Overweight and Obesity: Knowledge, Attitudes, and Practices of General Practitioners in France

Managing Adult Obese Patients at Primary Health Care Centers in Qassim Province, Saudi Arabia

Background Overweight and obesity have become a global health problem. This study aims to reduce the same problem, primarily with all levels of physicians and the hidden responsibility of all other allied health care workers and communities, including families and individuals. Objective The objective of this study is to determine the knowledge, attitude, and practice among the physicians toward the management of adult obesity at primary health care centers (PHCCs) of Qassim Province, Saudi Arabia. Methods A cross-sectional study was conducted among the 140 physicians working at the PHCC of Qassim through a self-administered questionnaire. A simple random method was used for the PHCC selection, and all the physicians were included at the PHCC level. Data was collected, cleaned, and analyzed with IBM SPSS Statistics, version 21.0 (IBM Corp., Armonk, NY). Necessary statistical tests were applied. Results The mean age and standard deviation (SD) in the study population were 34.29 ± 9.42, and 55.7% were males. The mean knowledge score and SD of correct answers were 4.61 ± 1.31. About four or more questions were answered correctly out of six knowledge questions (80.7%, n = 113). Out of 13 questions, the mean ± SD of correct practice questions was 9.88 ± 2.02. The mean ± SD of attitude questions was 8.06 ± 1.13. About 33 (23.6%) of the study population received obesity training courses. Conclusions Based on the study results, good knowledge, practice, and attitude were observed among the PHCC physicians of Qassim. However, a smaller number of physicians received obesity training in the study.

Obesity Bias and Stigma, Attitudes, and Beliefs Among Intern Doctors: a Cross-sectional Study from Türkiye

BACKGROUND

The purpose of this study was to determine intern physicians' attitudes and beliefs toward obesity and individuals with obesity and the frequency at which they encounter discriminatory language in their work environments.

METHODS

This cross-sectional study was performed with intern physicians at the Ondokuz Mayıs University Medical Faculty in Samsun, Türkiye. A questionnaire was employed for data collection (Appendix). Two hundred eighteen (82.2%) interns took part in the study. The questionnaire consisted of 53 questions in five sections, and included the attitudes toward obese persons (ATOP) and beliefs about obese persons (BAOP) scales.

RESULTS

The interns most frequently cited genetic factors (98.1%) and endocrine disorder-metabolic disorders (98.1%) as non-behavioral causes of obesity, and overeating (96.2%) and physical immobility (96.2%) as behavioral causes. Lifestyle changes and exercise were most frequently recommended for treatment. The interns' attitudes toward individuals with obesity were very slightly negative, but close to neutral. Analysis showed that 46.8% of the interns reported hearing members of academic staff, intern physicians, or health workers make negative or derogatory comments or jokes about obese patients during their education, while 22.0% reported witnessing an obese patient being subjected to discriminatory treatment in the hospital environment.

CONCLUSION

Medical faculties must develop curricula aimed at comprehensively addressing obesity-related bias. Such a curriculum should allow students to reflect on their biases, be aimed at reducing the effect of those biases on patient communication, and involve strategies directed toward eliminating those effects from physicians' treatment decisions.

How are people with obesity managed in primary care? - results of a qualitative, exploratory study in Germany 2022

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.

Weight Bias in Reproductive Medicine: A Curiously Unexplored Frontier

Obesity has been associated with a multitude of medical comorbidities, infertility, and adverse obstetric outcomes. Weight stigma and weight bias pervade not only the medical field but also education, employment, and activities of daily living. The experience of weight stigma has been shown to adversely impact not only the mental health of individuals with overweight or obesity but also worsen obesogenic behaviors, and medical comorbidities. This review frames the rise of weight stigma and weight bias within the context of the "obesity epidemic" and explores its associations with infertility and decreased access to health care and its subsequent impact on the lives of individuals. Furthermore, it explores the concepts of intrinsic and extrinsic weight stigma/bias and highlights the need for further examination and research into the impact of these factors on access to reproductive medicine and subsequent outcomes.

The design and rationale of a multicenter real-world trial: The Southeastern Collaboration to Improve Blood Pressure Control in the US Black Belt - Addressing the Triple Threat

BACKGROUND

Impoverished African Americans (AA) with hypertension face poor health outcomes.

PURPOSE

To conduct a cluster-randomized trial testing two interventions, alone and in combination, to improve blood pressure (BP) control in AA with persistently uncontrolled hypertension.

METHODS

We engaged primary care practices serving rural Alabama and North Carolina residents, and in each practice we recruited approximately 25 AA adults with persistently uncontrolled hypertension (mean systolic BP >140 mmHg over the year prior to enrollment plus enrollment day BP assessed by research assistants ≥140/90 mmHg). Practices were randomized to peer coaching (PC), practice facilitation (PF), both PC and PF (PC + PF), or enhanced usual care (EUC). Coaches met with participants from PC and PC + PF practices weekly for 8 weeks then monthly over one year, discussing lifestyle changes, medication adherence, home monitoring, and communication with the healthcare team. Facilitators met with PF and PC + PF practices monthly to implement ≥1 quality improvement intervention in each of four domains. Data were collected at 0, 6, and 12 months.

RESULTS

We recruited 69 practices and 1596 participants; 18 practices (408 participants) were randomized to EUC, 16 (384 participants) to PF, 19 (424 participants) to PC, and 16 (380 participants) to PC + PF. Participants had mean age 57 years, 61% were women, and 56% reported annual income <$20,000.

LIMITATIONS

The PF intervention acts at the practice level, possibly missing intervention effects in trial participants. Neither PC nor PF currently has established clinical reimbursement mechanisms.

CONCLUSIONS

This trial will fill evidence gaps regarding practice-level vs. patient-level interventions for rural impoverished AA with uncontrolled hypertension.

Weight Stigma and Barriers to Effective Obesity Care

Weight stigma is prevalent with negative consequences for health and well-being. This problem is present in health care; stigmatizing attitudes toward patients with obesity are expressed by medical professionals across diverse specialties and patient care settings. This article summarizes the ways in which weight stigma creates barriers to effective care, including poor patient-provider communication, reduced quality of care, and healthcare avoidance. Priorities for stigma reduction in healthcare are discussed, with a clear need for multifaceted approaches and inclusion of people with obesity whose perspectives can inform strategies to effectively remove bias-related barriers to patient care.

Impact of cannabis knowledge and attitudes on real-world practice

BACKGROUND

Increased cannabis consumption worldwide challenges allergists because of an upsurge in cannabis allergy and need to discuss cannabis with patients.

OBJECTIVE

To determine the knowledge, attitudes, and practices regarding cannabis among allergists and their approach to recognizing and diagnosing suspected cannabis allergy.

