study Using National Health and Education Survey Data. Clin Liver Dis (Hoboken) 2019; 14:156-160. [PMID: 31709046 PMCID: PMC6832099 DOI: 10.1002/cld.832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 05/07/2019] [Indexed: 02/04/2023] Open
Affiliation(s)
- Jessica P.E. Davis
- Division of Gastroenterology and HepatologyUniversity of VirginiaCharlottesvilleVA
| | - Zachary H. Henry
- Division of Gastroenterology and HepatologyUniversity of VirginiaCharlottesvilleVA
| | - Curtis K. Argo
- Division of Gastroenterology and HepatologyUniversity of VirginiaCharlottesvilleVA
| | - Patrick G. Northup
- Division of Gastroenterology and HepatologyUniversity of VirginiaCharlottesvilleVA
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Kriaucioniene V, Petkeviciene J, Raskiliene A. Nutrition and physical activity counselling by general practitioners in Lithuania, 2000-2014. BMC FAMILY PRACTICE 2019; 20:125. [PMID: 31493793 PMCID: PMC6732190 DOI: 10.1186/s12875-019-1022-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 09/03/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Primary health care plays a crucial role in providing recommendations on a healthy diet and physical activity to assist patients in weight management. The study aimed to evaluate health behaviour counselling provided by general practitioners (GPs) for adults with overweight and obesity in Lithuania between 2000 and 2014. METHODS Eight biennial postal surveys to independent nationally representative random samples of Lithuanians aged 20-64 were conducted. Response rates varied from 41.1 to 74%, with a decreasing trend over time. The data of 5867 participants who visited a GP at least once during the last year and had BMI of ≥25.0 kg/m2 were analysed. Respondents were asked about GP advice on nutrition and physical activity and changes in their health behaviour during the last year. RESULTS The proportion of persons with overweight who reported GP advice on nutrition increased from 23.6% in 2000 to 37.5% in 2010 and advice on physical activity from 11.9 to 17.2% respectively; however, later both proportions decreased slightly. The likelihood of reporting was higher in respondents with higher BMI, more chronic conditions and frequent contact with a GP. Respondents who were living in cities, older and highly educated women were all more likely to report being advised on physical activity. Men and women who received advice from a GP more often reported changes in health behaviour as compared with non-advised individuals. CONCLUSIONS Despite increasing trends, the rate of GP advice on nutrition and physical activity reported by patients with overweight and obesity remains low in Lithuania. GP advice appears to have a significant impact on attempts by patients to change behaviour related to weight control. Therefore, there is an obvious need to make additional efforts to increase the frequency of GP counselling and to identify and address barriers to advising patients with overweight.
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Affiliation(s)
- Vilma Kriaucioniene
- Faculty of Public Health, Academy of Medicine, Lithuanian University of Health Sciences, Tilzes 18, Kaunas, Lithuania.
| | - Janina Petkeviciene
- Faculty of Public Health, Academy of Medicine, Lithuanian University of Health Sciences, Tilzes 18, Kaunas, Lithuania
| | - Asta Raskiliene
- Faculty of Public Health, Academy of Medicine, Lithuanian University of Health Sciences, Tilzes 18, Kaunas, Lithuania
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de Heer H‘D, Kinslow B, Lane T, Tuckman R, Warren M. Only 1 in 10 Patients Told to Lose Weight Seek Help From a Health Professional: A Nationally Representative Sample. Am J Health Promot 2019; 33:1049-1052. [PMID: 30922060 PMCID: PMC6693951 DOI: 10.1177/0890117119839904] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE Receiving weight loss advice from a health-care provider has been associated with more weight loss efforts and greater odds of achieving weight loss. However, whether patients seek help from their provider or other health professional with weight loss after receiving advice from them to lose weight is largely unknown. DESIGN Cross-sectional data from the 2011 to 2012 National Health and Nutrition Examination Survey (NHANES). SAMPLE A total of 3862 overweight/obese adults. MEASURES Questionnaires asked whether participants received advice to lose weight, and whether they sought health professional's assistance with weight management. The NHANES 2011 to 2012 was the most recent year both questions were asked. ANALYSIS Accounting for NHANES sampling and design, frequency distributions characterized demographics and proportions. Logistic regressions estimated odds of seeking weight loss help by demographics. RESULTS Of 3682 overweight/obese adults, 1908 were told they were overweight or recommended to lose weight. Of 1908 people, 68% reported weight loss efforts, but only health 10.9% sought a health professional's help (dietician/nutritionist 4.7%, personal trainer 3.0%, doctor 2.8%). Females, people with health insurance and high health-care utilization had 1.5 to 3.5 times greater odds of seeking help; age, ethnicity, and income were not significantly associated with seeking help with weight management. CONCLUSION In a nationally representative sample, only 10.9% of overweight/obese adults told to lose weight by a provider sought help from a health professional with weight loss. This underscores the opportunity for greater health professional involvement with weight management beyond giving recommendations.
