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Chae K, German J, Kendrick K, Tackett S, O'Rourke P, Gudzune KA, Laudenslager M. An obesity medicine curriculum increases the obesity care self-efficacy of internal medicine residents in the primary care setting. Clin Obes 2024; 14:e12656. [PMID: 38551164 DOI: 10.1111/cob.12656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 07/13/2024]
Abstract
Primary care physicians (PCPs) report insufficient knowledge and training gaps in obesity care. Internal Medicine (IM) residency offers an opportunity to address this educational gap for future PCPs. We designed an innovative, multicomponent curriculum on obesity medicine (OM) in the primary care setting for IM residents. We then conducted a prospective, 6-month, two-arm study within two residency programs in Maryland evaluating feasibility (use, appropriateness for IM training, and satisfaction) of the curriculum as well as changes in self-efficacy within seven obesity care domains, assessed on 4-point scales (1-not at all confident to 4-very confident). One residency program received the curriculum and the other served as the control group. We recruited 35 IM residents to participate (17 intervention, 18 control). Among intervention residents, 42% used all curricular components; appropriateness and satisfaction with the curriculum were high. Compared with controls, intervention residents had statistically significant increases in five obesity care self-efficacy domains: nutrition (intervention 0.8 vs. control 0.2, p = .02), behaviour change (1.2 vs. 0.4, p < .01), weight-gain-promoting medications (0.8 vs. 0.1, p = .01), anti-obesity medications (1.2 vs. 0.5, p = .03), and bariatric surgical counselling (0.9 vs. 0.4, p = .03). There were no significant changes in physical activity or post-bariatric surgical care domains. Our OM curriculum is feasible with IM residents and increases residents' obesity care self-efficacy beyond what is achieved with usual IM training.
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Affiliation(s)
- Kacey Chae
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jashalynn German
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Karla Kendrick
- Winchester Hospital Weight Management Center, Beth Israel Lahey Health, Woburn, Massachusetts, USA
| | - Sean Tackett
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Biostatistics, Epidemiology, and Data Management Core, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Paul O'Rourke
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kimberly A Gudzune
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland, USA
| | - Marci Laudenslager
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Hassan A, Kerr DA, Begley A. 'It's Just Not Working', a Qualitative Exploration of the Weight-Related Healthcare Experiences of Individuals of Arab Heritage With Higher Weight in Australia. Health Expect 2024; 27:e14134. [PMID: 38967878 PMCID: PMC11225603 DOI: 10.1111/hex.14134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 06/06/2024] [Accepted: 06/19/2024] [Indexed: 07/06/2024] Open
Abstract
INTRODUCTION Culturally and linguistically diverse population groups disproportionately experience higher weight and other non-weight-related discrimination in healthcare settings outside of their ancestral country. Little is known about the experiences of individuals with Arab heritage. This study aimed to qualitatively explore the intersectional weight-related healthcare experiences of individuals of Arab heritage with higher weight in Australia. METHODS A general inductive enquiry approach was used. Purposive, convenience and snowball sampling was used to recruit individuals of Arab heritage residing in Australia. Individuals were invited to participate in an online semistructured interview. Interviews were recorded, transcribed and thematically analysed. RESULTS Fifteen participants took part in the study. Of these participants, 93% were female (n = 14), 80% were aged between 18 and 44 years (n = 12), 73% were university educated (n = 11), 53% were born outside of Australia (n = 8) and all were Muslim (n = 15). Four main themes were identified: (1) appearance-based judgement, (2) generalised advice and assumptions, (3) cultural responsiveness and (4) healthcare system constraints. CONCLUSION Individuals of Arab heritage with higher weight in Australia, namely, females, often perceive their healthcare experiences as dismissive of their cultural and religious needs and driven by causality assumptions around weight. It is crucial that care delivered encompasses cultural humility, is weight-inclusive and acknowledges systemic constraints. Cultural safety training benchmarks, healthcare management reform and weight-inclusive healthcare approaches are recommended to assist healthcare providers in delivering effective, holistic and culturally safe care. PATIENT OR PUBLIC CONTRIBUTION Insights gained from conversations with Arab heritage community members with lived experiences regarding weight-related healthcare encounters informed the study design and approach.
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Affiliation(s)
- Amira Hassan
- School of Population HealthCurtin UniversityPerthWestern AustraliaAustralia
- Curtin Health Innovation Research InstituteCurtin UniversityPerthWestern AustraliaAustralia
| | - Deborah A. Kerr
- School of Population HealthCurtin UniversityPerthWestern AustraliaAustralia
- Curtin Health Innovation Research InstituteCurtin UniversityPerthWestern AustraliaAustralia
| | - Andrea Begley
- School of Population HealthCurtin UniversityPerthWestern AustraliaAustralia
- Curtin Health Innovation Research InstituteCurtin UniversityPerthWestern AustraliaAustralia
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Allnutt AE, Smith DJ, Torrence WA, Alexander DS. Examining weight bias attitudes and obesity beliefs among undergraduate students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:1814-1819. [PMID: 35834745 DOI: 10.1080/07448481.2022.2093114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 05/23/2022] [Accepted: 06/19/2022] [Indexed: 06/15/2023]
Abstract
Objective: This cross-sectional study examined the weight bias attitudes and obesity beliefs of health science (HS), nursing, and pre-medicine undergraduate students. Methods: Using snowballing and convenience sampling strategies, students (N = 139) completed an online survey, including a 24-item Antifat Attitudes Scale (AFAS) and eight-item Belief About Obese Persons (BAOP) scale. Results: HS students have higher weight bias than nursing and pre-medicine students combined (M = 43.45, SD = 10.75), t(137) = -2.45, p = .016). A negative correlation exists between AFAS and BAOP suggesting high weight bias influences a belief that obesity is controllable. Gender positively predicted weight bias attitudes (ß = -11.43, t = -4.33, p < .001) and obesity beliefs (ß = 3.75, t = 3.01, p = . 003). Conclusions: Findings confirm that HS students have weight bias attitudes. This supports undergraduate curricular changes on obesity etiology that may improve treatment plans of individuals who are obese.
