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Wangler J, Jansky M. How are people with obesity managed in primary care? - results of a qualitative, exploratory study in Germany 2022. Arch Public Health 2023; 81:196. [PMID: 37957725 PMCID: PMC10641940 DOI: 10.1186/s13690-023-01214-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 11/03/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Counselling and management of overweight and obesity are tasks for which general practitioners possess favourable qualifications. Based on a long-term doctor-patient relationship, GPs have various options for actions to deal with overweight problems. To date, however, there is only little evidence on the experiences which people with obesity have made with the primary physician model and the care needs and wishes they actually address to their GPs. This study investigated what experiences people with obesity have had with GP care and what care needs and wishes they communicated to their GPs. The results will be used to derive starting points for optimising the primary healthcare setting. METHODS A total of 32 individuals affected by obesity were recruited over 24 online health forums. With them, we conducted qualitative interviews in the time between April and October 2022. RESULTS The respondents considered the primary care physician to be the central contact person when they sought advice and support with weight problems. The advice of the GP was associated with an increased willingness to deal with reducing one's own weight. Despite this positive perception, widespread drawbacks existed from the perspective of the respondents: (1) incidental or late discovery of obesity, (2) absence of continuous weight counselling, (3) no agreement on specific weight reduction goals, (4) no referrals to help and support services, (5) insensitive discussion. Only some of the respondents who have recently been able to reduce their weight sustainably attributed their success primarily to the support they received from their GP. CONCLUSION GPs should be encouraged to address obesity consistently and promptly. In addition, concrete recommendations and realistic goals for weight loss should be formulated. Continuous and motivating discussions are crucial in this regard. A focus on nutrition and exercise counselling in the GP's office should also be encouraged. GPs should be strengthened in their role as mediators by integrating their patients into a network of further assistance as needed. The development of care structures for obesity management should be promoted.
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Affiliation(s)
- Julian Wangler
- University Medical Center of the Johannes Gutenberg University Mainz, Centre for General Medicine and Geriatrics - Mainz, Mainz, Germany.
| | - Michael Jansky
- University Medical Center of the Johannes Gutenberg University Mainz, Centre for General Medicine and Geriatrics - Mainz, Mainz, Germany
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Znyk M, Zajdel R, Kaleta D. Consulting Obese and Overweight Patients for Nutrition and Physical Activity in Primary Healthcare in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137694. [PMID: 35805379 PMCID: PMC9265845 DOI: 10.3390/ijerph19137694] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/16/2022] [Accepted: 06/21/2022] [Indexed: 11/16/2022]
Abstract
The aim of this study was to evaluate the dietary and physical activity counseling provided to adults by family doctors. Predictors of counseling in primary healthcare were identified. A cross-sectional study was conducted from January 2020 to December 2021 among 896 adult primary care patients in the city of Łódź [Lodz], Poland. Almost 36% of the respondents were advised to change their eating habits, and 39.6% were advised to increase their physical activity. In a multivariate logistic regression analysis, people in poor health with chronic diseases related to overweight and obesity and with two, three or more chronic diseases, respectively, received advice on eating habits from their GP twice and three times more often than people in good health with no chronic conditions (OR = 1.81; p < 0.05 and OR = 1.63; p < 0.05; OR = 3.03; p < 0.001). People in the age groups 30−39 years and 40−49 years (OR = 1.71; p < 0.05 and OR = 1.58; p < 0.05), widowed (OR = 2.94; p < 0.05), with two, three or more chronic diseases (OR = 1.92; p < 0.01 and OR = 3.89; p < 0.001), and subjectively assessing overweight and obesity (OR = 1.61; p < 0.01) had a better chance of receiving advice on physical activity. The study found a higher proportion of advice on diet and physical activity provided to overweight and obese patients by primary care physicians than in other studies; however, still not all receive the necessary counseling. GPs should advise all patients not to become overweight and obese, not only those already affected by the problem.
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Affiliation(s)
- Małgorzata Znyk
- Department of Hygiene and Epidemiology, Medical University of Lodz, Żeligowskiego 7/9, 90-752 Łódź, Poland;
- Correspondence:
| | - Radosław Zajdel
- Department of Computer Science in Economics, University of Lodz, POW 3/5, 90-255 Łódź, Poland;
| | - Dorota Kaleta
- Department of Hygiene and Epidemiology, Medical University of Lodz, Żeligowskiego 7/9, 90-752 Łódź, Poland;
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McHale CT, Laidlaw AH, Cecil JE. Predictors of weight discussion in primary care consultations: A multilevel modeling approach. PATIENT EDUCATION AND COUNSELING 2022; 105:502-511. [PMID: 34253384 DOI: 10.1016/j.pec.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/14/2021] [Accepted: 07/03/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To understand how primary care weight-related communication processes are influenced by individual differences in primary care practitioner (PCP) and patient characteristics and communication use. METHODS Two multilevel logistic regression models were calculated to predict the occurrence of 1) weight-related discussion and 2) weight-related consultation outcomes. Coded communication data (Roter Interaction Analysis System) from 218 video-recorded consultations between PCPs and patients with overweight and obesity in Scottish primary care practices were combined with their demographic data to develop the multilevel models. RESULTS Weight-related discussions were more likely to occur when a greater proportion of PCP's total communication was partnership building and activating communication. More discrete weight discussions during a consultation predicted weight-related consultation outcomes. Patient BMI positively predicted both weight-related discussion and consultation outcomes. CONCLUSION This work demonstrates that multilevel modeling is a viable approach to investigating coded primary care weight-related communication data and that it can provide insight into the impact that various patient and PCP factors have on these communication processes. PRACTICE IMPLICATIONS Through the increased use of partnership building and activating communications, and by engaging in shorter, but more frequent, discussions about patient weight, PCPs may better facilitate weight-related discussion and weight-related consultation outcomes for their patients.
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Affiliation(s)
- Calum T McHale
- School of Medicine, University of St Andrews, St Andrews, UK.
| | - Anita H Laidlaw
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Joanne E Cecil
- School of Medicine, University of St Andrews, St Andrews, UK
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Gandhi S, Mohanty K, Sahu M, Naik SS, Pahuja E, Gunasekaran DM, Prasad MK. Profile of recipients of holistic health counselling in a psychiatric OPD in South India. Int J Soc Psychiatry 2021; 67:277-283. [PMID: 32744115 DOI: 10.1177/0020764020946797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND OF THE STUDY Persons with mental illness (PwMI) are prone to weight gain as a side effect of antipsychotics. Health counselling on diet, physical activity, medication adherence, expressed emotions and technology use, by health professionals, can help in managing these side-effects. AIM The aim of this study was to identify the pre-counselling profile of the subjects such as body mass index (BMI), diet, physical activity, medication adherence, expressed emotions and technology use among PwMI; to attend the Holistic Health Clinic as part of follow-up services in the psychiatry Outpatient Department (OPD) as well as to find correlation and association between the study variables. METHODS The study involved a cross-sectional descriptive design based on convenience sampling. The sample consists of 56 patients who are receiving antipsychotics under symptom control (self-reported) and were overweight. Data were collected with a patient assessment proforma and analysed using SPSS-22. RESULTS The patients referred to the holistic health counselling (HHC) had abnormal weight and BMI. The mean and SD of weight was 74.48 ± 14.07 and BMI 29.51 ± 5.15. All the participants received counselling on diet, 87.5% on physical activity, 62.5% on sleep hygiene, 55.4% on medication adherence, 8.9% on family emotional climate and only 5.4% on healthy use of technology. Weight has shown significant relation with gender (male = 80.84 ± 17.71, female = 71.09 ± 10.52, t = -2.52, p = .015) and near to significant relationship (χ2 = 7.685, p = .053) with educational status. CONCLUSION Patients receiving second-generation antipsychotics (SGA) have lesser extra pyramidal side-effects; however, they are more prone to gain weight. Proper screening and counselling during the follow-up visit in the outpatient setting can help in identification, prevention and management of the obesity-related metabolic syndrome and cardiovascular disease (CVD), and motivate them to adopt healthy behaviours.
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Affiliation(s)
- Sailaxmi Gandhi
- Department of Nursing, National Institute of Mental Health and Neurosciences (INI), Bengaluru, India
| | - Krutideepa Mohanty
- Department of Nursing, National Institute of Mental Health and Neurosciences (INI), Bengaluru, India
| | - Maya Sahu
- Department of Nursing, National Institute of Mental Health and Neurosciences (INI), Bengaluru, India
| | - Shalini S Naik
- Department Psychiatry, National Institute of Mental Health and Neurosciences (INI), Bengaluru, India
| | - Erika Pahuja
- Department Psychiatry, National Institute of Mental Health and Neurosciences (INI), Bengaluru, India
| | - Durai Murukan Gunasekaran
- Department of Biostatistics, National Institute of Mental Health and Neurosciences (INI), Bengaluru, India
| | - M Krishna Prasad
- Department Psychiatry, National Institute of Mental Health and Neurosciences (INI), Bengaluru, India
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Wangler J, Jansky M. Attitudes, behaviours and strategies towards obesity patients in primary care: A qualitative interview study with general practitioners in Germany. Eur J Gen Pract 2021; 27:27-34. [PMID: 33749477 PMCID: PMC7993392 DOI: 10.1080/13814788.2021.1898582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background Obesity poses severe challenges for the health care system. GPs are in an advantageous position to contribute to preventing obesity by diagnosing patients and initiating treatment. Sporadic studies have shown that attitudes towards obesity management in primary care can have a major influence on treating patients successfully. Objectives The study focuses on attitudes and behavioural patterns towards obesity patients, willingness to provide care, approaches and strategies, and the challenges experienced. Methods After developing the interview guides based on a literature review, 36 GPs in North Rhine-Westphalia and Saarland, Germany, were interviewed between November 2019 and March 2020. Using qualitative typing according to Kluge, different prototypes of GPs were formed. The dimensions of the interview guides were used for deriving the prototypes. Results GPs were categorised into four types depending on how they saw themselves and their role in treating patients. The first type (the resigned) was conspicuous through its negative attitude towards obesity management and a lack of willingness to provide care. The second type (the instructors) emphasised the value of active exercise, diet and health promotion, while the third type (the motivators) saw psychosocial support and motivation as a key element in helping patients. In contrast, type four (the educators) focussed primarily on early prevention through patient education. Conclusion Depending on which (proto-)type a patient visits, different focuses and strategies are pursued for obesity management and doctor–patient communication. This results in different perspectives and chances of success about therapeutic measures.