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Affiliation(s)
| | - Brian Kinslow
- Evolve Flagstaff Physical Therapy, Flagstaff, AZ, USA
- Department of Physical Therapy, Northern Arizona University, Flagstaff, AZ, USA
| | - Taylor Lane
- Department of Health Sciences, Northern Arizona University, Flagstaff, AZ, USA
| | - Ron Tuckman
- Mountain View Pediatrics, Flagstaff, AZ, USA
| | - Meghan Warren
- Department of Physical Therapy, Northern Arizona University, Flagstaff, AZ, USA
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Whipps J, Mort SC, Beverly EA, Guseman EH. Influence of Osteopathic Medical Students' Personal Health on Attitudes Toward Counseling Obese Pediatric Patients. ACTA ACUST UNITED AC 2019; 119:488-498. [PMID: 31355889 DOI: 10.7556/jaoa.2019.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Context Research has shown that physicians with positive health and lifestyle behaviors have more positive attitudes toward effective counseling, but little is known about how personal health behaviors of medical students influence their attitudes regarding pediatric obesity counseling before entering practice. Objective To determine whether the personal health status and habits of osteopathic medical students influence their attitudes toward counseling obese pediatric patients regarding lifestyle behaviors. Methods A cross-sectional survey was distributed electronically to first- through fourth-year osteopathic medical students. The survey assessed students' personal lifestyle habits and their top anticipated barriers to providing pediatric weight counseling. Results A total of 200 participants completed the survey. National physical activity recommendations were met by 81 participants (40.5%). These 81 participants had significantly more positive attitudes toward pediatric physical activity counseling than participants who did not meet the recommendations (H=-35.06, P=.001) or those who only met resistance training recommendations (H=40.63, P=.021). Participants with obesity had significantly lower pediatric weight management counseling scores than overweight participants (H=40.77, P=.028). Thirty-one participants (15.5%) consumed a healthy amount of both vegetables and fruit. These 31 participants had significantly higher dietary mean item counseling scores than those who did not (H=-30.40, P=.048). Participants identified the barriers "Time" (137 [68.5%]) and "Difficult for patients to change behavior" (99 [49.5%]) most frequently. Clinical participants identified "Poor or lacking reimbursement" (21 [28.0%]) more frequently than preclinical participants (12 [9.6]). Conclusion Medical students who exhibited healthier lifestyle habits were more likely to positively view pediatric obesity management counseling.