METHODS

The International Allergist Canna Knowledge, Attitudes, and Practices Survey was completed by members from 3 International Allergy Societies. Survey questions included the following: 13 on cannabis attitudes, 7 on cannabis knowledge, and 4 on real-world allergy practices. Knowledge level was dichotomized and Statistical Package for the Social Sciences TwoStep Cluster Analysis grouped participants by attitudes. Multivariate analysis determined the relationship of knowledge and attitude to practice delivery.

RESULTS

Of 570 eligible surveys started, 445 (78.1%) were completed. Participants were 49.7% of female sex, 65.9% aged 24 to 56 years, approximately 70% in practice for more than or equal to 10 years, and 29.2% practicing in an area where cannabis use is illegal. Of the respondents, 43.1% reported consulting on patients with suspected cannabis allergy and 54.7% had undertaken skin prick testing, in vitro cannabis testing, or both. Statistically significant differences were found between the 3 societies for most variables analyzed. Analysis of attitudes revealed 3 clusters named Traditional, Progressive, and Unsure. Those with more progressive attitudes toward cannabis and who had more knowledge were more comfortable speaking to patients about cannabis and more often asked patients on how often and how they used cannabis (all P < .001).

CONCLUSION

Varying knowledge and attitudes toward cannabis affecting comfort communicating with patients about cannabis were found in members of 3 allergy societies supporting the need for more cannabis research and education.

Interaction between patient and general practitioner according to the patient body weight: a cross-sectional survey

OBJECTIVE

To analyse whether patient-general practitioner (GP) interaction, measured by their disagreement, varies among overweight or obese patients compared with normal-weight patients.

METHODS

Twenty-seven GPs and 585 patients participated in the quantitative phase of the multidisciplinary INTERMEDE project and answered "mirrored" questionnaires collecting both GPs and patients' perceptions on information and advice given at the end of the consultation. Multilevel logistic regressions were performed to explore associations between patient body mass index (BMI) and patient-GP disagreement on information and advice given during the consultation.

RESULTS

Disagreement increased with the patients' excess weight, and it was particularly pronounced for advice given by GPs on weight and lifestyle issues. Compared with patients with a "normal" BMI, overweight patients were more likely to disagree with their GP regarding advice given on weight loss (odds ratio [OR] = 10.7, 95% confidence interval [CI] = 4.1-27.3), advice given on doing more physical activity (OR = 1.9, 95% CI = 1.1-3.4), and nutritional advice (OR = 2.9, 95% CI = 1.5-5.6).

CONCLUSION

These disagreements could degrade the quality of patient-physician relationship. Our study provides an opportunity for GPs to reflect on how they communicate with overweight and obese patients, particularly with regard to lifestyle and weight-related advice and interventions taking into account the patient's representations.

Consulting Obese and Overweight Patients for Nutrition and Physical Activity in Primary Healthcare in Poland

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.

U.S. medical students personal health behaviors, attitudes and perceived skills towards weight management counseling

Physicians' abilities to address obesity in routine care may be affected by their own health behaviors, skills in and attitudes toward weight management counseling (WMC). Gender differences have been noted amongst these factors as well. We examined gender differences in personal health behaviors and predictors of perceived WMC skills and attitudes of medical students enrolled in a WMC trial. Enrollment took place in 2020 and consisted of students from eight U.S. medical schools. Baseline measures included demographics, exercise, and weight management behaviors, WMC attitudes and perceived skills. Descriptive statistics were calculated, and linear mixed models used to assess the effect of personal health behaviors on outcomes of WMC attitudes and perceived skills. Complete data were available for 1145 medical students. More males reported exercising 4 or more days/week (58.6% v. 41.4%), being more likely to monitor their weight (75.6% v. 70.3%) and less likely to intentionally attempt weight loss in the past (50.3% v. 65.3%) compared to females (all p's < 0.05). Exercising 4 or more days per week was positively associated with perceived WMC skills in the adjusted model (β = 0.10, CI 0.06 to 0.14, p < 0.01). Exercise frequency was positively associated with perceived WMC skills, regardless of gender. WMC curriculum may consider focusing on personal health behaviors such as exercise to increase perceived WMC skills.

Gender Differences in the Attitudes and Management of People with Obesity in Saudi Arabia: Data from the ACTION-IO Study

Purpose

Several studies have investigated gender differences in various obesity-related outcomes. Females were found to have more accurate weight perception and reported more frequency of attempted weight loss. The objective of this study was to assess gender differences in the attitudes and management of people with obesity (PwO) in Saudi Arabia using data from the ACTION-IO study.

Patients and Methods

A survey was conducted in Saudi Arabia in June and July 2018 on adults with obesity (based on self-reported body mass index of ≥30 kg/m²).

Results

A total of 1000 people with obesity completed the survey; 565 (56.5%) were male (mean age of 36.9 years and mean BMI of 33.5 kg/m²) and 435 (43.5%) were female (mean age of 36.3 years and mean BMI of 34.5 kg/m²). The two most reported motivations for wanting to lose weight for both groups were to improve appearance (38%) and to have more energy (35%). Females were more likely to trust their health-care provider (HCP) advice about weight management when compared to males (87% females, 82% males, p = 0.059) and were more likely to have concerns regarding long-term safety associated with prescription weight loss medications (65% female versus 59% males, p = 0.043). On the other hand, males were more likely to seek their physician to prescribe weight loss medication if they hear of a new medication (55% males versus 46% females, p = 0.014), and more to believe that there are good options available for weight loss medications (74% males versus 67% females, p = 0.040). Also, more males prefer to take weight loss medications than to have a weight loss surgery (65% males, 59% females, p = 0.054).

Conclusion

Overall, this study increases our understanding on the attitudes of both females and males towards the management of weight loss and opens the discussion for gender-specific weight loss interventions.

Evaluation of Tear Evaporation Rate in Subjects with a High Body Mass Index

Aim This study evaluated the tear evaporation rate (TER) in subjects with a high body mass index (BMI) and tested the correlation between BMI and dry eye.

Methods Thirty male subjects aged 18 – 38 years (26.4 ± 4.0 years) with a high BMI (26.4 – 47.0 kg/m2) were enrolled in the study. In addition, a control group of 30 males aged 20 – 36 years (24.0 ± 3.6 years) with a normal BMI (< 25 kg/m2) participated in the study for comparison. Each subject completed the ocular surface disease index (OSDI), followed by the TER measurement using a handheld VapoMeter.

Results Significant differences (Wilcoxon test; p = 0.002 and 0.001) were found between the median scores of the OSDI (10.3 [3.7] vs. 5.9 [7.2]) and TER (35.5 [13.1] vs. 15.5 [12.8] g/m2 h) in the study and control groups, respectively. The OSDI indicated dry eye in 60.0% of subjects in the study group (n = 18). The TER measurements showed that 76.7% of subjects in the study group (n = 23) had dry eyes. A medium correlation (r = 0.569; p = 0.001) was found between the OSDI scores and TER measurements.

