Demographic factors, weight management behaviours, receipt of healthcare professional's counselling and having knowledge in basic anthropometric measurements associated with underassessment of weight status in overweight and obese type 2 diabetes patients

Diabetes self-management: a qualitative study of education needs, practices and caregiver support in the Keta Municipality of Ghana

Introduction

A major part of diabetes management involves patients' self-management. Poor self-management increases the risk of complications from the condition. Good self-management requires appropriate and adequate education and caregiver support, typically provided through structured diabetes education programmes. Education on various topics, including self-management, is a key component of diabetes management services in Ghana. However, challenges such as limited knowledge, economic constraints and sociocultural factors hinder self-management practices. We explored the self-management education (SME), practice and support needs of adults with type-2 diabetes (T2D) at the Keta Municipal Hospital.

Research design and methods

This phenomenological study involved 16 adults living with T2D and two healthcare providers in the Keta Municipality of Ghana. Data were collected through in-depth and expert interviews using interview guides. Interpretative phenomenological analysis was employed to analyse the data using NVivo V.12.

Results

SME was provided within an hour during the first section of the monthly diabetes clinic covering dietary needs and restrictions, physical exercises, adherence to medication and wound prevention and care. SME needs were individualised SME and extension of education to the general population. The participants practised self-management activities. They attributed their improved practices to both the general group education and the individualised goals and input received during individual counselling sessions. Motivators for self-management were cues from negative health outcomes, wanting to survive the condition for a long time and SME received. Challenges to self-management entailed job roles, insufficient medication dosages and unavailability of medication at the hospital during review visits.

Conclusions

The study suggests that individualised SME and caregiver support may enhance self-management practices and outcomes. This underscores the significance of considering patient-specific factors and support systems when designing effective diabetes management strategies. The provision of comprehensive SME, including group and individual sessions, along with the utilisation of visual aids, can contribute to improved self-management outcomes.

10-year level, trends and socio-demographic disparities of obesity among Ghanaian adults-A systematic review and meta-analysis of observational studies

The double burden of malnutrition has assumed severer forms in Low and Middle Income Countries (LMICs) arising from sharper increases in prevalence rates of overweight and obesity in these countries compared to higher income countries. Considering that LMICs already have fragile health systems, the rising obesity levels may just be a ticking time bomb requiring expeditious implementation of priority actions by all global and national actors to prevent an explosion of cardiovascular disease related deaths. The aim of this systematic review and meta-analysis was to provide a current estimate of obesity and overweight prevalence among Ghanaian adults and assess socio-demographic disparities following the PRISMA guidelines. We searched Pubmed with Medline, Embase, Science direct and African Journals Online (AJOL) for studies on overweight and obesity published between 2013 and January 2023. Applying a quality effects model, pooled mean Body Mass Index (BMI) and prevalence of overweight and obesity were obtained from 42 studies conducted across all three geographical locations of Ghana with a combined sample size of 29137. From the analysis, the mean BMI of adults in Ghana was 24.7 kgm-2 while overweight and obesity prevalence was estimated as 23.1% and 13.3% respectively. Temporal analysis showed sharper increases in overweight and obesity prevalence from 2017/2018. Mean BMI (Females: 25.3kgm-2 vrs Males: 23.1 kgm-2), overweight (Females: 25.9% vrs Males: 16.5%) and obesity (Females: 17.4% vrs Males: 5.5%) prevalence were higher among females than males. Gender differences in mean BMI and obesity prevalence were both significant at p<0.001. Urban dwellers had higher mean BMI than their rural counterparts (24.9kgm-2 vrs 24.4kgm-2). Overweight (27.6% vrs 18.2%) and obesity (17.3% vrs 11.0%) prevalence were also higher in urban areas than in rural areas. Body weight indicators for the various geographical areas of Ghana were; southern sector: 25.4kgm-2, 28.9% and 15.4%, middle sector: 24.8kgm-2, 26.4% and 16.2% and northern sector: 24.2kgm-2, 15.4% and 8.5% for mean BMI, overweight and obesity prevalence respectively. The southern part of Ghana was similar to the middle part in terms of mean BMI, overweight and obesity but higher than the northern part. We conclude that overweight and obesity prevalence in Ghana has risen to high levels in recent years with women and urban dwellers disproportionately more affected. There is a possible implication for increased cardiovascular diseases and a generally poor quality of life for the people. Evidence-based public health interventions are needed to reverse the current situation.