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Gelberg L, Rico MW, Herman DR, Belin TR, Chandler M, Ramirez E, Love S, McCarthy WJ. Comparative effectiveness trial comparing MyPlate to calorie counting for mostly low-income Latino primary care patients of a federally qualified community health center: study design, baseline characteristics. BMC Public Health 2019; 19:990. [PMID: 31340800 PMCID: PMC6651946 DOI: 10.1186/s12889-019-7294-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 07/10/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Primary care-based behavior change obesity treatment has long featured the Calorie restriction (CC), portion control approach. By contrast, the MyPlate-based obesity treatment approach encourages eating more high-satiety/high-satiation foods and requires no calorie-counting. This report describes study methods of a comparative effectiveness trial of CC versus MyPlate. It also describes baseline findings involving demographic characteristics and their associations with primary outcome measures and covariates, including satiety/satiation, dietary quality and acculturation. METHODS A comparative effectiveness trial was designed to compare the CC approach (n = 130) versus a MyPlate-based approach (n = 131) to treating patient overweight. Intervenors were trained community health workers. The 11 intervention sessions included two in-home health education sessions, two group education sessions, and seven telephone coaching sessions. Questionnaire and anthropometric assessments occurred at baseline, 6- and 12 months; food frequency questionnaires were administered at baseline and 12 months. Participants were overweight adult primary care patients of a federally qualified health center in Long Beach, California. Two measures of satiety/satiation and one measure of post-meal hunger comprised the primary outcome measures. Secondary outcomes included weight, waist circumference, blood pressure, dietary quality, sugary beverage intake, water intake, fruit and vegetable fiber intake, mental health and health-related quality of life. Covariates included age, gender, nativity status (U.S.-born, not U.S.-born), race/ethnicity, education, and acculturation. ANALYSIS Baseline characteristics were compared using chi square tests. Associations between covariates and outcome measures were evaluated using multiple regression and logistic regression. RESULTS Two thousand eighty-six adult patients were screened, yielding 261 enrollees who were 86% Latino, 8% African American, 4% White and 2% Other. Women predominated (95%). Mean age was 42 years. Most (82%) were foreign-born; 74% chose the Spanish language option. Mean BMI was 33.3 kg/m2; mean weight was 82 kg; mean waist circumference was 102 cm. Mean blood pressure was 122/77 mm. Study arms on key baseline measures did not differ except on dietary quality and sugary beverage intake. Nativity status was significantly associated with dietary quality. CONCLUSIONS The two treatment arms were well-balanced demographically at baseline. Nativity status is inversely related to dietary quality. TRIAL REGISTRATION NCT02514889 , posted on 8/4/2015.
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Affiliation(s)
- Lillian Gelberg
- Department of Family Medicine, David Geffen School of Medicine at UCLA, University of California, 10880 Wilshire Blvd, Ste 1800, Los Angeles, CA, 90024, USA
| | - Melvin W Rico
- Charles R. Drew/UCLA Medical Education Program, Los Angeles, USA
| | - Dena R Herman
- Family and Consumer Sciences, College of Health and Human Development, SQ 200M 18111 Nordhoff Street, Northridge, CA, 91330, USA
| | - Thomas R Belin
- UCLA Fielding School of Public Health, 51-267 CHS, mc 177220, 650 Charles Young Drive, Los Angeles, CA, 90095, USA
| | - Maria Chandler
- TCC, 701 East 28th Street, Suite 200, Long Beach, CA, 90806, USA
| | - Evangelina Ramirez
- The Children's Clinic of Long Beach Patient Representative, 1715 E. Anaheim St., Apt. 2, Long Beach, CA, 90813, USA
| | | | - William J McCarthy
- UCLA Fielding School of Public Health, A2-125 CHS, mc 690015, 650 Charles Young Drive, Los Angeles, CA, 90095, USA.
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Mudi SR, Datta PK, Mudi N, Saha SK, Ali M, Arslan MI, Biswas SK. Assessment of physicians' knowledge to combat obesity in Bangladesh. Diabetes Metab Syndr 2019; 13:2393-2397. [PMID: 31405649 DOI: 10.1016/j.dsx.2019.06.013] [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: 05/17/2019] [Accepted: 06/10/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Physicians need to play a proactive role to combat obesity and its associated comorbidities. The present survey was conducted to assess the awareness, knowledge, practice and attitude of the physicians in Bangladesh in the prevention and management of obesity. METHODS Three hundred physicians were randomly selected from a medical university, a government medical college and a private medical college in Bangladesh to be included in this survey. All of them voluntarily participated in the survey upon the assurance of anonymity. All the selected physicians were provided with a questionnaire consisting of nine questions for assessing their awareness, knowledge, practice and attitude regarding obesity. RESULTS Out of 300 participants, about 77% claimed that they know their own BMI and BMI cut-off points for overweight and obesity. But 38% physicians were unable to write the cut-off points correctly. Near about 50% physicians claimed that they know the BMI cut-off points for Asian population. However, only 7% were able to correctly write the BMI cut-off points for Asian population. About 47% physicians agreed that they do not calculate BMI or evaluate other measures of body fatness during clinical practice. However, 99% of the physicians considered that measuring BMI during consultation or clinical practice is important. CONCLUSIONS It may be concluded that Bangladeshi physicians' have positive attitude for managing obesity but their practice is grossly inadequate. Most importantly, knowledge and awareness of the physicians about diagnosis of obesity is very poor.
