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Moore EL, Kuhn AK, Leung JG, Myhre LJ. Striving for health equity: Stigmatizing language in inpatient pharmacy notes - A pilot study. Res Social Adm Pharm 2024; 20:553-556. [PMID: 38365520 DOI: 10.1016/j.sapharm.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 12/06/2023] [Accepted: 02/05/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND As pharmacy evolves, pharmacists have an increasing role in documentation. Publications examining the actions of other health professionals show that negative perception in written notes translates to patients receiving lower quality of care, resulting in worse health outcomes, suggesting that the use of stigmatizing language towards patients has concerning consequences. OBJECTIVES To identify the prevalence of stigmatizing language in inpatient pharmacy progress. notes based on patient specific characteristics and diagnoses. METHODS This retrospective pilot study reviewed inpatient pharmacy progress notes of a Midwestern (United States) tertiary academic institution from May to June 2023. Stigmatizing words and phrases associated with specified disease states were separated into the categories of general language, substance use disorders, and mental health. Notes of patients on internal medicine, family medicine, kidney/pancreas transplant, liver transplant, and gastroenterology services were included. RESULTS Stigmatizing language was found in 22% (n = 43) of notes. The words "abuse" and "dependence" had the highest prevalence. Patients diagnosed with substance use disorders experienced stigmatizing language at a high rate, exaggerated further if their note lacked a documented diagnosis. CONCLUSIONS This study demonstrated that stigmatizing language is present in pharmacy documentation. Providing context and resources of the proper documentation to reflect equitable healthcare is crucial for patient care.
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Affiliation(s)
- Elise L Moore
- Department of Pharmacy Services, Mayo Clinic, 1216 2nd St SW, Rochester, MN, 55902, United States.
| | - Alyssa K Kuhn
- Department of Pharmacy Services, Mayo Clinic, 1216 2nd St SW, Rochester, MN, 55902, United States.
| | - Jonathan G Leung
- Department of Pharmacy Services, Mayo Clinic, 1216 2nd St SW, Rochester, MN, 55902, United States.
| | - Laura J Myhre
- Department of Pharmacy Services, Mayo Clinic, 1216 2nd St SW, Rochester, MN, 55902, United States.
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2
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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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Lee-Baggley D, Fils-Aimé N, Audet I, Barakat M. Improving implementation of best practices in obesity management: Physician experiences in obesity care. Clin Obes 2024; 14:e12624. [PMID: 37846529 DOI: 10.1111/cob.12624] [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: 10/05/2022] [Revised: 02/20/2023] [Accepted: 06/23/2023] [Indexed: 10/18/2023]
Abstract
In this study, we sought to analyse experiences in weight management among physicians working in the area of obesity and contrast these experiences with best practices. By understanding experiences of physicians working in obesity management, we can better support implementation of best practices in their day-to-day practice. An online survey of Canadian primary care physicians, internists and endocrinologists recruited from a nationwide market research database was conducted. The survey captured demographic characteristics and perceptions about weight loss and its management. One hundred and ninety-two physicians (140 primary care, 22 internists and 30 endocrinologists) were recruited and completed the survey. Challenges identified by the physicians in helping patients lose weight included patients' poor compliance and lack of time and resources to address the issue. Most physicians reported considering obesity to be a chronic disease, but most did not incorporate a multi-dimensional, chronic disease model of obesity treatment (i.e., combination of lifestyle interventions with psychological, medical and/or surgical interventions). Endocrinologists reported management practices consistent with a chronic disease model more frequently than primary care physicians. These data highlight the need for improvement in obesity management, particularly in primary care. Despite proliferation of guidelines on best practices, implementation of these practices into daily practice remains low.
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Affiliation(s)
- Dayna Lee-Baggley
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Psychology Department, Saint Mary's University, Halifax, Nova Scotia, Canada
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Alqahtani SM, Rayzah M, Shaik RA, Alzahrani MK, Alalawi Y, Alnefaie S, Ahmad MS. Gauging the Awareness of Physicians in Saudi Arabia Regarding Risk Factors for Thyroid Cancer. Cureus 2024; 16:e53747. [PMID: 38465048 PMCID: PMC10921024 DOI: 10.7759/cureus.53747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 03/12/2024] Open
Abstract
Background The prevalence of obesity and thyroid cancer (TC) is increasing worldwide, and obesity is a risk factor for TC. Objectives This study aimed to elucidate physicians' awareness of obesity as a risk factor for TC. Materials and methods A cross-sectional, self-report online questionnaire was distributed to physicians in all regions of Saudi Arabia. The questionnaire comprised sociodemographic data and questions concerning the risk factors for TC, including obesity. Results A total of 310 physicians participated in this study. Of the respondents, 35.8% (n = 111) were aged 30-40 years, 40.6% (n = 126) were board certified, and 52.3% (n = 162) had >10 years of experience. Only 36.8% (n = 114) of respondents were familiar with the relationship between obesity and TC risk (P < 0.001). In terms of knowledge of obesity as a risk factor for TC, a significant difference was observed for the following sociodemographic characteristics: sex, educational attainment, and years of experience. A significant difference was also observed with awareness of other risk factors for TC. Conclusions In light of the limited awareness of the correlation between obesity and TC, the most effective approach to address these misconceptions would be to implement diverse and ongoing medical education initiatives.
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Affiliation(s)
- Saad M Alqahtani
- Department of Surgery, College of Medicine, Majmaah University, Al-Majmaah, SAU
| | - Musaed Rayzah
- Department of Surgery, College of Medicine, Majmaah University, Al-Majmaah, SAU
| | - Riyaz A Shaik
- Department of Family and Community Medicine, College of Medicine, Majmaah University, Al-Majmaah, SAU
| | - Mansour K Alzahrani
- Department of Family and Community Medicine, College of Medicine, Majmaah University, Al-Majmaah, SAU
| | - Yousef Alalawi
- Department of Surgery, King Salman Armed Forces Hospital, Tabuk, SAU
| | - Sahar Alnefaie
- Department of Surgery, College of Medicine, Taif University, Taif, SAU
| | - Mohammad S Ahmad
- Department of Family and Community Medicine, College of Medicine, Majmaah University, Al-Majmaah, SAU
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5
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Ladapo JA, Orstad SL, Wylie-Rosett J, Tseng CH, Chung UYR, Patel NR, Shu SB, Goldstein NJ, Wali S, Jay M. Cost-effectiveness of goal-directed and outcome-based financial incentives for weight loss in low-income populations: the FIReWoRk randomized clinical trial. Int J Obes (Lond) 2024; 48:231-239. [PMID: 37919433 DOI: 10.1038/s41366-023-01404-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/14/2023] [Accepted: 10/20/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND The Financial Incentives for Weight Reduction (FIReWoRk) clinical trial showed that financial incentive weight-loss strategies designed using behavioral economics were more effective than provision of weight-management resources only. We now evaluate cost-effectiveness. METHODS Cost-effectiveness analysis of a multisite randomized trial enrolling 668 participants with obesity living in low-income neighborhoods. Participants were randomized to (1) goal-directed incentives (targeting behavioral goals), (2) outcome-based incentives (targeting weight-loss), and (3) resources only, which were provided to all participants and included a 1-year commercial weight-loss program membership, wearable activity monitor, food journal, and digital scale. We assessed program costs, time costs, quality of life, weight, and incremental cost-effectiveness in dollars-per-kilogram lost. RESULTS Mean program costs at 12 months, based on weight loss program attendance, physical activity participation, food diary use, self-monitoring of weight, and incentive payments was $1271 in the goal-directed group, $1194 in the outcome-based group, and $834 in the resources-only group (difference, $437 [95% CI, 398 to 462] and $360 [95% CI, 341-363] for goal-directed or outcome-based vs resources-only, respectively; difference, $77 [95% CI, 58-130] for goal-directed vs outcome-based group). Quality of life did not differ significantly between the groups, but weight loss was substantially greater in the incentive groups (difference, 2.34 kg [95% CI, 0.53-4.14] and 1.79 kg [95% CI, -0.14 to 3.72] for goal-directed or outcome-based vs resources only, respectively; difference, 0.54 kg [95% CI, -1.29 to 2.38] for goal-directed vs outcome-based). Cost-effectiveness of incentive strategies based on program costs was $189/kg lost in the goal-directed group (95% CI, $124/kg to $383/kg) and $186/kg lost in the outcome-based group (95% CI, $113/kg to $530/kg). CONCLUSIONS Goal-directed and outcome-based financial incentives were cost-effective strategies for helping low-income individuals with obesity lose weight. Their incremental cost per kilogram lost were comparable to other weight loss interventions.
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Affiliation(s)
- Joseph A Ladapo
- Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA.
| | - Stephanie L Orstad
- Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, NY, USA
| | - Judith Wylie-Rosett
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Chi-Hong Tseng
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Un Young Rebecca Chung
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Nikhil R Patel
- Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, NY, USA
| | - Suzanne B Shu
- Cornell Dyson School of Applied Economics and Management, Ithaca, NY, USA
| | | | - Soma Wali
- Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA, USA
| | - Melanie Jay
- Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, NY, USA
- Veterans Affairs, New York Harbor, New York, NY, USA
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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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Bharati R, Kovach KA. Incorporating Lifestyle Medicine Into Primary Care Practice: Perceptions and Practices of Family Physicians. Am J Lifestyle Med 2023; 17:704-716. [PMID: 37711349 PMCID: PMC10498979 DOI: 10.1177/15598276211072506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
Introduction: Lifestyle medicine (LM) uses therapeutic lifestyle behavior change to address the root causes of chronic diseases. The purpose of this study was to assess family physicians' perceptions and utilization of LM principles in their primary care practices, as well as identify reported barriers to implementation. Methods: A survey was administered to 5770 family physicians registered with the American Academy of Family Physicians (AAFP). The survey questions assessed the gap between perception and practice of LM core competencies and the 6 domains of LM. Results: The responses from 447 family physicians were included in the study. Respondents' perceived importance and reported practice was higher for clinical skills compared to the community partnerships and advocacy. There was a substantial gap in the reported comfort with and practice of certain LM domains, such as sleep (47%) and relationships (39.4%). However, LM board-certified physicians had a significantly higher frequency of practice in these domains. The majority of participants identified both difficulty with changing patient behavior (89%) and having limited time (81%) as major barriers to incorporate LM into their practice. Conclusion: Lifestyle medicine concepts resonate strongly with family physicians although gaps exist surrounding engaging in community partnerships, advocacy, and certain domains of LM. This study assesses family physicians' perceptions and utilization of LM principles in their primary care practices, and identifies reported barriers to implementation.
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Suresh K, Willems E, Williams J, Gritz RM, Dickinson LM, Perreault L, Holtrop JS. An Assessment of Weight Loss Management in Health System Primary Care Practices. J Am Board Fam Med 2023; 36:51-65. [PMID: 36460354 PMCID: PMC10482321 DOI: 10.3122/jabfm.2022.220224r1] [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: 06/24/2022] [Revised: 08/12/2022] [Accepted: 08/17/2022] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Primary care practices can help patients address obesity through weight loss; however, there are many barriers to doing so. This study examined weight management services provided and factors associated with higher reported provision of services. METHODS A survey was given to practice members in 18 primary care practices in a Colorado-based health system. The survey assessed weight management services to determine the amount and type of weight loss assistance provided and other factors that may be important. We used descriptive statistics to summarize responses and linear regression with generalized estimating equations to assess the association between the practice and practice member characteristics and the amount of weight management services provided. RESULTS The overall response rate was 64% (254/399). On average, clinicians reported performing 73% of the services, and when grouped into minimal, basic, and extensive, the clinicians on average performed 87%, 68%, and 69% of them, respectively. In a multivariable model adjusted for demographics, factors associated with performing more services included perception of overall better practice culture and perception of weight management implementation climate. CONCLUSIONS Practice-associated factors such as culture and implementation climate may be worth examining to understand how to implement weight management in primary care.
