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Rodbard HW, Barnard-Kelly K, Pfeiffer AFH, Mauersberger C, Schnell O, Giorgino F. Practical strategies to manage obesity in type 2 diabetes. Diabetes Obes Metab 2024; 26:2029-2045. [PMID: 38514387 DOI: 10.1111/dom.15556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 03/23/2024]
Abstract
The rising phenomenon of obesity, a major risk factor for the development and progression of type 2 diabetes, is a complex and multifaceted issue that requires a comprehensive and coordinated approach to be prevented and managed. Although novel pharmacological measures to combat obesity have achieved unprecedented efficacy, a healthy lifestyle remains essential for the long-term success of any therapeutic intervention. However, this requires a high level of intrinsic motivation and continued behavioural changes in the face of multiple metabolic, psychological and environmental factors promoting weight gain, particularly in the context of type 2 diabetes. This review is intended to provide practical recommendations in the context of a holistic, person-centred approach to weight management, including evidence-based and expert recommendations addressing supportive communication, shared decision-making, as well as nutritional and pharmacological therapeutic approaches to achieve sustained weight loss.
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Affiliation(s)
| | - Katharine Barnard-Kelly
- Southern Health NHS Foundation Trust, Southampton, UK
- BHR Limited, Portsmouth, UK
- Spotlight Consultations, Fareham, UK
| | - Andreas F H Pfeiffer
- Department of Endocrinology, Diabetes and Nutrition, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Oliver Schnell
- Sciarc GmbH, Baierbrunn, Germany
- Forschergruppe Diabetes eV at the Helmholtz Centre, Munich-Neuherberg, Germany
| | - Francesco Giorgino
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, Italy
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Luig T, Ofosu NN, Chiu Y, Wang N, Omar N, Yip L, Aleba S, Maragang K, Ali M, Dormitorio I, Lee KK, Yeung RO, Campbell-Scherer D. Role of cultural brokering in advancing holistic primary care for diabetes and obesity: a participatory qualitative study. BMJ Open 2023; 13:e073318. [PMID: 37709303 PMCID: PMC10921915 DOI: 10.1136/bmjopen-2023-073318] [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: 03/02/2023] [Accepted: 08/18/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVES Diabetes and obesity care for ethnocultural migrant communities is hampered by a lack of understanding of premigration and postmigration stressors and their impact on social and clinical determinants of health within unique cultural contexts. We sought to understand the role of cultural brokering in primary healthcare to enhance chronic disease care for ethnocultural migrant communities. DESIGN AND SETTING Participatory qualitative descriptive-interpretive study with the Multicultural Health Brokers Cooperative in a Canadian urban centre. Cultural brokers are linguistic and culturally diverse community health workers who bridge cultural distance, support relationships and understanding between providers and patients to improve care outcomes. From 2019 to 2021, we met 16 times to collaborate on research design, analysis and writing. PARTICIPANTS Purposive sampling of 10 cultural brokers representing eight different major local ethnocultural communities. Data include 10 in-depth interviews and two observation sessions analysed deductively and inductively to collaboratively construct themes. RESULTS Findings highlight six thematic domains illustrating how cultural brokering enhances holistic primary healthcare. Through family-based relational supports and a trauma-informed care, brokering supports provider-patient interactions. This is achieved through brokers' (1) embeddedness in community relationships with deep knowledge of culture and life realities of ethnocultural immigrant populations; (2) holistic, contextual knowledge; (3) navigation and support of access to care; (4) cultural interpretation to support health assessment and communication; (5) addressing psychosocial needs and social determinants of health and (6) dedication to follow-up and at-home management practices. CONCLUSIONS Cultural brokers can be key partners in the primary care team to support people living with diabetes and/or obesity from ethnocultural immigrant and refugee communities. They enhance and support provider-patient relationships and communication and respond to the complex psychosocial and economic barriers to improve health. Consideration of how to better enable and expand cultural brokering to support chronic disease management in primary care is warranted.