Conclusions The means of the tear evaporation rate and the ocular surface disease index scores are significantly higher in subjects with a high BMI compared with the control group. Therefore, a high BMI is considered a risk factor for dry eye. The measurement of the tear evaporation rate using a handheld VapoMeter is a simple and rapid method to detect dry eyes in combination with other tools.

Obesity management: Attitudes and practice of Italian endocrinologists

INTRODUCTION

Obesity is a global pandemic and is cause of serious concern in all regions of the world. It is important to raise the attention of health care professionals in order to provide early treatment of patients with obesity. Obesity management, however, varies greatly amongst endocrinologists with respect to attitudes to diagnosis and treatment. Aim of this study was to identify practices and needs of Italian endocrinologists with respect to people with obesity.

METHODS

In this study, all members of the Italian Association of Clinical Endocrinologists (AME) were invited to participate in a web-based survey concerning the management of obesity.

RESULTS

The response rate was 24.1% (542/2248). Nutritional and obesity problems were reported as major areas of interest by 29.4% of the participants. A large proportion of patients seeking an endocrine consultation for other reasons are affected by obesity, but one in five respondents addressed the issue in 25% or less of the cases, while one in three always dealt with the problem. Obesity was managed personally/within a dedicated team by 42.6% of participants, while the remainders referred the patient to a dietician/nutritionist or a 2nd level center for obesity therapy. Metformin was used in a median of 30% of the patients (Interquartile range: 10-50) and liraglutide in 10% of the cases (IQR 0-30), while orlistat (median 0%; IQR 0-10) and naltrexone/bupropion (median 0%; IQR 0-5) were seldom prescribed. Cost of therapy was considered as the major limitation to the use of anti-obesity drugs, affecting adherence to long-term treatment. According to 41.9% of respondents, psychological support should be offered to all patients with obesity. Finally, 56% of participants believe that the availability of new drugs will increase the number of patients candidate to drug therapy.

DISCUSSION

In conclusion, it is of primary importance to raise the awareness of endocrinologists towards the problem of obesity and increase their confidence in managing this pathological condition.

Are patients with obesity "scapegoats"? The obesity prejudice levels of health care workers in Turkey

OBJECTIVE

This study assessed obesity prejudice levels, attitudes, and perceptions of health care workers toward individuals with obesity and the relationship between health care workers' perceptions of own and society's weight bias, healthy lifestyle preferences, body mass index, and other factors with obesity prejudice levels.

METHODS

This cross-sectional and descriptive study was conducted with 700 health care workers in Turkey via an online survey addressing characteristics, perceptions, and attitudes toward obesity including an obesity prejudice scale. Categorical variables were expressed as frequencies and percentages. The χ² test was applied to compare categorical variables. The distribution of the data was evaluated by the Kolmogorov-Smirnov test. Normally distributed data were compared by an independent sample t-test, while the Mann-Whitney U and Kruskal-Wallis tests were used for comparing non-normally distributed data.

RESULTS

Participants' mean age was 40.2±11.3 years and 67.9% were women. Notably, 57.9% worked at tertiary health care centers, 85.9% were physicians, and 64.8% were family physicians; 25% were prejudicial, while 58.1% tended to have prejudice toward individuals with obesity. Obesity prejudice scores were significantly higher among those who were in close contact with and who stated their preference for patients with obesity.

CONCLUSIONS

Half of the participants tended to have prejudice, and one-fourth were prejudicial toward individuals with obesity. These results highlight the necessity of raising awareness of health care workers to reduce prejudicial attitudes that may negatively impact patients with obesity. Stigmatizing experiences might be detrimental, reducing the quality of life with long-term consequences for emotional and physical health.

Utilization of evidence-based guidelines for prevention of obesity and hypercholesterolemia among primary healthcare physicians in southwest of Saudi Arabia

To evaluate knowledge and use of evidence-based guidelines for prevention of obesity and hypercholesterolemia among primary healthcare physicians in Jazan, Saudi Arabia.This cross-sectional study targeted 170 primary healthcare centres (PHCs) in Jazan. Measurement of study's variables was completed during personal interviews. The content of the study instrument was based on The Saudi Guidelines on the Prevention and Management of Obesity and The Cholesterol Management Guide for Healthcare Practitioners.A total of 234 physicians participated in this study. The age of the physicians varied between 25 and 65 years and 51.7% of them were females. Knowledge of the physicians about the eat-well plate recommendations was very low, with none of the physicians reporting the recommended daily portions of fruits and vegetables. Less than 20% of the physicians knew the cutoff points for considering central obesity among male and female individuals. Only 21% of the physicians reported adherence concerning screening for obesity and 42% reported adherence to the guidelines concerning screening for hypercholesterolemia. Only 9% of the physicians were adherent to the guidelines concerning reducing the risk of obesity and only 13% reported adherence to the guidelines related to the reduction of hypercholesterolemia risk.The current investigation detected a low level of knowledge and adherence concerning the evidence-based practice related to prevention of the obesity and hypercholesterolemia and therefore limited role of PHC physicians in the prevention of obesity or hypercholesterolemia.

Attitudes of Medical Professionals Towards Discrimination of Patients with Obesity

Purpose

Many studies show that discriminatory practices are common in healthcare institutions, also in the form of medical staff’s inappropriate behaviour. Weight stigma may not only become a source of unpleasant experience for the patients but also cause them to withdraw from the treatment, which may further exacerbate their condition.

Patients and Methods

In a nationwide study, we asked 184 medical professionals, about their experiences and opinions on the discrimination of patients with obesity. The study was conducted in 2020, with the use of CAWI method, based on an original survey created for this study.

Results

Most of the medical professionals (68.5%) estimated that the problem of worse attitudes towards patients suffering from obesity is a common phenomenon. About 48.4% witnessed medical staff’s discriminatory behaviours. The most frequent forms of inappropriate behaviours pertained to interpersonal relations – mocking the appearance (96.6%), looks of disgust and repulsion (96.2%), lack of reaction to offensive remarks (92.0%) or scaring a patient with the necessity to lose weight (57.7%). The participants of the study pointed to limited access to dedicated medical equipment (62.4%) as a discriminatory systemic limitation.

Conclusion

Discrimination of patients with obesity is a social issue, which also occurs within the health care system. Limited access to medical resources, gaps in knowledge of obesity and an insufficient level of soft skills in health care professionals are the key deficiencies, which hinder effective treatment.

Patient motivation to lose weight: Importance of healthcare professional support, goals and self-efficacy

BACKGROUND

People with obesity (PwO) often struggle to achieve and maintain weight loss. This can perpetuate and/or be influenced by feelings of low motivation. This analysis from ACTION-IO data identified factors associated with PwO motivation to lose weight.