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Affiliation(s)
| | - Daniel J Smith
- Concordia University Chicago, River Forest, Illinois, USA
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Laddu D, Neeland IJ, Carnethon M, Stanford FC, Mongraw-Chaffin M, Barone Gibbs B, Ndumele CE, Longenecker CT, Chung ML, Rao G. Implementation of Obesity Science Into Clinical Practice: A Scientific Statement From the American Heart Association. Circulation 2024; 150:e7-e19. [PMID: 38766861 DOI: 10.1161/cir.0000000000001221] [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: 05/22/2024]
Abstract
Obesity is a recognized public health epidemic with a prevalence that continues to increase dramatically in nearly all populations, impeding progress in reducing incidence rates of cardiovascular disease. Over the past decade, obesity science has evolved to improve knowledge of its multifactorial causes, identifying important biological causes and sociological determinants of obesity. Treatments for obesity have also continued to develop, with more evidence-based programs for lifestyle modification, new pharmacotherapies, and robust data to support bariatric surgery. Despite these advancements, there continues to be a substantial gap between the scientific evidence and the implementation of research into clinical practice for effective obesity management. Addressing barriers to obesity science implementation requires adopting feasible methodologies and targeting multiple levels (eg, clinician, community, system, policy) to facilitate the delivery of obesity-targeted therapies and maximize the effectiveness of guideline-driven care to at-need patient populations. This scientific statement (1) describes strategies shown to be effective or promising for enhancing translation and clinical application of obesity-based research; (2) identifies key gaps in the implementation of obesity science into clinical practice; and (3) provides guidance and resources for health care professionals, health care systems, and other stakeholders to promote broader implementation and uptake of obesity science for improved population-level obesity management. In addition, advances in implementation science that hold promise to bridge the know-do gap in obesity prevention and treatment are discussed. Last, this scientific statement highlights implications for health research policy and future research to improve patient care models and optimize the delivery and sustainability of equitable obesity-related care.
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Herbozo S, Brown KL, Burke NL, LaRose JG. A Call to Reconceptualize Obesity Treatment in Service of Health Equity: Review of Evidence and Future Directions. Curr Obes Rep 2023; 12:24-35. [PMID: 36729299 PMCID: PMC9894524 DOI: 10.1007/s13679-023-00493-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW Rates of obesity and associated comorbidities are higher among Black and Latino adults compared to white adults. We sought to provide an overview of both structural and individual factors contributing to obesity inequities and synthesize available evidence regarding treatment outcomes in Black and Latino adults, with an eye towards informing future directions. RECENT FINDINGS Obesity disparities are influenced by myriad systemic issues, yet the vast majority of interventions target individual-level factors only, and most behavioral treatments fail to target drivers beyond eating and physical activity. Extant treatments are not equally accessible, affordable, or effective among Black and Latino adults compared with white counterparts. Asset-based, culturally relevant interventions that target the root causes of obesity and address intersectional stress-designed in partnership with intended beneficiaries-are urgently needed. Treatment trials must improve enrollment of Black and Latino adults and report treatment outcomes by race and ethnicity.
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Affiliation(s)
- Sylvia Herbozo
- Department of Surgery, Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Illinois at Chicago, Chicago, USA.
- Department of Psychiatry and Behavioral Sciences and Department of Surgery, Rush University Medical Center, 1725 West Harrison Street, Chicago, IL, 60612, USA.
| | - Kristal Lyn Brown
- Division of General Internal Medicine, School of Medicine, The Johns Hopkins University, Baltimore, USA
| | - Natasha L Burke
- Department of Psychology, Fordham University, The Bronx, USA
| | - Jessica Gokee LaRose
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, USA
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Sex differences in overweight and obesity among Mexican Americans in the National Health and Nutrition Examination Survey: A comparison of measures. SSM Popul Health 2022; 20:101297. [DOI: 10.1016/j.ssmph.2022.101297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 11/24/2022] Open
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Cardel MI, Newsome FA, Pearl RL, Ross KM, Dillard JR, Miller DR, Hayes JF, Wilfley D, Keel PK, Dhurandhar EJ, Balantekin KN. Patient-Centered Care for Obesity: How Health Care Providers Can Treat Obesity While Actively Addressing Weight Stigma and Eating Disorder Risk. J Acad Nutr Diet 2022; 122:1089-1098. [PMID: 35033698 PMCID: PMC10056599 DOI: 10.1016/j.jand.2022.01.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 11/10/2021] [Accepted: 01/11/2022] [Indexed: 02/01/2023]
Affiliation(s)
- Michelle I Cardel
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL; WW International, Inc., New York, NY.