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Affiliation(s)
- Julian Wangler
- Centre for General and Geriatric Medicine, University Medical Centre Mainz, Mainz, Germany
| | - Michael Jansky
- Centre for General and Geriatric Medicine, University Medical Centre Mainz, Mainz, Germany
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Butsch WS, Robison K, Sharma R, Knecht J, Smolarz BG. Medicine Residents are Unprepared to Effectively Treat Patients with Obesity: Results from a U.S. Internal Medicine Residency Survey. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2020; 7:2382120520973206. [PMID: 33283047 PMCID: PMC7691912 DOI: 10.1177/2382120520973206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/23/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND In an obesity epidemic, physicians are unprepared to treat patients with obesity. The objective of this study was to understand how obesity is currently addressed in United States (U.S.) Internal Medicine (IM) residency programs and benchmark the degree to which curricula incorporate topics pertaining to the recently developed Obesity Medicine Education Collaborative (OMEC) competencies. METHODS Invitations to complete an online survey were sent via postal mail to U.S IM residency programs in 2018. Descriptive analyzes were performed. RESULTS Directors/associate directors from 81 IM residencies completed the online survey out of 501 programs (16.2%). Although obesity was an intentional educational objective for most programs (66.7%), only 2.5% of respondents believed their residents are "very prepared" to manage obesity. Formal rotation opportunities in obesity are limited, and at best, only one-third (34.6%) of programs reported any one of the core obesity competencies are covered to "a great extent." Many programs reported psychosocial components of obesity (40.7%), weight stigma (44.4%), etiological aspects of obesity (64.2%) and pharmacological treatment of obesity (43.2%) were covered to "very little extent" or "not at all." Lack of room in the curriculum and lack of faculty expertise are the greatest barriers to integrating obesity education; only 39.5% of residency programs have discussed incorporating or expanding formal obesity education. CONCLUSIONS Our study found the current obesity curricula within U.S. IM residency programs do not adequately cover important aspects that address the growing obesity epidemic, suggesting that obesity education is not enough of a priority for IM residency programs to formalize and implement within their curricula.
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Affiliation(s)
- W Scott Butsch
- Bariatric and Metabolic Institute,
Cleveland Clinic, Cleveland, OH, USA
| | | | - Ranita Sharma
- Rutgers Robert Wood Johnson Medical
School, Department of Medicine, Brunswick, NJ, USA
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McHale CT, Cecil JE, Laidlaw AH. An analysis of directly observed weight communication processes between primary care practitioners and overweight patients. PATIENT EDUCATION AND COUNSELING 2019; 102:2214-2222. [PMID: 31378309 DOI: 10.1016/j.pec.2019.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 06/18/2019] [Accepted: 07/09/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To analyse weight-related communication prevalence and processes (content/context) between primary care practitioners (PCPs) and overweight patients within routine primary healthcare consultations. METHODS Consultations between 14 PCPs and 218 overweight patients (BMI ≥ 25 kg/m2) were video recorded. Weight communication was coded using the Roter Interaction Analysis System (RIAS) and the novel St Andrews Issue Response Analysis System (SAIRAS). Communication code frequencies were analysed. RESULTS Weight discussion occurred in 25% of consultations with overweight patients; 26% of these had weight-related consultation outcomes (e.g. weight-related counselling and referrals, stated weight-related intention from patients). Weight discussions were more likely to occur if PCPs provided space to patient attempts to discuss weight (p = 0.013). Longer weight discussions (p < 0.001) and contextualising weight as problematic when PCP/patient-initiated weight discussion (p < 0.001) were associated with weight-related consultation outcomes. CONCLUSION Weight was rarely discussed with overweight patients, however PCP space provision to patient weight-discussion initiation attempts increased weight discussion. When weight was discussed, increased time and/or contextualising weight as a problem increased the likelihood of weight-related consultation outcomes. PRACTICAL IMPLICATION PCP use of specific communication approaches when discussing, contextualising and responding to patient weight may facilitate weight-related discussion and consultation outcomes and could lead to more effective patient weight management.
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Affiliation(s)
- Calum T McHale
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, Medical and Biological Sciences Building, North Haugh, St Andrews, Fife, KY16 9TF, UK.
| | - Joanne E Cecil
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, Medical and Biological Sciences Building, North Haugh, St Andrews, Fife, KY16 9TF, UK
| | - Anita H Laidlaw
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, Medical and Biological Sciences Building, North Haugh, St Andrews, Fife, KY16 9TF, UK
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Communication between patients and primary care physicians after behavioural weight loss: an observational study. Prim Health Care Res Dev 2019; 20:e75. [PMID: 32799979 PMCID: PMC8060814 DOI: 10.1017/s1463423619000124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Primary care physicians can play a key role in supporting patients after behavioural weight loss, though little is known about communication between patients and physicians during this time. Adults (n=139) in a behavioural weight loss trial (delivered outside of primary care) who attended a primary care appointment after an initial weight loss period were surveyed to assess weight-related communication at their most recent appointment. Most participants (78%) reported discussing weight with their physician. Participants who discussed weight, compared to those who did not, lost more weight, had higher blood pressure, and were more likely to be male. Most (89%) reported that their physician was supportive of their weight loss, but only a few participants (6.9%) reported that their physician gave feedback on medical parameters. Areas for improvement identified include physicians providing universal support for modest weight changes and providing interpretation of medical measurements that changed due to weight loss.
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Keller AO, Ortiz A. Physical Activity Health Communication for Adults With Mood Disorders in the United States. West J Nurs Res 2019; 42:97-107. [PMID: 31113294 DOI: 10.1177/0193945919848772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Using national representative data, this study sought to examine receipt of physical activity communication and counseling among adults with mood disorders in comparison to the general population in the United States. The sample consisted of adult primary-care visits in the National Hospital Ambulatory Medical Care and National Ambulatory Medical Care Surveys. Multivariable logistic regression was used to examine the relationship between mental health status and receipt of physical activity communication and counseling. Overall, less than 20% of visits included physical activity communication and counseling. Controlling for covariates, visits for adults with a mood disorder diagnosis were associated with an increased odds of including physical activity communication and counseling, odds ratio = 1.25, 95% confidence interval = [1.08, 1.45]. Although adults with mood disorders were more likely to receive physical activity communication and counseling, most primary-care visits for adults in the United States did not include physical activity communication and counseling.
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Malatzky C, Glenister K. Talking about overweight and obesity in rural Australian general practice. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:599-608. [PMID: 30311287 DOI: 10.1111/hsc.12672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 07/25/2018] [Accepted: 09/10/2018] [Indexed: 06/08/2023]
Abstract
As many patients' sole point of contact with the health care system, primary health care physicians (general practitioners [GPs] in Australia) are often positioned as key players in responding to rates of overweight and obesity in dominant public discourse. However, research from Western industrialised countries suggests that GPs may not be prepared for, or confident in, having conversations about overweight and obesity with patients. Little attention has been given to this topic in Australia, particularly in the context of rural health. The aim of this study was to understand how GPs in two rural settings in Victoria, Australia talk about overweight and obesity with patients. Working from a multidisciplinary perspective, a qualitative study design was adopted, and semi-structured interviews were conducted with seven GPs and seven GP patients living in two rural communities between January and April, 2016. Data was coded manually and thematic analysis was used to explore the data. The findings of this study support the argument that, in contrast to dominant messages within public health discourses, GPs may not be best placed to act as the primary actors in responding to overweight and obesity as they are constructed in epidemiological terms. In fact, the perspectives of GP study participants suggest that to do so would compromise important dimensions of general medical practice that make it simultaneously a human practice. Instead, more balanced, holistic approaches to discussing and responding to overweight and obesity with patients could be taken up in local, interdisciplinary collaborations between different health professionals and patients, which utilise broader social supports. Focussing on long-term, incremental programs that consider the whole person within their particular socio-cultural environment would be a productive means of working with the complexities of overweight and obesity. However, structural level changes are required to ensure such initiatives are sustainable in rural practice.
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Affiliation(s)
- Christina Malatzky
- Culture and Rural Health, Department of Rural Health, Melbourne Medical School, The University of Melbourne, Shepparton, VIC, Australia
| | - Kristen Glenister
- Rural Chronic Ill Health, Department of Rural Health, Melbourne Medical School, The University of Melbourne, Wangaratta, VIC, Australia
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Grabovac I, Smith L, Stefanac S, Haider S, Cao C, Waldhoer T, Jackson SE, Yang L. Health Care Providers' Advice on Lifestyle Modification in the US Population: Results from the NHANES 2011-2016. Am J Med 2019; 132:489-497.e1. [PMID: 30521796 DOI: 10.1016/j.amjmed.2018.11.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 11/09/2018] [Accepted: 11/09/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Health care providers are encouraged to prescribe lifestyle modifications for preventing and managing obesity and associated chronic conditions. However, the pattern of lifestyle advice provision is unknown. We investigate the prevalence of advised lifestyle modification according to weight status and chronic conditions in a US nationally representative sample. METHODS Adults ages 20-64years (n = 11,467) from the National Health and Nutrition Examination Survey between 2011 and 2016 were analyzed, with weight status and chronic conditions (high blood pressure, high blood cholesterol, osteoarthritis, coronary heart disease, and type 2 diabetes mellitus). Lifestyle modification advice by health care providers included: increase physical activity/exercise, reduce dietary fat/calories, control/lose weight, and all of the above. RESULTS High blood pressure (32.7%) and cholesterol (29.3%) were highly prevalent compared with osteoarthritis (7.4%), type 2 diabetes (5.7%), and coronary heart disease (3.7%). Those with type 2 diabetes received considerably more frequent advice (56.5%; 95% confidence interval [CI], 52.4%-60.6%) than those with high blood pressure (31.4%; 95% CI, 29.3%-33.6%) and cholesterol (27.0%; 95% CI, 24.9%-29.3%). Prevalence of lifestyle advice exhibited substantial increases with graded body mass index and comorbidity (all P < .001). After adjusting for comorbid conditions, advice was more commonly reported among women, those overweight/obese, nonwhite, or insured. A remarkably low proportion of overweight (21.4; 95% CI, 18.7%-24.3%) and obese (44.2%; 95% CI, 41.0%-47.4%) adults free of chronic conditions reported receiving any lifestyle advice. CONCLUSIONS Prevalence of lifestyle modification advised by health care providers is generally low among US adults with chronic conditions, and worryingly low among those without chronic conditions, however overweight or obese. Prescribed lifestyle modification is a missing opportunity in implementing sustainable strategies to reduce chronic condition burden.