METHODS

PwO completed an online survey in 11 countries. Exploratory multinomial logistic regression analyses identified independent variables associated with self-report of feeling motivated versus not motivated to lose weight.

RESULTS

Data from 10,854 PwO were included (5,369 motivated; 3,312 neutral; 2,173 not motivated). Variables associated with feeling motivated versus not motivated included (odds ratio [95% confidence interval]): acknowledgement of healthcare professional (HCP) responsibility to contribute to weight loss (2.32 [1.86-2.88]), comfort in talking to their HCP about weight (1.46 [1.24-1.72), agreement that it is easy to lose weight (1.73 [1.30-2.31]), and a goal of reducing risks from excess weight (1.45 [1.22-1.73]). Conversely, if PwO considered obesity less important than other diseases they were less likely to report feeling motivated (0.49 [0.41-0.58]). PwO who reported being motivated to lose weight were more likely to exercise ≥5 times a week versus <1 time a week (2.77 [2.09-3.68]) than those who reported they were not motivated.

CONCLUSIONS

Positive interactions with HCPs, self-efficacy, setting goals and knowledge of the importance of weight management, in addition to regular exercising, may increase PwO motivation for weight loss. Appropriate HCP support may help PwO who are ready to engage in weight management.

CLINICAL TRIAL REGISTRATION

NCT03584191.

Turkish primary care physicians’ attitudes and knowledge of obesity and bariatric surgery: a survey study

Objective: This survey study attempted to determine Turkish primary care physicians’ (PCP) knowledge, attitudes, and perceptions of obesity treatment and bariatric surgery. Moreover, the relationship between the duration of practice as a physician, and especially the indications for bariatric surgery and referral to surgery were investigated.

Material and Methods: A survey of 27 questions was administered via social media and the internet using the SurveyMonkey platform. The physicians who responded to the survey were grouped based on the duration of working life. Among these groups, the responses to the questions about bariatric surgery were compared using univariate analysis.

Results: A total of 1044 physicians responded to the survey. The number of physicians who strongly agreed that a PCP should play role in the treatment of obesity was 743 (71.1%). The most important reason for not undertaking this treatment was reported as the requirement for a multidisciplinary approach to obesity treatment (51.5%, n= 537). The percentage of those who thought that patients with a body mass index (BMI) above 40 kg/m2 should be referred to surgery was 72.3%,while the percentage of those referring patients with a BMI of 35-40 kg/m2 and comorbidities to surgery was 53.3%, and the percentage of those referring patients with a BMI of 35-40 kg/m2 and uncontrolled diabetes to surgery was 35.9%. Physicians who were new to the profession were found to evaluate surgical indications more positively (p< 0.05).

Conclusion: This study found that PCPs in Turkey had a basic knowledge of obesity treatment and were willing to treat and follow up these patients. However, it was observed that they could not adequately focus on this issue due to the requirement for a multidisciplinary approach to the disease and the workload. It was found that the young physiciansð level of knowledge of bariatric surgery was higher, but their attitudes towards patient referral were similar.

The roles of experienced and internalized weight stigma in healthcare experiences: Perspectives of adults engaged in weight management across six countries

BACKGROUND/OBJECTIVES

Considerable evidence from U.S. studies suggests that weight stigma is consequential for patient-provider interactions and healthcare for people with high body weight. Despite international calls for efforts to reduce weight stigma in the medical community, cross-country research is lacking in this field. This study provides the first multinational investigation of associations between weight stigma and healthcare experiences across six Western countries.

METHODS

Participants were 13,996 adults residing in Australia, Canada, France, Germany, the UK, and the US who were actively enrolled in an internationally available behavioral weight management program. Participants completed identical online surveys in the dominant language for their country that assessed experienced weight stigma, internalized weight bias, and healthcare behaviors and experiences including perceived quality of care, avoidance or delay of seeking care, experiences with providers, and perceived weight stigma from doctors.

RESULTS

Among participants who reported a history of weight stigma (56-61%), two-thirds of participants in each country reported experiencing weight stigma from doctors. Across all six countries, after accounting for demographics, BMI, and experienced stigma, participants with higher internalized weight bias reported greater healthcare avoidance, increased perceived judgment from doctors due to body weight, lower frequency of obtaining routine checkups, less frequent listening and respect from providers, and lower quality of healthcare. Additionally, experienced weight stigma (from any source) was indirectly associated with poorer healthcare experiences through weight bias internalization, consistently across the six countries.

CONCLUSIONS

Weight stigma in healthcare is prevalent among adults actively engaged in weight management across different Western countries, and internalized weight bias has negative implications for healthcare even after controlling for BMI. The similar findings across all six countries underscore the negative consequences of weight stigma on healthcare behaviors and experiences, and emphasize the need for collective international efforts to address this problem.

Misperceptions and barriers to obesity management: Italian data from the ACTION-IO study

PURPOSE

Despite the increasing prevalence of obesity in Italy, it remains largely underdiagnosed and undertreated. We aimed to identify the perceptions, attitudes, behaviours and barriers to effective obesity care among people with obesity (PwO) and healthcare professionals (HCPs) in Italy.

METHODS

The ACTION-IO study was an online cross-sectional survey conducted in 11 countries from June to October 2018. Findings from the Italian cohort are reported here.

RESULTS

The survey was completed by 1501 PwO and 302 HCPs in Italy. Most PwO (84%) and HCPs (77%) acknowledged the large impact of obesity on overall health. However, fewer PwO (62%) than HCPs (91%) perceived obesity as a chronic disease. Most PwO (84%) assumed full responsibility for their weight loss. A median of 3 (mean 6) years elapsed between when PwO started struggling with obesity and when they first discussed their weight with an HCP. Many PwO expressed that they liked (80%) or would like (74%) their HCPs to initiate weight management conversations, and only 3% were offended by such a conversation. For 77% of HCPs, perceiving their patients as unmotivated or disinterested in losing weight prevented them from initiating these conversations. Short appointment times were also considered a limiting factor for 40% of HCPs.

CONCLUSIONS

Most PwO took complete responsibility for their own weight loss and waited considerable time before seeking help from an HCP. There is a need for improved education of both PwO and HCPs and for a more positive attitude from HCPs towards initiating weight discussions with PwO. Trial registration ClinicalTrials.gov: Awareness, Care & Treatment in Obesity Management - an International Observation (ACTION-IO). ClinicalTrials.gov: NCT03584191 LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Women with obesity in cervical cancer screening. The double penalty: Underscreening and income inequalities

The regular performance of Pap tests reduces the mortality of cervical cancer. Obesity is associated with low Pap test rates. We analyze the combined role of obesity and low income. We calculated a Slope Index of Inequality. Among the 28,905 women included, 23.1% were underscreened. The rate of underscreening increased with BMI. The income gradient increased significantly from 0.17 among normal-weight women to 0.19 in overweight and 0.23 in obese women (p = 0.047). Women who are obese are subject to a double penalty in cervical cancer screening: they are underscreened and subject to a more unfavorable economic gradient than normalweight women.