| | - Faith A Newsome
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL
| | - Rebecca L Pearl
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, FL
| | - Kathryn M Ross
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, FL
| | - Julia R Dillard
- University of Toledo, College of Medicine and Life Sciences, Toledo, OH
| | - Darci R Miller
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL
| | - Jacqueline F Hayes
- Weight Control and Diabetes Research Center at the Miriam Hospital and Department of Psychiatry and Human Behavior, Brown University, Providence, RI
| | - Denise Wilfley
- Washington University in St Louis, College of Medicine, St Louis, MO
| | - Pamela K Keel
- Department of Psychology, Florida State University, Tallahassee, FL
| | | | - Katherine N Balantekin
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY
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Gandrakota N, Patel VB, Moore M, Benameur K, Shah MK. Trends in Diet Counseling Among Stroke Versus Non-Stroke Patients: Evidence from the NAMCS, 2011-2016. J Stroke Cerebrovasc Dis 2022; 31:106223. [PMID: 34844125 PMCID: PMC8792666 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/01/2021] [Accepted: 11/07/2021] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Dietary modifications in post-stroke patients facilitated by diet counseling improves post-stroke recovery and stroke recurrence. The extent to which clinicians provide dietary counseling for these patients is unknown. METHODS 2011 to 2016 National Ambulatory Medical Care Surveys (NAMCS) data were used to assess trends in post-stroke diet consultations by age. Multivariate logistic regression models assessed the likelihood of dietary counseling provision among patients with and without stroke. RESULTS The proportion of patients with stroke aged 60-79 who received diet counseling decreased from 18.2% in 2011 to 5.3%, 11.9%, 8.7%, 13.4%, and 15.2% in 2012-2016, respectively. Among patients without stroke aged 60-79, diet counseling rate decreased from 12.9% in 2011 to 7%, 9.5%, 10.5%, 13.5%, and 12% in 2012-2016, respectively. Similar trends were observed among patients with and without stroke aged over 80. CONCLUSIONS The proportion of patients with and without stroke receiving dietary counseling has remained low over the past half-decade. It is likely multifactorial- related to clinician knowledge, patients' receptiveness, and system-level factors of time and reimbursement. Future interventions should explore methods to address barriers to nutrition recommendations for post-stroke patients and patient activation to adopt dietary changes.
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Affiliation(s)
- Nikhila Gandrakota
- Department of Family and Preventive Medicine, PGY-1, Family Medicine, Emory University School of Medicine, Atlanta, GA, USA.
| | | | - Miranda Moore
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Karima Benameur
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Megha K Shah
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, USA
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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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Bomberg EM, Palzer EF, Rudser KD, Kelly AS, Bramante CT, Seligman HK, Noni F, Fox CK. Anti-obesity medication prescriptions by race/ethnicity and use of an interpreter in a pediatric weight management clinic. Ther Adv Endocrinol Metab 2022; 13:20420188221090009. [PMID: 35432917 PMCID: PMC9005816 DOI: 10.1177/20420188221090009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 03/04/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Race/ethnicity and low English proficiency healthcare disparities are well established in the United States. We sought to determine if there are race/ethnicity differences in anti-obesity medication (AOM) prescription rates among youth with severe obesity treated in a pediatric weight management clinic and if, among youth from non-primary English speaking families, there are differences in prescriptions between those using interpreters during visits versus not. METHODS We reviewed electronic health records of 2- to 18-year-olds with severe obesity seen from 2012 to 2021. Race/ethnicity was self-report, and AOMs included topiramate, stimulants (e.g. phentermine, lisdexamfetamine), naltrexone (±bupropion), glucagon-like peptide-1 agonists, and orlistat. We used general linear regression models with log-link to compare incidence rate ratios (IRRs) within the first 1 and 3 years of being followed, controlling for age, percent of the 95th BMI percentile (%BMIp95), number of obesity-related comorbidities (e.g. insulin resistance, hypertension), median household income, and interpreter use. We repeated similar analyses among youth from non-primary English speaking families, comparing those using interpreters versus not. RESULTS 1,725 youth (mean age 11.5 years; %BMIp95 142%; 53% non-Hispanic White, 20% Hispanic/Latino, 16% non-Hispanic black; 6% used interpreters) were seen, of which 15% were prescribed AOMs within 1 year. The IRR for prescriptions was lower among Hispanic/Latino compared to non-Hispanic White youth at one (IRR 0.70; CI: 0.49-1.00; p = 0.047) but not 3 years. No other statistically significant differences by race/ethnicity were found. Among non-primary English speaking families, the IRR for prescriptions was higher at 1 year (IRR 2.49; CI: 1.32-4.70; p = 0.005) in those using interpreters versus not. CONCLUSIONS Among youth seen in a pediatric weight management clinic, AOM prescription incidence rates were lower in Hispanics/Latinos compared to non-Hispanic Whites. Interpreter use was associated with higher prescription incidence rates among non-primary English speakers. Interventions to achieve equity in AOM prescriptions may help mitigate disparities in pediatric obesity.
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Affiliation(s)
| | - Elise F. Palzer
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Kyle D. Rudser
- Center for Pediatric Obesity Medicine, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Aaron S. Kelly
- Center for Pediatric Obesity Medicine, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
- Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Carolyn T. Bramante
- Center for Pediatric Obesity Medicine, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
- Department of Medicine, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Hilary K. Seligman
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Favour Noni
- University of Minnesota, Minneapolis, MN, USA
| | - Claudia K. Fox
- Center for Pediatric Obesity Medicine, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
- Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
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Tucker CM, Roncoroni J, Klein KG, Derias TO, Ateyah W, Williams J, Nmezi NA, Shah NR, Bilello LA, Anton S. Views of Black women patients with obesity on desired and undesired weight-focused clinical encounters. Clin Obes 2021; 11:e12468. [PMID: 34101372 DOI: 10.1111/cob.12468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/29/2021] [Accepted: 04/01/2021] [Indexed: 11/29/2022]
Abstract
Non-Hispanic Black women have the highest rates of overweight/obesity of any group in the United States. To date, few interventions have worked to reduce overweight/obesity in this population. This study investigated the views of Black women with overweight and obesity treated in a primary care setting regarding desired and undesired verbal and non-verbal behaviours by providers in provider-patient clinical encounters focused on losing weight, maintaining weight loss, and/or obesity. Two focus groups and an individual interview (n = 15) were conducted. Qualitative data analysis yielded five distinct themes, with 11 codes (listed in parenthesis): (a) desired weight-focused discussions (codes: Discussing weight loss with patients and discussing weight-loss maintenance with patients), (b) desired weight-focused support (codes: Supporting patients experiencing weight loss and supporting patients experiencing weight gain), (c) undesired weight-focused discussions (codes: Things to avoid during weight loss discussions and things to avoid during weight gain discussions), (d) desired attitudes and behaviours during weight-focused discussions (codes: Show caring and understanding and encourage behaviour change for weight loss), and (e) building physician-patient rapport (codes: Enable patients to feel respected by doctors, enable patients to feel comfortable with doctors and enable patients to trust their doctors). The qualitative approach employed in this study generates a deep understanding not only of the experiences of Black women patients but also of potential strategies that physicians could employ to succeed in their discussions with patients regarding healthy weight achievement and maintenance.