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Affiliation(s)
- Krithika Suresh
- From Colorado School of Public Health Department of Biostatistics & Informatics, Aurora (KS, EW); University of Colorado Department of Family Medicine, Aurora (JW, LMD, JSH); University of Colorado Department Medicine-Division of Health Care Policy Research, Aurora (RMG); University of Colorado Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), Aurora (RMG, JSH); University of Colorado Department Medicine-Endocrinology/Metabolism/Diabetes, Aurora (LP)
| | - Emileigh Willems
- From Colorado School of Public Health Department of Biostatistics & Informatics, Aurora (KS, EW); University of Colorado Department of Family Medicine, Aurora (JW, LMD, JSH); University of Colorado Department Medicine-Division of Health Care Policy Research, Aurora (RMG); University of Colorado Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), Aurora (RMG, JSH); University of Colorado Department Medicine-Endocrinology/Metabolism/Diabetes, Aurora (LP)
| | - Johnny Williams
- From Colorado School of Public Health Department of Biostatistics & Informatics, Aurora (KS, EW); University of Colorado Department of Family Medicine, Aurora (JW, LMD, JSH); University of Colorado Department Medicine-Division of Health Care Policy Research, Aurora (RMG); University of Colorado Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), Aurora (RMG, JSH); University of Colorado Department Medicine-Endocrinology/Metabolism/Diabetes, Aurora (LP)
| | - R Mark Gritz
- From Colorado School of Public Health Department of Biostatistics & Informatics, Aurora (KS, EW); University of Colorado Department of Family Medicine, Aurora (JW, LMD, JSH); University of Colorado Department Medicine-Division of Health Care Policy Research, Aurora (RMG); University of Colorado Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), Aurora (RMG, JSH); University of Colorado Department Medicine-Endocrinology/Metabolism/Diabetes, Aurora (LP)
| | - L Miriam Dickinson
- From Colorado School of Public Health Department of Biostatistics & Informatics, Aurora (KS, EW); University of Colorado Department of Family Medicine, Aurora (JW, LMD, JSH); University of Colorado Department Medicine-Division of Health Care Policy Research, Aurora (RMG); University of Colorado Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), Aurora (RMG, JSH); University of Colorado Department Medicine-Endocrinology/Metabolism/Diabetes, Aurora (LP)
| | - Leigh Perreault
- From Colorado School of Public Health Department of Biostatistics & Informatics, Aurora (KS, EW); University of Colorado Department of Family Medicine, Aurora (JW, LMD, JSH); University of Colorado Department Medicine-Division of Health Care Policy Research, Aurora (RMG); University of Colorado Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), Aurora (RMG, JSH); University of Colorado Department Medicine-Endocrinology/Metabolism/Diabetes, Aurora (LP)
| | - Jodi Summers Holtrop
- From Colorado School of Public Health Department of Biostatistics & Informatics, Aurora (KS, EW); University of Colorado Department of Family Medicine, Aurora (JW, LMD, JSH); University of Colorado Department Medicine-Division of Health Care Policy Research, Aurora (RMG); University of Colorado Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), Aurora (RMG, JSH); University of Colorado Department Medicine-Endocrinology/Metabolism/Diabetes, Aurora (LP)
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Ladapo JA, Orstad SL, Wali S, Wylie-Rosett J, Tseng CH, Chung UYR, Cuevas MA, Hernandez C, Parraga S, Ponce R, Sweat V, Wittleder S, Wallach AB, Shu SB, Goldstein NJ, Jay M. Effectiveness of Goal-Directed and Outcome-Based Financial Incentives for Weight Loss in Primary Care Patients With Obesity Living in Socioeconomically Disadvantaged Neighborhoods: A Randomized Clinical Trial. JAMA Intern Med 2023; 183:61-69. [PMID: 36469353 PMCID: PMC9857219 DOI: 10.1001/jamainternmed.2022.5618] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/16/2022] [Indexed: 12/12/2022]
Abstract
Importance Financial incentives for weight management may increase use of evidence-based strategies while addressing obesity-related economic disparities in low-income populations. Objective To examine the effects of 2 financial incentive strategies developed using behavioral economic theory when added to provision of weight management resources. Design, Setting, and Participants Three-group, randomized clinical trial conducted from November 2017 to May 2021 at 3 hospital-based clinics in New York City, New York, and Los Angeles, California. A total of 1280 adults with obesity living in low-income neighborhoods were invited to participate, and 668 were enrolled. Interventions Participants were randomly assigned to goal-directed incentives, outcome-based incentives, or a resources-only group. The resources-only group participants were given a 1-year commercial weight-loss program membership, self-monitoring tools (digital scale, food journal, and physical activity monitor), health education, and monthly one-on-one check-in visits. The goal-directed group included resources and linked financial incentives to evidence-based weight-loss behaviors. The outcome-based arm included resources and linked financial incentives to percentage of weight loss. Participants in the incentive groups could earn up to $750. Main Outcomes and Measures Proportion of patients achieving 5% or greater weight loss at 6 months. Results The mean (SD) age of the 668 participants enrolled was 47.7 (12.4) years; 541 (81.0%) were women, 485 (72.6%) were Hispanic, and 99 (14.8%) were Black. The mean (SD) weight at enrollment was 98.96 (20.54) kg, and the mean body mass index (calculated as weight in kilograms divided by height in meters squared) was 37.95 (6.55). At 6 months, the adjusted proportion of patients who lost at least 5% of baseline weight was 22.1% in the resources-only group, 39.0% in the goal-directed group, and 49.1% in the outcome-based incentive group (difference, 10.08 percentage points [95% CI, 1.31-18.85] for outcome based vs goal directed; difference, 27.03 percentage points [95% CI, 18.20-35.86] and 16.95 percentage points [95% CI, 8.18-25.72] for outcome based or goal directed vs resources only, respectively). However, mean percentage of weight loss was similar in the incentive arms. Mean earned incentives was $440.44 in the goal-directed group and $303.56 in the outcome-based group, but incentives did not improve financial well-being. Conclusions and Relevance In this randomized clinical trial, outcome-based and goal-directed financial incentives were similarly effective, and both strategies were more effective than providing resources only for clinically significant weight loss in low-income populations with obesity. Future studies should evaluate cost-effectiveness and long-term outcomes. Trial Registration ClinicalTrials.gov Identifier: NCT03157713.
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Affiliation(s)
- Joseph A. Ladapo
- Department of Medicine, University of Florida College of Medicine, Gainesville
| | - Stephanie L. Orstad
- Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, New York
| | - Soma Wali
- Department of Medicine, Olive View–UCLA Medical Center, Sylmar, California
| | - Judith Wylie-Rosett
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Chi-Hong Tseng
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Un Young Rebecca Chung
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Miguel A. Cuevas
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Christina Hernandez
- Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, New York
| | - Susan Parraga
- Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, New York
| | - Robert Ponce
- Department of Medicine, Olive View–UCLA Medical Center, Sylmar, California
| | - Victoria Sweat
- Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, New York
| | - Sandra Wittleder
- Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, New York
| | - Andrew B. Wallach
- Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, New York
- Bellevue Hospital Center, New York, New York
| | - Suzanne B. Shu
- Cornell Dyson School of Applied Economics and Management, Ithaca, New York
| | | | - Melanie Jay
- Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, New York
- New York Harbor Veterans Health Affairs, New York, New York
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10
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Faro JM, D'Addario A, King AM, Mazor KM, Pbert L, Sadasivam RS, Geller AC, Murphy EA, Ockene JK. Video-based communication assessment for weight management counseling training in medical residents: a mixed methods study. BMC MEDICAL EDUCATION 2022; 22:899. [PMID: 36578064 PMCID: PMC9795434 DOI: 10.1186/s12909-022-03984-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Physician delivered weight management counseling (WMC) occurs infrequently and physicians report lack of training and poor self-efficacy. The purpose of this study was to develop and test the Video-based Communication Assessment (VCA) for weight management counseling (WMC) training in medical residents. METHODS This study was a mixed methods pilot conducted in 3 phases. First, we created five vignettes based on our prior data and expert feedback, then administered the vignettes via the VCA to Internal Medicine categorical residents (n = 16) from a University Medical School. Analog patients rated responses and also provided comments. We created individualized feedback reports which residents were able to view on the VCA. Lastly, we conducted debriefing interviews with the residents (n = 11) to obtain their feedback on the vignettes and personalized feedback. Interviews were transcribed, and we used thematic analysis to generate and apply codes, followed by identifying themes. RESULTS Descriptive statistics were calculated and learning points were created for the individualized feedback reports. In VCA debriefing interviews with residents, five themes emerged: 1) Overall the VCA was easy to use, helpful and more engaging than traditional learning and assessment modes, 2) Patient scenarios were similar to those encountered in the clinic, including diversity, health literacy and different stages of change, 3) The knowledge, skills, and reminders from the VCA can be transferred to practice, 4) Feedback reports were helpful, to the point and informative, including the exemplar response of how to best respond to the scenario, and 5) The VCA provide alternatives and practice scenarios to real-life patient situations when they aren't always accessible. CONCLUSIONS We demonstrated the feasibility and acceptability of the VCA, a technology delivered platform, for delivering WMC to residents. The VCA exposed residents to diverse patient experiences and provided potential opportunities to tailor providers responses to sociological and cultural factors in WMC scenarios. Future work will examine the effect of the VCA on WMC in actual clinical practice.
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Affiliation(s)
- Jamie M Faro
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation St, Worcester, MA, 01605, USA.
| | | | - Ann M King
- National Board of Medical Examiners, Philadelphia, USA
| | - Kathleen M Mazor
- Meyers Health Care Institute, University of Massachusetts Medical School, 385 Grove St, Worcester, MA, USA
- Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Ave. North, Worcester, MA, USA
| | - Lori Pbert
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation St, Worcester, MA, 01605, USA
| | - Rajani S Sadasivam
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation St, Worcester, MA, 01605, USA
| | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard University, 677 Huntington Ave, Cambridge, MA, USA
| | - Elizabeth A Murphy
- Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Ave. North, Worcester, MA, USA
| | - Judith K Ockene
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation St, Worcester, MA, 01605, USA
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11
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Atlantis E, Chimoriya R, Seifu CN, Peters K, Murphy G, Carr B, Lim D, Fahey P. Enablers and barriers to implementing obesity assessments in clinical practice: a rapid mixed-methods systematic review. BMJ Open 2022; 12:e063659. [PMID: 36446466 PMCID: PMC9710371 DOI: 10.1136/bmjopen-2022-063659] [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] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES This systematic review aims to improve our knowledge of enablers and barriers to implementing obesity-related anthropometric assessments in clinical practice. DESIGN A mixed-methods systematic review. DATA SOURCES Medline, Embase and CINAHL to November 2021. ELIGIBILITY CRITERIA Quantitative studies that reported patient factors associated with obesity assessments in clinical practice (general practice or primary care); and qualitative studies that reported views of healthcare professionals about enablers and barriers to their implementation. DATA EXTRACTION AND SYNTHESIS We used random-effects meta-analysis to pool ratios for categorical predictors reported in ≥3 studies expressed as pooled risk ratio (RR) with 95% CI, applied inverse variance weights, and investigated statistical heterogeneity (I2), publication bias (Egger's test), and sensitivity analyses. We used reflexive thematic analysis for qualitative data and applied a convergent integrated approach to synthesis. RESULTS We reviewed 22 quantitative (observational) and 3 qualitative studies published between 2004 and 2020. All had ≥50% of the quality items for risk of bias assessments. Obesity assessment in clinical practice was positively associated with patient factors: female sex (RR 1.28, 95% CI 1.10 to 1.50, I2 99.8%, mostly UK/USA), socioeconomic deprivation (RR 1.21, 95% CI 1.18 to 1.24, I2 73.9%, UK studies), non-white race/ethnicity (RR 1.27, 95% CI 1.03 to 1.57, I2 99.6%) and comorbidities (RR 2.11, 95% CI 1.60 to 2.79, I2 99.6%, consistent across most countries). Obesity assessment was also most common in the heaviest body mass index group (RR 1.55, 95% CI 0.99 to 2.45, I2 99.6%). Views of healthcare professionals were positive about obesity assessments when linked to patient health (convergent with meta-analysis for comorbidities) and if part of routine practice, but negative about their role, training, time, resources and incentives in the healthcare system. CONCLUSIONS Our evidence synthesis revealed several important enablers and barriers to obesity assessments that should inform healthcare professionals and relevant stakeholders to encourage adherence to clinical practice guideline recommendations.