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Affiliation(s)
- Sonchita Rani Mudi
- Department of Biochemistry, Kumudini Women's Medical College, Mirzapur, Tangail, Bangladesh
| | - Ponkaj Kanti Datta
- Department of Clinical Pathology, Dhaka Medical College Hospital, Dhaka, Bangladesh
| | - Nondita Mudi
- Department of Pathology, Sir Salimullah Medical College, Dhaka, Bangladesh
| | - Suman Kumar Saha
- Department of Biochemistry, Kumudini Women's Medical College, Mirzapur, Tangail, Bangladesh
| | - Mohammad Ali
- Department of Biochemistry, Sir Salimullah Medical College, Dhaka, Bangladesh
| | - M Iqbal Arslan
- Department of Biochemistry and Molecular Biology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka, Bangladesh
| | - Subrata Kumar Biswas
- Department of Biochemistry and Molecular Biology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka, Bangladesh.
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Srivastava P, Verma A, Geronimo C, Button TM. Behavior stages of a physician- and coach-supported cloud-based diabetes prevention program for people with prediabetes. SAGE Open Med 2019; 7:2050312119841986. [PMID: 31105938 PMCID: PMC6509979 DOI: 10.1177/2050312119841986] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/13/2019] [Indexed: 12/30/2022] Open
Abstract
Introduction: Centers for Disease Control and Prevention Diabetes Prevention Program recognition requires successful program completion by a cohort of at least five people with prediabetes. Such programs have generally been “in-person” and provided by a qualified coach from a recognized program. A cohort of 10 patients with prediabetes was enrolled in a physician’s office to use the cloud-based Type II Diabetes Prevention Module in an effort to achieve recognition. Module use was supported by the physician and a qualified coach. The purpose of this article is to evaluate Module performance relative to behavior stages associated with long-term behavior modification. Methods: The Module employs a web application supporting diabetes prevention education and a mobile application that is an electronic diary and virtual coach. A dashboard allows an efficient review of user performance and the ability to send users notifications of support from the user’s coach or physician. The cohort of 10 patients with prediabetes was offered Module use upon diagnosis of prediabetes. Results: All 10 patients with prediabetes offered Module use agreed participation. Six have completed educational sessions, made diary entries, and have met the 5% Centers for Disease Control and Prevention Diabetes Prevention Program weight loss target prior to 6 months of Module use. This high success rate (60%) is contrary to behavior stages often associated with long-term behavior modification. Conclusion: The strength of the physician–patient relationship appears to allow patients with prediabetes to skip or advance rapidly through behavioral stages in the process of lifestyle modification.
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Affiliation(s)
| | - Ashish Verma
- Evidence Based Medical Apps LLC, Middle Island, NY, USA
| | | | - Terry M Button
- Evidence Based Medical Apps LLC, Middle Island, NY, USA.,Department of Radiology, Stony Brook University, Stony Brook, NY, USA
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Kraschnewski JL, Kong L, Francis E, Yeh HC, Bryce C, Poger J, Lehman E. A Patient-Centered PaTH to Address Diabetes: Protocol for a Study on the Impact of Obesity Counseling. JMIR Res Protoc 2019; 8:e12054. [PMID: 30946024 PMCID: PMC6538312 DOI: 10.2196/12054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 01/07/2019] [Accepted: 02/04/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Overweight and obesity are America's number one health concern. The prevalence of obesity in the United States is greater than 36%, a rate that has doubled since 1970. As the second most preventable cause of death, obesity is a risk factor for diabetes, cardiovascular disease, stroke, and cancer, all major causes of death. Primary care clinics may be an ideal setting for weight control interventions to help manage and prevent diabetes. For this reason, the Centers for Medicare and Medicaid Services (CMS) implemented a health care procedure coding system code for intensive behavioral therapy (IBT) for obesity within primary care in 2012 to facilitate payment for addressing obesity, which was followed by broader coverage by most insurers for IBT for adults in 2013. However, the impact of this coverage on patient-centered outcomes is largely unknown. OBJECTIVE The overarching goal of this study is to understand the comparative effectiveness of obesity counseling as covered by CMS and other insurers in improving weight loss for adults either with or at increased risk for type 2 diabetes. METHODS This study leverages the novel infrastructure of the Patient-Centered Outcomes Research Institute-funded PaTH Clinical Data Research Network. The PaTH network is comprised of Geisinger Health System, Johns Hopkins University, Johns Hopkins Health System, Lewis Katz School of Medicine at Temple University, Temple Health