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Affiliation(s)
- Carolyn M Tucker
- Department of Psychology, University of Florida, Gainesville, Florida, USA
| | - Julia Roncoroni
- Department of Counseling Psychology, University of Denver, Denver, Colorado, USA
| | - Kirsten G Klein
- Department of Psychology, University of Florida, Gainesville, Florida, USA
| | - Terry O Derias
- Department of Psychology, University of Florida, Gainesville, Florida, USA
| | - Wafaa Ateyah
- Department of Psychology, University of Florida, Gainesville, Florida, USA
| | | | - Nwakaego A Nmezi
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nipa R Shah
- Department of Community Health and Family Medicine, University of Florida Jacksonville, Jacksonville, Florida, USA
| | - Lori A Bilello
- Department of Medicine, University of Florida, Jacksonville, Florida, USA
| | - Stephen Anton
- Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida, USA
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Fitzgerald JD, Andrade JM, Curl SL, Smith EB, Torna E, Nelson DS. Development of nutrition counselling resources for family medicine using the knowledge to action framework. Fam Pract 2021; 38:32-37. [PMID: 32255188 DOI: 10.1093/fampra/cmaa020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Obesity within the USA is a public health crisis. Nutrition counselling in primary care is an effective yet underutilized intervention because of both health care professional (HCP) barriers and patient barriers. OBJECTIVE The purpose of this study was to: (i) identify HCP and patient perceptions, needs and barriers surrounding nutrition counselling, (ii) develop nutrition resources for HCPs and patients and (iii) assess utility of the approach. METHODS Paper surveys were completed by 48 HCPs (response rate: 63.2%) and 185 patients in five family medicine clinics. Based on results, nutrition resources were developed and integrated into the electronic medical record. To assess utility, paper surveys were completed by 25 HCPs (response rate: 32.9%) after 4 weeks. Results were presented as descriptive statistics. RESULTS Both HCPs and patients indicated that nutrition counselling is necessary to improve dietary behaviours, but barriers prevented HCPs from providing counselling and patients from improving dietary behaviours. HCPs indicated that improved patient handouts (74.5%), community nutrition classes (72.3%) and community cooking classes (63.8%) could enhance nutrition counselling. Patients identified that coupons and discounts (45.5%), sample meal plans and recipes (44.3%) and websites for recipes, grocery guides, and cooking videos (35.9%) would help them to consume a healthy diet. Patient education handouts, patient resource guides and HCP education were created. Following receipt, most HCPs (85%) indicated that the resources enhanced their nutrition counselling. CONCLUSIONS HCP and patient barriers to nutrition counselling are multiple and varied. Design and implementation of an approach tailored to stakeholders' needs have potential to improve nutrition counselling in primary care.
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Affiliation(s)
| | - Jeanette M Andrade
- University of Florida Institute of Food Science and Agricultural Sciences, Department of Food Science and Human Nutrition, Gainesville, FL, USA
| | - Sarah L Curl
- University of Florida Institute of Food Science and Agricultural Sciences, Department of Food Science and Human Nutrition, Gainesville, FL, USA
| | - Elena B Smith
- University of Florida Institute of Food Science and Agricultural Sciences, Department of Food Science and Human Nutrition, Gainesville, FL, USA
| | - Elena Torna
- University of Florida Institute of Food Science and Agricultural Sciences, Department of Food Science and Human Nutrition, Gainesville, FL, USA
| | - Danielle S Nelson
- University of Florida College of Medicine, Gainesville, FL, USA.,University of Florida, Department of Community Health and Family Medicine, Gainesville, FL, USA
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Pourat N, Chen X, Lu C, Zhou W, Daniel M, Hoang H, Sripipatana A. Racial/ethnic variations in weight management among patients with overweight and obesity status who are served by health centres. Clin Obes 2020; 10:e12372. [PMID: 32447835 DOI: 10.1111/cob.12372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 04/09/2020] [Accepted: 04/28/2020] [Indexed: 11/28/2022]
Abstract
This study sought to examine racial/ethnic variations in receipt of provider recommendations on weight loss, patient adherence, perception of weight, attempts at weight loss and actual weight loss among patients with overweight/obesity status at Health Resources and Services Administration-funded health centres (HC). We used a 2014 nationally representative survey of adult HC patients with overweight/obesity status (PwOW/OB) last year and reported the HC was their usual source of care (n = 3517). We used logistic regression models to assess the interaction of race/ethnicity and having obesity in (1) provider recommendations of diet or (2) exercise, (3) patient adherence to diet or (4) exercise, (5) perceptions of weight and (6) weight loss attempts. We used a multinomial regression model to examine (7) weight loss or gain vs no change and a linear regression model to evaluate (8) percent weight change. We found Black PwOW/OB (OR = 1.65) experienced greater odds of receiving diet recommendations than Whites. We found limited racial/ethnic disparities in adherence. Black (OR = 0.41), Hispanic/Latino (OR = 0.45), and American Indian/Alaska Native (OR = 0.41) PwOW/OB had lower odds of perceiving themselves as overweight. Black (OR = 1.68) and Hispanic (OR = 1.98) PwOW/OB had a greater odds of reporting weight gain, and Asian PwOW/OB (OR = 0.42) had lower odds of reporting weight loss than Whites. Disparities in provider diet recommendations among Blacks and Hispanics indicated the importance of personalized weight management recommendations. Understanding underlying reasons for discordance between self-perception and observed weight among different groups is needed. Overall increase in weight, despite current interventions, should be addressed through targeted racially/ethnically appropriate approaches.