Body size perception, knowledge about obesity and factors associated with lifestyle change among patients, health care professionals and public health experts

Background

The attitudes towards obesity may have an important role on healthier behavior. The goal of the present study was to explore the attitudes towards obesity and to investigate how these attitudes were associated with lifestyle-changing behavior among the patients attending primary care centers, health care professionals and public health experts.

Methods

This cross-sectional survey study was performed in 10 primary care offices in different regions in Lithuania and in 2 public health institutions. Nine hundred thirty-four patients, 97 nurses, 65 physicians and 30 public health experts have filled the questionnaire about attitudes towards obesity and presented data about lifestyle-changing activities during last 12 months. The attitudes were compared between different respondent groups and factors associated with healthier behaviors were analyzed among overweight/obese individuals in our study population.

Results

Participants failed to visually recognize correct figure corresponding to male and female with obesity. Majority of respondents’ perceived obesity as a risk factor for heart diseases and diabetes but had less knowledge about other diseases associated with weight. About one third of respondents changed their lifestyle during last 12 months. Overweight individuals with age < 45 years (OR 1.64, 1.06–2.55; p = 0.025) were more likely and those who overestimated current weight (OR 0.44, 0.20–0.96; p = 0.036) less likely to change their lifestyle. Disappointment with their current weight (OR 2.57, 1.36–4.84; p = 0.003) was associated with healthier behavior among participants with obesity.

Conclusion

Participants had similar body size perception and knowledge about obesity. Younger age had significant association with lifestyle changing behavior among overweight individuals and disappointment with current weight among obese participants.

Exploring general practitioners' perceptions about the primary care gatekeeper role in Indonesia

Background

In the current healthcare delivery system funded by National Health Insurance (NHI) in Indonesia, the gatekeeper role of primary care services is critical to ensuring equal healthcare access for the population. To be effective, gatekeeping relies on the performance of general practitioners (GPs). However, the perceptions held by Indonesian GPs about their gatekeeper role are not yet well documented. This study describes the self-perceived knowledge, attitudes and performance of Indonesian GPs with respect to the gatekeeper role and explores associated factors.

Methods

We conducted a cross-sectional study of all primary care facilities (N = 75) contracted by the regional NHI office in the Banyumas district. The 73 participating GPs completed a written questionnaire that assessed their knowledge, attitudes and performance in relation to the gatekeeper role. Personal and facility characteristics were analysed in a generalised linear model as possible associating factors, as well as for the association between GPs’ knowledge and attitude with performance as gatekeepers.

Results

GPs scored relatively high in the domains of knowledge and performance but scored lower in their attitudes towards the gatekeeper role of primary care. In the full-adjusted model, no factors were significantly associated with the knowledge score. Work experience as GPs, private or civil service employment status and rural or urban location of the primary care facility were linked to attitude scores. Full- or part-time employment and type of facility were factors associated with the performance score. Attitude scores were positively associated with performance score.

Conclusion

GPs in Indonesia are knowledgeable and report that they adequately perform their function as gatekeepers in primary care. However, their attitudes towards the gatekeeper function are less positive. Attitudes and performance with respect to the primary care gatekeeper role are likely influenced more by contextual factors such as location and type of facility than by personal factors. Efforts to address contextual issues could include improvements in practice standards for privately practising physicians and public information campaigns about gatekeeping regulations. Such efforts will be crucial to improving the gatekeeper role of primary care in Indonesia and assuring efficient access to high-quality care for all.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-020-01365-w.

Influence of Body Mass Index and Gender on Stigmatization of Obesity

BACKGROUND

Stigmatization and discrimination of people with obesity due to their weight are a common problem that may lead to additional weight gain. This study evaluated the influence of different parameters on the stigmatization of obesity.

MATERIAL AND METHODS

Participants of six groups (general population, patients with obesity, medical students, physicians, nurses in training and nurses; n = 490) answered the short-form fat phobia scale (FPS) between August 2016 and July 2017. The influence of body mass index (BMI), gender and other factors on total scores and single adjective pairs was analyzed.

RESULTS

A total of 490 participants were evaluated. The total mean FPS rating was 3.5 ± 0.6. FPS was significantly lower (more positive) in participants with obesity (3.2 ± 0.7) compared with participants without obesity (3.5 ± 0.5, p < 0.001). Individuals with obesity and diabetes rated the FPS significantly lower (more positive), whereas age and gender did not have a significant influence. Participants with obesity linked obesity more often with good self-control (p < 0.001), being shapely (p = 0.002), industrious (p < 0.001), attractive (p < 0.001), active (p < 0.001), self-sacrificing (p < 0.001) and having more willpower (p < 0.001) than the participants without obesity. Females rated more positive in shapely versus shapeless (p = 0.038) and attractive versus non-attractive (p < 0.001) than males.

CONCLUSIONS

The present study shows that stigmatization of obesity is present in medical professionals as well as the general population. People affected by obesity characterized other people with obesity more positively (e.g. attractive or active), whereas people without obesity linked negative characteristics with obesity. Gender had an influence only on single items of FPS but did not affect overall stigmatization of obesity.

Impact of an educational intervention combining clinical obesity preceptorship with electronic networking tools on primary care professionals: a prospective study

BACKGROUND

Primary care providers' (PCPs) attitude toward obesity is often negative, and their confidence level for helping patients manage their weight is low. Continuing professional development (CPD) on the subject of obesity is often based on a single activity using a traditional passive approach such as lectures known to have little effect on performance or patient outcomes. The aim of this study was to evaluate the impact of an educational intervention for obesity management on PCPs' attitude, self-efficacy, practice changes and patient-related outcomes.

METHODS

Prospective interventional study with 12 months follow-up. A two-day clinical obesity preceptorship was offered where participants were actively involved in competence building using real-life situations, in addition to electronic networking tools, including a discussion forum and interactive monthly webinars. Thirty-five participants (12 nurses and 23 physicians) from seven Family medicine groups were enrolled. Questionnaires were used to evaluate the impact on primary care nurses' and physicians' attitudes and self-efficacy for obesity management. Practice changes and patient outcomes were evaluated using clinical vignettes, de-identified electronic patient records and qualitative analyses from group interviews.

RESULTS

Physicians' general attitude towards patients with obesity was improved (61 ± 22 mm vs 85 ± 17 mm, p <  0.001). Self-efficacy for obesity management and lifestyle counselling were also improved immediately and 1 year after the intervention (all Ps <  0.05). De-identified patient records and clinical vignettes both showed improvement in recording of weight, waist circumference and evaluation of readiness to change lifestyle (all Ps <  0.05) that was confirmed by group interviews. Also, 15% of patients who were prospectively registered for weight management had lost more than 5% of their initial weight at the time of their last visit (P <  0.0001, median follow-up of 152 days).