Recognising undernutrition in a community hospital: the nursing judgement is insufficient

Introduction

Standardised nutritional screening methods improve the rate of recognising older patients with undernutrition, which is strongly encouraged in hospitals and residential settings. Therefore, our study compared the rates of identifying undernutrition before and after introducing the Mini Nutritional Assessment (MNA®) in a community hospital.

Methods

This was a single-centre, retrospective, observational before–after study. Participants were subjects aged 65 years or older, admitted to a community hospital from May 2018 to December 2020. The nursing assessment at admission included the MNA® from January 2020. The prevalence of undernutrition gathered by nursing diagnoses from 2018 to 2019 was compared with data obtained using the MNA® in 2020. Then, a confirmatory analysis was conducted to compare the prevalence of undernutrition in 2020 when both nursing diagnoses and the MNA® were used.

Results

We analysed data of approximately 316 patients (238 before and 78 after introducing the MNA®). Overall, results showed that 47.1% (n = 149) of the patients were undernourished. As observed, the prevalence of undernutrition was 38.6% (n = 92) in 2018–2019 and 73.1% (n = 57) in 2020 (p < 0.001). In 2020, however, 38.5% of patients (n = 30) were identified as undernourished using the MNA® but not using nursing diagnoses. Therefore, the correlation between these two methods was poor (Pearson’s correlation 0.169, p = 0.14).

Conclusion

Identifying elderly patients with undernutrition significantly increased after introducing the MNA®. Undernutrition is a common condition that should be systematically screened using a validated tool to activate personalised nutritional interventions promptly.

Perception of School Committee Members (SCMs) on Factors Contributing to Overweight and Obesity Among High School Students in Kiribati: A Qualitative Study

Background

Schools are vital settings for overweight and obesity prevention among children and adolescents. School Committee Members (SCMs) are crucial assets to engaging students with overweight and obesity prevention programs. This study aimed to determine factors contributing to overweight and obesity among high school students in Kiribati through the perception of SCMs.

Methods

This prospective qualitative study was conducted in four randomly selected senior high schools in South Tarawa, Kiribati, from August to November 2020. With a purposive selection of 20 SCMs employed at the four high schools, both male and female participants consented to participate in the study. A semi-structured open-ended questionnaire was used for data collection using focus group discussions (FGDs). Data were transcribed and analyzed using the thematic analysis method.

Results

Twenty participants were involved in FGDs with equal number of SCMs (n = 5) who attended FGDs for each school and 45% of them were female participants. Six themes were identified, namely, knowledge, behaviors, perceived status toward overweight and obesity, perceived action benefits, perceived barriers to practices, and proposed strategies to overweight and obesity prevention. These themes reveal that SCMs have a broad understanding and skill set for overweight and obesity causes and effects. However, the aptitude alone is not enough to prevent the occurrence, and thus, proposed feasible plans were voiced for responsible stakeholders to include in policy developments for overweight and obesity prevention.

Conclusion

This study recognized that the knowledge-behavior gap is the main reason behind the failure in preventative strategic approaches among adolescents. As role models to students, SCMs and their schools should team up in implementing the public health policies and building mutual awareness and understanding with students and other specialist stakeholders for a more momentous and viable impact.

Factors Accounting for Obesity and Its Perception among the Adult Spanish Population: Data from 1,000 Computer-Assisted Telephone Interviews

OBJECTIVE

Our aim was to go deeper in the self-perception of weight and health status among the Spanish population, together with the connections of familiar relationships, physical activity practice, nutritional habits, and sleep patterns with the presence of obesity.

METHODS

A total of 1,000 subjects were enrolled in April 2017 in a representative adult Spanish population sample. Computer-assisted telephone interviewing was used and self-reported anthropometric data was obtained.

RESULTS

The population was composed of 51.3% women, with a mean age of 48 (36-63) years and a BMI of 23.2 (20.3-26.6). Although only 17.7% of subjects with self-reported obesity exhibited the self-perception to suffer from obesity, they referred a bad (16%) or regular (47%) self-perceived health status. Subjects who considered themselves as people with overweight and obesity displayed a BMI of 30.5 (28.7-32.2) and 37.1 (34.8-41.5), respectively. The obesity group displayed the highest percentage (71.9%) of participants with some first-degree relative with overweight or obesity (p < 0.001) in comparison with the other groups. The main reason put forward of preventing healthy eating among subjects with obesity was that they dislike healthy food. The multivariable logistic regression model for presence of obesity showed that there was a significant association with older age, presence of a first-degree relative with weight excess, a positive snacking habit, and daily alcohol consumption (p ≤ 0.019).