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Affiliation(s)
- Nadereh Pourat
- UCLA Center for Health Policy Research, UCLA Fielding School of Public Health, Los Angeles, California, USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Xiao Chen
- UCLA Center for Health Policy Research, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Connie Lu
- UCLA Center for Health Policy Research, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Weihao Zhou
- UCLA Center for Health Policy Research, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Marlon Daniel
- Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, Maryland, USA
| | - Hank Hoang
- Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, Maryland, USA
| | - Alek Sripipatana
- Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, Maryland, USA
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Breland JY, Wong MS, Frayne SM, Hoggatt KJ, Steers WN, Saechao F, Washington DL. Obesity and Health Care Experiences among Women and Men Veterans. Womens Health Issues 2019; 29 Suppl 1:S32-S38. [PMID: 31253240 DOI: 10.1016/j.whi.2019.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 03/29/2019] [Accepted: 04/05/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Obesity is highly stigmatized, especially for women, and therefore may negatively affect health care experiences. Past findings on the relationship between obesity and health care experiences are mixed, perhaps because few studies examine relationships by gender and obesity class. Our objective was to evaluate whether women and men with more severe obesity report worse health care experiences related to Veterans Health Administration (VA) care. METHODS Health care experiences (self-management support, mental health assessments, office staff courtesy, communication with providers) and overall provider ratings were assessed with the 2014 VA Survey of Health Care Experiences of Patients. Using multiple regression analyses (n = 13,462 women, n = 268,180 men), we assessed associations among obesity classes, health care experiences, and overall provider ratings, adjusting for sociodemographic, health, and primary care use characteristics. RESULTS The greatest differences in health care experiences between patients with and without obesity were in self-management support experiences, which were more favorable among women and men of all obesity classes. There were gender differences in associations between obesity and mental health assessments: for men, but not women, those in any obesity class gave higher ratings than those without obesity. For most other health care experiences and provider ratings, men with obesity reported slightly less favorable experiences than those without. There was no consistent pattern for women. CONCLUSIONS It is promising that VA patients with obesity report more self-management support, given the behavior change required for weight management. Lower health care experience and provider ratings among men with obesity suggest a need to further investigate possible obesity-related stigma in VA primary care.
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Affiliation(s)
- Jessica Y Breland
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, California.
| | - Michelle S Wong
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Susan M Frayne
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, California; Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Katherine J Hoggatt
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
| | - W Neil Steers
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California; Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Fay Saechao
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, California
| | - Donna L Washington
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California; Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
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Shah MK, Moore MA, Narayan KMV, Ali MK. Trends in Lifestyle Counseling for Adults With and Without Diabetes in the U.S., 2005-2015. Am J Prev Med 2019; 57:e153-e161. [PMID: 31630765 PMCID: PMC6814385 DOI: 10.1016/j.amepre.2019.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/30/2019] [Accepted: 07/01/2019] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Strong evidence shows that lifestyle change and weight loss stimulated by counseling improve glycemic control and lower comorbidities for patients with diabetes, but it is unclear whether diet or physical activity counseling for patients with diabetes in ambulatory settings has actually been responsive to this evidence. METHODS Data from the 2005-2015 National Ambulatory Medical Care Surveys were used to assess trends in provider-reported diet or exercise counseling during ambulatory care visits. The data were pooled and multivariate logistic regression models were built, adjusting for patient-, provider-, and practice-level characteristics to examine whether the provision of counseling varied by these characteristics. Data were analyzed from September 2018 to December 2018. RESULTS There were 42,234 adults with diabetes and 272,094 adults without diabetes. The proportions of patients with provider-reported Type 2 diabetes who received any diet or exercise counseling were no different over time, 30% in 2005 (95% CI=25%, 35%) and 25% in 2015 (95% CI=18%, 31%). Lower proportions of those without diabetes received any counseling, 17% in 2005 (95% CI=14%, 19%) and 15% in 2015 (95% CI=11%, 18%). Adjusted models showed that Hispanic patients had a higher likelihood of receiving diet or exercise counseling, compared with whites (OR=1.38, 95% CI=1.09, 1.75). Those aged 30-49 years were more likely to receive diet or exercise counseling than those aged >75 years (OR=1.51, 95% CI=1.27, 1.80). Compared with rural areas and other providers, visits in a metropolitan area (OR=1.27, 95% CI=1.09, 1.47) or with an advanced practice provider (OR=1.66, 95% CI=1.00, 2.75) had a higher likelihood of any diet or exercise counseling delivery. CONCLUSIONS Less than 30% of Americans with diabetes receive diet or exercise counseling in ambulatory visits, and this proportion has not changed significantly in a decade. Future interventions should focus on addressing this gap in counseling.