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Affiliation(s)
- Igor Grabovac
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Austria
| | - Lee Smith
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Compass House, Cambridge, UK
| | - Sinisa Stefanac
- Institute of Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria; Ludwig Boltzmann Cluster Arthritis and Rehabilitation, Vienna, Austria.
| | - Sandra Haider
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Austria
| | - Chao Cao
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, StLouis, Mo
| | - Thomas Waldhoer
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Austria
| | - Sarah E Jackson
- Department of Behavioral Science and Health, University College London, UK
| | - Lin Yang
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Austria; Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Holy Cross Centre, Calgary, Alberta, Canada; Preventive Oncology & Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
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Incidence and predictors of multimorbidity among a multiethnic population in Malaysia: a community-based longitudinal study. Aging Clin Exp Res 2019; 31:215-224. [PMID: 30062670 DOI: 10.1007/s40520-018-1007-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 07/13/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Multimorbidity in older adults needs to be assessed as it is a risk factor for disability, cognitive decline, and mortality. AIMS A community-based longitudinal study was performed to determine the incidence and to identify possible predictors of multimorbidity among multiethnic older adults population in Malaysia. METHODS Comprehensive interview-based questionnaires were administered among 729 participants aged 60 years and above. Data were analyzed from the baseline data of older adults participating in the Towards Useful Aging (TUA) study (2014-2016) who were not affected by multimorbidity (349 without any chronic diseases and 380 with one disease). Multimorbidity was considered present in an individual reporting two or more chronic diseases. RESULTS After 1½ years of follow-up, 18.8% of participants who were initially free of any diseases and 40.9% of those with one disease at baseline, developed multimorbidity. The incidence rates were 13.7 per 100 person-years and 34.2 per 100 person-years, respectively. Female gender, smoking, and irregular preparing of food (lifestyle) were predictors for incidence of multimorbidity, especially in those without any disease, while Body Mass Index (BMI) 22-27 kg/m2 and inadequate daily intake of iron were identified as predictors of multimorbidity among participants who already have one disease. CONCLUSIONS The incidence rates of multimorbidity among Malaysian older adults were between the ranges of 14-34 per 100 person-years at a 1½-year follow-up. Gender, smoking, BMI 22-27 kg/m2, inadequate daily intake of iron and lack of engagement in leisure or lifestyle physical activities were possible predictors in the development of multimorbidity. There is a need to formulate effective preventive management strategies to decelerate multimorbidity among older adults.
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LeBlanc ES, Patnode CD, Webber EM, Redmond N, Rushkin M, O'Connor EA. Behavioral and Pharmacotherapy Weight Loss Interventions to Prevent Obesity-Related Morbidity and Mortality in Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2018; 320:1172-1191. [PMID: 30326501 DOI: 10.1001/jama.2018.7777] [Citation(s) in RCA: 269] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Overweight and obesity have been associated with adverse health effects. OBJECTIVE To systematically review evidence on benefits and harms of behavioral and pharmacotherapy weight loss and weight loss maintenance interventions in adults to inform the US Preventive Services Task Force. DATA SOURCES MEDLINE, PubMed Publisher-Supplied Records, PsycINFO, and the Cochrane Central Register of Controlled Trials for studies published through June 6, 2017; ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials through August 2017; and ongoing surveillance in targeted publications through March 23, 2018. Studies from previous reviews were reevaluated for inclusion. STUDY SELECTION Randomized clinical trials (RCTs) focusing on weight loss or weight loss maintenance in adults. DATA EXTRACTION AND SYNTHESIS Data were abstracted by one reviewer and confirmed by another. Random-effects meta-analyses were conducted for weight loss outcomes in behavior-based interventions. MAIN OUTCOMES AND MEASURES Health outcomes, weight loss or weight loss maintenance, reduction in obesity-related conditions, and adverse events. RESULTS A total of 122 RCTs (N = 62 533) and 2 observational studies (N = 209 993) were identified. Compared with controls, participants in behavior-based interventions had greater mean weight loss at 12 to 18 months (-2.39 kg [95% CI, -2.86 to -1.93]; 67 studies [n = 22065]) and less weight regain (-1.59 kg [95% CI, -2.38 to -0.79]; 8 studies [n = 1408]). Studies of medication-based weight loss and maintenance interventions also reported greater weight loss or less weight regain in intervention compared with placebo groups at 12 to 18 months (range, -0.6 to -5.8 kg; no meta-analysis). Participants with prediabetes in weight loss interventions had a lower risk of developing diabetes compared with controls (relative risk, 0.67 [95% CI, 0.51 to 0.89]). There was no evidence of other benefits, but most health outcomes such as mortality, cardiovascular disease, and cancer were infrequently reported. Small improvements in quality of life in some medication trials were noted but were of unclear clinical significance. There was no evidence of harm such as cardiovascular disease from behavior-based interventions; higher rates of adverse events were associated with higher dropout rates in medication groups than in placebo groups. CONCLUSIONS AND RELEVANCE Behavior-based weight loss interventions with or without weight loss medications were associated with more weight loss and a lower risk of developing diabetes than control conditions. Weight loss medications, but not behavior-based interventions, were associated with higher rates of harms. Long-term weight and health outcomes data, as well as data on important subgroups, were limited.
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Affiliation(s)
- Erin S LeBlanc
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Carrie D Patnode
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Elizabeth M Webber
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Nadia Redmond
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Megan Rushkin
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Elizabeth A O'Connor
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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Yang HY, Chen HJ, Hsu YJ, Cheskin LJ, Wang Y. Impact of weight-related advice from healthcare professionals on body mass index of patients in the USA. Public Health 2018; 159:50-57. [PMID: 29729491 DOI: 10.1016/j.puhe.2018.02.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 11/28/2017] [Accepted: 02/28/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Healthcare professionals (HCPs) can help promote healthy eating and active living in patients. This study assessed the effects of weight-related advice from HCPs on change in body mass index (BMI) of patients in the USA. STUDY DESIGN A 1-year follow-up study of 20,002 adults who participated in a nationally representative survey between 2004 and 2008. METHODS Using the 2004-2008 Medical Expenditure Panel Survey data, 1-year BMI and weight status changes were compared between patients who did and did not report receiving advice on exercise or on restricted intake of fat and cholesterol from their HCPs. RESULTS Patients who received weight-related advice had a greater increase in BMI compared with those who did not receive weight-related advice. Stratified by the baseline weight status of patients (i.e. normal weight, overweight or obese), adverse direction of BMI change was only significantly associated with advice on exercise. Patients who received advice to exercise more were more likely to move to a higher weight status than remaining at the same weight status, compared with patients who did not receive advice to exercise more. CONCLUSION This study did not find that weight-related advice from HCPs had a positive impact on BMI loss in patients. On the contrary, patients who reported receiving weight-related advice from HCPs had worse weight outcomes 1 year later than patients who did not report receiving weight-related advice. Further research is warranted to elucidate the role of weight-related advice from HCPs on lifestyle change and obesity prevention and control.
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Affiliation(s)
- H-Y Yang
- Department of Nursing, Mackay Medical College, Taipei, Taiwan; Johns Hopkins Global Center on Childhood Obesity, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - H-J Chen
- Johns Hopkins Global Center on Childhood Obesity, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Institute of Public Health and Department of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Y-J Hsu
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - L J Cheskin
- Johns Hopkins Global Center on Childhood Obesity, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Johns Hopkins Weight Management Center, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Y Wang
- Johns Hopkins Global Center on Childhood Obesity, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Johns Hopkins Weight Management Center, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Fisher Institute of Health and Well-Being, Ball State University, Muncie, IN, USA.
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Trends and disparities in the prevalence of physicians' counseling on exercise among the U.S. adult population, 2000-2010. Prev Med 2017; 99:1-6. [PMID: 28161645 DOI: 10.1016/j.ypmed.2017.01.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 12/08/2016] [Accepted: 01/29/2017] [Indexed: 11/21/2022]
Abstract
Recognizing the undisputed health benefits of exercise, physicians' counseling has been included in the Healthy People Objectives since 2000. To address the paucity of data on such counseling at the national level, we examined changing trends and disparities in receiving physicians' counseling on exercise among the physically-able, non-institutionalized U.S. adult population. Data from the 2000, 2005, and 2010 National Health Interview Surveys (NHIS) were examined using logistic regression that included race/ethnicity, age, gender, education, insurance status, number of physician visits in the past year, and body mass index. In 2000, only 22.9% of NIHS respondents had received counseling on exercise, increasing to 33.6% in 2010. Compared with non-Hispanic Whites, non-Hispanic Blacks were 27% less likely to receive exercise advice in 2000 (adjusted odds ratio [AOR] 0.73, 95% confidence interval [CI] 0.61-0.87). In later years, they were equally likely to receive advice. Although decreased over the years, male respondents were significantly (34% to 23%) less likely to report receipt of exercise counseling than female patients (in 2010: AOR 0.77, CI 0.72-0.83). Uninsured respondents were 35% less likely to report receiving exercise advice from their provider in all study years (2010: AOR 0.64, CI 0.59-0.72). Patients with increasing levels of education were increasingly more likely to report receipt of counseling in each successive survey year. The overall prevalence of physicians' counseling on exercise increased moderately between 2000 and 2010. Some disparities narrowed and even reversed but significant disparities continue to exist across gender, insurance status, and education level.
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O'Neil CE, Nicklas TA. State of the Art Reviews: Relationship Between Diet/ Physical Activity and Health. Am J Lifestyle Med 2016. [DOI: 10.1177/1559827607306433.] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Obesity and 4 of the leading causes of death—heart disease, cancer, stroke, and type 2 diabetes mellitus—are related to lifestyle. The combination of a healthy weight, prudent diet, and daily physical activity clearly plays a role in primary, secondary, and tertiary prevention of these and other chronic diseases. Because nearly 65% of the adult population is overweight or obese, weight loss and maintenance are central to this review article. Improved lipid profiles, blood pressure, insulin sensitivity, and euglycemia are associated with weight loss or a normal body weight; thus, maintaining a healthy weight is a universal recommendation for health. The methods for improving lifestyle described in the section on obesity include assessing nutritional status and stages of change of the client, setting realistic goals, eating a diet high in fruits and vegetables with low-fat sources of dairy and protein, and achieving appropriate physical activity levels. The importance of physicians discussing weight with clients and vice versa is stressed. The common features of lifestyle-related diseases make them amenable to similar lifestyle interventions.
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Affiliation(s)
- Carol E. O'Neil
- Department of Pediatrics, Children's Nutrition Research Center, Baylor
College of Medicine, Houston, Texas (TAN)
| | - Theresa A. Nicklas
- Department of Pediatrics, Children's Nutrition Research Center, 1100
Bates Avenue, Baylor College of Medicine, Houston, TX 77030-2600,
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Ahmed NU, Delgado M, Saxena A. Trends and disparities in the prevalence of physicians' counseling on diet and nutrition among the U.S. adult population, 2000-2011. Prev Med 2016; 89:70-75. [PMID: 27196147 DOI: 10.1016/j.ypmed.2016.05.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 05/02/2016] [Accepted: 05/15/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Although healthy eating plays a crucial role in addressing the obesity and chronic disease epidemics, a few Americans have diets that meet dietary guidelines. Because physicians-delivered counseling is a strong predictor for behavioral modification among patients, the Healthy People Objectives have emphasized diet counseling since 2000. However, research on impact of physicians' counseling over time on a national level has been limited. METHODS We used data from the 2000 and 2011 National Health Interview Surveys to apply a logistic regression model to identify predictors of physicians' counseling and examine any changes in disparities over a decade. RESULTS In 2000, only 23.7% of our national sample had received dietary counseling, it increased to 32.6% in 2011. Hispanics were less likely than Whites to receive advice on diet in 2000 (adjusted odds ratio [AOR]=0.74, 95% confidence interval [CI]=0.62-0.88). By 2011, Hispanics 18% (AOR=1.18, CI=1.09-1.28) and Blacks were 42% (AOR=1.42, CI=1.32-1.54) more likely to receive advice from their physicians on diet than Whites. In both years, men were significantly less likely than women to receive counseling. The uninsured patients were increasingly less likely than insured patients in receiving diet counseling, being 60% less likely in 2011 (AOR=0.40, CI=0.37-0.40). Obese patients were substantially (88% in 2000 to 290% in 2011) more likely to receive counseling than normal-weight patients. CONCLUSIONS The overall prevalence of physicians' counseling on diet increased moderately between 2000 and 2011. However, substantial disparities in dietary counseling related to access to care and gender continue to exist.