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Affiliation(s)
- Evan Atlantis
- Schoolof Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
- Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
- Discipline of Medicine, Faculty of Medicine and Health, Nepean Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Ritesh Chimoriya
- Schoolof Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
- Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
- Schoolof Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Canaan Negash Seifu
- Schoolof Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Kath Peters
- Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
- Schoolof Nursing and Midwifery, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Gill Murphy
- Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
- Schoolof Nursing and Midwifery, Western Sydney University, Campbelltown, New South Wales, Australia
| | | | - David Lim
- Schoolof Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
| | - P Fahey
- Schoolof Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
- Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
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12
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Vrkatić A, Grujičić M, Jovičić-Bata J, Novaković B. Nutritional Knowledge, Confidence, Attitudes towards Nutritional Care and Nutrition Counselling Practice among General Practitioners. Healthcare (Basel) 2022; 10:2222. [PMID: 36360563 PMCID: PMC9691229 DOI: 10.3390/healthcare10112222] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/30/2022] [Accepted: 11/03/2022] [Indexed: 08/04/2023] Open
Abstract
Nutritional care represents any practice provided by a health professional, aimed to improve the patient's health outcomes by influencing patient's dietary habits. Clearly, dietitians are the ones supposed to provide top-quality nutrition care, but their services are often inaccessible to many for various reasons. This obliges general practitioners (GPs) in primary health care to provide nutritional counselling to their patients to a certain extent. Preconditions to successful nutritional counselling are GPs with adequate nutritional knowledge, positive attitudes towards nutrition and nutritional care, self-confident and competent in nutritional counselling. Therefore, the aim of this review is to summarise currently available information on nutritional knowledge, confidence and attitudes towards nutritional care and nutrition counselling practice of GPs, as well as barriers towards provision of nutritional counselling. GPs do not consistently obtain satisfying results in nutrition knowledge assessments and their self-confidence in nutrition counselling skills varies. Studies suggest that nutritional counselling practice still has not met its full potential, and GPs frequently report various barriers that impair nutritional counselling practice. Thus, health policies that help overcome barriers and create stimulating environment for GPs to implement nutrition counselling strategies efficiently are the key to improving quality and quantity of nutritional counselling.
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Affiliation(s)
- Aleksandra Vrkatić
- Department of Pharmacy, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
| | - Maja Grujičić
- Department of General Education Subjects, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
| | - Jelena Jovičić-Bata
- Department of Pharmacy, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
| | - Budimka Novaković
- Department of Pharmacy, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
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13
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Carrasco D, Thulesius H, Jakobsson U, Memarian E. Primary care physicians’ knowledge and attitudes about obesity, adherence to treatment guidelines and association with confidence to treat obesity: a Swedish survey study. BMC PRIMARY CARE 2022; 23:208. [PMID: 35971075 PMCID: PMC9378264 DOI: 10.1186/s12875-022-01811-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/15/2022] [Indexed: 12/03/2022]
Abstract
Background Obesity is a chronic disease with increasing prevalence. We aimed to explore primary care physicians’ knowledge and attitudes about obesity and how knowledge and attitudes are associated with confidence and adherence to obesity guidelines and barriers to obesity treatment. Methods A questionnaire survey was sent by e-mail to 1642 primary care physicians in four regions in Sweden. The survey focused on the physicians’ knowledge, attitudes towards obesity, confidence in obesity management, adherence to obesity guidelines and barriers to optimal care. We created different statistical indices for knowledge, attitudes and adherence. To analyse the correlation between these indices, we used linear regression analyses. Results Replies from 235 primary care physicians yielded a response rate of 14.3%. Most physicians answered correctly that obesity is a disease (91%), that obesity regulation sits in the hypothalamus (70%) and that obesity is due to disorders of appetite regulation (69%). However, 44% of the physicians thought that the most effective weight reduction method for severe obesity was lifestyle changes; 47% believed that obesity is due to lack of self-control, 14% mentioned lack of motivation and 22% stated laziness. Although 97% believed that physicians can help individuals with obesity and 56% suggested that obesity treatment should be prioritised, 87% of the physicians expressed that losing weight is the patients’ responsibility. There was a positive association between higher knowledge and better adherence to obesity guidelines (B = 0.07, CI 0.02–0.12, p-value = 0.005) and feeling confident to suggest medication (p < 0.001) or bariatric surgery (p = 0.002). While 99% of the physicians felt confident to discuss lifestyle changes, 67% and 81% were confident to suggest medication or bariatric surgery, respectively. Respondents perceived that the greatest barrier in obesity management was lack of time (69%) and resources (49%). Conclusion There was a positive association between Swedish primary care physicians’ knowledge and adherence to obesity guidelines and being more confident to suggest obesity treatment. Yet, many physicians had an ambivalent attitude towards obesity management. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01811-x.
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14
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McVay MA, Cooper KB, Donahue ML, Carrera Seoane M, Shah NR, Webb F, Perri M, Jake‐Schoffman DE. Engaging primary care patients with existing online tools for weight loss: A pilot trial. Obes Sci Pract 2022; 8:569-584. [PMID: 36238223 PMCID: PMC9535672 DOI: 10.1002/osp4.592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/29/2021] [Accepted: 01/18/2022] [Indexed: 11/11/2022] Open
Abstract
Objective Free online tools show potential for promoting weight loss at a low cost, but there is limited evidence about how to effectively engage patients with them. To address this, a low‐dose, flexible intervention was developed that aims to enhance weight‐related discussions with primary care providers (PCPs) and engage patients with an organic (i.e., not researcher‐created) weight loss‐focused social media community and online self‐monitoring tool. Feasibility and acceptability of the intervention was evaluated in a single‐arm, 12‐week pilot. Methods PCPs were recruited at two clinics, then PCP's patients with upcoming appointments were identified and recruited. Patients received an interactive online kickoff before their scheduled primary care appointment, then 8 follow‐up messages over 12 weeks via email or their electronic health record patient portal. Patients completed assessments at baseline, post‐appointment, and week 12. Primary care providers and patients completed semi‐structured interviews. Results All PCPs approached enrolled (n = 6); patient recruitment was on track to meet the study goal prior to COVID‐19 restrictions, and n = 27 patients enrolled. Patient satisfaction with the pre‐appointment kickoff was high. Twenty‐four patients reported discussing weight‐related topics at their primary care appointment and all were satisfied with the discussion. Twenty‐two patients completed 12‐week assessments. Of these, 15 reported engaging with the self‐monitoring tool and 9 with the social media community. Patient interviews revealed reasons for low social media community engagement, including perceived lack of fit. On average, patients with available data (n = 21) lost 2.4 ± 4.1% of baseline weight, and 28.6% of these patients lost ≥3% of baseline weight. Primary care providers reported high intervention satisfaction. Conclusions The intervention and trial design show potential, although additional strategies are needed to promote tool engagement.
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Affiliation(s)
- Megan A. McVay
- Department of Health Education & Behavior University of Florida Gainesville FL
| | - Kellie B Cooper
- Department of Health Education & Behavior University of Florida Gainesville FL
| | | | | | - Nipa R. Shah
- Department of Community Health and Family Medicine University of Florida College of Medicine Jacksonville FL
| | - Fern Webb
- Department of Surgery University of Florida Jacksonville FL
| | - Michael Perri
- College of Public Health and Health Professions University of Florida Gainesville
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15
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Osterland A, King C, Kumar N, Mocarski M, Ramasamy A, Walker C, Darji H, Godley P. Retrospective descriptive analysis of a managed care population with obesity. Curr Med Res Opin 2022; 38:83-89. [PMID: 34643454 DOI: 10.1080/03007995.2021.1991900] [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] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To reveal the extent of obesity in a single healthcare system and provide a blueprint for other health systems to perform similar analyses, this study describes characteristics and weight change patterns of patients classified with overweight and obesity at a large integrated delivery network (IDN) in the South-Central United States. METHODS A descriptive, observational, retrospective study was conducted using electronic medical records and claims data. Patients were ≥18 years old, body mass index (BMI) ≥27 kg/m2, and continuously enrolled in the IDN plan for ≥6 months before and ≥12 months after the index date. Demographics, comorbidities, BMI, and weight were collected. Weight changes were assessed annually, and anti-obesity medications (AOM) use was also captured. RESULTS A total of 36,430 eligible patients were identified. A subset of 22,712 patients was continuously enrolled for the entire study period (mean age: 57.2) and were primarily white (83.3%) and commercially insured (54.3%). Most patients were categorized as overweight (40.1%) or obesity class I (32.5%) at baseline. At years 1 and 4 post-index, patients who maintained index weight (±3%) was 56.2% and 37.0%, respectively, whereas weight gain (≥3% increase) was 23.7% and 33.3%, respectively. AOM use (1.1%) primarily consisted of phentermine-hydrochloride (n = 114, 0.5%) and orlistat (n = 115, 0.5%). CONCLUSIONS An increasing proportion of patients gained weight over time, combined with low AOM use, emphasizing the need for weight-loss interventions in this population. Findings from this study provide a foundation for health systems to perform similar analyses.
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Affiliation(s)
| | - Claire King
- Baylor Scott & White Health, Temple, TX, USA
| | | | | | | | | | | | - Paul Godley
- Baylor Scott & White Health, Temple, TX, USA
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16
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de Lannoy L, Cowan T, Fernandez A, Ross R. Physical activity, diet, and weight loss in patients recruited from primary care settings: An update on obesity management interventions. Obes Sci Pract 2021; 7:619-628. [PMID: 34631139 PMCID: PMC8488444 DOI: 10.1002/osp4.514] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/18/2021] [Accepted: 03/23/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Obesity and related comorbidities are the most common chronic conditions in North America where behavior modification including the adoption of physical activity (PA) and a healthful diet are primary treatment strategies. Patients are more likely to engage in behavior modification if encouraged by their physician; however, behavioral counseling in primary care rarely occurs due to lack of training and resources. A more effective method may be to refer patients from clinical settings to other health professionals. OBJECTIVE This systematic review examines the effectiveness of behavior-based counseling for obesity management among participants referred from clinical settings. METHODS PubMed, CINAHL, and EMBASE were used to identify randomized clinical trials (2014-2020) for weight loss with the following inclusion criteria: trial duration ≥12 months, included a control or usual care group, recruited adults with overweight or obesity from primary care and/or treated in the primary care setting, and the intervention included counseling on PA and diet. RESULTS Seventeen studies, encompassing 21 different intervention groups with 6185 unique participants (56% female) met the inclusion criteria. All participants had overweight or obesity, with a body mass index between 28.2 and 41.0 kg/m2. In 11 (52%) of the intervention groups, significant weight loss in the intervention group was observed compared to usual care (mean weight loss: 4.9[2.1] kg vs. 1.0[0.9] kg). In 13 out of 18 interventions (72%) reporting weight loss at two time points, weight regain was observed by 12 months. Statistically significant weight loss was observed in one intervention (of two total) that was longer than 12 months. CONCLUSIONS Sustained weight loss regardless of the behavior-based, intervention strategy remains a challenge for most adults. Given the established benefits of routine PA and a healthful diet, prioritizing the adoption of healthy behaviors regardless of weight loss may be a more effective strategy for ensuring long-term health benefit.
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Affiliation(s)
- Louise de Lannoy
- School of Kinesiology and Health StudiesQueen's UniversityKingstonOntarioCanada
| | - Theresa Cowan
- School of Kinesiology and Health StudiesQueen's UniversityKingstonOntarioCanada
| | - Angela Fernandez
- School of Kinesiology and Health StudiesQueen's UniversityKingstonOntarioCanada
| | - Robert Ross
- School of Kinesiology and Health StudiesQueen's UniversityKingstonOntarioCanada
- School of MedicineFaculty of Health SciencesQueen's UniversityKingstonOntarioCanada
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17
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Nederveld A, Phimphasone-Brady P, Connelly L, Fitzpatrick L, Holtrop JS. The Joys and Challenges of Delivering Obesity Care: a Qualitative Study of US Primary Care Practices. J Gen Intern Med 2021; 36:2709-2716. [PMID: 33532954 PMCID: PMC8390622 DOI: 10.1007/s11606-020-06548-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/22/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Obesity is of epidemic proportion in the USA but most people with obesity do not receive treatment. OBJECTIVE To explore the experience of providing obesity management among primary care clinicians and their team members involved with weight loss in primary care practices. The study's focus was on examining the use of the Medicare payment code for intensive behavioral therapy for obesity (IBT), but other obesity management services and payment mechanisms were also studied. DESIGN/PARTICIPANTS We conducted 85 interviews of clinicians (physician, advanced practice clinicians, registered dietitian, or other) practicing in primary care practices. Interviews gathered information about treatment approach to obesity, barriers, and facilitators to providing obesity care including the handling of billing and reimbursement (especially use of the IBT code), personal beliefs about the appropriateness of primary care providing weight loss services, and recommendations for improving weight management in primary care practice. The analysis was conducted using a grounded theory hermeneutic editing approach and the constant comparative method. KEY RESULTS Seventy-five interviews were included in this analysis. We identified three primary themes: (1) clinicians and staff involved in obesity management in primary care believe that addressing obesity is an essential part of primary care services, (2) because providing obesity care can be challenging, many practices opt out of treatment, and (3) despite the challenges, many clinicians and others find treating obesity feasible, satisfying, and worthwhile. CONCLUSIONS Treating obesity in primary care settings poses several challenges but can also be very satisfying and rewarding. To improve the ability of clinicians and practice members to treat obesity, important changes in payment, education, and work processes are necessary.