CONCLUSION

A multimodal educational intervention for obesity management can improve PCPs'attitude and self-efficacy for obesity management and lifestyle counselling. This translates into beneficial practice changes and patient-related outcomes.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT01385397 . Retrospectively registered, 28 June 2011.

Attitudes and treatment practice of general practitioners towards patients with obesity in primary care

Background

Obesity is one of the most common and relevant health problems in need of urgent action in Germany. General practitioners (GPs) are the initial contact and thus one of the most important starting points for the successful treatment of overweight and obesity. The aim of the study was to assess the treatment practice and attitudes towards patients with obesity in primary health care in Germany.

Methods

Analyses were based on baseline data of the INTERACT trial of 47 GPs in central Germany. Stigmatizing attitudes were identified using the Fat Phobia Scale (FPS). In addition, questionnaires including sociodemographic information, attribution of causes of obesity, referral behavior and clinical activities were completed. Statistical investigations include descriptive analysis, principal component analysis, inference statistics and linear regression models.

Results

GPs rated the quality of medical care for patients with obesity in Germany as below average. The FPS score revealed a value of 3.70, showing that GPs’ attitudes towards patients with obesity are stigmatizing. Younger GP age, male gender and a lower number of referrals to specialists were associated with higher levels of stigmatizing attitudes.

Conclusion

Weight-related stigmatization has an impact on medical treatment. Obesity management guides would help to increase knowledge and reduce weight-related stigmatization in primary care, thereby improving medical care for obese and overweight patients.

Investigating lay beliefs regarding the effect of weight loss on health

OBJECTIVE

Individuals with obesity are often recommended weight loss for their health; however, the amount of weight loss that is recommended varies. Lay people's beliefs about weight loss could influence the types of behaviours they view as necessary for people with obesity. The present study explored lay beliefs regarding the health benefits of varying degrees of weight loss.

DESIGN

Participants (379 community members and 235 students) read information about an obese target who lost varying amounts of weight (none vs. modest vs. substantial) following behaviour changes.

MAIN OUTCOME

Participants evaluated the target's health and recommended health-related behaviours to the target.

RESULTS

The substantial weight-loss target, but not the modest weight-loss target, was perceived as being healthier than the no weight-loss target. There were no differences in behaviour recommendations made to the no weight-loss and modest weight-loss targets, with most participants recommending further weight loss to both targets.

CONCLUSIONS

Lay people appear to view substantial, but not modest, weight loss as beneficial to health, and they recommend further, more unrealistic amounts of weight loss to obese individuals who have already achieved modest weight loss. A failure to recognise the health benefits of modest weight loss may contribute to unrealistic weight loss goals.

Attitudes about cannabis mediate the relationship between cannabis knowledge and use in active adult athletes

BACKGROUND

Little is known about how cannabis knowledge and attitudes impact cannabis use behavior.

OBJECTIVE

To test the knowledge-attitudes-behavior paradigm in active adult athletes.

DESIGN

The Athlete Pain, Exercise, and Cannabis Experience (PEACE) Survey, a cross-sectional survey study, used social media and email blasts to recruit participants and SurveyGizmo to collect data.

PARTICIPANTS

Self-defined active adult athletes (n = 1161).

MAIN MEASURES

Knowledge about cannabis was evaluated with four questions. Attitudes toward cannabis was evaluated with 11 questions. The attitudes questions were used in a TwoStep Cluster analysis in SPSS to assign group membership by attitudes. Chi-square was used to determine if there were differences in cluster membership by demographic factors and if knowledge about cannabis differed by cluster membership. Regression analysis was performed to determine if cannabis attitudes mediated the relationship between cannabis knowledge and cannabis use.

KEY RESULTS

A three-cluster solution was the best fit to the data. The clusters were named Conservative (n = 374, 32.2%), Unsure (n = 533, 45.9%), and Liberal (n = 254, 21.9). There was a significant difference among the clusters for all 11 attitudes items (all p < 0.001). Attitude cluster membership was significantly different by age (p < 0.001), primary sport (p < 0.05), and knowledge about cannabis (p < 0.001). Athletes in the liberal cluster answered the knowledge questions correctly most often. Attitudes mediated the relationship between cannabis knowledge and cannabis use [Never (32.4%), Past (41.6%), Current (26.0%)] with athletes in the liberal cluster showing more knowledge and greater likelihood to be a current cannabis user (p < 0.001). Among current cannabis users there were differential patterns of cannabis use depending on their attitudes and knowledge; liberal athletes tended to co-use THC and CBD and used cannabis longer. (p < 0.001).

CONCLUSIONS

Cannabis education needs to consider attitudes about cannabis, especially among those who might benefit from medical cannabis.

Primary care patient and practitioner views of weight and weight-related discussion: a mixed-methods study

OBJECTIVE

To understand the beliefs that primary care practitioners (PCPs) and patients with overweight and obesity have about obesity and primary care weight management in Scotland.

SETTING

Seven National Health Service (NHS) Scotland primary care centres.

PARTICIPANTS

A total of 305 patients and 14 PCPs (12 general practitioners; two practice nurses) participated.

DESIGN AND METHODOLOGY

A cross-sectional mixed-methods study. PCPs and patients completed questionnaires assessing beliefs about obesity and primary care weight communication and management. Semi-structured interviews were conducted with PCPs to elaborate on questionnaire topics. Quantitative and qualitative data were synthesised to address study objectives.

RESULTS

(1) Many patients with overweight and obesity did not accurately perceive their weight or risk of developing weight-related health issues; (2) PCPs and patients reported behavioural factors as the most important cause of obesity, and medical factors as the most important consequence; (3) PCPs perceive their role in weight management as awareness raising and signposting, not prevention or weight monitoring; (4) PCPs identify structural and patient-related factors as barriers to weight communication and management, but not PCP factors.

CONCLUSIONS

Incongruent and/or inaccurate beliefs held by PCPs and patient may present barriers to effective weight discussion and management in primary care. There is a need to review, standardise and clarify primary care weight management processes in Scotland. Acknowledging a shared responsibility for obesity as a disease may improve outcomes for patients with overweight and obesity.

Experience of Polish Patients with Obesity in Contacts with Medical Professionals

PURPOSE

Discrimination and stigmatization of patients with obesity are a commonly occurring social problem. The purpose of our research was to analyze the scale of the experience including medical staff's improper behaviours towards patients with obesity in Poland.

PATIENTS AND METHODS

In a completed national study, we studied the statements of 621 adult patients who suffer from obesity. An original closed question survey was used as a tool to collect the data. Patients were informed about the possibility to participate in the study through social media, medical institutions and patient foundations.