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Affiliation(s)
- Nasar U Ahmed
- Department of Epidemiology, Florida International University, United States.
| | - Michael Delgado
- Department of Epidemiology, Florida International University, United States
| | - Anshul Saxena
- Department of Health Promotion and Disease Prevention, Florida International University, United States
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Brown AL, Poston WSC, Jahnke SA, Keith Haddock C, Luo S, Delclos GL, Sue Day R. Weight loss advice and prospective weight change among overweight firefighters. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2016; 22:233-239. [PMID: 27467464 DOI: 10.1080/10773525.2016.1207045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Obesity compromises firefighter safety, yet more than 70% of firefighters are overweight. Though healthcare professionals are encouraged to counsel overweight patients, the effectiveness of weight counseling is not consistent across studies. OBJECTIVE Examine longitudinal changes in cardiovascular risk factors and determine the role of healthcare professional weight loss advice on six-month weight changes among a national sample of male, overweight and obese firefighters. METHODS This study included baseline and six-month assessments of 757 firefighters. Medical and demographic data were collected using questionnaires. Investigators collected height, weight, percent body fat, waist circumference, blood pressure, and fasting serum samples (total cholesterol, high-density lipoprotein, low-density lipoprotein, glucose). Multilevel linear regression assessed the association between weight advice and outcomes. RESULTS Participants lost an average of 0.55 kg (95%CI: 0.17-0.93), and experienced significant improvements in systolic blood pressure (mean: 3.75 mm Hg; 95% CI: 2.35-5.14) and non-significant improvements in other clinical outcomes. Healthcare professional weight advice was not significantly associated with weight loss or other outcomes. CONCLUSION Similar to other studies, results show little benefit of low intensity weight loss counseling. Additional research is needed to identify effective and feasible weight management strategies to address firefighter obesity.
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Affiliation(s)
- Austin L Brown
- a Department of Pediatrics - Section of Hematology Oncology , Baylor College of Medicine , Houston , TX , USA.,b Division of Epidemiology, Human Genetics and Environmental Sciences , School of Public Health, The University of Texas Health Science Center at Houston , Houston , TX , USA
| | - Walker S C Poston
- c Center for Fire, Rescue, and EMS Health Research , National Development and Research Institutes, Institute for Biobehavioral Health Research , Leawood , KS , USA
| | - Sara A Jahnke
- c Center for Fire, Rescue, and EMS Health Research , National Development and Research Institutes, Institute for Biobehavioral Health Research , Leawood , KS , USA
| | - C Keith Haddock
- c Center for Fire, Rescue, and EMS Health Research , National Development and Research Institutes, Institute for Biobehavioral Health Research , Leawood , KS , USA
| | - Sheng Luo
- d Division of Biostatistics , School of Public Health, The University of Texas Health Science Center at Houston , Houston , TX , USA
| | - George L Delclos
- b Division of Epidemiology, Human Genetics and Environmental Sciences , School of Public Health, The University of Texas Health Science Center at Houston , Houston , TX , USA
| | - R Sue Day
- e Division of Epidemiology, Human Genetics and Environmental Sciences , School of Public Health, Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston , Houston , TX , USA
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Davies R, Lehman E, Perry A, McCall-Hosenfeld JS. Association of intimate partner violence and health-care provider-identified obesity. Women Health 2016; 56:561-75. [PMID: 26495745 PMCID: PMC5808410 DOI: 10.1080/03630242.2015.1101741] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The association of physical and nonphysical intimate partner violence (IPV) with obesity was examined. Women (N = 1,179) were surveyed regarding demographics, obesity, and IPV exposure using humiliate-afraid-rape-kick (HARK), an IPV screening tool. A three-level lifetime IPV exposure variable measured physical, nonphysical or no IPV. Health-care provider-identified obesity was defined if participants were told by a medical provider within the past 5 years that they were obese. Bivariate analyses examined obesity by IPV and demographics. Multivariable logistic regression assessed odds of obesity by IPV type, adjusting for age, race/ethnicity, education, and marital status. Among participants, 44% reported lifetime IPV (25% physical, 19% nonphysical), and 24% reported health-care provider-identified obesity. In unadjusted analyses, obesity was more prevalent among women exposed to physical IPV (30%) and nonphysical IPV (27%), compared to women without IPV (20%, p = .002). In multivariable models, women reporting physical IPV had 1.67 times greater odds of obesity (95% confidence interval [CI] 1.20, 2.33), and women reporting nonphysical IPV had 1.46 times greater odds of obesity (95% CI 1.01, 2.10), compared to women reporting no exposure. This study extends prior data by showing, not only an association between physical IPV and obesity, but also an association between obesity and nonphysical IPV.
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Affiliation(s)
- Rhian Davies
- Division of General Internal Medicine, Department of Medicine, Pennsylvania State University College of Medicine and Milton S. Hershey Medical Center, Hershey, PA
| | - Erik Lehman
- Division of Health Services Research, Department of Public Health Sciences, Pennsylvania State University College of Medicine and Milton S. Hershey Medical Center, Hershey, PA
| | - Amanda Perry
- Division of Rural Sociology, Department of Agricultural Economics, Sociology, and Education, College of Agriculture, Pennsylvania State University, University Park, PA
| | - Jennifer S. McCall-Hosenfeld
- Division of General Internal Medicine, Department of Medicine, Pennsylvania State University College of Medicine and Milton S. Hershey Medical Center, Hershey, PA
- Division of Health Services Research, Department of Public Health Sciences, Pennsylvania State University College of Medicine and Milton S. Hershey Medical Center, Hershey, PA
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Mogre V, Wanaba P, Apala P, Nsoh JA. Self-reported receipt of healthcare professional's weight management counselling is associated with self-reported weight management behaviours of type 2 diabetes mellitus patients. SPRINGERPLUS 2016; 5:379. [PMID: 27066386 PMCID: PMC4811845 DOI: 10.1186/s40064-016-2029-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 03/18/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Weight loss has been shown to influence the health outcomes of type 2 diabetes patients. Providing weight management counselling to diabetes patients may help them adopt appropriate weight management behaviours to lose weight. This study determined the association between self-reported receipt of healthcare professional's weight management counselling and the weight management behaviours of type 2 diabetes patients. METHODS This cross-sectional study was conducted among 378 type 2 diabetes mellitus patients seeking care from two hospitals. Using a questionnaire, participants' weight management behaviours were assessed as well as receipt of healthcare professional's weight management counselling. RESULTS Half (51.3 %) of the participants reported receipt of healthcare professional's weight management counselling in the last 12 months. Half of the participants ever tried to lose weight. Fewer than half of the participants reported modifying their dietary habits (45.5 %) or engaging in exercise (48.7 %) to lose weight. Those who reported receipt of weight management counselling were more likely to report ever trying to lose weight (AOR 43.0, 95 % CI 23.0-81.6; p < 0.001), modifying their dietary habits (AOR 22.5, 95 % CI 13.0-39.19; p < 0.001), and engaging in exercise (AOR 13.0, 95 % CI 7.8-21.7; p < 0.001) to lose weight. CONCLUSION Participants engaged in varied weight management behaviours. Receipt of health care professionals' weight management counselling was associated to participants' reported participation in weight management behaviours. Weight management counselling from health care professionals may support the adoption of weight management behaviours in type 2 diabetes mellitus patients.
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Affiliation(s)
- Victor Mogre
- />Department of Human Biology, School of Medicine and Health Sciences, University for Development Studies, P.O. Box TL 1883, Tamale, Ghana
| | - Peter Wanaba
- />Department of Nursing, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Peter Apala
- />Department of Nursing, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Jonas A. Nsoh
- />Department of Nursing, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
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Yang HY, Chen HJ, Marsteller JA, Liang L, Shi L, Wang Y. Patient-health care professional gender or race/ethnicity concordance and its association with weight-related advice in the United States. PATIENT EDUCATION AND COUNSELING 2016; 99:271-278. [PMID: 26349935 PMCID: PMC6159929 DOI: 10.1016/j.pec.2015.08.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 08/22/2015] [Accepted: 08/27/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Examine association between adult patients' and health care providers' (HCPs) gender or race/ethnicity concordance and patients' reported receiving weight-related advice from HCP's in USA. METHODS Using Medical Expenditure Panel Survey (MEPS) 2004-2007 data, studied prevalence of weight-related advice (on exercise and diet) given to patients and its association with patients/HCPs concordance in gender (n=9,686) and race/ethnicity (n=8,825). RESULTS Overall, 46% of patients received HCP advice on diet and 49% on exercise. Overweight females seeing female HCPs were more likely to receive exercise advice than those seeing male HCPs (OR=1.44 [95% CI: 1.10-1.89]). Race/ethnicity concordance was associated with lower odds of advice-receiving in certain populations (OR=0.80 [0.67-0.97] for exercise and OR=0.42 [0.19-0.91] for diet among white patients, OR=0.47 [0.23-0.98] for exercise among Hispanic overweight patients). CONCLUSIONS Patient/HCP gender or race/ethnicity concordance was not positively associated with HCPs providing weight-related advice. Patients with female HCPs or with racial/ethnic discordant HCPs (especially black or Asian HCPs) were more likely to receive advice. PRACTICE IMPLICATIONS Health care providers need be empowered, particularly white and male HCPs, to improve delivery of weight-related advice. It may reflect better of receiving weight-related advice based on patients' recall.
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Affiliation(s)
- Hsing-Yu Yang
- Department of Nursing, Mackay Medical College, Taipei, Taiwan; Johns Hopkins Global Center on Childhood Obesity, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Hsin-Jen Chen
- Johns Hopkins Global Center on Childhood Obesity, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Institute of Public Health and Department of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Jill A Marsteller
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lan Liang
- Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, Rockville, MD, USA
| | - Leiyu Shi
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Youfa Wang
- Johns Hopkins Global Center on Childhood Obesity, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA.