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Affiliation(s)
- Andrea Nederveld
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
| | | | - Lauri Connelly
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Laurie Fitzpatrick
- Department of Obstetrics and Gynecology, Michigan State University, East Lansing, MI, USA
| | - Jodi Summers Holtrop
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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18
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Chang LS, Malmasi S, Hosomura N, Zhang H, Brown CJ, Lei VJ, Rubin A, Ting C, Tong K, Shubina M, Turchin A. Patient-provider discussions of bariatric surgery and subsequent weight changes and receipt of bariatric surgery. Obesity (Silver Spring) 2021; 29:1338-1346. [PMID: 34111329 DOI: 10.1002/oby.23183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/20/2021] [Accepted: 03/23/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether patients who discuss bariatric surgery with their providers are more likely to undergo the procedure and to lose weight. METHODS A retrospective cohort study of adults with BMI ≥ 35 kg/m2 treated between 2000 and 2015 was conducted to analyze the relationship between a discussion of bariatric surgery in the first year after study entry and weight changes (primary outcome) and receipt of bariatric surgery (secondary outcome) over 2 years after study entry. Natural language processing was used to identify the documentation of bariatric surgery discussion in electronic provider notes. RESULTS Out of 30,560 study patients, a total of 2,659 (8.7%) discussed bariatric surgery with their providers. The BMI of patients who discussed bariatric surgery decreased by 2.18 versus 0.21 for patients who did not (p < 0.001). In a multivariable analysis, patients who discussed bariatric surgery with their providers lost more weight (by 1.43 [change in BMI]; 95% CI: 1.29-1.57) and had greater odds (10.2; 95% CI: 9.0-11.6; p < 0.001) of undergoing bariatric surgery. CONCLUSIONS Clinicians rarely discussed bariatric surgery with their patients. Patients who did have this discussion were more likely to lose weight and to undergo bariatric surgery.
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Affiliation(s)
- Lee-Shing Chang
- Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Shervin Malmasi
- Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Naoshi Hosomura
- Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Huabing Zhang
- Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | | | - Victor J Lei
- Northeastern University, Boston, Massachusetts, USA
| | - Alexa Rubin
- Northeastern University, Boston, Massachusetts, USA
| | - Clara Ting
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kimhouy Tong
- Northeastern University, Boston, Massachusetts, USA
| | - Maria Shubina
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Alexander Turchin
- Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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19
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Pfoh ER, Heinberg LJ, Rothberg MB. Factors Impacting Physician Referral To and Patient Attendance at Weight Management Programs Within a Large Integrated Health System. J Gen Intern Med 2021; 36:2339-2345. [PMID: 33483826 PMCID: PMC8342643 DOI: 10.1007/s11606-020-06520-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 12/20/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Identifying which patients receive referrals to and which ones attend weight management programs can provide insights into how physicians manage obesity. OBJECTIVE To describe patient factors associated with referrals, which primarily reflect physician priorities, and attendance, which reflects patient priorities. We also examine the influence of the individual physician by comparing adjusted rates of referral and attendance across physicians. DESIGN Retrospective cohort study. PARTICIPANTS Adults with a body mass index (BMI) ≥ 30 kg/m2 who had a primary care visit between 2015 and 2018 at a large integrated health system MAIN MEASURES: Referrals and visits to programs were collected from the EHR in 2019 and analyzed in 2019-2020. Multilevel logistic regression models were used to identify the association between patient characteristics and (1) receiving a referral, and (2) attending a visit after a referral. We compared physicians' adjusted probabilities of referring patients and of their patients attending a visit. KEY RESULTS Our study included 160,163 adults, with a median BMI of 35 kg/m2. Seventeen percent of patients received ≥ 1 referral and 29% of those attended a visit. The adjusted odds of referral increased 57% for patients with a BMI 35-39 (versus 30-34) and 32% for each comorbidity (p < 0.01). Attending a visit was less strongly associated with BMI (aOR 1.18 for 35-39 versus 30-34, 95% CI 1.09-1.27) and not at all with comorbidity. For the physician-level analysis, the adjusted probability of referral had a much wider range (0 to 83%; mean = 19%) than did the adjusted probability of attendance (range 27 to 34%). CONCLUSIONS Few patients attended a weight management program. Physicians vary greatly in their probability of referring patients to programs but not in their patients' probability of attending.
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Affiliation(s)
- Elizabeth R Pfoh
- Center for Value-Based Care Research, Cleveland Clinic Community Care, Cleveland, OH, USA.
| | - Leslie J Heinberg
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA.,Enterprise Weight Management Center, Cleveland Clinic, Cleveland, OH, USA
| | - Michael B Rothberg
- Center for Value-Based Care Research, Cleveland Clinic Community Care, Cleveland, OH, USA
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Lepre B, Mansfield KJ, Ray S, Beck E. Reference to nutrition in medical accreditation and curriculum guidance: a comparative analysis. BMJ Nutr Prev Health 2021; 4:307-318. [PMID: 34308139 PMCID: PMC8258055 DOI: 10.1136/bmjnph-2021-000234] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/10/2021] [Accepted: 02/17/2021] [Indexed: 01/04/2023] Open
Abstract
Objective Poor diet is a leading cause of death worldwide. Doctors are well placed to provide dietary advice, yet nutrition remains insufficiently integrated into medical education. Enforcement of curriculum or accreditation requirements such as nutrition requires relevant regulatory frameworks. The aim of this review was to identify nutrition content or requirements for nutrition education in accreditation standards or formal curriculum guidance for medical education internationally. Design Non-systematic comparative analysis. Data sources An internet search using the Google Search engine, the WHO Directory of Medical Schools and Foundation for Advancement of International Medical Education and Research Directory of Organizations that Recognise/Accredit Medical Schools was conducted through September 2020 to identify government and organisational reports as well as publications from regulatory and professional bodies relevant to medical education. Eligibility criteria Eligible publications included (A) accreditation standards, (B) competency standards or a framework, (C) curricula, and (D) assessment content. Data extraction and synthesis We stratified findings by country or region and both preregistration and postregistration education. Findings were synthesised based on the existence of nutrition content or requirements for nutrition education within systems used to guide medical education internationally. Results This review found that despite an emphasis on meeting the needs of the community and the demands of the labour market, only 44% of accreditation and curriculum guidance included nutrition. Nutrition remains inadequately represented in accreditation and curriculum guidance for medical education at all levels internationally. Accreditation standards provide a mandated framework for curricula and inclusion of nutrition in accreditation frameworks provides an incentive for the integration of nutrition into medical education. Conclusions This review is a call to action for the medical profession including government, health agencies and educational and accreditation entities. The inclusion of nutrition in medical education has appeared throughout medical education literature for more than five decades, yet without consensus standards there is little likelihood of uniform adoption.
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Affiliation(s)
- Breanna Lepre
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.,NNEdPro Global Centre for Nutrition and Health, Cambridge, UK
| | - Kylie J Mansfield
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Sumantra Ray
- NNEdPro Global Centre for Nutrition and Health, Cambridge, UK
| | - Eleanor Beck
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
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Zelenytė V, Valius L, Domeikienė A, Gudaitytė R, Endzinas Ž, Šumskas L, Maleckas A. Body size perception, knowledge about obesity and factors associated with lifestyle change among patients, health care professionals and public health experts. BMC FAMILY PRACTICE 2021; 22:37. [PMID: 33588766 PMCID: PMC7885487 DOI: 10.1186/s12875-021-01383-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 02/04/2021] [Indexed: 11/21/2022]
Abstract
Background The attitudes towards obesity may have an important role on healthier behavior. The goal of the present study was to explore the attitudes towards obesity and to investigate how these attitudes were associated with lifestyle-changing behavior among the patients attending primary care centers, health care professionals and public health experts. Methods This cross-sectional survey study was performed in 10 primary care offices in different regions in Lithuania and in 2 public health institutions. Nine hundred thirty-four patients, 97 nurses, 65 physicians and 30 public health experts have filled the questionnaire about attitudes towards obesity and presented data about lifestyle-changing activities during last 12 months. The attitudes were compared between different respondent groups and factors associated with healthier behaviors were analyzed among overweight/obese individuals in our study population. Results Participants failed to visually recognize correct figure corresponding to male and female with obesity. Majority of respondents’ perceived obesity as a risk factor for heart diseases and diabetes but had less knowledge about other diseases associated with weight. About one third of respondents changed their lifestyle during last 12 months. Overweight individuals with age < 45 years (OR 1.64, 1.06–2.55; p = 0.025) were more likely and those who overestimated current weight (OR 0.44, 0.20–0.96; p = 0.036) less likely to change their lifestyle. Disappointment with their current weight (OR 2.57, 1.36–4.84; p = 0.003) was associated with healthier behavior among participants with obesity. Conclusion Participants had similar body size perception and knowledge about obesity. Younger age had significant association with lifestyle changing behavior among overweight individuals and disappointment with current weight among obese participants.
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Affiliation(s)
- Virginija Zelenytė
- Department of Preventive Medicine, Medical Academy, Lithuanian University of Health Sciences, A. Mickevičiaus st. 9, LT-44307, Kaunas, Lithuania.
| | - Leonas Valius
- Department of Family Medicine, Medical Academy, Lithuanian University of Health Sciences, A. Mickevičiaus st. 9, LT-44307, Kaunas, Lithuania
| | - Auksė Domeikienė
- Department of Preventive Medicine, Medical Academy, Lithuanian University of Health Sciences, A. Mickevičiaus st. 9, LT-44307, Kaunas, Lithuania.,Department of Family Medicine, Medical Academy, Lithuanian University of Health Sciences, A. Mickevičiaus st. 9, LT-44307, Kaunas, Lithuania
| | - Rita Gudaitytė
- Department of Surgery, Medical Academy, Lithuanian University of Health Sciences, A. Mickevičiaus st. 9, LT-44307, Kaunas, Lithuania
| | - Žilvinas Endzinas
- Department of Surgery, Medical Academy, Lithuanian University of Health Sciences, A. Mickevičiaus st. 9, LT-44307, Kaunas, Lithuania
| | - Linas Šumskas
- Department of Preventive Medicine, Medical Academy, Lithuanian University of Health Sciences, A. Mickevičiaus st. 9, LT-44307, Kaunas, Lithuania.,Institute of Health Research, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Almantas Maleckas
- Department of Surgery, Medical Academy, Lithuanian University of Health Sciences, A. Mickevičiaus st. 9, LT-44307, Kaunas, Lithuania.,Department of Gastrosurgical Research and Education, Sahlgrenska Academy, University of Gothenburg, Bla Straket 5, SE-41345, Gothenburg, Sweden
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22
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McVay MA, Yancy WS, Bennett GG, Levine E, Jung SH, Jung S, Anton S, Voils CI. A web-based intervention to increase weight loss treatment initiation: results of a cluster randomized feasibility and acceptability trial. Transl Behav Med 2021; 11:226-235. [PMID: 31586443 PMCID: PMC7877306 DOI: 10.1093/tbm/ibz143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Evidence-based behavioral weight loss treatment is under-utilized. To increase initiation of treatment, we developed a single-session, online, primary care-based intervention ("mobilization tool"). We evaluated the mobilization tool's acceptability for primary care patients with obesity, trial design feasibility, and signal of an effect of the tool on treatment initiation. In this cluster randomized feasibility trial, primary care providers (PCPs) were randomized to a mobilization tool or comparator tool arm. Patients with obesity and a scheduled appointment with a randomized PCP were assigned to complete the mobilization or comparator tool prior to their appointment. The online mobilization tool asks patients to answer questions about a variety of weight-related topics and then provides automated, tailored feedback that addresses psychosocial determinants of weight loss treatment initiation. The comparator tool provided a nontailored description of treatments. All participants were offered free enrollment in behavioral weight loss treatments. Six PCPs were randomized. Sixty patients (57% female; 66% white; aged 55 ± 13 years) participated in this study of 296 contacted for eligibility evaluation (20.2%). Six-month follow-up assessments were completed by 65% (22/34) of the mobilization and 73% (19/26) of comparator tool participants. Participants completing the acceptability survey reported that the mobilization tool was usable, enjoyable, informative, and useful. Weight loss treatment was initiated by 59% (n = 19) of mobilization and 33% (n = 8) of comparator tool participants. The mobilization tool shows promise for increasing treatment initiation among primary care patients, which may increase population weight loss. Trial Registration: Clinicaltrials.gov identifier: NCT02708121.