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Affiliation(s)
- Megha K Shah
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia; Emory Global Diabetes Research Center, Emory University, Atlanta, Georgia.
| | - Miranda A Moore
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | - K M Venkat Narayan
- Emory Global Diabetes Research Center, Emory University, Atlanta, Georgia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Mohammed K Ali
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia; Emory Global Diabetes Research Center, Emory University, Atlanta, Georgia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Saxon DR, Chaussee EL, Juarez-Colunga E, Tsai AG, Iwamoto SJ, Speer RB, Heyn H, Kealey EH, Bessesen DH. A Toolbox Approach to Obesity Treatment in Urban Safety-Net Primary Care Clinics: a Pragmatic Clinical Trial. J Gen Intern Med 2019; 34:2405-2413. [PMID: 31485965 PMCID: PMC6848318 DOI: 10.1007/s11606-019-05222-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 12/04/2018] [Accepted: 06/26/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is a need for new strategies to improve the success of obesity treatment within the primary care setting. OBJECTIVE To determine if patients offered low out-of-pocket cost weight management tools achieved more weight loss compared to usual care. DESIGN Twelve-month pragmatic clinical weight loss trial with a registry-based comparator group performed in primary care clinics of an urban safety-net hospital. PARTICIPANTS From a large clinical registry, we randomly selected 428 patients to have the opportunity to receive the intervention. INTERVENTIONS Medical weight management tools-partial meal replacements, recreation center vouchers, pharmacotherapy, commercial weight loss program vouchers, and a group behavioral weight loss program-for $5 or $10 monthly. Patients chose their tools, could switch tools, and could add a second tool at 6 months. MAIN MEASURES The primary outcome was the proportion of intervention-eligible patients who achieved ≥ 5% weight loss. The main secondary outcome was the proportion of on-treatment patients who achieved ≥ 5% weight loss. KEY RESULTS Overall, 71.3% (305 of 428) had available weight measurement data/PCP visit data to observe the primary outcome. At 12 months, 23.3% (71 of 305) of intervention-eligible participants and 15.7% (415 of 2640) of registry-based comparators had achieved 5% weight loss (p < 0.001). Of the on-treatment participants, 34.5% (39 of 113) achieved 5% weight loss. Mean percentage weight loss was - 3.15% ± 6.41% for on-treatment participants and - 0.30% ± 6.10% for comparators (p < 0.001). The initially preferred tools were meal replacements, pharmacotherapy, and recreation center passes. CONCLUSIONS Access to a variety of low out-of-pocket cost weight management tools within primary care resulted in ≥ 5% body weight loss in approximately one quarter of low-income patients with obesity. TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT01922934.
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Affiliation(s)
- David R Saxon
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Aurora, CO, USA.
- Denver/Seattle Center of Innovation for Veteran-Centered and Values Driven Care, VA Eastern Colorado Health Care System, Denver, CO, USA.
| | - Erin L Chaussee
- Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, CO, USA
- Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine, Aurora, CO, USA
| | - Elizabeth Juarez-Colunga
- Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, CO, USA
- Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Sean J Iwamoto
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
- Division of Endocrinology, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
| | | | - Hilde Heyn
- Denver Health Medical Center, Denver, CO, USA
| | - Elizabeth H Kealey
- Anschutz Health and Wellness Center, University of Colorado School of Medicine, Aurora, CO, USA
| | - Daniel H Bessesen
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
- Denver Health Medical Center, Denver, CO, USA
- Anschutz Health and Wellness Center, University of Colorado School of Medicine, Aurora, CO, USA
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West DS, Dutton G, Delahanty LM, Hazuda HP, Rickman AD, Knowler WC, Vitolins MZ, Neiberg RH, Peters A, Gee M, Cassidy Begay M. Weight Loss Experiences of African American, Hispanic, and Non-Hispanic White Men and Women with Type 2 Diabetes: The Look AHEAD Trial. Obesity (Silver Spring) 2019; 27:1275-1284. [PMID: 31338998 PMCID: PMC6658112 DOI: 10.1002/oby.22522] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 04/17/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of this study was to characterize weight loss, treatment engagement, and weight control strategies utilized by African American, Hispanic, and non-Hispanic white participants in the Action for Health in Diabetes (Look AHEAD) Intensive Lifestyle Intervention by racial/ethnic and sex subgroups. METHODS Weight losses at 1, 4, and 8 years among 2,361 adults with obesity and type 2 diabetes randomized to intervention (31% minority; 42% men) are reported by subgroup. Multivariable models within subgroups examine relative contributions of treatment engagement variables and self-reported weight control behaviors. RESULTS All subgroups averaged weight losses ≥ 5% in year 1 but experienced regain; losses ≥ 5% were sustained at year 8 by non-Hispanic white participants and minority women (but not men). Session attendance was high (≥ 86%) in year 1 and exceeded protocol-specified minimum levels into year 8. Individual session attendance had stronger associations with weight loss among Hispanic and African American participants than non-Hispanic white participants at 4 years (P = 0.04) and 8 years (P = 0.001). Daily self-weighing uptake was considerable in all subgroups and was a prominent factor associated with year 1 weight loss among African American men and women. Greater meal replacement use was strongly associated with poorer 1-year weight losses among African American women. CONCLUSIONS Experiences of minority men and women with diabetes in lifestyle interventions fill important gaps in the literature that can inform treatment delivery.