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Sadiya A, Abdi S, Abusnana S. Lifestyle Intervention for Weight Loss: a group-based program for Emiratis in Ajman, United Arab Emirates. Diabetes Metab Syndr Obes 2016; 9:101-8. [PMID: 27051310 PMCID: PMC4807891 DOI: 10.2147/dmso.s103620] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Lifestyle Intervention for Weight Loss (LIFE-8) is developed as a structured, group-based weight management program for Emiratis with obesity and type 2 diabetes. It is a 3-month program followed by a 1-year follow-up. The results from the first 2 years are presented here to indicate the possibility of its further adaptation and implementation in this region. METHODOLOGY We recruited 45 participants with obesity and/or type 2 diabetes based on inclusion/exclusion criteria. The LIFE-8 program was executed by incorporating dietary modification, physical activity, and behavioral therapy, aiming to achieve up to 5% weight loss. The outcomes included body weight, fat mass, waist circumference, blood pressure, fasting blood glucose (FBG), hemoglobin A1c (HbA1c), and nutritional knowledge at 3 months and 12 months. RESULTS We observed a reduction of 5.0% in body weight (4.8±2.8 kg; 95% CI 3.7-5.8), fat mass (-7.8%, P<0.01), and waist circumference (Δ=4±4 cm, P<0.01) in the completed participants (n=28). An improvement (P<0.05) in HbA1c (7.1%±1.0% vs 6.6%±0.7%) and FBG (8.2±2.0 mmol/L vs 6.8±0.8 mmol/L) was observed in participants with obesity and type 2 diabetes after the program. Increase in nutritional knowledge (<0.01) and overall evaluation of the program (9/10) was favorable. On 1-year follow-up, we found that the participants could sustain weight loss (-4.0%), while obese, type 2 diabetic participants sustained HbA1c (6.6%±0.7% vs 6.4%±0.7%) and further improved (P<0.05) the level of FBG (6.8±0.8 mmol/L vs 6.7±0.4 mmol/L). CONCLUSION LIFE-8 could be an effective, affordable, acceptable, and adaptable lifestyle intervention program for the prevention and management of diabetes in Emiratis. It was successful not only in delivering a modest weight loss but also in improving glycemic control in diabetic participants.
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Affiliation(s)
- Amena Sadiya
- Lifestyle Clinic, Rashid Center for Diabetes and Research, Ajman, United Arab Emirates
- Correspondence: Amena Sadiya, Lifestyle Clinic, Rashid Center for Diabetes and Research, PO Box 21499, Ajman, United Arab Emirates, Tel +971 5 0353 9532, Fax +971 6 7434 547, Email
| | - Sarah Abdi
- Lifestyle Clinic, Rashid Center for Diabetes and Research, Ajman, United Arab Emirates
| | - Salah Abusnana
- Research and Education Department, Rashid Center for Diabetes and Research, Ajman, United Arab Emirates
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Goldkamp J, Anderson S, Lifits-Podorozhansky Y, Gavard JA. Women's Perceptions Regarding Obesity and Comorbidities and Provider Interaction. J Obstet Gynecol Neonatal Nurs 2015; 44:784-92. [PMID: 26402301 DOI: 10.1111/1552-6909.12751] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To assess women's perceptions of current body mass index (BMI) category, evaluate their knowledge of medical and surgical conditions associated with obesity, and assess their previous exposure to counseling on obesity. DESIGN Questionnaire-based survey. SETTING Gynecology clinics in a large midwestern city. PARTICIPANTS Non-pregnant women age 18 to 65 years. METHODS Descriptive design with distribution of anonymous questionnaires pertaining to demographics, current medical conditions, perceived weight, medical conditions associated with obesity, surgical complications from obesity, and previous weight loss counseling. All data were analyzed using chi-squared tests, and statistical significance was set at a p value of <.05. RESULTS The majority of the sample (65%) was overweight or obese, and 44% of participants underestimated their BMI categories. The relationship of perceived versus actual BMI differed significantly by race (p < .001), income (p < .05), and education (p < .05); African American women and women with less education tended to underestimate their BMI categories. Increasing actual BMI was inversely correlated with the ability to identify obesity as a risk factor for medical conditions (p < .01). Only 43% of participants discussed their weight or related concerns with medical professionals. CONCLUSION A significant number of participants were unaware of their BMI status as well as the relationship between obesity and other comorbidities. Counseling and patient education efforts by health care providers are essential.
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Calderón-Larrañaga A, Hernández-Olivan P, González-Rubio F, Gimeno-Feliu LA, Poblador-Plou B, Prados-Torres A. Multimorbidity and weight loss in obese primary care patients: longitudinal study based on electronic healthcare records. BMJ Open 2015; 5:e006227. [PMID: 25783419 PMCID: PMC4368983 DOI: 10.1136/bmjopen-2014-006227] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 11/25/2014] [Accepted: 01/16/2015] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To analyse the association between cardiovascular and mental comorbidities of obesity and weight loss registered in the electronic primary healthcare records. DESIGN AND SETTING Longitudinal study of a cohort of adult patients assigned to any of the public primary care centres in Aragon, Spain, during 2010 and 2011. PARTICIPANTS Adult obese patients for whom data on their weight were available for 2010 (n=62,901), and for both 2010 and 2011 (n=42,428). OUTCOMES Weight loss (yes/no) was calculated based on the weight difference between the first value registered in 2010 and the last value registered in 2011. Multivariate logistic regression models were adjusted for individuals' age, sex, total number of chronic comorbidities, type of obesity and length of time between both weight measurements. RESULTS According to the recorded clinical information, 9 of 10 obese patients showed at least one chronic comorbidity. After adjusting for covariates, weight loss seemed to be more likely among obese patients with a diagnosis of diabetes and/or dementia and less likely among those with hypertension, anxiety and/or substance use problems (p<0.05). The probability of weight loss was also significantly higher in male patients with more severe obesity and older age. CONCLUSIONS An increased probability of weight loss over 1 year was observed in older obese male patients, especially among those already manifesting high levels of obesity and severe comorbidities such as diabetes and/or dementia. Yet patients with certain psychological problems showed lower rates of weight reduction. Future research should clarify if these differences persist beyond potential selective weight documentation in primary care, to better understand the trends in weight reduction among obese patients and the underlying role of general practitioners regarding such trends.
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Affiliation(s)
- Amaia Calderón-Larrañaga
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- University of Zaragoza, Zaragoza, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, Zaragoza, Spain
| | | | - Francisca González-Rubio
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- University of Zaragoza, Zaragoza, Spain
- Delicias Sur Health Centre, Zaragoza, Spain
| | - Luis A Gimeno-Feliu
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- University of Zaragoza, Zaragoza, Spain
- San Pablo Health Centre, Zaragoza, Spain
| | - Beatriz Poblador-Plou
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, Zaragoza, Spain
| | - Alexandra Prados-Torres
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- University of Zaragoza, Zaragoza, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, Zaragoza, Spain
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Pool AC, Kraschnewski JL, Cover LA, Lehman EB, Stuckey HL, Hwang KO, Pollak KI, Sciamanna CN. The impact of physician weight discussion on weight loss in US adults. Obes Res Clin Pract 2015; 8:e131-9. [PMID: 24743008 DOI: 10.1016/j.orcp.2013.03.003] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 02/01/2013] [Accepted: 03/19/2013] [Indexed: 11/19/2022]
Abstract
PROBLEM The increasing prevalence of overweight and obesity in the United States and worldwide is at epidemic levels. Physicians may play a vital role in addressing this epidemic. We aimed to examine the association of a physician's discussion of patients’ weight status with self-reported weight loss. We hypothesized that physician discussion of patients’ being overweight is associated with increased weight loss in patients with overweight and obesity. METHODS Data analysis of participants (n = 5054) in the National Health and Nutritional Examination Survey (NHANES) in 2005-2008. The main outcome was rates of self-reported weight loss and the association with physicians’ discussion of their patients’ weight status. RESULTS Overweight and obese participants were significantly more likely to report a 5% weight loss in the past year if their doctor had told them they were overweight (adjusted OR (AOR) 1.88; 95% CI 1.45-2.44; AOR 1.79; 95% CI 1.30-2.46, respectively). CONCLUSIONS Physicians’ direct discussion of their patients’ weight status is associated with clinically significant patient weight loss and may be a targetable intervention. Further studies are needed to determine if increasing physician discussion of patients’ weight status leads to significant weight loss.
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Affiliation(s)
- Andrew C Pool
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Jennifer L Kraschnewski
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Lindsay A Cover
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Erik B Lehman
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Heather L Stuckey
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Kevin O Hwang
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Kathryn I Pollak
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Christopher N Sciamanna
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States
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Wilkinson ML, Brown AL, Poston WSC, Haddock CK, Jahnke SA, Day RS. Physician weight recommendations for overweight and obese firefighters, United States, 2011-2012. Prev Chronic Dis 2014; 11:E116. [PMID: 25010998 PMCID: PMC4093977 DOI: 10.5888/pcd11.140091] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION National guidelines state that health care professionals (HCPs) should advise patients on the importance of maintaining a healthy weight. Firefighters have high rates of obesity, and cardiovascular events are the leading cause of line-of-duty deaths in firefighters. This study assessed the association of age and body mass index (BMI) with HCP weight recommendations among male firefighters. METHODS We used data on self-reported HCP weight recommendations and measured BMI from a 2011-2012 national sample of male firefighters (N = 1,002). HCP recommendations were recorded as no advice, maintain, gain, or lose weight, and BMI was categorized as normal (<25.0 kg/m(2)), overweight (25.0-29.9 kg/m(2)), class I obese (30.0-34.9 kg/m(2)), and class II or III obese (≥35.0 kg/m(2)). We used multinomial logistic regression to estimate the odds of receiving weight advice by age and BMI categories. RESULTS Most firefighters (96%) reported visiting an HCP in the past year. Most (69%) firefighters and 48% of class I to III obese firefighters reported receiving no weight advice. Higher BMI predicted HCP advice to lose weight (odds ratio class I obese vs normal weight: 12.98; 95% confidence interval: 5.38-31.34). Younger firefighters were less likely to receive weight loss advice than older firefighters, except among those who were class II or III obese. CONCLUSIONS HCPs are important sources of health information for firefighters. Overweight and obese firefighters, particularly those who are younger, do not consistently receive HCP advice to lose weight. This marks a missed opportunity to prevent further weight gain and reduce obesity-related health outcomes.