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Affiliation(s)
- Megan A McVay
- Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA
- Department of Psychiatry and Behavioral Science, Duke University, Durham, NC, USA
| | - William S Yancy
- Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Department of Veteran Affairs, Durham, NC, USA
| | - Gary G Bennett
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Erica Levine
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Seung-Hye Jung
- Duke Office of Clinical Research, Duke University School of Medicine, Durham, NC, USA
| | - Soyeon Jung
- Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA
| | - Steve Anton
- Center for Aging, University of Florida, Gainesville, FL, USA
| | - Corrine I Voils
- William S Middleton VA, Department of Veterans Affairs, Madison, WI, USA
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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23
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Magallanes E, Sen A, Siler M, Albin J. Nutrition from the kitchen: culinary medicine impacts students' counseling confidence. BMC MEDICAL EDUCATION 2021; 21:88. [PMID: 33541352 PMCID: PMC7863372 DOI: 10.1186/s12909-021-02512-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/26/2021] [Indexed: 06/02/2023]
Abstract
BACKGROUND Although a poor diet is the number one risk factor for early death in the United States and globally, physicians receive little to no training in dietary interventions and lack confidence counseling patients about lifestyle modifications. Innovative, interprofessional strategies to address these gaps include the emergence of culinary medicine, a hands-on approach to teaching the role of food in health outcomes. We sought to assess the impact of a culinary medicine elective on counseling confidence, awareness of an evidence-based approach to nutrition, and understanding of the role of interprofessional teamwork in dietary lifestyle change among medical students at one undergraduate medical school. METHODS We administered pre- and post-course surveys to two cohorts of medical students (n = 64 at pre-test and n = 60 at post-test) participating in a culinary medicine enrichment elective. Chi-square analysis was used to assess the relationship between participation in the course and a positive response to each survey item. RESULTS Compared with the baseline, students participating in culinary medicine were more likely to feel confident discussing nutrition with patients (29% vs 92%; p < 0.001), to feel familiar with the Mediterranean diet (54% vs. 97%; p < 0.001), and to understand the role of dietitians in patient care (37% vs. 93%; p < 0.001). CONCLUSIONS Culinary medicine shows promise as an impactful educational strategy among first-year medical students for increasing counseling confidence, promoting familiarity with evidence-based nutrition interventions, and augmenting understanding of the role of interprofessional engagement to address lifestyle-related disease.
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Affiliation(s)
- Emily Magallanes
- UT Southwestern School of Medicine, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Ahana Sen
- Department of Internal Medicine, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Milette Siler
- Moncrief Cancer Institute at UT Southwestern, 400 W. Magnolia Ave, Fort Worth, TX, 76104, USA
| | - Jaclyn Albin
- Departments of Pediatrics and Internal Medicine, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
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24
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Gudzune KA, Wickham EP, Schmidt SL, Stanford FC. Physicians certified by the American Board of Obesity Medicine provide evidence-based care. Clin Obes 2021; 11:e12407. [PMID: 33280270 PMCID: PMC9999726 DOI: 10.1111/cob.12407] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/28/2020] [Accepted: 08/01/2020] [Indexed: 11/29/2022]
Abstract
Our objective was to determine the clinical services offered by American Board of Obesity Medicine (ABOM) Diplomates and whether guideline concordant services varied by clinical practice attributes. We conducted a cross-sectional analysis of the 2019 ABOM Diplomate survey (response rate 19.2%). Respondents (n = 494) self-reported services offered: nutrition, exercise, mental health, minimally invasive bariatric procedures, perioperative bariatric surgical care and FDA-approved anti-obesity medications. We graded concordance of services offered with three evidence-based obesity guidelines, and then conducted bivariate analyses comparing concordance by practice attributes. Most responding ABOM Diplomates offered nutrition (90.1%), exercise (67.8%) and mental health (76.7%). Few offered minimally invasive procedures (24.3%), and most provided perioperative surgical care (63.0%). Most (83.4%) prescribed FDA-approved medications-typically both short- and long-term agents (70.9%). Few Diplomates had low concordance with the American Heart Association/American College of Cardiology/The Obesity Society (AHA/ACC/TOS) guidelines (24.7%). Those who managed more obesity-related conditions and endorsed AHA/ACC/TOS guideline use had higher concordance with these recommendations. No differences in guideline concordance existed by population, clinical effort or location. We found similar findings regarding concordance with ) American Association of Clinical Endocrinologists/American College of Endocrinology and Obesity Medicine Association guidelines. In conclusion, most responding ABOM Diplomates offer evidence-based obesity medicine services. Clinicians may therefore have increased confidence in patient receipt of evidence-based care when referring to an ABOM Diplomate.
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Affiliation(s)
- Kimberly A. Gudzune
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institution, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Edmond P. Wickham
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia
- Division of Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | | | - Fatima Cody Stanford
- Massachusetts General Hospital, MGH Weight Center, Department of Medicine-Division of Endocrinology-Neuroendocrine, Department of Pediatrics-Division of Endocrinology, Boston, Massachusetts
- Harvard Medical School, Harvard University, Boston, Massachusetts
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25
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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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26
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Zatz LY, Hersh E, Gudzune KA, Thorndike AN, N Goldenberg M, Bleich SN. Physicians' political party affiliation and clinical management of obesity. Clin Obes 2020; 10:e12396. [PMID: 32803863 DOI: 10.1111/cob.12396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/02/2020] [Accepted: 07/07/2020] [Indexed: 11/30/2022]
Abstract
Studies have documented that few patients with obesity receive evidence-based care. One provider characteristic that may impact clinical obesity care, but that has been under studied to date, is political party affiliation. This study sought to evaluate how primary care physicians (PCPs) report managing patients with obesity and assess whether there are differences between Democratic and Republican PCPs. This was a secondary analysis of a cross-sectional survey of 225 PCPs registered to vote as Democrats or Republicans in 29 US States. After reading a patient vignette, the PCPs reported the following outcomes: likelihood of documenting obesity in the medical record; likelihood of discussing obesity with the patient; and likelihood of engaging in eight different obesity management options. Almost all PCPs reported they would document obesity in the medical record (Republican = 97.6%, Democrat = 94.3%) and discuss it further (Republican = 95.2%, Democrat = 92.2%). Among eight obesity management options, PCPs were least likely to say they would prescribe medication (3.9%) or refer the patient to counselling (24.0%), regardless of political affiliation. Republicans were more likely to report that they would inquire about the time course of obesity (73.4% v. 56.2%, P = 0.012) and discuss health risks of obesity (91.0% vs 78.3%, P = .018). Republican and Democratic PCPs report some differences in managing patients with obesity, suggesting that political beliefs may play a role in some clinical care.
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Affiliation(s)
- Laura Y Zatz
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Eitan Hersh
- Department of Political Science, Tufts University, Medford, Massachusetts, USA
| | - Kimberly A Gudzune
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anne N Thorndike
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Sara N Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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27
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Gudzune KA, Clark JM. Role of Commercial Weight-Loss Programs in Medical Management of Obesity. Endocrinol Metab Clin North Am 2020; 49:275-287. [PMID: 32418590 DOI: 10.1016/j.ecl.2020.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Rates of obesity counseling are low among physicians because of the lack of time and training in this area. In recognition of this challenge, recent national guidelines encourage physicians to refer patients with obesity to intensive, comprehensive lifestyle programs to lose weight. Some commercial weight-loss programs meet these criteria, and this article reviews the evidence from randomized controlled trials regarding such programs' weight-loss efficacy and safety as well as glycemic outcomes among patients with and without diabetes mellitus. A discussion of how physicians might approach the referral process and continued management of patients participating in these programs is included.
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Affiliation(s)
- Kimberly A Gudzune
- Department of Medicine, Johns Hopkins University School of Medicine, 2024 East Monument Street, Room 2-621, Baltimore, MD 21224, USA.
| | - Jeanne M Clark
- Department of Medicine, Johns Hopkins University School of Medicine, 2024 East Monument Street, Room 2-600, Baltimore, MD 21224, USA. https://twitter.com/jmclark_md
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28
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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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Befort CA, Kurz D, VanWormer JJ, Ellerbeck EF. Recruitment and reach in a pragmatic behavioral weight loss randomized controlled trial: implications for real-world primary care practice. BMC FAMILY PRACTICE 2020; 21:47. [PMID: 32126987 PMCID: PMC7055122 DOI: 10.1186/s12875-020-01117-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 02/25/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Obesity is a major risk factor behind some of the most common problems encountered in primary care. Although effective models for obesity treatment have been developed, the 'reach' of these interventions is poor and only a small fraction of primary care patients receive evidence-based treatment. The purpose of this study is to identify factors that impact the uptake (reach) of an evidence-based obesity treatment program within the context of a pragmatic cluster randomized controlled trial comparing three models of care delivery. METHODS Recruitment and reach were evaluated by the following measures: 1) mailing response rates, 2) referral sources among participants contacting the study team, 3) eligibility rates, 4) participation rates, and 5) representativeness based on demographics, co-morbid conditions, and healthcare utilization of 1432 enrolled participants compared to > 17,000 non-participants from the clinic-based patient populations. Referral sources and participation rates were compared across study arms and level of clinic engagement. RESULTS The response rate to clinic-based mailings was 13.2% and accounted for 66% of overall program recruitment. An additional 22% of recruitment came from direct clinic referrals and 11% from media, family, or friends. Of those screened, 87% were eligible; among those eligible, 86% enrolled in the trial. Participation rates did not vary across the three care delivery arms, but were higher at clinics with high compared to low provider involvement. In addition, clinics with high provider involvement had a higher rate of in clinic referrals (33% versus 16%) and a more representative sample with regards to BMI, rurality, and months since last clinic visit. However, across clinics, enrolled participants compared to non-participants were older, more likely to be female, more likely to have had a joint replacement but less likely to have CVD or smoke, and had fewer hospitalizations. CONCLUSIONS A combination of direct patient mailings and in-clinic referrals may enhance the reach of primary care behavioral weight loss interventions, although more proactive outreach is likely necessary for men, younger patients, and those at greater medial risk. Strategies are needed to enhance provider engagement in referring patients to behavioral weight loss programs. TRIAL REGISTRATION clnicialtrials.gov NCT02456636. Registered May 28, 2015, https://www.clinicaltrials.gov/ct2/results?cond=&term=RE-POWER&cntry=&state=&city=&dist=.
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Affiliation(s)
- Christie A Befort
- Department of Population Health, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 1008, Kansas City, KS, 66160, USA.
| | - Danny Kurz
- Department of Population Health, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 1008, Kansas City, KS, 66160, USA
| | - Jeffrey J VanWormer
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, 1000 North Oak Ave (ML2), Marshfield, WI, 54449, USA
| | - Edward F Ellerbeck
- Department of Population Health, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 1008, Kansas City, KS, 66160, USA
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Kaiser KA, Carson TL, Dhurandhar EJ, Neumeier WH, Cardel MI. Biobehavioural approaches to prevention and treatment: A call for implementation science in obesity research. Obes Sci Pract 2020; 6:3-9. [PMID: 32128237 PMCID: PMC7042105 DOI: 10.1002/osp4.384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/11/2019] [Accepted: 10/24/2019] [Indexed: 12/31/2022] Open
Abstract
Much progress has been made in the last 30 years in understanding the causes and mechanisms that contribute to obesity, yet widely available and successful strategies for prevention and treatment remain elusive at population levels. This paper discusses the biobehavioural framework and provides suggestions for applying it to enable greater progress in the science of obesity prevention and treatment, including an increased focus on implementation of science strategies. The objective is to promote a re-evaluation of current views about preventing and treating obesity within a unified biobehavioural framework. Further integration of research exploring how both behavioural and biological components interact is a critical step forward.