CONCLUSION

The Spanish population has a low self-perception of obesity. Our data also reinforces the strong association between obesity and age, family interactions, usual snacking, and daily consumption of wine or beer.

Exploring the Experiences of West African Immigrants Living with Type 2 Diabetes in the UK

The increasing prevalence and poorer management of Type 2 diabetes among West African immigrants in the UK is a public health concern. This research explored the experiences of West African immigrants in the management of Type 2 diabetes in the UK using a constructivist grounded theory approach. In-depth individual interviews were conducted with thirty-four West African immigrants living with Type 2 diabetes in the London area. Fifteen male and nineteen female adult West African immigrants with age range from 33-82 years participated in the study. Participants were recruited from five diabetes support groups and community settings. Initial, focused and theoretical coding, constant comparison and memos were used to analyse collected data. Three concepts emerged: Changing dietary habits composed of participants' experiences in meeting dietary recommendations, improving physical activity concerned with the experience of reduced physical activity since moving to the UK and striving to adapt which focus on the impact of migration changes in living with Type 2 diabetes in the UK. These address challenges that West African immigrants experience in the management of Type 2 diabetes in the UK. The findings of this research provide a better understanding of the influencing factors and can be used to improve the support provided for West Africans living with Type 2 diabetes in the UK, presenting a deeper understanding of socio-cultural factors that contribute to supporting individuals from this population.

Patient Body Mass Index (BMI) Knowledge in a Rural Primary Care Population

INTRODUCTION

Body mass index (BMI) is a traditional method of measuring obesity and an accepted quality measure in many health systems. However, little is known about how patients' understanding of BMI has progressed/changed in the last several years. The primary purpose of this study was to determine the change in patients' knowledge of BMI and weight-related risk factors. A secondary outcome of this study was to determine the incidence of physician discussion about BMI with the patient.

METHODS

We administered an anonymous survey to primary care patients in 33 rural family medicine clinics in 2013 and 2017. The survey included 8 questions regarding BMI knowledge and 5 demographic questions.

RESULTS

A total of 573 patients completed the survey. There were 345 participants from 2013 and 238 from 2017. The sample included more women than men. There was no significant difference in age or proportion of comorbidities across the 2 survey years. Compared with year 2013, more survey participants from year 2017 knew that BMI stood for "body mass index" (71.1% vs 61.2%, P = .02) and understood what medical concerns were related to BMI (65.5% vs 50.7%, P = .0005). The percentages of participants who reported that their doctor ever discussed BMI with them went up from 20.1% to 28.7% (P = .02).

CONCLUSION

In this cross-sectional cohort study, it was found that patients' knowledge about BMI and weight-related risk factors has increased modestly. However, despite the increase in patients' knowledge and discussions about BMI with their primary care physician, there was not a decrease in BMI. Future studies are needed to provide more detailed information about the discussion between patients and providers in relation to the patient's personal weight status.

Self-management of diabetes in Sub-Saharan Africa: a systematic review

BACKGROUND

The prevalence of diabetes in sub-Saharan Africa has increased rapidly over the last years. Self-management is a key element for the proper management, but strategies are currently lacking in this context. This systematic review aims to describe the level of self-management among persons living with type 2 diabetes mellitus in sub-Saharan Africa.

METHOD

Relevant databases including PubMed, Web of Science and Google Scholar were searched up to September 2016. Studies reporting self-management behavior of people with type 2 diabetes mellitus and living in sub-Saharan Africa were included.

RESULTS

A total of 550 abstracts and 109 full-text articles were assessed. Forty-three studies, mainly observational, met the inclusion criteria. The studies showed that patients rarely self-monitored their glucose levels, had low frequency/duration of physical activity, moderately adhered to recommended dietary and medication behavior, had poor level of knowledge regarding diabetes related complications and sought traditional or herbal medicines beside of their biomedical treatment. The analysis also revealed a lack of studies on psychosocial aspects.

CONCLUSION

Except for the psychosocial area, there is a good amount of recent studies on self-management behavior of type 2 diabetes mellitus sub-Saharan Africa. These studies indicate that self-management in sub-Saharan Africa is poor and therefore a serious threat to the health of individuals and the health systems capacity.