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Affiliation(s)
- Michelle Lynn Wilkinson
- The University of Texas Health Science Center at Houston, School of Public Health, Houston, Texas
| | - Austin Lane Brown
- The University of Texas Health Science Center at Houston, School of Public Health, Houston, Texas
| | | | | | | | - Rena Sue Day
- The University of Texas Health Science Center at Houston, School of Public Health, Division of Epidemiology, Human Genetics, and Environmental Sciences, Michael & Susan Dell Center for Healthy Living, 1200 Pressler Dr, RAS E1027, Houston, TX 77030. E-mail:
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Yoong SL, Carey ML, Sanson-Fisher RW, D'Este CA, Mackenzie L, Boyes A. A cross-sectional study examining Australian general practitioners' identification of overweight and obese patients. J Gen Intern Med 2014; 29:328-34. [PMID: 24101533 PMCID: PMC3912305 DOI: 10.1007/s11606-013-2637-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Revised: 08/23/2013] [Accepted: 09/10/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Overweight and obese patients attempt weight loss when advised to do so by their physicians; however, only a small proportion of these patients report receiving such advice. One reason may be that physicians do not identify their overweight and obese patients. OBJECTIVES We aimed to determine the extent that Australian general practitioners (GP) recognise overweight or obesity in their patients, and to explore patient and GP characteristics associated with non-detection of overweight and obesity. METHODS Consenting adult patients (n = 1,111) reported weight, height, demographics and health conditions using a touchscreen computer. GPs (n = 51) completed hard-copy questionnaires indicating whether their patients were overweight or obese. We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for GP detection, using patient self-reported weight and height as the criterion measure for overweight and obesity. For a subsample of patients (n = 107), we did a sensitivity analysis with patient-measured weight and height. We conducted an adjusted, multivariable logistic regression to explore characteristics associated with non-detection, using random effects to adjust for correlation within GPs. RESULTS Sensitivity for GP assessment was 63 % [95 % CI 57-69 %], specificity 89 % [95 % CI 85-92 %], PPV 87 % [95 % CI 83-90 %] and NPV 69 % [95 % CI 65-72 %]. Sensitivity increased by 3 % and specificity was unchanged in the sensitivity analysis. Men (OR: 1.7 [95 % CI 1.1-2.7]), patients without high blood pressure (OR: 1.8 [95 % CI 1.2-2.8]) and without type 2 diabetes (OR: 2.4 [95 % CI 1.2-8.0]) had higher odds of non-detection. Individuals with obesity (OR: 0.1 [95 % CI 0.07-0.2]) or diploma-level education (OR: 0.3 [95%CI 0.1-0.6]) had lower odds of not being identified. No GP characteristics were associated with non-detection of overweight or obesity. CONCLUSIONS GPs missed identifying a substantial proportion of overweight and obese patients. Strategies to support GPs in identifying their overweight or obese patients need to be implemented.
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Affiliation(s)
- Sze Lin Yoong
- Priority Research Centre for Health Behaviour and Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW, 2308, Australia,
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Getaneh A, Giardina EGV, Findley SE. Factors related to weight loss attempt among Dominican immigrants. J Immigr Minor Health 2014; 15:591-7. [PMID: 22653615 DOI: 10.1007/s10903-012-9638-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
To assess weight loss attempt among a Latino immigrant population from the Dominican Republic we analyzed data on 585 overweight and obese Dominicans from a cross-sectional survey using Chi-square statistics, Student's t-tests, and logistic regression models. We found 58% of the overweight and obese tried to lose weight. Female gender (OR 2.28, CI 1.53-3.39), overweight perception (OR 2.37, CI 1.57-3.60) and weight loss advice from health professionals (OR 1.90, CI 1.24-2.91) were strongly associated with weight loss attempt. Individuals with diabetes were more likely to receive advice to lose weight (OR 2.58, CI 1.18-5.63; yet, they were more satisfied with their weight (40.5 vs. 27.8%, p < 0.021), and no difference in their weight loss attempt (p = 0.849) was detected compared to individuals without diabetes. We conclude a significant proportion of overweight and obese Dominican immigrants do not attempt to lose weight. Overweight perception and, except among individuals with diabetes, weight loss advice were strong inducements to weight loss attempt.
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Affiliation(s)
- Asqual Getaneh
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY 10033, USA.
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Accuracy and congruence of patient and physician weight-related discussions: from project CHAT (Communicating Health: Analyzing Talk). J Am Board Fam Med 2014; 27:70-7. [PMID: 24390888 PMCID: PMC3965664 DOI: 10.3122/jabfm.2014.01.130110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Primary care providers should counsel overweight patients to lose weight. Rates of self-reported, weight-related counseling vary, perhaps because of self-report bias. We assessed the accuracy and congruence of weight-related discussions among patients and physicians during audio-recorded encounters. METHODS We audio-recorded encounters between physicians (n = 40) and their overweight/obese patients (n = 461) at 5 community-based practices. We coded weight-related content and surveyed patients and physicians immediately after the visit. Generalized linear mixed models assessed factors associated with accuracy. RESULTS Overall, accuracy was moderate: patient (67%), physician (70%), and congruence (62%). When encounters containing weight-related content were analyzed, patients (98%) and physicians (97%) were highly accurate and congruent (95%), but when weight was not discussed, patients and physicians were more inaccurate and incongruent (patients, 36%; physicians, 44%; 28% congruence). Physicians who were less comfortable discussing weight were more likely to misreport that weight was discussed (odds ratio, 4.5; 95% confidence interval, 1.88-10.75). White physicians with African American patients were more likely to report accurately no discussion about weight than white physicians with white patients (odds ratio, 0.30; 95% confidence interval, 0.13-0.69). CONCLUSION Physician and patient self-report of weight-related discussions were highly accurate and congruent when audio-recordings indicated weight was discussed but not when recordings indicated no weight discussions. Physicians' overestimation of weight discussions when weight is not discussed constitutes missed opportunities for health interventions.
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Bray G, Look M, Ryan D. Treatment of the obese patient in primary care: targeting and meeting goals and expectations. Postgrad Med 2013; 125:67-77. [PMID: 24113665 DOI: 10.3810/pgm.2013.09.2692] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Obesity is a serious disease associated with increased patient risk of several comorbidities, including type 2 diabetes mellitus, cardiovascular disease, dyslipidemia, hypertension, some cancers, and greater mortality. Furthermore, obesity has a deleterious impact on quality of life and increases health care costs. Moderate weight loss of 5% to 10% has been shown to significantly improve several patient cardiometabolic risk factors and physical functioning, however, it is often difficult to begin the weight-loss conversation with patients. Primary care providers play a critical role in discussing the health effects of excess weight with patients, managing obesity-related comorbidities, and recommending appropriate weight-loss strategies. Open communication, realistic goal setting, and consistent monitoring are key factors in implementing an effective weight-loss program in the primary care setting. Although diet and lifestyle modifications are the first lines of approach and the foundation of any weight-loss strategy, in many cases, additional interventions may be necessary, including medical or surgical management. Herein, we discuss the approaches that primary care providers should consider when recommending appropriate weight-loss strategies for overweight/obese patients to achieve clinically meaningful weight loss, including pharmacotherapies approved for chronic management of patients with obesity, to be used as adjuncts to diet and lifestyle modifications, and surgical options.
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Affiliation(s)
- George Bray
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA.
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31
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Tang JW, Allen N, de Chavez P, Goff DC, Kiefe CI, Lewis CE, Carnethon M. Health-care access and weight change among young adults: the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Public Health Nutr 2013; 16:1796-800. [PMID: 22894769 PMCID: PMC3574627 DOI: 10.1017/s1368980012003813] [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: 10/07/2011] [Revised: 06/03/2012] [Accepted: 07/12/2012] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Health-care access is associated with improved control of multiple chronic diseases, but the association between health-care access and weight change is unclear. The present study aims to test the association between health-care access and weight change. DESIGN The Coronary Artery Risk Development in Young Adults (CARDIA) Study is a multicentre population-based prospective study. Weight change was calculated at 3 and 13 years after CARDIA year 7 (1992-1993). Health-care access was defined as no barriers or one or more barriers to access (health insurance gap, no usual source of care, not seeking care due to expense). Intermediary variables evaluated included history of dieting and use of diet pills, meal replacements or weight-control programmes. SETTING Four cities in the USA. SUBJECTS Participants were aged 18-30 years at baseline (1985-1986). Analyses include 3922 black and white men and women with relevant data from CARDIA years 7, 10 and 20 (1992-1993, 1995-1996 and 2005-2006, respectively). RESULTS Mean weight change was +2.22 kg (+4.9 lb) by 3 years and +8.48 kg (+18.7 lb) by 13 years, with no differences by health-care access. Being on a weight-reducing diet was not consistently associated with health-care access across examinations. Use of diet pills, meal replacements or organized weight-control programmes was low, and did not vary by health-care access. CONCLUSIONS Weight gain was high irrespective of health-care access. Public health and clinical approaches are needed to address weight gain.
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Affiliation(s)
- Joyce W Tang
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
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Engström M, Skytt B, Ernesäter A, Fläckman B, Mamhidir AG. District nurses' self-reported clinical activities, beliefs about and attitudes towards obesity management. Appl Nurs Res 2013; 26:198-203. [PMID: 23928123 DOI: 10.1016/j.apnr.2013.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 04/27/2013] [Accepted: 06/30/2013] [Indexed: 11/18/2022]
Abstract
AIM To describe district nurses' self-reported clinical activities, beliefs about and attitudes towards obesity management; and to examine associations between the variables. BACKGROUND Obesity is increasing worldwide and primary care could play a central role in the management. METHODS Questionnaire data were collected from 247 nurses in 33 centres. RESULTS The most common activities performed weekly were; advice about physical activity (40.1%) and general lifestyle advice (34.8%). However, nearly one third seldom/never performed these activities. Approximately half seldom/never performed BMI assessment and even fewer waist circumference (78.1%). Values for the factors Importance of obesity and Personal effectiveness were skewed towards a positive view and Negative view close to neutral. Multivariate analysis revealed that nurses with specialized tasks, longer working experience and higher perceived personal effectiveness performed more clinical activities. CONCLUSION Managers need to make efforts to engage all personnel in obesity management; and strategies to increase self-efficacy are called for.
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Affiliation(s)
- Maria Engström
- Department of Health and Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, 801 76 Gävle, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Sweden.
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33
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Josyula L, Lyle R. Health Care Provider Physical Activity Prescription Intervention. AMERICAN JOURNAL OF HEALTH EDUCATION 2013. [DOI: 10.1080/19325037.2013.779903] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Lakshmi Josyula
- a Indian Institute of Public Health , Hyderabad
- b Purdue University
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34
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Orlowski M, Adkins S, Ellison S, Choh A, Terwoord N, Schuster R. Assessment and Management of Adult Obesity in a Primary Care Practice. WORLD MEDICAL & HEALTH POLICY 2013. [DOI: 10.1002/wmh3.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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van Dillen SME, van Binsbergen JJ, Koelen MA, Hiddink GJ. Nutrition and physical activity guidance practices in general practice: a critical review. PATIENT EDUCATION AND COUNSELING 2013; 90:155-169. [PMID: 23246149 DOI: 10.1016/j.pec.2012.10.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 09/17/2012] [Accepted: 10/06/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE The aim of this critical review is to provide insight into the main outcomes of research on communication about nutrition and/or physical activity between GPs and patients for prevention or treatment of overweight and obesity. METHODS Relevant studies were identified by a computerized search of multiple electronic databases (MEDLINE, PsycINFO) for all available papers between 1 January 1995 and 1 January 2012. In addition, two independent reviewers judged all studies on ten quality criteria. RESULTS In total, 41 studies were retrieved. More studies were found about the guidance of obese patients than of overweight patients. The most common weight guidance practice was discussion of weight. The range of communication strategies for nutrition showed to be more diverse than for physical activity. Twelve studies were considered as high-quality studies, 18 were having medium quality, and 11 were seen as low quality. CONCLUSION We reflected on the fact that the content of advice about nutrition and physical activity was quite general. GPs' provision of combined lifestyle advice to overweight and obese patients seems to be rather low. PRACTICE IMPLICATIONS Observational research is needed to unravel the quality of the advice given by GPs to overweight and obese patients.