RESULTS

As many as 82.6% have experienced improper behaviours. Usually, it came from doctors (90%), nurses and midwives (51%), people who operated medical equipment (24%), nutritionists (14%) and paramedics (9%). Exactly 81% of the respondents pointed to unpleasant and judgmental comments as the most frequent form of improper behaviour which they have encountered mainly during diagnostic tests, palpation or procedures.

CONCLUSION

There is an urgent need for developing national strategies connected with care for individuals with higher body weight. Introducing dedicated solutions in this field may contribute to increasing the quality of health care and reducing stigmatizing behaviours.

An analysis of directly observed weight communication processes between primary care practitioners and overweight patients

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.

Metabolically healthy and unhealthy obesity in erectile dysfunction and male infertility

Introduction: Metabolically unhealthy obesity (MUHO) is the most important preventable cardiovascular (CV) risk factor. Recently, the significance of metabolically healthy obesity (MHO) as a CV risk factor has raised increasing interest. MUHO is a known risk factor for erectile dysfunction (ED); however, the effect of MHO on ED has barely been investigated. This review aims at summarizing the evidence supporting the relation of MUHO and MHO to male sexual functioning and fertility. Areas covered: An extensive Medline search on obesity and ED or male infertility was conducted to summarize the role of MUHO or MHO on male sexual dysfunction and infertility. Expert opinion: Longitudinal studies have demonstrated that MHO causes vascular damage, which is consistent with the impairment in penile blood flows found in ED subjects. In this population, MHO is a predictor of CV events. The relationship between male infertility and MUHO is currently debated and data on MHO are almost completely lacking. The only available study did not find an association between obesity classes and semen parameters. Although the andrological correlates of MHO must be better assessed, in the current state, evidence suggests that MHO does not represent a benign condition and measures for improving lifestyle are mandatory.

Is an obesity simulation suit in an undergraduate medical communication class a valuable teaching tool? A cross-sectional proof of concept study

OBJECTIVE

With the growing prevalence of overweight and obesity, medical students should be prepared to engage in weight management and obesity-related communications in order to prevent patients from having stigmatising experiences. In addition, medical students should have training to reduce anti-fat prejudices.

DESIGN

Cross-sectional proof of concept study.

SETTING

University Hospital Tuebingen, Germany.

PARTICIPANTS

246 participants (207 second-year medical students, 13 standardised patients (SPs) and 22 teachers) took part in the study.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was the assessment of degree of reality of the encounter with the SP wearing an obesity simulation suit (OSS). The secondary outcome was the evaluation of students' awareness and prejudice against patients with obesity in a simulated role play. Additionally, a description of the advantages and disadvantages when using such a teaching tool is delivered.

RESULTS

The OSS contributed to a realistic perception of the patient group depicted in a role play according to students, teachers and SPs. OSS body mass index estimation by students, teachers and SPs correctly was over 30 kg/m²-thus in the range of obesity. In a selected subscale of the Anti-Fat Attitudes Test, students showed significantly stronger anti-fat stigmatisation compared with teachers and SPs.

CONCLUSIONS

An OSS worn by an SP is a valuable teaching tool to raise awareness about patients with obesity. It gives a realistic picture of the encounter. Stigmatisation was low in general but was especially present in the students. Further research should include intervention studies to address this issue.

Gaps to bridge: Misalignment between perception, reality and actions in obesity

AIMS

Despite increased recognition as a chronic disease, obesity remains greatly underdiagnosed and undertreated. We aimed to identify international perceptions, attitudes, behaviours and barriers to effective obesity care in people with obesity (PwO) and healthcare professionals (HCPs).

MATERIALS AND METHODS

An online survey was conducted in 11 countries. Participants were adults with obesity and HCPs who were primarily concerned with direct patient care.

RESULTS

A total of 14 502 PwO and 2785 HCPs completed the survey. Most PwO (68%) and HCPs (88%) agreed that obesity is a disease. However, 81% of PwO assumed complete responsibility for their own weight loss and only 44% of HCPs agreed that genetics were a barrier. There was a median of three (mean, six) years between the time PwO began struggling with excess weight or obesity and when they first discussed their weight with an HCP. Many PwO were concerned about the impact of excess weight on health (46%) and were motivated to lose weight (48%). Most PwO (68%) would like their HCP to initiate a conversation about weight and only 3% were offended by such a conversation. Among HCPs, belief that patients have little interest in or motivation for weight management may constitute a barrier for weight management conversations. When discussed, HCPs typically recommended lifestyle changes; however, more referrals and follow-up appointments are required.

CONCLUSIONS

Our international dataset reveals a need to increase understanding of obesity and improve education concerning its physiological basis and clinical management. Realization that PwO are motivated to lose weight offers an opportunity for HCPs to initiate earlier weight management conversations.

Personality Traits and Obesity

Objective: Previous studies investigating the association between body weight and personality traits have found mixed results. This paper uses a large data set and two different study designs (cross-sectional and longitudinal) to provide more consistent estimates of the effect of personality traits on obesity. Methods: The present study is based on data from the German Socio-Economic Panel (GSOEP) from the waves 2005 to 2013; GSOEP is a longitudinal survey of private households in Germany that has been carried out since 1984. Responses provided data about personality, measured using the BFI-S Questionnaire, data for self-rated body mass index BMI (to determine the obesity level), as well as information for potential confounders. Cross-sectional and longitudinal logistic regression models were used. Results: The cross-sectional study yielded statistically significant results for the association between the outcome variable and four personality factors neuroticism, extraversion, openness and agreeableness. After controlling for several potential confounders, the association between obesity and extraversion, openness as well as agreeableness remained; additionally, the personality factor consciousness reached statistical significance. In the longitudinal study, a statistically significant association was found only for two personality factors, namely extraversion and agreeableness. After adding the control variables, the FE-regression yielded an association only for agreeableness (negative). Gender differences were not significant. Discussion: The findings show that results of a cross-sectional study design differ from the outcome of the longitudinal study design. The latter stresses the association between excess weight and the personality factor agreeableness, contrasting with most outcomes of previous research.

Assessment of tear film in subjects with a high body mass index

PURPOSE

The aim of the study was to assess the tear film in subjects with a high body mass index (BMI).

METHODS

Twenty male subjects aged 23-42 years (mean ± standard deviation =31.3±5.7 years) with a high BMI [median (interquartile range) =31.8 (5.2) kg/m2] were recruited. An age-matched control group of twenty male subjects aged 22-38 years with a normal BMI [20.5 (2.8) kg/m2] also participated in the study.