Weight underestimation for adults in Beijing and its association with chronic disease awareness and weight management

Background

Obesity is known to be a risk factor to a variety of chronic diseases. Weight misperception has an impact on weight-loss attitude and behavior. We aimed to investigate factors associated with weight underestimation, and to assess the effect of hypertension, diabetes and dyslipidemia awareness on weight underestimation and weight management for overweight and obese adults.

Methods

Data was obtained from the 2011 Beijing Non-communicable disease and risk factors Surveillance (BJNCDRS). A total of 19,932 participants with measures of weight and height were included in the analysis. Self-perception of weight was obtained by asking, “How do you describe your weight?”, and the question for weight management was “Are you taking any actions to control your body weight?”. Multiple logistic regression was used to investigate factors related to weight underestimation.

Results

For the underweight, normal weight, and overweight/obese categories, more than half of the participants perceived their weight accurately (63.6, 53.8, 66.2%, respectively). For overweight and obese adults, older age, male, rural residence, lower level of education, lower level of income, absence of hypertension, presence of diabetes and absence of dyslipidemia positively associated with weight underestimation, and awareness of having hypertension and dyslipidemia were negatively associated with weight underestimation (Adjusted OR(95%CI) were 0.70(0.61~ 0.79) and 0.71(0.62~ 0.80), respectively). Awareness of having hypertension and dyslipidemia were significantly associated with weight management (Adjusted OR (95%CI) were 1.42(1.25~ 1.62) and 1.53(1.36~ 1.72), respectively). There was no significant association between awareness of diabetes and weight underestimation(P > 0.05) or weight management(P > 0.05).

Conclusions

More than half of the participants perceived their weight accurately. For overweight/obese population, awareness of having hypertension and dyslipidemia could improve weight perception and weight management, whereas awareness of having diabetes might not.

Adherence to and factors associated with self-care behaviours in type 2 diabetes patients in Ghana

BACKGROUND

Previous research has failed to examine more than one self-care behaviour in type 2 diabetes patients in Ghana. The purpose of this study is to investigate adult Ghanaian type 2 diabetes patients' adherence to four self-care activities: diet (general and specific), exercise, self-monitoring of blood glucose (SMBG) and foot care.

METHODS

Consenting type 2 diabetes patients attending diabetes outpatient clinic appointments at three hospitals in the Tamale Metropolis of Ghana completed a cross-sectional survey comprising the Summary of Diabetes Self-Care Activities Measure, and questions about demographic characteristics and diabetes history. Height and weight were also measured. Multiple linear regression analyses were conducted to identify the factors associated with adherence to each of the four self-care behaviours.

RESULTS

In the last 7 days, participants exercised for a mean (SD) of 4.78 (2.09) days and followed diet, foot care and SMBG for a mean (SD) of 4.40 (1.52), 2.86 (2.16) and 2.15 (0.65) days, respectively. More education was associated with a higher frequency of reported participation in exercise (r = 0.168, p = 0.022), following a healthy diet (r = 0.223, p = 0.002) and foot care (r = 0.153, p = 0.037) in the last 7 days. Males reported performing SMBG (r = 0.198, p = 0.007) more frequently than their female counterparts.

CONCLUSION

Adherence to diet, SMBG and checking of feet were relatively low. People with low education and women may need additional support to improve adherence to self-care behaviours in this type 2 diabetes population.

Perceived Health Status: Is Obesity Perceived as a Risk Factor and Disease?

One might expect that a perception of obesity being a risk factor and disease, contributes to effective obesity prevention and management strategies. However, obesity rates continue to increase worldwide. The question arises whether obesity is truly perceived as a risk factor and a disease. This paper aims at describing perception of obesity as risk factor and disease among individuals seeking care, individuals not seeking care, the society, and different professionals having a role in the field of obesity. The paper is a reflection of the lecture on the topic that was given at the EASO's New Investigators United's Summer School 2016 in Portugal and the discussion with the new investigators and other senior speakers. Individual obese patients seeking help are very much aware of obesity being a risk factor and disease, but perceptions regarding obesity seem to be flawed among those who do not seek help for obesity. Also, misperceptions regarding obesity play a role at different levels, including society, different political levels, the fields of health care and social work, prevention organizations, and the food and marketing industry. The food and marketing industry has an enormous role in changing perceptions by the society and policy makers. Obesity rates will continue to increase as long as individuals, the society, and professionals at different levels have false interpretations of the severity of obesity. Severe action is needed against those who are playing a role in maintaining false perceptions of obesity as a risk factor and disease.