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Affiliation(s)
- Delia Smith West
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina, USA
| | - Gareth Dutton
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Linda M Delahanty
- Diabetes Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Helen P Hazuda
- Division of Nephrology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Amy D Rickman
- Department of Exercise & Rehabilitative Sciences, Slippery Rock University, Slippery Rock, Pennsylvania, USA
| | - William C Knowler
- Diabetes Epidemiology and Clinical Research Section, NIDDK, Phoenix, Arizona, USA
| | - Mara Z Vitolins
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Rebecca H Neiberg
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Anne Peters
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Molly Gee
- Behavioral Medicine Research Center, Baylor College of Medicine, Houston, Texas, USA
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Iwamoto S, Saxon D, Tsai A, Leister E, Speer R, Heyn H, Kealey E, Juarez-Colunga E, Gudzune K, Bleich S, Clark J, Bessesen D. Effects of Education and Experience on Primary Care Providers' Perspectives of Obesity Treatments during a Pragmatic Trial. Obesity (Silver Spring) 2018; 26:1532-1538. [PMID: 30257072 PMCID: PMC6168402 DOI: 10.1002/oby.22223] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 05/08/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine the impact of a 1-year pragmatic obesity trial on primary care providers' (PCPs) perspectives of treatment. METHODS PCPs from four intervention clinics (PCP-I) and five control clinics (PCP-C) completed pre- and postintervention surveys on weight-loss counseling, comfort discussing obesity treatments, and perceived effectiveness of interventions; questions were rated on 0 to 10 Likert scales. Only PCP-I received patient updates and education about obesity management. RESULTS Eighty PCPs completed preintervention surveys (pre: 71% female, 71% physicians); 82 PCPs completed postintervention surveys (post: 66% female, 70% physicians). PCPs were most comfortable discussing exercise before and after the trial (pre PCP-C: 8.22 [1.44], mean [standard deviation (SD)]; post PCP-C: 8.37 [1.24]; P = 0.8; pre/post PCP-I: 7.88 [1.51] vs. 7.80 [1.71]; P = 0.3). PCPs were initially least comfortable discussing phentermine/topiramate extended release (ER) but developed significantly more comfort after the trial, to a greater degree among PCP-I (pre/post PCP-C: 2.86 [2.66] vs. 3.73 [2.72], P < 0.001; pre/post PCP-I: 4.00 [2.57] vs. 6.17 [2.27], P < 0.001). After the trial, both PCPs rated exercise significantly less effective for weight loss, with a greater decrease in effectiveness rations among PCP-I (pre/post PCP-C: 7.73 [1.94] vs. 6.93 [2.35], P = 0.017; pre/post PCP-I: 6.27 [2.69] vs. 5.15 [2.31], P = 0.001). Both PCPs rated phentermine (pre/post PCP-C: 5.03 [2.05] vs. 5.50 [2.12], P = 0.002; pre/post PCP-I: 5.70 [1.64] vs. 6.83 [1.18], P = 0.001) and phentermine/topiramate ER (pre/post PCP-C: 3.91 [2.33] vs. 5.47 [2.54], P < 0.001; pre/post PCP-I: 5.58 [2.21] vs. 7.02 [1.47], P < 0.001) significantly more effective after the trial, though ratings were higher among PCP-I. CONCLUSIONS PCPs initially overvalued exercise and undervalued weight-loss medications. PCPs exposed to education and experience gave higher comfort and effectiveness ratings to weight-loss medications.
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Affiliation(s)
- Sean Iwamoto
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
- Department of Endocrinology, Veterans Affairs Eastern Colorado Health Care System, Denver, CO, USA
| | - David Saxon
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
- Denver/Seattle Center of Innovation for Veteran-Centered and Values Driven Care, Department of Endocrinology, Veterans Affairs Eastern Colorado Health Care System, Denver, CO, USA
| | - Adam Tsai
- Department of Internal Medicine and Metabolic-Surgical Weight Management, Kaiser Permanente Colorado, Denver, CO, USA
| | - Erin Leister
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA
- Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine, Aurora, CO, USA
| | - Rebecca Speer
- Department of Medicine, Section of Endocrinology, Denver Health Medical Center, Denver, CO, USA
| | - Hilde Heyn
- Department of Medicine, Section of Endocrinology, Denver Health Medical Center, Denver, CO, USA
| | - Elizabeth Kealey
- Anschutz Health and Wellness Center, University of Colorado at Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Elizabeth Juarez-Colunga
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA
- Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine, Aurora, CO, USA
| | - Kimberly Gudzune
- Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University, Baltimore, MD, USA
| | - Sara Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jeanne Clark
- Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University, Baltimore, MD, USA
| | - Daniel Bessesen
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
- Department of Medicine, Section of Endocrinology, Denver Health Medical Center, Denver, CO, USA
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Hudgel DW, Patel SR, Ahasic AM, Bartlett SJ, Bessesen DH, Coaker MA, Fiander PM, Grunstein RR, Gurubhagavatula I, Kapur VK, Lettieri CJ, Naughton MT, Owens RL, Pepin JLD, Tuomilehto H, Wilson KC. The Role of Weight Management in the Treatment of Adult Obstructive Sleep Apnea. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2018; 198:e70-e87. [DOI: 10.1164/rccm.201807-1326st] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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20
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Kahan SI. Practical Strategies for Engaging Individuals With Obesity in Primary Care. Mayo Clin Proc 2018; 93:351-359. [PMID: 29502565 DOI: 10.1016/j.mayocp.2018.01.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 12/12/2017] [Accepted: 01/03/2018] [Indexed: 01/07/2023]
Abstract
Although widely recognized as a chronic disease that requires long-term, structured, and multidisciplinary management, obesity remains largely underdiagnosed and undertreated. The prevalence of obesity continues to increase dramatically, with the highest rates seen in the United States. Despite the availability of several clinical practice guidelines, published studies suggest that health care professionals (HCPs) infrequently and inconsistently follow guideline recommendations. Barriers to HCP participation in obesity management are likely to inhibit obesity counseling in primary care. Improving HCP obesity-related practices and counseling is important. This article discusses current practices, barriers to effective obesity management, and recommendations to improve HCP obesity management and counseling, based on findings from a PubMed search and clinical experience. The aim of the article is to share best-practice strategies for engaging patients.
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Affiliation(s)
- Scott I Kahan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, and George Washington University School of Medicine and Health Sciences, Washington, DC.
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21
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Srivastava G, Palmer KD, Ireland KA, McCarthy AC, Donovan KE, Manders AJ, McDougal J, Lenders CM, Apovian CM. Shape-Up and Eat Right Families Pilot Program: Feasibility of a Weight Management Shared Medical Appointment Model in African-Americans With Obesity at an Urban Academic Medical Center. Front Pediatr 2018; 6:101. [PMID: 29707530 PMCID: PMC5906543 DOI: 10.3389/fped.2018.00101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 03/27/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Disparities in obesity care exist among African-American children and adults. We sought to test the feasibility of a pilot program, a 1-year family-based intervention for African-American families with obesity [shape up and eat right (SUPER)], adopting the shared medical appointment model (SMA) at an urban safety net hospital. OUTCOMES Primary outcomes: (1) family attendance rate and (2) program satisfaction. Secondary outcomes: change in body mass index (BMI), eating behaviors, and sedentary activity. METHODS Adult parents (BMI ≥ 25 kg/m2) ≥18 years and their child(ren) (BMI ≥ 85th percentile) ages 6-12 years from adult or pediatric weight management clinics were recruited. One group visit per month (n = 12) consisting of a nutrition and exercise component was led by a nurse practitioner and registered dietitian. Height and weight were recorded during each visit. Participants were queried on program satisfaction, food logs and exercise journals, Food Stamp Program's Food Behavior, and the Expanded Food and Nutrition Education Program food checklists. RESULTS Thirteen participants from lower socioeconomic zip codes consented [n = 5 mothers mean age 33 years, BMI of 47.4 kg/m2 (31.4-73.6 kg/m2); n = 8 children; mean age 9 years, BMI of 97.6th percentile (94-99th percentile); 60% enrolled in state Medicaid]. Average individual attendance was 23.4% (14-43%; n = 13); monthly session attendance rates declined from 100 to 40% by program completion; two families completed the program in entirety. Program was rated (n = 5 adults) very satisfactory (40%) and extremely satisfactory (60%). Pre-intervention, families rated their eating habits as fair and reported consuming sugar-sweetened beverages or sports drinks, more so than watching more than 1 h of television (p < 0.002) or video game/computer activity (p < 0.006) and consuming carbonated sodas (p < 0.004). Post-intervention, reducing salt intake was the only statistically significant variable (p < 0.029), while children watched fewer hours of television and spent less time playing video games (from average 2 to 3 h daily; p < 0.03). CONCLUSION Attendance was lower than expected though children seemed to decrease screen time and the program was rated satisfactory. Reported socioeconomic barriers precluded families from attending most sessions. Future reiterations of the intervention could be enhanced with community engagement strategies to increase participant retention.
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Affiliation(s)
- Gitanjali Srivastava
- Nutrition and Weight Management Research Center, Boston Medical Center, Department of Medicine, Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University School of Medicine, Boston, MA, United States
| | - Kenya D Palmer
- Nutrition and Weight Management Research Center, Boston Medical Center, Department of Medicine, Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University School of Medicine, Boston, MA, United States
| | - Kathy A Ireland
- Nutrition and Fitness for Life Program, Boston Medical Center, Department of Pediatrics, Boston University School of Medicine, Boston, MA, United States
| | - Ashley C McCarthy
- Nutrition and Weight Management Research Center, Boston Medical Center, Department of Medicine, Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University School of Medicine, Boston, MA, United States
| | - Kate E Donovan
- Nutrition and Fitness for Life Program, Boston Medical Center, Department of Pediatrics, Boston University School of Medicine, Boston, MA, United States
| | - Aaron J Manders
- Nutrition and Fitness for Life Program, Boston Medical Center, Department of Pediatrics, Boston University School of Medicine, Boston, MA, United States
| | - Juhee McDougal
- Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Carine M Lenders
- Nutrition and Fitness for Life Program, Boston Medical Center, Department of Pediatrics, Boston University School of Medicine, Boston, MA, United States
| | - Caroline M Apovian
- Nutrition and Weight Management Research Center, Boston Medical Center, Department of Medicine, Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University School of Medicine, Boston, MA, United States
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Marquez B, Murillo R. Racial/Ethnic Differences in Weight-Loss Strategies among US Adults: National Health and Nutrition Examination Survey 2007-2012. J Acad Nutr Diet 2017; 117:923-928. [PMID: 28330732 DOI: 10.1016/j.jand.2017.01.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 01/24/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Dieting, exercising, and seeking professional help have been associated with intentional weight loss among adults. OBJECTIVE This study examined the use of diet (eg, ate less, ate less fat, or switched to low-calorie foods), exercise, diet and exercise, and professional help (eg, weight-loss program or prescribed diet pills) for weight loss among non-Hispanic whites, Mexican Americans, and non-Hispanic blacks. DESIGN Cross-sectional data from the 2007-2012 National Health and Nutrition Examination Survey were used. PARTICIPANTS Males and females (n=9,046) aged 20 to 65 years were included. MAIN OUTCOME MEASURE The weight history questionnaire assessed weight-loss attempts and use of weight-loss strategies in the past year. STATISTICAL ANALYSES PERFORMED Multivariate logistic regression models were used to estimate associations of race/ethnicity with strategies to lose weight. Models controlled for age, sex, education, and body mass index. In fully adjusted models, interactions of race/ethnicity by sex were tested. RESULTS Lower proportions of Mexican Americans (35%) and non-Hispanic blacks (35%) than non-Hispanic whites (39%) reported trying to lose weight. Among those who tried to lose weight, non-Hispanic blacks were less likely than non-Hispanic whites to use diet (odds ratio [OR] 0.78, 95% CI 0.67 to 0.90) or exercise (OR 0.83, 95% CI 0.70 to 0.99) for weight loss. Mexican Americans (OR 0.71, 95% CI 0.53 to 0.95) and non-Hispanic blacks (OR 0.71, 95% CI 0.52 to 0.95) were also less likely than non-Hispanic whites to use professional help for weight loss. The relationships between race/ethnicity and weight-loss strategy were stronger for females than males. CONCLUSIONS Targeted efforts are needed to address racial/ethnic disparities in weight-loss attempts and use of recommended strategies especially among females.
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