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Affiliation(s)
- Kathryn A. Kaiser
- Department of Health Behavior, School of Public HealthUniversity of Alabama at BirminghamBirminghamAlabama
- Nutrition Obesity Research CenterUniversity of Alabama at BirminghamBirminghamAlabama
| | - Tiffany L. Carson
- Nutrition Obesity Research CenterUniversity of Alabama at BirminghamBirminghamAlabama
- Division of Preventive Medicine, School of MedicineUniversity of Alabama at BirminghamBirminghamAlabama
| | - Emily J. Dhurandhar
- Department of Kinesiology and Sport ManagementTexas Tech UniversityLubbockTexas
| | - William H. Neumeier
- United States Army Research Institute of Environmental MedicineNatickMassachusetts
| | - Michelle I. Cardel
- Department of Health Outcomes & Biomedical Informatics, College of MedicineUniversity of FloridaGainesvilleFlorida
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Koliaki C, Tzeravini E, Papachristoforou E, Severi I, El Deik E, Karaolia M, Noutsou M, Thanopoulou A, Kountouri A, Balampanis K, Lambadiari V, Tentolouris N, Kokkinos A. Eligibility and Awareness Regarding Metabolic Surgery in Patients With Type 2 Diabetes Mellitus in the Real-World Clinical Setting; Estimate of Possible Diabetes Remission. Front Endocrinol (Lausanne) 2020; 11:383. [PMID: 32582036 PMCID: PMC7292012 DOI: 10.3389/fendo.2020.00383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/14/2020] [Indexed: 01/06/2023] Open
Abstract
Despite high-quality evidence highlighting metabolic surgery as an effective treatment option for type 2 diabetes mellitus (T2DM), the number of patients receiving bariatric surgery (BS) remains low. Since the introduction of the Diabetes Surgery Summit II (DSS-II) eligibility criteria, data on eligibility rates for BS in T2DM cohorts remain scarce. The aims of the present study were to examine in a real-world clinical setting: (i) what is the percentage of T2DM patients visiting diabetes outpatient clinics who meet the DSS-II eligibility criteria, (ii) how many of these have been informed about the option of BS, and (iii) what are the characteristics associated with eligibility and awareness of BS. Demographic, anthropometric, clinical and socioeconomic data were obtained for all patients with T2DM who were consecutively examined in the outpatient clinics of three large-volume university hospitals (n = 1167). A medical registry form was completed to screen for BS eligibility. Patients were considered eligible if the recommendation by DSS-II criteria was either to "consider" or "recommend" BS. Eligible patients were further inquired whether they had ever been informed about the option of BS by their physicians. The advanced DiaRem score (ADRS) was applied to eligible patients to assess their probability of achieving postoperative T2DM remission. A significant percentage of T2DM patients who are routinely assessed in outpatient clinics meet the DSS-II eligibility criteria (15.3%). Eligible patients are younger and more obese, have a shorter T2DM duration, worse glycaemic control and better renal function, compared to non-eligible ones. Among eligible patients, only 39.3% have been medically informed about the option of BS. Informed patients are younger and more severely obese than non-informed ones. A significant percentage of non-informed patients (35%) have an ADRS ≤10, indicating a considerable probability for T2DM remission after BS, and are thus deprived of this opportunity due to lack of appropriate medical counseling. Screening and awareness of BS remain an unmet need in current T2DM management. Future research should focus on intensifying screening for BS eligibility at every medical visit and promoting evidence-based clinical recommendations for patients expected to benefit the most.
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Affiliation(s)
- Chrysi Koliaki
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Evangelia Tzeravini
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Eleftheria Papachristoforou
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Ioanna Severi
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Elina El Deik
- Diabetes Center, Second Department of Internal Medicine, Medical School, Hippokratio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Melina Karaolia
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Marina Noutsou
- Diabetes Center, Second Department of Internal Medicine, Medical School, Hippokratio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Thanopoulou
- Diabetes Center, Second Department of Internal Medicine, Medical School, Hippokratio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Kountouri
- Second Department of Internal Medicine and Research Institute, Medical School, National and Kapodistrian University of Athens, Attikon General Hospital, Athens, Greece
| | - Konstantinos Balampanis
- Second Department of Internal Medicine and Research Institute, Medical School, National and Kapodistrian University of Athens, Attikon General Hospital, Athens, Greece
| | - Vaia Lambadiari
- Second Department of Internal Medicine and Research Institute, Medical School, National and Kapodistrian University of Athens, Attikon General Hospital, Athens, Greece
| | - Nicholas Tentolouris
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Alexander Kokkinos
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
- *Correspondence: Alexander Kokkinos
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Gudzune KA, Johnson VR, Bramante CT, Stanford FC. Geographic Availability of Physicians Certified by the American Board of Obesity Medicine Relative to Obesity Prevalence. Obesity (Silver Spring) 2019; 27:1958-1966. [PMID: 31515965 PMCID: PMC6868336 DOI: 10.1002/oby.22628] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 05/20/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The objective of this study is to determine the distribution of adult and pediatric American Board of Obesity Medicine (ABOM) diplomates relative to the prevalence of obesity by US state. METHODS Data from the ABOM physician directory were used to determine original specialty and US state. Physicians were labeled as "adult medicine" physicians (i.e., internal medicine, family medicine, or internal medicine and pediatrics), "pediatric medicine" physicians (i.e., pediatrics, family medicine, or internal medicine and pediatrics), and "other physicians" (i.e., surgical specialty, other specialty, or unknown). Prevalence of obesity by state, according to the Centers for Disease Control and Prevention, was used for adults and adolescents in 2017 and for children in 2014. Counts of ABOM-certified adult medicine physicians and pediatric medicine physicians were conducted relative to obesity prevalence by state. RESULTS A total of 2,577 US-based ABOM-certified physicians were included (79% from adult medicine, 38% from pediatric medicine, and 15% from other fields). All US states had more than one ABOM-certified adult medicine physician, although geographic disparities existed in physician availability relative to obesity prevalence. Fewer pediatric medicine ABOM diplomates were available in all states. CONCLUSIONS Promotion of ABOM training and certification in certain geographic locations and among pediatric physicians may help address disparities in ABOM diplomate availability relative to obesity burden.
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Affiliation(s)
- Kimberly A Gudzune
- Division of General Internal Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Veronica R Johnson
- Center for Obesity Medicine and Metabolic Performance, Department of Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Carolyn T Bramante
- Division of General Internal Medicine, Department of Medicine, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
- Center for Pediatric Obesity Management, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
- Program in Health Disparities Research, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
| | - Fatima Cody Stanford
- Weight Center and Departments of Medicine and Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
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Laidlaw A, Napier C, Neville F, Collinson A, Cecil JE. Talking about weight talk: primary care practitioner knowledge, attitudes and practice. ACTA ACUST UNITED AC 2019. [DOI: 10.1080/17538068.2019.1646061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- A. Laidlaw
- School of Medicine, University of St Andrews, St Andrews, UK
| | - C. Napier
- School of Medicine, University of St Andrews, St Andrews, UK
| | - F. Neville
- School of Management, University of St Andrews, St Andrews, UK
| | - A. Collinson
- School of Medicine, University of St Andrews, St Andrews, UK
| | - J. E. Cecil
- School of Medicine, University of St Andrews, St Andrews, UK
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Evans‐Hoeker EA, Ramalingam NS, Harden SM. Weight management perceptions and clinical practices among gynaecology providers caring for reproductive-aged patients. Obes Sci Pract 2019; 5:304-311. [PMID: 31452915 PMCID: PMC6700516 DOI: 10.1002/osp4.338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/12/2019] [Accepted: 03/13/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Research suggests that patient and provider conversations about healthy eating and physical activity behaviours may lead to patients' increased health behaviours, access to dietary and physical activity resources, and weight management. The American College of Obstetrics and Gynecology (ACOG) has a number of weight management intervention options, but it is unclear if providers have conversations about intervention options with their patients who are of reproductive age. The purpose of this work was to evaluate the degree to which gynaecology healthcare providers offer the weight management intervention options as recommended by ACOG. METHODS Cross-sectional study of gynaecology providers in Southwest Virginia utilizing an electronic survey to identify weight management perceptions and current clinical practices. Responses were measured using quantitative methods, and agreeability and frequency responses were measured using a 5-point Likert scale. RESULTS Twenty-three of the 31 eligible providers (74.2%) completed the survey. Providers acknowledge that patients need weight management discussions and they feel comfortable and are willing to have these discussions. While physical activity recommendations were consistent among providers, they did not reflect the complete physical activity recommendations for Americans. Consistency in dietary recommendations was lacking. Although providers make recommendations for physical activity and/or diet at least sometimes, they rarely utilize other methods of weight management as outlined in the ACOG recommendations, such as referrals to other providers, programmes or medications. CONCLUSIONS Areas for improvement in weight management practices include frequency of counselling, consistency in dietary counselling and frequency of utilization of weight loss medications and referrals to ancillary services. These results can be used to aid the development of methods for targeting these deficiencies.
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Affiliation(s)
- E. A. Evans‐Hoeker
- Department of Obstetrics and GynecologyCarilion ClinicRoanokeVirginiaUSA
- Department of Obstetrics and GynecologyVirginia Tech Carilion School of MedicineRoanokeVirginiaUSA
| | - N. S. Ramalingam
- Translational Biology, Medicine and HealthVirginia TechBlacksburgVirginiaUSA
- Department of Human Nutrition, Foods, and ExerciseVirginia TechBlacksburgVirginiaUSA
| | - S. M. Harden
- Department of Obstetrics and GynecologyVirginia Tech Carilion School of MedicineRoanokeVirginiaUSA
- Department of Human Nutrition, Foods, and ExerciseVirginia TechBlacksburgVirginiaUSA
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Look M, Kolotkin RL, Dhurandhar NV, Nadglowski J, Stevenin B, Golden A. Implications of differing attitudes and experiences between providers and persons with obesity: results of the national ACTION study. Postgrad Med 2019; 131:357-365. [DOI: 10.1080/00325481.2019.1620616] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Michelle Look
- San Diego Sports Medicine and Family Health, San Diego, CA, USA
| | - Ronette L. Kolotkin
- Quality of Life Consulting, Durham, NC, USA
- Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC, USA
- Faculty of Health Studies, Western Norway University of Applied Sciences, Førde, Norway
- Førde Hospital Trust, Førde, Norway
- Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway
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Jay M, Orstad SL, Wali S, Wylie-Rosett J, Tseng CH, Sweat V, Wittleder S, Shu SB, Goldstein NJ, Ladapo JA. Goal-directed versus outcome-based financial incentives for weight loss among low-income patients with obesity: rationale and design of the Financial Incentives foR Weight Reduction (FIReWoRk) randomised controlled trial. BMJ Open 2019; 9:e025278. [PMID: 30962231 PMCID: PMC6500238 DOI: 10.1136/bmjopen-2018-025278] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 01/23/2019] [Accepted: 02/12/2019] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Obesity is a major public health challenge and exacerbates economic disparities through employment discrimination and increased personal health expenditures. Financial incentives for weight management may intensify individuals' utilisation of evidence-based behavioural strategies while addressing obesity-related economic disparities in low-income populations. Trials have focused on testing incentives contingent on achieving weight loss outcomes. However, based on social cognitive and self-determination theories, providing incentives for achieving intermediate behavioural goals may be more sustainable than incentivising outcomes if they enhance an individual's skills and self-efficacy for maintaining long-term weight loss. The objective of this paper is to describe the rationale and design of the Financial Incentives foR Weight Reduction study, a randomised controlled trial to test the comparative effectiveness and cost-effectiveness of two financial incentive strategies for weight loss (goal directed vs outcome based) among low-income adults with obesity, as well as compared with the provision of health behaviour change resources alone. METHODS AND ANALYSIS We are recruiting 795 adults, aged 18-70 years with a body mass index ≥30 kg/m2, from three primary care clinics serving residents of socioeconomically disadvantaged neighbourhoods in New York City and Los Angeles. All participants receive a 1-year commercial weight loss programme membership, self-monitoring tools (bathroom scale, food journal and Fitbit Alta HR), health education and monthly check-in visits. In addition to these resources, those in the two intervention groups can earn up to $750 over 6 months for: (1) participating in an intensive weight management programme, self-monitoring weight and diet and meeting physical activity guidelines (goal-directed arm); or (2) a ≥1.5% to ≥5% reduction in baseline weight (outcome-based arm). To maximise incentive efficacy, we incorporate concepts from behavioural economics, including immediacy of payments and framing feedback to elicit regret aversion. We will use generalised mixed effect models for repeated measures to examine intervention effects on weight at 6, 9 and 12 months. ETHICS AND DISSEMINATION Human research protection committees at New York University School of Medicine, University of California Los Angeles (UCLA) David Geffen School of Medicine and Olive-View-UCLA Medical Center granted ethics approval. We will disseminate the results of this research via peer-reviewed publications, conference presentations and meetings with stakeholders. TRIAL REGISTRATION NUMBER NCT03157713.