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Ekezue BF, Platonova EA. Underassessment of weight and weight management in patients with diabetes: one more reason in support of weight management advice. Prim Care Diabetes 2012; 6:253-259. [PMID: 22985913 DOI: 10.1016/j.pcd.2012.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 08/17/2012] [Accepted: 08/19/2012] [Indexed: 01/22/2023]
Abstract
AIMS The purpose of this study was to determine whether underassessment of weight affects weight management behaviors of overweight and obese individuals with diabetes and to determine whether weight management advice from health care professionals modifies the effect of underassessment of weight. METHODS Data (n=979) from the 2006 and 2008 National Health and Nutrition Examination Survey were analyzed. Multivariate logistic regression was used to identify factors associated with underassessment of weight, weight management behaviors, and receipt of weight management advice from health care professionals. RESULTS Underassessment of weight was common (26%). Men, overweight persons, Blacks and Hispanics were more likely to underassess their weight. Those who underassessed their weight were 53% less likely to report weight management behaviors, odds ratio 0.47 (95% CI=0.31-0.73). Weight management advice increased weight management behaviors among individuals who underassessed their weight, 3.49 (95% CI=1.70-7.18). CONCLUSIONS Underassessment of weight can negatively affect weight management behaviors of overweight and obese individuals with diabetes. Weight management advice from health care professionals is important, and can modify the effect of underassessment of weight on weight management behaviors in this high risk group.
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Affiliation(s)
- Bola F Ekezue
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC 28223, USA
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Use of the internet in the treatment of obesity and prevention of type 2 diabetes in primary care. Proc Nutr Soc 2012; 72:98-108. [PMID: 23098133 DOI: 10.1017/s0029665112002777] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Cardiovascular prevention, including emphasising healthy diet and physical activity patterns for weight loss and diabetes prevention, is an important focus of primary care medicine, yet provision of intensive lifestyle counselling in the primary care setting remains uncommon. Online approaches for providing lifestyle counselling are emerging as a new avenue for bringing support to outpatient patient populations. Features of successful programmes include the use of a structured behavioural programme, electronic counselling support and feedback, and uncomplicated user interfaces. Online tools may be used independently or to complement in-person approaches. Limited data also suggest that the internet can be used to support the maintenance of weight loss. In addition, the internet may help overcome various clinical barriers to lifestyle support, including significant time limitations, a need to prioritise acute care and maintain clinical workflow, and the high cost of counselling. Furthermore, the continuity of the primary care patient-provider(s) relationship provides an established source of long-term support which has been difficult to create in other community settings. As the field of online lifestyle counselling matures, nutrition and physical activity experts will face new challenges in providing asynchronous counselling without the assistance of traditional non-verbal communication cues. However, the potential for reaching a wider population in a convenient and accessible manner also creates unique opportunities for providing lifestyle support.
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Salmela SM, Vähäsarja K, Villberg J, Vanhala M, Saaristo T, Lindström J, Oksa H, Korpi-Hyövälti E, Niskanen L, Keinänen-Kiukaanniemi S, Poskiparta M. The reporting of previous lifestyle counseling by persons at high risk of Type 2 diabetes. PATIENT EDUCATION AND COUNSELING 2012; 87:178-185. [PMID: 21943790 DOI: 10.1016/j.pec.2011.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Revised: 08/01/2011] [Accepted: 08/26/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To assess (i) whether the reporting of counseling previously received is associated with high-risk individuals' agreement to participate in lifestyle intervention, (ii) whether the reporting of previous counseling differed within such a high-risk group, and (iii) the associations between lifestyles and previous lifestyle counseling. METHODS Cross-sectional data were drawn from 10149 adults at high risk of Type 2 diabetes, who were participating in a Finnish national diabetes prevention project (FIN-D2D). Bivariate analysis and multivariate logistic regression were used. RESULTS In relation to the reporting of previous counseling, no difference was found between persons who had agreed and persons who had not agreed to participate in the lifestyle intervention. Persons who were more educated or who had dyslipidemia or diabetes were more likely than the others to report previous counseling. A generally healthy lifestyle, or certain health behaviors (being a non-smoker or eating large amounts of fruit and vegetables) may make the reporting of previous counseling more likely. CONCLUSION The results raise questions about the amount and quality of the previously received lifestyle counseling. PRACTICE IMPLICATIONS There is a need for sustainable lifestyle counseling structures, within vigorously implemented diabetes prevention projects, if long-lasting lifestyle changes are to be achieved.
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Affiliation(s)
- Sanna M Salmela
- Research Centre for Health Promotion, Faculty of Sport and Health Sciences, Department of Health Sciences, University of Jyväskylä, Finland.
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Powell-Wiley TM, Ayers CR, Banks-Richard K, Berry JD, Khera A, Lakoski SG, McGuire DK, de Lemos JA, Das SR. Disparities in counseling for lifestyle modification among obese adults: insights from the Dallas Heart Study. Obesity (Silver Spring) 2012; 20:849-55. [PMID: 21818156 PMCID: PMC3514073 DOI: 10.1038/oby.2011.242] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Clinician counseling is a catalyst for lifestyle modification in obesity. Unfortunately, clinicians do not appropriately counsel all obese patients about lifestyle modification. The extent of disparities in clinician counseling is not well understood. Obese participants (BMI ≥30 kg/m(2), N = 2097) in the Dallas Heart Study (DHS), a probability-based sample of Dallas County residents ages 18-65, were surveyed regarding health-care utilization and lifestyle counseling over the year prior to DHS enrollment. Health-care utilization and counseling were compared between obese participants across three categories based on the presence of 0, 1, or 2+ of the following cardiovascular (CV) risk factors: hypertension, hypercholesterolemia, or diabetes. Logistic regression modeling was used to determine likelihood of counseling in those with 0 vs. 1+ CV risk factors, stratified by race, adjusting for age, sex, insurance status, and education. Among obese subjects who sought medical care, those with 0 CV risk factors, compared to those with 1 or 2+ CV risk factors, were less likely to report counseling about losing weight (41% vs. 67% vs. 87%, P trend <0.001), dietary changes (44% vs. 71% vs. 85%, P trend <0.001), and physical activity (46% vs. 71% vs. 86%, P trend <0.001). Blacks and Hispanics without CV risk factors had a lower odds of receiving counseling than whites without risk factors on weight loss (adjusted odds ratio (OR), 95% confidence interval (CI) for nonwhites 0.19, [0.13-0.28], whites 0.48, [0.26-0.87]); dietary changes (nonwhites 0.19, [0.13-0.27], whites 0.37, [0.21-0.64]); and physical activity (nonwhites 0.22, [0.16-0.32], whites 0.32, [0.18-0.57]). Lifestyle counseling rates by clinicians are suboptimal among obese patients without CV risk factors, especially blacks and Hispanics. Systematic education about and application of lifestyle interventions could capitalize on opportunities for primary CV risk prevention.
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Affiliation(s)
| | - Colby R. Ayers
- Donald W. Reynolds Cardiovascular Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kamakki Banks-Richard
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jarett D. Berry
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Donald W. Reynolds Cardiovascular Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Amit Khera
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Donald W. Reynolds Cardiovascular Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Susan G. Lakoski
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Donald W. Reynolds Cardiovascular Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Darren K. McGuire
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Donald W. Reynolds Cardiovascular Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - James A. de Lemos
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Donald W. Reynolds Cardiovascular Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sandeep R. Das
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Donald W. Reynolds Cardiovascular Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Impact of genetic causal information on medical students' clinical encounters with an obese virtual patient: health promotion and social stigma. Ann Behav Med 2011; 41:363-72. [PMID: 21136226 DOI: 10.1007/s12160-010-9242-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Health care providers will increasingly encounter information about the genetics of obesity as genetics research progresses. PURPOSE This study explores whether information about the genetics of obesity reduces medical student stigmatization of obese patients, and how it affects rates of health behavior-related referral. METHODS One hundred and ten third and fourth year medical students were randomly assigned to read about genetic or behavioral mechanisms of obesity, or a control topic. Students interacted with an obese virtual patient in a virtual clinic and completed a battery of measures. RESULTS Rates of most health behavior screening recommendations (weight loss, exercise, and diet consultations) were lower among participants exposed to genetic causal information than control. The genetic causal information group exhibited less negative stereotyping of the patient than control, F(1,105) = 5.00, p = 0.028, but did not differ in anticipated patient adherence, F(1,105) = 3.18, p = 0.077. CONCLUSIONS Information highlighting genetic contributions to obesity may lead to both positive and negative outcomes. Communication about the genetics of obesity should discuss the multi-factorial and non-deterministic nature of genetic risk.
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Nguyen HT, Markides KS, Winkleby MA. Physician advice on exercise and diet in a U.S. sample of obese Mexican-American adults. Am J Health Promot 2011; 25:402-9. [PMID: 21721967 DOI: 10.4278/ajhp.090918-quan-305] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE To document the prevalence of obese Mexican-Americans never advised by health professionals regarding exercise and diet, and to determine risk factors for no advice. METHODS Data came from 1787 obese Mexican-American adults (body mass index ≥30; age ≥18 years) in the Medical Expenditure Panel Survey. The survey included self-reported receipt of health care provider advice on exercise and diet as well as sociodemographic, health-related, and provider-related factors. Multivariable logistic regression models were performed separately for advice regarding exercise and advice regarding diet. RESULTS Overall, 45% of respondents reported that they had never received advice from a doctor or health care professional to exercise more, and 52% reported that they have received advice to eat fewer higher-fat/high-cholesterol foods. Men, nonmarried respondents, lower-educated respondents, those who preferred to speak Spanish at home, and those without comorbid chronic conditions were less likely to receive advice. DISCUSSION Results suggest that obese Mexican-Americans are insufficiently advised by health care providers regarding exercise and diet. Given the seriousness of obesity-related health risks and the increasing prevalence of overweight status and obesity among Mexican-Americans, it is vital that providers are involved in finding ways to effectively educate and/or treat overweight patients.