RESULTS

There were significant (Kolmogorov-Smirnov test; P<0.05) differences in the BMI, non-invasive tear break-up time (NITBUT), and tear ferning (TF) scores between the study and control groups. There were some differences in the ocular surface disease index (OSDI), tear meniscus height (TMH), and phenol red thread (PRT) scores between the study and control groups, but these differences were not significant (Kolmogorov-Smirnov test; P>0.05). For the study group, the NITBUT and TF tests mean scores showed a dry eye condition (8.5±2.8 s and 2.0±1.1, respectively). However, these two tests showed a normal eye condition within the control group (14.7±2.8 s and 0.7±0.6, respectively). The TMH score had strong correlations with the NITBUT (r=0.711; P=0.001) and PRT scores (r=0.566; P=0.009) and strong negative correlations with age (r=-0.503; P=0.024) and the OSDI scores (r=-0.520; P=0.018). The TF score had a strong correlation with age (r=0.579; P=0.007) and strong negtive correlations with the scores from the NITBUT (r=-0.525; P=0.018), TMH (r=-0.575; P=0.008), and PRT (r=-0.773; P=0.001) tests.

CONCLUSION

The acquired data suggest a high BMI has an effect on the quality of tears. The quality of tears seems to be lower in subjects with a high BMI compared with normal subjects. On the other hand, the tear volume in subjects with a high BMI was just as high and adequate as for normal eye subjects.

An Investigation of Chiropractor-Directed Weight-Loss Interventions: Secondary Analysis of O-COAST

OBJECTIVE

The purpose of this study was to investigate weight-loss interventions offered by Canadian doctors of chiropractic to their adult patients.

METHODS

This paper reports a secondary analysis of data from the Ontario Chiropractic Observation and Analysis STudy (N_c = 42 chiropractors, N_p = 2162 patient encounters). Multilevel logistic regression was performed to assess the odds of chiropractors initiating or continuing weight management interventions with patients. Two chiropractor variables and 8 patient-level variables were investigated for influence on chiropractor-directed weight management. In addition, the interaction between the effects of patient weight and comorbidity on weight management interventions by chiropractors was assessed.

RESULTS

Around two-thirds (61.3%) of patients who sought chiropractic care were either overweight or had obesity. Very few patients had weight loss managed by their chiropractor. Among patients with body mass index equal to or greater than 18.5 kg/m², guideline recommended weight management was initiated or continued by Ontario chiropractors in only 5.4% of encounters. Chiropractors did not offer weight management interventions at different rates among patients who were of normal weight, overweight, or obese (P value = 0.23). Chiropractors who graduated after 2005 who may have been exposed to reforms in chiropractic education to include public health were significantly more likely to offer weight management than chiropractors who graduated between 1995 and 2005 (odds ratio 0.02; 95% CI [0.00-0.13]) or before 1995 (odds ratio 0.08; 95% CI [0.01-0.42]).

CONCLUSION

The prevalence of weight management interventions offered to patients by Canadian chiropractors in Ontario was low. Health care policy and continued chiropractic educational reforms may provide further direction to improve weight-loss interventions offered by doctors of chiropractic to their patients.

The Importance of Language in Behavior Change

Communication between health care providers and patients is important for behavioral treatment in lifestyle medicine. Ineffective communication can lead to patient dissatisfaction, demotivation, and discontinuation of treatment. It is important for health care providers to understand their biases, praise patients' behaviors rather than health outcomes, and use language to prevent dichotomous thinking. These strategies may lead to sustained lifestyle behavior changes and better treatment outcomes among patients.

Perception and Management of Obesity Among Pakistani Doctors

Background The incidence of obesity has been on the rise worldwide. In Pakistan alone, one in four adults is overweight/obese and thus at risk of developing a number of comorbidities such as cardiovascular disease and diabetes. This research aimed to examine how doctors perceived and managed their obese patients. Methods A standardized questionnaire was filled by 100 doctors working in Pakistan, either by hand or online. The study was conducted from November 2017 to January 2018. Results It was found that only 8% of doctors had completed a training course on obesity. Doctors discussed the links between obesity and diabetes (88%) most often whilst neglecting cancer (30%) and dementia (17%). Only 60% of doctors calculated body mass index (BMI) for adult obese patients, with general practitioners (GPs) being the most confident in discussing their weight issues (p=0.001). In terms of childhood obesity, 54% of doctors were confident in putting in place a weight management program. Doctors who checked their weight more than four times a year were found to calculate the BMI of children and adult patients more often (p=0.000 and p=0.044). Comparably, doctors of normal weight were more confident in managing the complications of adult obesity (p=0.015). Conclusion Training courses regarding obesity should be provided to doctors not only to increase their knowledge but also to increase their confidence levels in managing such patients. Further research needs to be carried out in order to understand the patients' perception of obesity management.

Health advice and education given to overweight patients by primary care doctors and nurses: A scoping literature review

Health advice for overweight patients in primary care has been a focus of obesity guidelines. Primary care doctors and nurses are well placed to provide evidence based preventive health advice. This literature review addressed two research questions: ‘When do primary care doctors and nurses provide health advice for weight management?’ and ‘What health advice is provided to overweight patients in primary care settings?’

The study was conducted in the first half of 2018 and followed Arksey and O'Malley (2005) five stage framework to conduct a comprehensive scoping review. The following databases were searched: Emcare, Ovid, Embase, The Cochrane library, Proquest family health, Health source (nursing academic), Joanna Briggs Institute EBP database, Medline, PubMed, Rural and remote, Proquest (nursing and allied health) and TRIP using search term parameters. Two hundred and forty-eight (248) articles were located and screened by two reviewers.

Twenty-three research papers met the criteria and data were analysed using a content analysis method. The results show that primary care doctors and nurses are more likely to give advice as BMI increases and often miss opportunities to discuss weight with overweight patients. Body Mass Index (BMI) is often wrongly categorised as overweight, when in fact it is in the range of obese, or not recorded and when health advice is given, it can be of poor quality. Few studies on this topic included people under 40 years, practice nurses as the focus and those with a BMI of 25–29.9 without a risk factor. A ‘toolkit’ approach to improve advice and adherence to evidence based guidelines should be explored in future research.

A weight loss intervention delivered by peer coaches in primary care: Rationale and study design of the PROMISE trial

Primary care offers a familiar and accessible clinical venue for patients with obesity to receive evidence-based lifestyle interventions for weight management. However, there are numerous barriers to the implementation of such programs in primary care, and previous primary care weight loss interventions demonstrate modest and temporary effects. Weight loss treatment delivered within primary care by peer coaches may offer a viable and effective alternative. The purpose of this trial is to test the effects of weight loss treatment that includes ongoing support from a peer coach (i.e., trained, salaried community health workers) as compared to self-directed treatment. Peer coach treatment will be delivered over 18 months and includes a combination of in-person, group-based office visits and individual telephone contacts. This weight loss trial will include 375 adults with obesity (BMI = 30-50 kg/m2) randomized from 10 primary care practices. The primary outcome will be changes in body weight at month 18. