Patient perception matters in weight management

Obesity Management Education Needs Among General Internists: A Survey

Objective

The purpose of this study was to determine self-reported knowledge, attitudes, prior experience, and perceived needs for the management of overweight and obese patients within a General Internal Medicine Practice.

Patients and Methods

An emailed cross-sectional survey was sent between June 20, 2019 and September 12, 2019 to 194 healthcare workers (93 primary care providers (PCPs) and 101 nurses) which focused on management of patients with weight issues.

Results

In total, 80 of the eligible 194 participants completed the survey (nurses = 42, PCPs = 38). Up to 87% were white, 74.7% female (74.7%). Most of the responders were either in the age group of 30’s (30%) or 50’s (30%). Among the responders, 48.8% reported some type of specialty training in weight management since their medical training with lectures being the most common form of training (36%). When asked about their interest in either weight management training or strategies to initiate weight conversations, 79% of the respondents reported an interest in education on weight management or strategies to initiate weight conversations, while 65.8% indicated they would be interested in both topics.

Conclusion

Our study suggests that healthcare workers have a self-reported need for further training in management of overweight and obese patients, irrespective of previous training in this area.

Associations of Body Mass Index with Demographics, Lifestyle, Food Intake, and Mental Health among Postpartum Women: A Structural Equation Approach

As postpartum obesity is becoming a global public health challenge, there is a need to apply postpartum obesity modeling to determine the indicators of postpartum obesity using an appropriate statistical technique. This research comprised two phases, namely: (i) development of a previously created postpartum obesity modeling; (ii) construction of a statistical comparison model and introduction of a better estimator for the research framework. The research model displayed the associations and interactions between the variables that were analyzed using the Structural Equation Modeling (SEM) method to determine the body mass index (BMI) levels related to postpartum obesity. The most significant correlations obtained were between BMI and other substantial variables in the SEM analysis. The research framework included two categories of data related to postpartum women: living in urban and rural areas in Iran. The SEM output with the Bayesian estimator was 81.1%, with variations in the postpartum women's BMI, which is related to their demographics, lifestyle, food intake, and mental health. Meanwhile, the variation based on SEM with partial least squares estimator was equal to 70.2%, and SEM with a maximum likelihood estimator was equal to 76.8%. On the other hand, the output of the root mean square error (RMSE), mean absolute error (MSE) and mean absolute percentage error (MPE) for the Bayesian estimator is lower than the maximum likelihood and partial least square estimators. Thus, the predicted values of the SEM with Bayesian estimator are closer to the observed value compared to maximum likelihood and partial least square. In conclusion, the higher values of R-square and lower values of MPE, RMSE, and MSE will produce better goodness of fit for SEM with Bayesian estimators.

Identifying Opportunities for Advancing Weight Management in Primary Care

Objective: Much has been written about the patients' perspective concerning weight management in health care. The purpose of this survey study was to assess perspectives of primary care providers (PCPs) and nurses toward patient weight management and identify possible areas of growth. Patients and Methods: We emailed a weight management-focused survey to 674 eligible participants (437 [64.8%] nurses and 237 [35.2%] PCPs) located in 5 outpatient primary care clinics. The survey focused on opportunities, practices, knowledge, confidence, attitudes, and beliefs. A total of 219 surveys were returned (137 [62.6%] from nurses and 82 [34.4%] from PCPs). Results: Among 219 responders, 85.8% were female and 93.6% were white non-Hispanic. In this study, PCPs and nurses believed obesity to be a major health problem. While PCPs felt more equipped than nurses to address weight management (P < .001) and reported receiving more training than nurses (50.0% vs 17.6%, respectively), both felt the need for more training on obesity (73.8% and 79.4%, respectively). Although, PCPs also spent more patient contact time providing weight management services versus nurses (P < .001), the opportunity/practices score was lower for PCPs than nurses (-0.35 ± 0.44 vs -0.17 ± 0.41, P < .001) with PCPs more likely to say they lacked the time to discuss weight and they worried it would cause a poor patient-PCP relationship. The knowledge/confidence score also differed significantly between the groups, with nurses feeling less equipped to deal with weight management issues than PCPs (-0.42 ± 0.43 vs -0.03 ± 0.55, P < .001). Neither group seemed very confident, with those in the PCP group only answering with an average score of neutral. Conclusion: By asking nurses and PCP general questions about experiences, attitudes, knowledge, and opinions concerning weight management in clinical care, this survey has identified areas for growth in obesity management. Both PCPs and nurses would benefit from additional educational training on weight management.

mHealth Apps Assessment among Postpartum Women with Obesity and Depression

BACKGROUND

Pregnancy has become the main constituent for women to become overweight or obese during the postpartum phase. This could lead women to suffer from postpartum depression as well. Information technology (IT) has become more prevalent in the healthcare industry. It offers patients the opportunity to manage their health conditions via the use of several applications, one being the mHealth applications.

OBJECTIVE

The main purpose of this study is to experiment and understand the effects the mHealth applications (i.e., fitness and nutrition applications) have on the body mass index (BMI) and depression levels amongst postpartum women.

METHODS

Online questionnaires were sent to postpartum women within one year after their pregnancy, of which 819 completed questionnaires were returned. The frequency of the mHealth applications usage was categorized into daily, weekly, rarely and never streams. Therefore, the frequency of use of the mHealth applications for BMI and depression levels was analyzed based on the available statistical data. Descriptive statistics, ANOVA, and Dunnet tests were applied to analyze the experimental data.

RESULTS

Out of 819 respondents, 37.9% and 42.1% of them were overweight and obese, respectively. Almost 32.9% of the respondents were likely depressed, and 45.6% were at an increased risk. This study reports that only 23.4% and 28.6% of respondents never used the fitness and nutrition applications. The impact of the frequency of using the fitness applications on BMI and depression levels was obvious. This means that with the increased use of the fitness applications, there was also a significant effect in maintaining and decreasing the BMI and depression levels amongst Malaysians postpartum women. However, from the data of weekly and daily use of fitness applications, we found that the contribution toward the BMI and depression levels was high (p = 0.000). However, nutrition applications amongst the users were not significant within the main variables (p > 0.05). From the Dunnet test, the significance of using the fitness applications within the depression levels started from daily usage, whereas for BMI, it started from weekly usage.

CONCLUSION

The efficiency of the fitness applications toward the BMI and depression levels has been proven in this research work. While nutrition applications did not affect the BMI and depression levels, some of the respondents were still categorized as weekly and daily users. Thus, the improvements in BMI and depression levels are associated with the types of mHealth app that had been used.

Sauver J, Phelan SM, Croghan IT. Experience and expectations of patients on weight loss: The Learning Health System Network Experience

OBJECTIVE

Weight perception and degree of confidence in achieving healthy lifestyle can be determinants of engagement in obesity interventions. This study explored patients' perceived need for weight loss and the degree of self-confidence in ability to lose weight and sought to identify factors associated with patients' self-confidence in ability to lose weight.

METHODS

The authors analysed data from a survey mailed to primary care patients within five sites of the Learning Health Systems Network that explored participants' prior experience with weight management.

RESULTS

Among the 2,263 participants who completed the survey section on 'Patients' Experience with Weight Management', perceived need to lose 51 lb or more was statistically significant among those with class III obesity compared with other body mass index (BMI) groups (p value < 0.001). Reported desire to lose weight was also significantly higher among those with the highest BMI than those who were overweight (p value < 0.001). However, this same group had the lowest belief in ability to lose weight (p value < 0.001). In a multiple regression analysis, female gender, higher BMI and need to lose >10 lb were each independently associated with less belief in being able to lose weight.

CONCLUSIONS

Patients had varying perceptions on weight loss; those with category III obesity had the highest desire to lose weight but had the least confidence in ability to lose weight. Higher BMI, female gender and need to lose >10 lb were associated with decreased self-confidence in ability to lose weight.

Needs Assessment for Weight Management: The Learning Health System Network Experience

Objective

To assess patients' weight management needs and experiences across multiple sites within the Learning Health System Network.

Patients and Methods

A total of 19,964 surveys were sent to patients identified with overweight or obesity through medical record query at 5 health care systems throughout 11 states. The survey collected patients' experiences with and opinions about weight management in clinical care from October 27, 2017, through March 1, 2018.

Results

Among the 2380 responders, being younger, female, nonwhite, and single and having some college education or less were all significantly associated with higher body mass index (BMI). The most frequent weight loss barriers included food cravings (30.7%-49.9%) and having a medical condition limiting physical activity (17.7%-47.1%) (P<.001). Higher BMI was associated with a higher frequency of comorbidities and lower health status (P<.001). Higher BMI was also associated with a higher belief that primary care providers (PCPs) should be involved in weight loss management (P=.01) but lower belief that the PCP had the necessary skills and knowledge to help (P<.001). Responders with a higher BMI were more likely to feel judged (P<.001) and not always respected (P<.001) by their PCP. In addition, those with a higher BMI more frequently reported avoiding health care visits because of weight gain, not wanting to undress or be weighed, and not wanting to discuss their weight with their PCP (P<.001).

Conclusion

Physician involvement in weight management is important to patients whose needs and experiences differ by BMI. These data may inform clinical weight management efforts and create greater alignment with patient expectations.