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Affiliation(s)
- Thea Luig
- Physician Learning Program, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Nicole N Ofosu
- Physician Learning Program, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Yvonne Chiu
- Multicultural Health Brokers Cooperative, Edmonton, Alberta, Canada
| | - Nancy Wang
- Multicultural Health Brokers Cooperative, Edmonton, Alberta, Canada
| | - Nasreen Omar
- Multicultural Health Brokers Cooperative, Edmonton, Alberta, Canada
| | - Lydia Yip
- Multicultural Health Brokers Cooperative, Edmonton, Alberta, Canada
| | - Sarah Aleba
- Multicultural Health Brokers Cooperative, Edmonton, Alberta, Canada
| | - Kiki Maragang
- Multicultural Health Brokers Cooperative, Edmonton, Alberta, Canada
| | - Mulki Ali
- Multicultural Health Brokers Cooperative, Edmonton, Alberta, Canada
| | - Irene Dormitorio
- Multicultural Health Brokers Cooperative, Edmonton, Alberta, Canada
| | - Karen K Lee
- Division of Preventive Medicine, Department of Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Roseanne O Yeung
- Division of Endocrinology and Metabolism, Department of Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Denise Campbell-Scherer
- Physician Learning Program, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Family Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
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Handelsman Y, Butler J, Bakris GL, DeFronzo RA, Fonarow GC, Green JB, Grunberger G, Januzzi JL, Klein S, Kushner PR, McGuire DK, Michos ED, Morales J, Pratley RE, Weir MR, Wright E, Fonseca VA. Early intervention and intensive management of patients with diabetes, cardiorenal, and metabolic diseases. J Diabetes Complications 2023; 37:108389. [PMID: 36669322 DOI: 10.1016/j.jdiacomp.2022.108389] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 01/04/2023]
Abstract
Increasing rates of obesity and diabetes have driven corresponding increases in related cardiorenal and metabolic diseases. In many patients, these conditions occur together, further increasing morbidity and mortality risks to the individual. Yet all too often, the risk factors for these disorders are not addressed promptly in clinical practice, leading to irreversible pathologic progression. To address this gap, we convened a Task Force of experts in cardiology, nephrology, endocrinology, and primary care to develop recommendations for early identification and intervention in obesity, diabetes, and other cardiorenal and metabolic diseases. The recommendations include screening and diagnosis, early interventions with lifestyle, and when and how to implement medical therapies. These recommendations are organized into primary and secondary prevention along the continuum from obesity through the metabolic syndrome, prediabetes, diabetes, hypertension, dyslipidemia, nonalcoholic fatty liver disease (NAFLD), atherosclerotic cardiovascular disease (ASCVD) and atrial fibrillation, chronic kidney disease (CKD), and heart failure (HF). The goal of early and intensive intervention is primary prevention of comorbidities or secondary prevention to decrease further worsening of disease and reduce morbidity and mortality. These efforts will reduce clinical inertia and may improve patients' well-being and adherence.
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Affiliation(s)
| | - Javed Butler
- Baylor Scott and White Research Institute, Baylor Scott and White Health, Dallas, TX, USA; University of Mississippi Medical Center, Jackson, MS, USA
| | - George L Bakris
- American Heart Association Comprehensive Hypertension Center, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Ralph A DeFronzo
- University of Texas Health Science Center at San Antonio, Texas Diabetes Institute, San Antonio, TX, USA
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, UCLA Preventative Cardiology Program, UCLA Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jennifer B Green
- Division of Endocrinology and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - George Grunberger
- Grunberger Diabetes Institute, Internal Medicine and Molecular Medicine & Genetics, Wayne State University School of Medicine, Department of Internal Medicine, Oakland University William Beaumont School of Medicine, Bloomfield Hills, MI, USA; Department of Internal Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - James L Januzzi
- Cardiology Division, Harvard Medical School, Massachusetts General Hospital, Cardiometabolic Trials, Baim Institute, Boston, MA, USA
| | - Samuel Klein
- Washington University School of Medicine, Saint Louis, MO, USA; Sansum Diabetes Research Institute, Santa Barbara, CA, USA
| | - Pamela R Kushner
- University of California Medical Center, Kushner Wellness Center, Long Beach, CA, USA
| | - Darren K McGuire
- University of Texas Southwestern Medical Center, and Parkland Health and Hospital System, Dallas, TX, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Javier Morales
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Advanced Internal Medicine Group, PC, East Hills, NY, USA
| | | | - Matthew R Weir
- Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Eugene Wright
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Vivian A Fonseca
- Section of Endocrinology, Tulane University Health Sciences Center, New Orleans, LA, USA
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Ells LJ, Ashton M, Li R, Logue J, Griffiths C, Torbahn G, Marwood J, Stubbs J, Clare K, Gately PJ, Campbell-Scherer D. Can We Deliver Person-Centred Obesity Care Across the Globe? Curr Obes Rep 2022; 11:350-355. [PMID: 36272056 PMCID: PMC9589792 DOI: 10.1007/s13679-022-00489-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW This article discusses what person-centred care is; why it is critically important in providing effective care of a chronic, complex disease like obesity; and what can be learnt from international best practice to inform global implementation. RECENT FINDINGS There are four key principles to providing person-centred obesity care: providing care that is coordinated, personalised, enabling and delivered with dignity, compassion and respect. The Canadian 5AsT framework provides a co-developed person-centred obesity care approach that addresses complexity and is being tested internationally. Embedding person-centred obesity care across the globe will require a complex system approach to provide a framework for healthcare system redesign, advances in people-driven discovery and advocacy for policy change. Additional training, tools and resources are required to support local implementation, delivery and evaluation. Delivering high-quality, effective person-centred care across the globe will be critical in addressing the current obesity epidemic.
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Affiliation(s)
- Louisa J Ells
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK.
| | | | - Rui Li
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Jennifer Logue
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Claire Griffiths
- Obesity Institute, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - Gabriel Torbahn
- Department of Pediatrics, Paracelsus Medical University, Klinikum Nürnberg, Universitätsklinik Der Paracelsus Medizinischen Privatuniversität Nürnberg, Nuremberg, Germany
| | - Jordan Marwood
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | - James Stubbs
- School of Psychology, University of Leeds, Leeds, UK
| | - Ken Clare
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
- , Obesity UK, Leeds, UK
| | - Paul J Gately
- , Obesity UK, Leeds, UK
- Obesity Institute, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
- MoreLife UK Ltd, Leeds, UK
| | - Denise Campbell-Scherer
- Physician Learning Program, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
- Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
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Hazlehurst JM, Singh P, Bhogal G, Broughton S, Tahrani AA. How to manage weight loss in women with obesity and PCOS seeking fertility? Clin Endocrinol (Oxf) 2022; 97:208-216. [PMID: 35319122 PMCID: PMC9541741 DOI: 10.1111/cen.14726] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/03/2022] [Accepted: 03/16/2022] [Indexed: 01/14/2023]
Abstract
Obesity exacerbates the phenotype of polycystic ovarian syndrome (PCOS) including infertility as well as reducing the efficacy and access to fertility treatments. Weight management is, therefore, a key component of treatment for women with PCOS and coexistent obesity. Many women with PCOS describe significant difficulty losing weight and treatment options are limited. The first-line treatment is lifestyle interventions though the weight loss and any impact on fertility are limited. No one dietary strategy can be preferentially recommended based on current evidence. While very low energy diets can result in significant weight loss the evidence for impact on fertility is limited. Pharmacotherapy, including a range of treatments can result in marked weight loss and there is some evidence of improved rates of conception including spontaneous and in response to assisted reproduction treatment. As with pharmacotherapy, data regarding bariatric surgery is largely from nonrandomized studies and though the significant weight loss is anticipated to improve fertility the available data prevents firm conclusions. Clinicians and patients must consider the magnitude of weight loss to be targeted as well as the anticipated fertility treatment required and the timeline of treatment when deciding upon the personalized weight loss strategy. Clinicians and patients should be confident in targeting the most appropriate treatment early in the patient's management to avoid unnecessary delays.
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Affiliation(s)
- Jonathan M. Hazlehurst
- The Medical School, Institute of Applied Health ResearchUniversity of BirminghamBirminghamUK
- Centre for Endocrinology, Diabetes and MetabolismBirmingham Health PartnersBirminghamUK
- Department of Diabetes and EndocrinologyUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Pushpa Singh
- Department of Diabetes and EndocrinologyUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
- The Medical School, Institute of Metabolism and Systems ResearchUniversity of BirminghamBirminghamUK
| | | | | | - Abd A. Tahrani
- Centre for Endocrinology, Diabetes and MetabolismBirmingham Health PartnersBirminghamUK
- Department of Diabetes and EndocrinologyUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
- The Medical School, Institute of Metabolism and Systems ResearchUniversity of BirminghamBirminghamUK
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Swaleh R, McGuckin T, Myroniuk TW, Manca D, Lee K, Sharma AM, Campbell-Scherer D, Yeung RO. Using the Edmonton Obesity Staging System in the real world: a feasibility study based on cross-sectional data. CMAJ Open 2021; 9:E1141-E1148. [PMID: 34876416 PMCID: PMC8673483 DOI: 10.9778/cmajo.20200231] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The Edmonton Obesity Staging System (EOSS) combined with body mass index (BMI) enables improved functional and prognostic assessment for patients. To facilitate application of the EOSS in practice, we aimed to create tools for capturing comorbidity assessments in electronic medical records and for automating the calculation of a patient's EOSS stage. METHODS In this feasibility study, we used cross-sectional data to create a clinical dashboard to calculate and display the relation between BMI and EOSS and the prevalence of related comorbidities. We obtained data from the Northern Alberta Primary Care Research Network and the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). We included patients at least 18 years of age with BMI between 30 and 60 who visited a network clinic between July 2016 and July 2019. We calculated descriptive statistics and used stepwise ordinary least squares regression to assess the contributions of age, sex and BMI to EOSS variation. RESULTS We created a clinical dashboard using the CPCSSN data presentation tool. Of the total 31 496 patients included in the study, 23 460 had a BMI of at least 30; BMI was unavailable for 8036 patients. Within each EOSS disease severity stage, there were similar proportions of patients from each BMI class (e.g., patients with EOSS stage 2 included 51.8% of those with BMI class I, 55.3% of those with BMI class II and 58.8% of those with BMI class III). INTERPRETATION Using data from primary care electronic medical records, it was feasible to create a clinical dashboard for obesity that highlighted the severity and stage of obesity. Making this information easily accessible for individual clinical care and practice-level quality improvement may advance obesity care.
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Affiliation(s)
- Rukia Swaleh
- Division of Endocrinology and Metabolism, Department of Medicine (Swaleh, Yeung), Edmonton Physician Learning Program (McGuckin, Myroniuk, Manca, Campbell-Scherer, Yeung), Department of Family Medicine (Manca, Campbell-Scherer), Division of Preventive Medicine, Department of Medicine (Lee), and Department of Medicine (Sharma), Faculty of Medicine and Dentistry; School of Public Health (Lee); School of Urban and Regional Planning (Lee); and Alberta Diabetes Institute (Sharma, Campbell-Scherer, Yeung), University of Alberta, Edmonton, Alta.; and Department of Public Health (Myroniuk), University of Missouri-Columbia, Columbia, Mo
| | - Taylor McGuckin
- Division of Endocrinology and Metabolism, Department of Medicine (Swaleh, Yeung), Edmonton Physician Learning Program (McGuckin, Myroniuk, Manca, Campbell-Scherer, Yeung), Department of Family Medicine (Manca, Campbell-Scherer), Division of Preventive Medicine, Department of Medicine (Lee), and Department of Medicine (Sharma), Faculty of Medicine and Dentistry; School of Public Health (Lee); School of Urban and Regional Planning (Lee); and Alberta Diabetes Institute (Sharma, Campbell-Scherer, Yeung), University of Alberta, Edmonton, Alta.; and Department of Public Health (Myroniuk), University of Missouri-Columbia, Columbia, Mo
| | - Tyler W Myroniuk
- Division of Endocrinology and Metabolism, Department of Medicine (Swaleh, Yeung), Edmonton Physician Learning Program (McGuckin, Myroniuk, Manca, Campbell-Scherer, Yeung), Department of Family Medicine (Manca, Campbell-Scherer), Division of Preventive Medicine, Department of Medicine (Lee), and Department of Medicine (Sharma), Faculty of Medicine and Dentistry; School of Public Health (Lee); School of Urban and Regional Planning (Lee); and Alberta Diabetes Institute (Sharma, Campbell-Scherer, Yeung), University of Alberta, Edmonton, Alta.; and Department of Public Health (Myroniuk), University of Missouri-Columbia, Columbia, Mo
| | - Donna Manca
- Division of Endocrinology and Metabolism, Department of Medicine (Swaleh, Yeung), Edmonton Physician Learning Program (McGuckin, Myroniuk, Manca, Campbell-Scherer, Yeung), Department of Family Medicine (Manca, Campbell-Scherer), Division of Preventive Medicine, Department of Medicine (Lee), and Department of Medicine (Sharma), Faculty of Medicine and Dentistry; School of Public Health (Lee); School of Urban and Regional Planning (Lee); and Alberta Diabetes Institute (Sharma, Campbell-Scherer, Yeung), University of Alberta, Edmonton, Alta.; and Department of Public Health (Myroniuk), University of Missouri-Columbia, Columbia, Mo
| | - Karen Lee
- Division of Endocrinology and Metabolism, Department of Medicine (Swaleh, Yeung), Edmonton Physician Learning Program (McGuckin, Myroniuk, Manca, Campbell-Scherer, Yeung), Department of Family Medicine (Manca, Campbell-Scherer), Division of Preventive Medicine, Department of Medicine (Lee), and Department of Medicine (Sharma), Faculty of Medicine and Dentistry; School of Public Health (Lee); School of Urban and Regional Planning (Lee); and Alberta Diabetes Institute (Sharma, Campbell-Scherer, Yeung), University of Alberta, Edmonton, Alta.; and Department of Public Health (Myroniuk), University of Missouri-Columbia, Columbia, Mo
| | - Arya M Sharma
- Division of Endocrinology and Metabolism, Department of Medicine (Swaleh, Yeung), Edmonton Physician Learning Program (McGuckin, Myroniuk, Manca, Campbell-Scherer, Yeung), Department of Family Medicine (Manca, Campbell-Scherer), Division of Preventive Medicine, Department of Medicine (Lee), and Department of Medicine (Sharma), Faculty of Medicine and Dentistry; School of Public Health (Lee); School of Urban and Regional Planning (Lee); and Alberta Diabetes Institute (Sharma, Campbell-Scherer, Yeung), University of Alberta, Edmonton, Alta.; and Department of Public Health (Myroniuk), University of Missouri-Columbia, Columbia, Mo
| | - Denise Campbell-Scherer
- Division of Endocrinology and Metabolism, Department of Medicine (Swaleh, Yeung), Edmonton Physician Learning Program (McGuckin, Myroniuk, Manca, Campbell-Scherer, Yeung), Department of Family Medicine (Manca, Campbell-Scherer), Division of Preventive Medicine, Department of Medicine (Lee), and Department of Medicine (Sharma), Faculty of Medicine and Dentistry; School of Public Health (Lee); School of Urban and Regional Planning (Lee); and Alberta Diabetes Institute (Sharma, Campbell-Scherer, Yeung), University of Alberta, Edmonton, Alta.; and Department of Public Health (Myroniuk), University of Missouri-Columbia, Columbia, Mo
| | - Roseanne O Yeung
- Division of Endocrinology and Metabolism, Department of Medicine (Swaleh, Yeung), Edmonton Physician Learning Program (McGuckin, Myroniuk, Manca, Campbell-Scherer, Yeung), Department of Family Medicine (Manca, Campbell-Scherer), Division of Preventive Medicine, Department of Medicine (Lee), and Department of Medicine (Sharma), Faculty of Medicine and Dentistry; School of Public Health (Lee); School of Urban and Regional Planning (Lee); and Alberta Diabetes Institute (Sharma, Campbell-Scherer, Yeung), University of Alberta, Edmonton, Alta.; and Department of Public Health (Myroniuk), University of Missouri-Columbia, Columbia, Mo
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Luig T, Keenan L, Campbell-Scherer DL. Transforming Health Experience and Action through Shifting the Narrative on Obesity in Primary Care Encounters. QUALITATIVE HEALTH RESEARCH 2020; 30:730-744. [PMID: 31617456 PMCID: PMC7322940 DOI: 10.1177/1049732319880551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
We sought to understand the impact of primary care conversations about obesity on people's everyday life health experience and practices. Using a dialogic narrative perspective, we examined key moments in three very different clinical encounters, the patients' journals, and follow-up interviews over several weeks. We trace how people living with obesity negotiate narrative alternatives that are offered during clinical dialogue to transform their own narrative and experience of obesity and self. Findings provide pragmatic insights into how providers can play a significant role in shifting narratives about obesity and self and how such co-constructed narratives translate into change and tangible health outcomes in people's lives.
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Affiliation(s)
- Thea Luig
- University of Alberta, Edmonton, Canada
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