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Affiliation(s)
- Ha T Nguyen
- Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1084, USA.
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Rao G, Burke LE, Spring BJ, Ewing LJ, Turk M, Lichtenstein AH, Cornier MA, Spence JD, Coons M. New and emerging weight management strategies for busy ambulatory settings: a scientific statement from the American Heart Association endorsed by the Society of Behavioral Medicine. Circulation 2011; 124:1182-203. [PMID: 21824925 DOI: 10.1161/cir.0b013e31822b9543] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Aucott LS, Riddell RE, Smith WCS. Attitudes of General Practitioner Registrars and Their Trainers Toward Obesity Prevention in Adults. J Prim Care Community Health 2011; 2:181-6. [DOI: 10.1177/2150131911401029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Obesity prevalence in developed countries is around 25% and rising. Prevention is beginning to receive attention. In the United Kingdom, general practice provides services to most of the population; on average, a patient is seen 4 times a year. Doctors’ attitudes toward obesity prevention have not been well documented. Objectives: Obtain doctors’ views toward obesity prevention and determine any differences between registrars and their trainers. Methods: During 2006-2007, a postal questionnaire was sent to all general practitioner registrars in Scotland and their trainers. The questions included individual details, opinions about current obesity prevention strategies, and facts about current obesity prevention practices. Results: Of those targeted (103 registrars, 91 trainers), 51% responded, representing 5% of all general practitioners in Scotland. Most agreed obesity and its prevention were important. However, more experienced practitioners were less convinced as to whether primary care could or should help with obesity prevention. Individual change was viewed as important, whereas primary care screening was of least importance. Conclusion: As the largest survey on doctors’ attitudes about obesity prevention, these results indicate that obesity and its prevention are important but that there are concerns and differences between registrars and trainers, in that trainers are more neutral about their agreement. A multifaceted approach building on current good practices of general practitioners with support from other specialty care providers may help to minimize the risk of alienation, fear, and resistance to primary care involvement for both treatment and prevention of obesity. However, resources and training would be necessary, along with methods to protect the doctor/patient relationship.
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McTigue KM, Bhargava T, Bryce CL, Conroy M, Fischer GS, Hess R, Simkin-Silverman LR, Zickmund S. Patient perspectives on the integration of an intensive online behavioral weight loss intervention into primary care. PATIENT EDUCATION AND COUNSELING 2011; 83:261-264. [PMID: 21459256 DOI: 10.1016/j.pec.2010.05.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Revised: 04/17/2010] [Accepted: 05/09/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To examine patients' perception of how a referral-based online lifestyle intervention contributed to primary care medicine. METHODS We invited 50 adults to complete a semi-structured interview after a 1-year online behavioral weight loss intervention (average weight change: -4.79 kg). We developed an iterative codebook using content analysis. Two coders independently coded all transcripts (kappa=0.895). We analyzed responses regarding the integration of the program with primary care. RESULTS Among the 35 participants who completed the interview, 46% described a positive experience between the program and their routine medical care; 14% noted it was fine/OK; 9% reported no effect, 3% were negative, 11% said that the program was unrelated to their medical care, and 14% that the only connection was the referral. Factors such as physician feedback and support, coordination with routine health care, and improved cardiovascular risk factors were cited in support of a positive experience. Physician feedback was reported by 89%, and 80% stated that the program helped them to follow their physician's advice. CONCLUSION Physician referral to online education and counseling may facilitate the integration of evidence-based behavioral counseling with primary care. PRACTICE IMPLICATIONS Internet technology may enable improved access to evidence-based counseling for chronic health problems.
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Affiliation(s)
- Kathleen M McTigue
- University of Pittsburgh Department of Medicine, Pittsburgh, PA 15213, USA.
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Diagnosis Management of Obesity: A Survey of General Practitioners' Awareness of Familiarity with the 2006 Canadian Clinical Practice Guidelines. Can J Diabetes 2011. [DOI: 10.1016/s1499-2671(11)53010-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Padwal RS, Damjanovic S, Schulze KM, Lewanczuk RZ, Lau DCW, Sharma AM. Canadian Physicians' Use of Antiobesity Drugs and Their Referral Patterns to Weight Management Programs or Providers: The SOCCER Study. J Obes 2011; 2011:686521. [PMID: 21113310 PMCID: PMC2989451 DOI: 10.1155/2011/686521] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 10/15/2010] [Indexed: 12/15/2022] Open
Abstract
Antiobesity pharmacotherapy and programs/providers that possess weight management expertise are not commonly used by physicians. The underlying reasons for this are not known. We performed a cross-sectional study in 33 Canadian medical practices (36 physicians) examining 1788 overweight/obese adult patients. The frequency of pharmacotherapy use and referral for further diet, exercise, behavioral management and/or bariatric surgery was documented. If drug treatment or referral was not made, reasons were documented by choosing amongst preselected categories. Logistic regression models were used to identify predictors of antiobesity drug use. No single antiobesity management strategy was recommended by physicians in more than 50% of patients. Referral was most common for exercise (49% of cases) followed by dietary advice (46%), and only 5% of eligible patients were referred for bariatric surgery. Significant predictors of initiating/continuing pharmacotherapy were male sex (OR 0.70; 95% CI 0.52-0.94), increasing BMI (1.02; 95% CI 1.01-1.03), and private drug coverage (1.78; 95% CI 1.39-2.29). "Not considered" and "patient refusal" were the main reasons for not initiating further weight management. We conclude that both physician and patient factors act as barriers to the use of weight management strategies and both need to be addressed to increase uptake of these interventions.
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Affiliation(s)
- R. S. Padwal
- Department of Medicine, University of Alberta, Edmonton, AB, Canada T6G 2V2
- Department of Medicine, Walter C. MacKenzie Health Sciences Center (2F1.26), University of Alberta Hospital, 8440-112 Street, Edmonton, AB, Canada T6G 2B7
- *R. S. Padwal:
| | - S. Damjanovic
- Madella Clinical Research Consulting, Hamilton, Ontario, Canada L9C 7W6
| | - K. M. Schulze
- Population Health Research Institute, McMaster Hamilton, University Health Sciences, Hamilton, ON, Canada L8L 2X2
| | - R. Z. Lewanczuk
- Department of Medicine, University of Alberta, Edmonton, AB, Canada T6G 2V2
| | - D. C. W. Lau
- Department of Medicine, University of Calgary, Calgary, AB, Canada T2N 4N1
| | - A. M. Sharma
- Department of Medicine, University of Alberta, Edmonton, AB, Canada T6G 2V2
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Affiliation(s)
- Karen A Kemper
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
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Burroughs VJ, Nonas C, Sweeney CT, Rohay JM, Harkins AM, Kyle TK, Burton SL. Self-reported weight loss practices among African American and Hispanic adults in the United States. J Natl Med Assoc 2010; 102:469-75. [PMID: 20575211 DOI: 10.1016/s0027-9684(15)30554-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To describe weight loss methods used and interactions with health care professionals on the issue of weight among African Americans and Hispanics. METHODS Five hundred thirty-seven African American and 526 Hispanic adults who self-described as being overweight participated in a telephone interview. RESULTS Exercise and healthy eating were the 2 most commonly used weight loss methods among both groups; prescription medications were the least-utilized weight loss aid. Forty-one percent of African Americans and 35% of Hispanics reported having been advised to lose weight by a health care professional. CONCLUSIONS Do-it-yourself approaches to weight loss predominate among African Americans and Hispanics; formal assistance is rarely used. Physician advice on weight loss is suboptimal.
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Singh S, Lopez-Jimenez F. Medically diagnosed overweight and weight loss in a US national survey. Prev Med 2010; 51:24-6. [PMID: 20420850 DOI: 10.1016/j.ypmed.2010.04.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2009] [Revised: 04/16/2010] [Accepted: 04/18/2010] [Indexed: 12/01/2022]
Abstract
BACKGROUND Impact of physician diagnosis of overweight on successful weight loss in community-based patients is not known. We analyzed data from NHANES 1999-04 to assess if self-reported physician diagnosis of overweight was associated with attempted and successful weight loss in the preceding year. METHODS We determined if physician-rendered diagnosis of overweight was associated with attempted and successful weight loss in multivariable Poisson regression models that adjusted for age, gender, ethnicity, education, income, insurance status, BMI, central obesity, self-rated health, number of office/emergency room visits, hyperlipidemia, hypertension, diabetes and cardiovascular disease. Successful weight loss was defined as intentional loss of > or = 5% body weight over the last year. RESULTS We included 8767 adults with BMI > or = 25 kg/m(2) who met the criteria for this analysis. In multivariate models physician-rendered diagnosis of overweight was associated with attempted weight loss (PrR 1.39; 95% CI, 1.30-1.48) and successful weight loss (PrR 2.09; 95% CI, 1.72-2.55). Female gender, self-rated health, number of office/emergency room visits in preceding year, severity of overweight and presence of overweight-related co-morbidities were all significantly associated with physician diagnosis of overweight. CONCLUSION In a nationally representative sample of community dwelling adults, self-reported physician diagnosis of overweight was associated with successful weight loss.
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Affiliation(s)
- Siddharth Singh
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic Rochester and Mayo Foundation, Minnesota, USA
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Kushner RF, Choi SW. Prevalence of unhealthy lifestyle patterns among overweight and obese adults. Obesity (Silver Spring) 2010; 18:1160-7. [PMID: 19875995 DOI: 10.1038/oby.2009.376] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This study determined the prevalence of unhealthy eating, exercise, and coping pattern traits among a large sample of overweight and obese adults. We analyzed responses to a 53-item lifestyle pattern questionnaire posted on a commercial weight loss program Web site collected from 2004 through 2008. Subjects included 446,608 healthy weight, overweight, and obese adults, 18-65 years old, average age 31.9 (s.d. = 11.8), average BMI 30.5 kg/m(2) (s.d. = 7.5). Categorically, 25.5% were healthy weight, 29.0% were overweight, 33.7% were class I-II obesity, and 11.8% class III obesity. A stratified random sample was used to estimate the prevalence of the 21 lifestyle patterns (7 eating, 7 exercise, and 7 coping) in the general population, and the prevalence of patterns in the complete dataset was further analyzed by gender, age, and BMI. Finally, we analyzed the odds ratio of the pattern prevalence for each BMI category. We found that unhealthy lifestyle patterns in diet, exercise, and coping were highly prevalent among this population. In general, the prevalence of these patterns rose with increasing BMI and is correlated with advancing age. Gender differences were seen with many of the patterns, most noticeably among the coping patterns. The odds ratio for 18 of the 21 patterns was >1.0 and steadily increased with higher BMI categories. We conclude that unhealthy lifestyle patterns in diet, exercise, and coping are highly prevalent among the overweight and obese population. Pattern recognition represents a new method to analyze the cluster of behaviors, attitudes, and traits seen among this population.
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Affiliation(s)
- Robert F Kushner
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
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