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Affiliation(s)
- Melanie Jay
- Departments of Medicine and Population Health, New York University School of Medicine, New York, New York, USA
| | - Stephanie L Orstad
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - Soma Wali
- Department of Medicine, Olive View-University of California Los Angeles (UCLA) Medical Center, Sylmar, California, USA
| | - Judith Wylie-Rosett
- Division of Health Promotion and Nutrition Research, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Chi-Hong Tseng
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Victoria Sweat
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - Sandra Wittleder
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - Suzanne B Shu
- Anderson School of Management at UCLA, University of California Los Angeles, Los Angeles, California, USA
| | - Noah J Goldstein
- Anderson School of Management at UCLA, University of California Los Angeles, Los Angeles, California, USA
| | - Joseph A Ladapo
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Blunt SB, Kafatos A. Clinical Nutrition Education of Doctors and Medical Students: Solving the Catch 22. Adv Nutr 2019; 10:345-350. [PMID: 30624632 PMCID: PMC6416044 DOI: 10.1093/advances/nmy082] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/27/2018] [Accepted: 09/24/2018] [Indexed: 01/07/2023] Open
Abstract
There is a well-documented pandemic of malnutrition. It has numerous sequelae, including physical and psychological ill health, early death, and socioeconomic burden. The nutrition landscape and dynamics of the nutrition transition are extremely complex, but one significant factor in both is the role of medical management. Doctors have a unique position in society from which to influence this scenario at global, public, and personal levels, but we are failing to do so. There are several reasons for this, including inadequate time; historical educational bias towards disease and therapeutic intervention-rather than diet, lifestyle, and prevention; actual or perceived incompetency in the field of nutrition; confusion or deflection within medicine about whose role(s) it is on a medical team to address nutrition; and public confusion about whom to turn to for advice. But the most fundamental reason is that current doctors (and thus the trainers of medical students) have not received-and future doctors are thus still not receiving-adequate training to render them confident or competent to take on the role. A small number of important educational approaches exist aimed at practicing doctors and medical students, but the most effective methods of teaching are still being evaluated. Without properly trained trainers, we have no one to train the doctors of tomorrow. This is a "catch 22." To break this deadlock, there is an urgent need to make appropriate nutrition training available, internationally, and at all levels of medical education (medical students, doctors-in-training, and practicing doctors). Until this is achieved, the current pandemic of nutrition-related disease will continue to grow. Using important illustrative examples of existing successful nutrition education approaches, we suggest potential approaches to breaking this deadlock.
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Affiliation(s)
- Stavia B Blunt
- Independent writer and researcher, Richmond, London, United Kingdom
| | - Anthony Kafatos
- University of Crete School of Medicine, Department of Social Medicine, Preventive Medicine and Nutrition Clinic, Heraklion, Greece
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Ciciurkaite G, Moloney ME, Brown RL. The Incomplete Medicalization of Obesity: Physician Office Visits, Diagnoses, and Treatments, 1996-2014. Public Health Rep 2019; 134:141-149. [PMID: 30794761 DOI: 10.1177/0033354918813102] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Despite increased awareness of obesity-related health risks and myriad treatment options, obesity still affects more than one-third of persons in the United States and is a substantial public health problem. Studies show that physicians play a key role in obesity prevention and treatment. The objective of this study was to examine the extent to which obesity is diagnosed and treated at the level of patient-physician interaction. METHODS We used data from the National Ambulatory Medical Care Survey (NAMCS), a nationally representative data set of US physician office visits. We estimated the number of obesity diagnoses and prescriptions of weight-loss management solutions (exercise counseling, diet counseling, or weight-loss drugs) in clinical practice from 1996 through 2014. We also calculated rates of obesity diagnosis and compared these rates with national rates of obesity based on body mass index data from the Behavioral Risk Factor Surveillance System (BRFSS) for the same period. RESULTS The estimated number of weight gain-related physician office visits increased from 2.3 million in 1996 to a peak of 7.6 million in 2012, and then fell to 4.5 million in 2014. National estimates of obesity diagnoses resulting from physician office visits ranged from 7.1 million in 1996 to 12.7 million in 2014 and substantially outnumbered the estimates for weight gain-related physician office visits throughout the study period. Estimates of exercise counseling and diet counseling and weight-loss medication prescriptions resulting from physician office visits fluctuated over time but never exceeded obesity diagnoses. When compared with national rates of obesity from the BRFSS, rates of obesity diagnoses resulting from physician office visits were substantially lower in the NAMCS (17%-30% vs 1%). National trends for weight-loss medication prescriptions closely mirrored those of weight gain-related physician office visits, even though fluctuations were substantial. CONCLUSIONS Our results suggest that obesity is largely underdiagnosed and undertreated in clinical encounters. Future studies should investigate the structural changes needed to better engage physicians in obesity prevention and care. Practitioners should also reflect on their biases in treating obesity as a chronic disease.
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Affiliation(s)
- Gabriele Ciciurkaite
- 1 Department of Sociology, Social Work and Anthropology, Utah State University, Logan, UT, USA
| | | | - Robyn Lewis Brown
- 2 Department of Sociology, University of Kentucky, Lexington, KY, USA
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Sung H, Siegel RL, Rosenberg PS, Jemal A. Emerging cancer trends among young adults in the USA: analysis of a population-based cancer registry. LANCET PUBLIC HEALTH 2019; 4:e137-e147. [PMID: 30733056 DOI: 10.1016/s2468-2667(18)30267-6] [Citation(s) in RCA: 308] [Impact Index Per Article: 61.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 12/11/2018] [Accepted: 12/17/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cancer trends in young adults, often under 50 years, reflect recent changes in carcinogenic exposures, which could foreshadow the future overall disease burden. Previous studies reported an increase in early onset colorectal cancer, which could partly reflect the obesity epidemic. We examined age-specific contemporary incidence trends in the USA for 30 common cancers, including 12 obesity-related cancers. METHODS We obtained incidence data for invasive cancers among people aged 25-84 years diagnosed from Jan 1, 1995, to Dec 31, 2014, for 25 population-based state registries in the USA. All patients in the registry were included in the analyses. We considered the 20 most common cancer types and 12 obesity-related cancers (30 cancer types in total). We used age-period-cohort modelling to estimate average annual percentage change in incidence rates by 5-year age group (25-29 years to 80-84 years in 5-year increments) and incidence rate ratios (IRR) by birth cohort (10-year overlapping birth cohorts from 1910-19 to 1980-89 in 5-year increments). No exclusion criteria were applied after including all invasive cancer cases based on age group and diagnosis year. FINDINGS From 1995 to 2014 there were 14 672 409 incident cases for 30 types of cancer. Incidence significantly increased for six of 12 obesity-related cancers (multiple myeloma, colorectal, uterine corpus, gallbladder, kidney, and pancreatic cancer) in young adults (25-49 years) with steeper rises in successively younger generations. Annual increases ranged from 1·44% (95% CI -0·60 to 3·53) for multiple myeloma to 6·23% (5·32-7·14) for kidney cancer at age 25-29 years, and ranged from 0·37% (0·03-0·72) for uterine corpus cancer to 2·95% (2·74-3·16) for kidney cancer at age 45-49 years. Compared with people born around 1950, IRRs for those born around 1985 ranged from 1·59 (95% CI 1·14-2·21) for multiple myeloma to 4·91 (4·27-5·65) for kidney cancer. Conversely, incidence in young adults increased in successively younger generations for only two cancers (gastric non-cardia cancer and leukaemia), and decreased for eight of the 18 additional cancers, including smoking and HIV infection-associated cancers. INTERPRETATION The risk of developing an obesity-related cancer seems to be increasing in a stepwise manner in successively younger birth cohorts in the USA. Further studies are needed to elucidate exposures responsible for these emerging trends, including excess bodyweight and other risk factors. FUNDING Intramural Research Department of the American Cancer Society and the Intramural Research Program of the National Cancer Institute.
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Affiliation(s)
- Hyuna Sung
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA, USA
| | - Rebecca L Siegel
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA, USA
| | - Philip S Rosenberg
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ahmedin Jemal
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA, USA.
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Goldberg DM, Cho BY, Lin HC. Factors influencing U.S. physicians' decision to provide behavioral counseling. Prev Med 2019; 119:70-76. [PMID: 30593794 DOI: 10.1016/j.ypmed.2018.12.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 11/13/2018] [Accepted: 12/24/2018] [Indexed: 01/03/2023]
Abstract
Prevention and treatment of non-communicable diseases is critical due to high costs of healthcare and increasing prevalence. Historical trends suggest physicians underperform in behavioral counseling (including exercise, diet/nutrition, or weight management). This study investigated physicians' decision-making by examining non-clinical sociological factors that influence ordering and provision of behavioral counseling. This was a retrospective multi-year cross-sectional study. Using the Eisenberg model of physician-decision making, we analyzed data from the 2005-2015 National Ambulatory Medical Care Surveys (unweighted N = 177,599). Four weighted logistic regressions were performed to examine sociological factors associated with physician prescribing or ordering of behavioral counseling. Behavioral counseling was provided at suboptimal rates. Patient age, race/ethnicity, body weight status, and reasons for a medical visit were associated with physicians' decision to provide or order behavioral counseling. There was in general a decreasing trend of odds of provision of behavior counseling from 2005 to 2015. Patients who had been seen before were more likely to receive diet/nutrition and exercise counseling. This study concluded that ordering and provision of behavioral counseling was less than optimal. Policy makers and educators can consider factors that influence physicians' decisions for behavioral counseling to improve training and site policies. Future research examining effective behavioral counseling training and strategies to promote its provision, in particular to patients of different races/ethnicities and with different medical conditions, may increase effectiveness. Integrated care with behavioral health professionals could improve rates and/or delivery of counseling. Physicians can consider providing behavioral counseling when patients present with new problems and to newly seen patients.
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Affiliation(s)
- Daniel M Goldberg
- Department of Counseling and Educational Psychology, School of Education, Indiana University Bloomington, 201 N. Rose Ave., Bloomington, IN 47405, USA.
| | - Beom-Young Cho
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Hsien-Chang Lin
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, 1025 E. 7th Street, Bloomington, IN 47405, USA.
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Hyer S. Practice patterns of nurse practitioners related to weight management in primary care. J Am Assoc Nurse Pract 2019; 31:236-244. [PMID: 30681653 DOI: 10.1097/jxx.0000000000000122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Obesity prevalence rates for adults are at an all-time high. This systematic review of the literature aimed to examine the practice patterns of nurse practitioners (NPs) related to weight management in primary care and recommend future areas of research as it relates to the diagnosis and management of patients with obesity by NPs. DATA SOURCES The databases CINAHL PLUS with Full Text, Cochrane Central Register of Controlled Trials, ERIC, MEDLINE, PsycINFO, and SPORTDiscuss were searched. CONCLUSIONS The initial search resulted in 169 articles. Fifteen peer-reviewed articles from 13 studies were included in the analysis. Four themes emerged from the analysis: approach to practice; the practitioner's role within the interdisciplinary team; communication; and resources and tools. IMPLICATIONS FOR PRACTICE This review was conducted to better understand the challenges and facilitators to the management of patients with obesity in primary care. Future research between NPs and variables related to obesity are necessary to further identify areas for education, training, and policy development.
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Affiliation(s)
- Suzanne Hyer
- University of Central Florida, College of Nursing, Orlando, Florida
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Bennett GG, Steinberg D, Askew S, Levine E, Foley P, Batch BC, Svetkey LP, Bosworth HB, Puleo EM, Brewer A, DeVries A, Miranda H. Effectiveness of an App and Provider Counseling for Obesity Treatment in Primary Care. Am J Prev Med 2018; 55:777-786. [PMID: 30361140 PMCID: PMC6388618 DOI: 10.1016/j.amepre.2018.07.005] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/31/2018] [Accepted: 07/03/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Obesity treatment is less successful for socioeconomically disadvantaged populations, particularly when delivered in primary care. Digital health strategies can extend the reach of clinical obesity treatments to care settings serving patients at highest risk. METHODS Track was an effectiveness RCT of a 12-month digital weight-loss intervention, embedded within a community health center system. Participants were 351 adult patients (aged 21-65 years) with obesity and hypertension, diabetes, and hyperlipidemia. Patients were randomized to usual care (n=175) or an intervention (n=176) comprising app-based self-monitoring of behavior change goals with tailored feedback, a smart scale, dietitian-delivered counseling calls, and clinician counseling informed by app-generated recommendations, delivered via electronic health record. The primary outcome was 12-month weight change. Randomization began on June 18, 2013, final assessments were completed on September 10, 2015. Data analysis was conducted in 2016 and 2017. The trial retained 92% of usual care and 96% of intervention participants at 12 months. RESULTS The Track intervention produced larger weight losses relative to usual care at 6 months (net effect: -4.4 kg, 95% CI= -5.5, -3.3, p<0.001) and 12 months (net effect: -3.8 kg, 95% CI= -5.0, -2.5, p<0.001). Intervention participants were more likely to lose ≥5% of their baseline weight at 6 months (43% vs 6%, p<0.001) and 12 months (40% vs 17%, p<0.001). Intervention participants completing ≥80% of expected self-monitoring episodes (-3.5 kg); counseling calls (-3.0 kg); or self-weighing days (-4.4 kg) lost significantly more weight than less engaged intervention participants (all p<0.01). CONCLUSIONS A digital obesity treatment, integrated with health system resources, can produce clinically meaningful weight-loss outcomes among socioeconomically disadvantaged primary care patients with elevated cardiovascular disease risk. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT01827800.