System, Penn State College of Medicine, Penn State Milton S Hershey Medical Center, University of Pittsburgh, UPMC and UPMC Health Plan, and the University of Utah. Electronic health record (EHR) data will originate from the 6 PaTH health systems. Specifically, we will (1) evaluate the impact of broader preventive service coverage for obesity screening and counseling on weight loss, diabetes incidence, and diabetes outcomes in patients with diabetes or at increased risk for diabetes (defined by body mass index [BMI] ≥25). We will determine how the annual probability of receiving obesity and/or nutritional counseling changed pre- and postpolicy across all insurers in a cohort of patients with diabetes and at high risk for diabetes. We will (2) compare patient weight loss and diabetes-related outcomes among those who receive obesity screening and counseling with those who do not, following implementation of preventive service coverage. We will examine postpolicy impact of obesity screening and counseling in a cohort of patients with diabetes and at increased risk for diabetes. Specific outcomes to be examined include weight loss, diabetes incidence, and diabetes outcomes. Exploratory outcomes will include patient-reported outcomes. Furthermore, we will determine patient characteristics, including demographics, and practice characteristics, including provider type. RESULTS Our PCORI-funded study is underway. To date, we have obtained our second data extraction from the PaTH CDRN and are performing data editing and cleaning. Next steps include analysis of early policy change. CONCLUSIONS Given patients who are overweight are at highest risk for diabetes, improved weight management services could prevent diabetes and its negative health outcomes. Comparing weight and diabetes outcomes in 3 states using EHRs and claims data before and after this policy was implemented using the PaTH Network will allow important insight into policy effectiveness. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/12054.
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Affiliation(s)
| | - Lan Kong
- Penn State Health, College of Medicine, Penn State University, Hershey, PA, United States
| | - Erica Francis
- Penn State Health, College of Medicine, Penn State University, Hershey, PA, United States
| | - Hsin-Chieh Yeh
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Cindy Bryce
- University of Pittsburgh, Department of Public Health, Pittsburgh, PA, United States
| | - Jennifer Poger
- Penn State Health, College of Medicine, Penn State University, Hershey, PA, United States
| | - Erik Lehman
- Penn State Health, College of Medicine, Penn State University, Hershey, PA, United States
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Janardhan SV. Common Misconceptions in Hepatology: Nonalcoholic Fatty Liver Disease. Clin Liver Dis (Hoboken) 2019; 13:79-81. [PMID: 30988942 PMCID: PMC6446581 DOI: 10.1002/cld.769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/27/2018] [Indexed: 02/04/2023] Open
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Greaney ML, Cohen SA, Ward-Ritacco CL, Riebe D. Rural-Urban Variation in Weight Loss Recommendations Among US Older Adults with Arthritis and Obesity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16060946. [PMID: 30884784 PMCID: PMC6466170 DOI: 10.3390/ijerph16060946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/07/2019] [Accepted: 03/13/2019] [Indexed: 12/11/2022]
Abstract
Purpose: Weight loss is advantageous for individuals with obesity and arthritis. Therefore, this study was conducted to determine if there are differences by rural-urban status among older adults with these conditions who reported being advised by a health care provider to lose weight for arthritis or to ameliorate arthritis symptoms. Methods: A cross-sectional analysis of 2011 Behavioral Risk Factor Surveillance System (BRFSS) data. Respondents reported if they had been diagnosed with arthritis and if they received a provider weight loss recommendation (WLR). The analytic sample was limited to older adults aged 60⁻79 living in the five states that administered the examined BRFSS arthritis module who had body mass index ≥ 30 kg/m² and reported having arthritis (n = 2920). The respondent's county of residence was linked to the corresponding county-level population density from the US Decennial Census to determine rural-urban status. A generalized linear model examined the association between receipt of a WLR and population density, controlling for demographics. Results: The sample was 83.6% white, 57.8% female, and 63.2% received a WLR. Respondents from more urban counties were more likely to receive a WLR (p value for trend <0.001). Additionally, older respondents, men, individuals with less than a high school education, and whites had a decreased likelihood of receiving a WLR. Conclusions: The analysis identified notable rural-urban differences with respondents in more urban counties being more likely to receive a WLR. Furthermore, there were differences in those who received a WLR by age, sex, and education. Reasons for these differences should be explored.