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Affiliation(s)
- Gary G Bennett
- Duke Global Digital Health Science Center, Duke Global Health Institute, Durham, North Carolina; Department of Psychology and Neuroscience, Duke University, Durham, North Carolina.
| | - Dori Steinberg
- Duke Global Digital Health Science Center, Duke Global Health Institute, Durham, North Carolina
| | - Sandy Askew
- Duke Global Digital Health Science Center, Duke Global Health Institute, Durham, North Carolina
| | - Erica Levine
- Duke Global Digital Health Science Center, Duke Global Health Institute, Durham, North Carolina
| | - Perry Foley
- Duke Global Digital Health Science Center, Duke Global Health Institute, Durham, North Carolina
| | - Bryan C Batch
- Department of Medicine, Division of Endocrinology, Duke University Medical Center, Durham, North Carolina; Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina
| | - Laura P Svetkey
- Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina; Department of Medicine, Division of Nephrology, Duke University Medical Center, Durham, North Carolina
| | - Hayden B Bosworth
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Elaine M Puleo
- School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts
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Killeen Á, Geoghegan R, Flaherty G. Documentation and follow-up of anthropometric measurements of hospitalised patients. Eur J Prev Cardiol 2018; 27:1004-1006. [PMID: 30354742 DOI: 10.1177/2047487318809496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Á Killeen
- School of Medicine, National University of Ireland Galway, Ireland.,National Institute for Preventive Cardiology, Ireland
| | - R Geoghegan
- School of Medicine, National University of Ireland Galway, Ireland
| | - G Flaherty
- School of Medicine, National University of Ireland Galway, Ireland.,National Institute for Preventive Cardiology, Ireland
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Hopkins CM, Bennett GG. Weight-Related Terms Differentially Affect Self-Efficacy and Perception of Obesity. Obesity (Silver Spring) 2018; 26:1405-1411. [PMID: 30226011 DOI: 10.1002/oby.22255] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 08/22/2016] [Accepted: 10/31/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Little work has explored the effect of weight-related terms on treatment initiation; only one study has investigated weight-related terms and the psychological constructs associated with treatment uptake. The present study examines the effects of four common weight-related terms on treatment initiation and the moderating effect of weight bias internalization. METHODS Adult participants with overweight and obesity (n = 436) were recruited online and asked to read three vignettes describing clinical encounters; the weight-related term (i.e., "weight," "BMI," "obesity," or "fat") was varied randomly. Participants then reported self-efficacy, cognitive and emotional illness beliefs about obesity (i.e., illness perception), and interest in a weight loss program. RESULTS The term "obesity" resulted in the greatest self-efficacy and perceived control over obesity. "Fat" resulted in the least illness coherence (i.e., understanding of obesity). Weight bias internalization did not moderate the effect of term on self-efficacy, nor did it moderate illness perception. No differences in weight loss program enrollment were observed. CONCLUSIONS Use of the term "obesity" may promote patients' perceived control and self-efficacy. Use of "fat" should be avoided. Results suggest that, despite patient and clinician preference for euphemistic weight terms, use of clinical language such as "obesity" may perform better in provider intervention.
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Affiliation(s)
- Christina M Hopkins
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA
| | - Gary G Bennett
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA
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Hite A, Victorson D, Elue R, Plunkett BA. An Exploration of Barriers Facing Physicians in Diagnosing and Treating Obesity. Am J Health Promot 2018; 33:217-224. [PMID: 29986601 DOI: 10.1177/0890117118784227] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To determine whether primary care physicians can accurately assess body mass index (BMI) by visual inspection and to assess barriers related to the diagnosis and management of obesity. DESIGN Prospective Survey Study. SETTING Hospitals and Clinics. SUBJECTS Primary care providers in the fields of Internal Medicine, Family Medicine and Obstetrics/Gynecology. MEASURES Measures investigated included providers visual assessment of BMI, BMI knowledge, diagnosis and management of obese patients, and perceived barriers to treatment. ANALYSIS Top and bottom quartiles and total scores were determined for responses regarding the reported management of obesity, reported comfort with care, and reported barriers to care and used as the cut point. Statistical analyses were utilized to examine relations and compare groups. RESULTS 206 (74%) of the 280 eligible providers completed the survey. The accuracy of visual assessment of BMI was 52%. Physicians were more likely to underestimate BMI than overestimate (36% ± 4% vs 12% ± 6%, respectively, P < .001). Although 91% of providers report routinely calculating BMI, only 61% routinely discuss BMI. Providers feel comfortable providing exercise (72%) and dietary counseling (61%). However, fewer are comfortable prescribing medical (16.4%) and surgical options (36%). CONCLUSION Visual assessment of BMI is not reliable. Primary care physicians in our study population do not consistently discuss obesity with their patients and many report insufficient knowledge with regard to treatment options. Further studies are needed to determine whether these results are valid for other physicians in various practice settings and to mid-level providers. In addition, research is needed that investigate how collaboration with providers outside the medical field could reduce the burden on physicians in treating patients with overweight or obesity.
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Affiliation(s)
- Ashley Hite
- 1 Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Pritzker School of Medicine, University of Chicago, Evanston, IL, USA
| | - David Victorson
- 2 Department of Medical Social Science, Northwestern University, Chicago, IL, USA
| | - Rita Elue
- 1 Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Pritzker School of Medicine, University of Chicago, Evanston, IL, USA
| | - Beth A Plunkett
- 1 Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Pritzker School of Medicine, University of Chicago, Evanston, IL, USA
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Hanna RM, Fischer G, Conroy MB, Bryce C, Hess R, McTigue K. Online Lifestyle Modification Intervention: Survey of Primary Care Providers' Attitudes and Views. J Med Internet Res 2018; 20:e167. [PMID: 29884605 PMCID: PMC6015269 DOI: 10.2196/jmir.8616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 12/20/2017] [Accepted: 01/06/2018] [Indexed: 12/22/2022] Open
Abstract
Background Online tools are a convenient and effective method of delivering lifestyle interventions to obese adult primary care patients. A referral model allows physicians to efficiently direct their patients to the intervention during a primary care visit. However, little is known of physicians’ perspectives and utilization of the referral model for an online lifestyle modification intervention. Objective The aim was to evaluate the response of primary care providers (PCPs) to a referral model for implementing a year-long online intervention for weight loss to obese adult patients. Methods The PCPs at six primary care clinics were asked to refer adult obese patients to a year-long online lifestyle intervention providing self-management support for weight loss. Following the 1-year intervention, all providers at the participating practices were surveyed regarding their views of the program. Respondents completed survey items assessing their attitudes regarding the 1-year intensive weight loss intervention and identifying resources they would find helpful for assisting patients with weight loss. Referring physicians were asked about their level of satisfaction with implementing the counseling services using standard electronic health record referral processes. Attitudes toward obesity counseling among referring and nonreferring providers were compared. Impressions of how smoothly the referral model of obesity treatment integrated with the clinical workflow were also quantified. Results Of the 67 providers who completed the surveys, nonreferring providers (n=17) were more likely to prefer counseling themselves (P=.04) and to report having sufficient time to do so (P=.03) than referring providers (n=50) were. Nonreferring providers were more likely to report that their patients lacked computer skills (76%, 13/17 vs 34%, 17/50) or had less access to the Internet (65%, 11/17 vs 32%, 16/50). Conclusions Understanding providers’ views and barriers regarding the integration of online tools will facilitate widespread implementation of an online lifestyle modification intervention.
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Affiliation(s)
- Reem M Hanna
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Gary Fischer
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Molly B Conroy
- Division of General Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Cindy Bryce
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Rachel Hess
- Department of Population Health Science, University of Utah Health Sciences, Salt Lake City, UT, United States
| | - Kathleen McTigue
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, United States
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Zacharoulis D, Bakalis V, Zachari E, Sioka E, Tsimpida D, Magouliotis D, Tasiopoulou V, Chatedaki C, Tzovaras G. Current knowledge and perception of bariatric surgery among Greek doctors living in Thessaly. Asian J Endosc Surg 2018; 11:138-145. [PMID: 29105338 DOI: 10.1111/ases.12436] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 08/29/2017] [Accepted: 09/03/2017] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The purpose of this study was to assess doctors' knowledge, current conceptions, and clinical practice regarding obesity and bariatric surgery. METHODS A self-administered survey was administered to 500 doctors with varying medical specialties in public and private practice. RESULTS The response rate was 60%. Most participants (77.3%) were in private practice. Although almost half of the participants could define morbid obesity and obesity-related comorbidities, only 8.7% felt educated about bariatric surgery. Participants had little knowledge of various types of bariatric procedures. A minority of doctors (24.7%) knew of the existence of a bariatric center in their area. Only 21.3% of doctors had referred a patient to a bariatric center. Reasons for non-referral included lack of interest in bariatric surgery (37.3%), patient refusal (35.3%), increased operative fees (17.3%), lack of confidence in bariatric surgery (6.3%), and lack of access to a nearby bariatric center (3.7%). The majority of doctors were interested in learning more about bariatric surgery and related guidelines, but they remained reluctant to conduct patients' postoperative follow-ups. CONCLUSION The penetration of bariatric surgery in the medical community remains limited, despite its proven effectiveness in facilitating sustained weight loss and resolving several obesity-related comorbidities. A great effort should be made to inform health-care providers about the evolution of bariatric procedures, the potential benefits they offer, and the existence of certified bariatric centers. This will allow doctors to provide optimum health care to patients who could benefit from bariatric surgery.
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Affiliation(s)
- Dimitris Zacharoulis
- Department of Surgery, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Vissarion Bakalis
- Department of Surgery, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Eleni Zachari
- Department of Surgery, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Eleni Sioka
- Department of Surgery, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Dialecthi Tsimpida
- Department of Surgery, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Dimitrios Magouliotis
- Department of Surgery, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Vasiliki Tasiopoulou
- Department of Surgery, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Christina Chatedaki
- Department of Surgery, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - George Tzovaras
- Department of Surgery, University Hospital of Larissa, University of Thessaly, Larissa, Greece
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Goldschmidt AB, Wall MM, Choo THJ, Evans EW, Jelalian E, Larson N, Neumark-Sztainer D. Fifteen-year Weight and Disordered Eating Patterns Among Community-based Adolescents. Am J Prev Med 2018; 54:e21-e29. [PMID: 29132950 PMCID: PMC5736404 DOI: 10.1016/j.amepre.2017.09.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 08/24/2017] [Accepted: 09/07/2017] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The current study aims to characterize weight-change trajectories and their concomitant associations with prospectively measured dieting and other disordered eating behaviors among initially nonoverweight adolescents during the transition to adulthood. METHODS A population-based sample (n=1,091) self-reported their height/weight, dieting, unhealthy weight-control behaviors, and binge eating at 5-year intervals between 1998/1999 and 2013/2014, spanning early/middle adolescence through middle/late young adulthood. Data were analyzed in 2016/2017. RESULTS Groups were categorized as those who were never overweight (n=562), were overweight during at least one measurement point and gained weight more rapidly (n=246) or gradually (n=238) than their peers, or were overweight during at least one measurement point but returned to nonoverweight status by middle/late young adulthood (n=45). Thus, nearly half of adolescents became overweight during the transition to adulthood. Those who were never overweight had the lowest rates of dieting (males: F[9, 1,314]=2.54, p=0.0069, females: F[9, 1,927]=3.02, p=0.0014) and unhealthy weight-control behaviors (males: F[9, 1,313]=3.30, p=0.0005, females: F[9, 1,927]=3.02, p=0.0014), whereas some of these behaviors tended to track with weight gain in rapid and gradual weight gainers. CONCLUSIONS Although adolescents who are already overweight are most frequently targeted for weight-gain prevention and early intervention programs, results suggest that healthy lifestyle interventions could also benefit individuals who may be perceived as low risk for overweight in adulthood by nature of being nonoverweight in adolescence. Dieting and unhealthy weight-control behaviors tended to be associated with weight gain, suggesting that they are ineffective in addition to being potentially harmful.
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Affiliation(s)
- Andrea B Goldschmidt
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, The Miriam Hospital/Weight Control and Diabetes Research Center, Providence, Rhode Island.
| | - Melanie M Wall
- Department of Biostatistics, Columbia University, New York, New York
| | - Tse-Hwei J Choo
- Department of Biostatistics, Columbia University, New York, New York
| | - E Whitney Evans
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, The Miriam Hospital/Weight Control and Diabetes Research Center, Providence, Rhode Island
| | - Elissa Jelalian
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, The Miriam Hospital/Weight Control and Diabetes Research Center, Providence, Rhode Island
| | - Nicole Larson
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Dianne Neumark-Sztainer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
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