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Affiliation(s)
- Mary L Greaney
- Health Studies, University of Rhode Island, 25 West Independence Way, Kingston, RI 02881, USA.
| | - Steven A Cohen
- Health Studies, University of Rhode Island, 25 West Independence Way, Kingston, RI 02881, USA.
| | - Christie L Ward-Ritacco
- Department of Kinesiology, University of Rhode Island, 25 West Independence Way, Kingston, RI 02881, USA.
| | - Deborah Riebe
- Department of Kinesiology, University of Rhode Island, 25 West Independence Way, Kingston, RI 02881, USA.
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Viglione C, Bouwman D, Rahman N, Fang Y, Beasley JM, Sherman S, Pi-Sunyer X, Wylie-Rosett J, Tenner C, Jay M. A technology-assisted health coaching intervention vs. enhanced usual care for Primary Care-Based Obesity Treatment: a randomized controlled trial. BMC OBESITY 2019; 6:4. [PMID: 30766686 PMCID: PMC6360675 DOI: 10.1186/s40608-018-0226-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 12/26/2018] [Indexed: 11/17/2022]
Abstract
Background Goals for Eating and Moving (GEM) is a technology-assisted health coaching intervention to improve weight management in primary care at the Veterans Health Administration (VHA) that we designed through prior rigorous formative studies. GEM is integrated within the patient-centered medical home and utilizes student health coach volunteers to counsel patients and encourage participation in VHA’s intensive weight management program, MOVE!. The primary aim of this study was to determine the feasibility and acceptability of GEM when compared to Enhanced Usual Care (EUC). Our secondary aim was to test the impact of GEM on weight, diet and physical activity when compared to EUC. Methods Veterans with a Body Mass Index ≥30 kg/m2 or 25–29.9 kg/m2 with comorbidities (n = 45) were recruited in two phases and randomized to GEM (n = 22) or EUC (n = 23). We collected process measures (e.g. number of coaching calls completed, number and types of lifestyle goals, counseling documentation) and qualitative feedback on quality of counseling and acceptability of call duration. We also measured weight and behavioral outcomes. Results GEM participants reported receiving high quality counseling from health coaches and that call duration and frequency were acceptable. They received 5.9 (SD = 3.7) of 12 coaching calls on average, and number of coaching calls completed was associated with greater weight loss at 6-months in GEM participants (Spearman Coefficient = 0.71, p < 0.001). Four participants from GEM and two from EUC attended the MOVE! program. PCPs completed clinical reminders in 12% of PCP visits with GEM participants. Trends show that GEM participants (n = 21) tended to lose more weight at 3-, 6-, and 12-months as compared to EUC, but this was not statistically significant. There were no significant differences in diet or physical activity. Conclusions We found that a technology assisted health coaching intervention delivered within primary care using student health coaches was feasible and acceptable to Veteran patients. This pilot study helped elucidate challenges such as low provider engagement, difficulties with health coach continuity, and low patient attendance in MOVE! which we have addressed and plan to test in future studies. Trial registration NCT03006328 Retrospectively registered on December 30, 2016. Electronic supplementary material The online version of this article (10.1186/s40608-018-0226-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Clare Viglione
- 1Veteran Affairs New York Harbor Healthcare System & NYU School of Medicine, New York, USA
| | - Dylaney Bouwman
- 2NYU School of Medicine & Veteran Affairs New York Harbor Healthcare System, New York, USA
| | - Nadera Rahman
- 3NYU Langone Health & Veteran Affairs New York Harbor Healthcare System, New York, USA
| | - Yixin Fang
- 4New Jersey Institute of Technology, New York, USA
| | | | - Scott Sherman
- 1Veteran Affairs New York Harbor Healthcare System & NYU School of Medicine, New York, USA
| | | | | | - Craig Tenner
- 1Veteran Affairs New York Harbor Healthcare System & NYU School of Medicine, New York, USA
| | - Melanie Jay
- 1Veteran Affairs New York Harbor Healthcare System & NYU School of Medicine, New York, USA
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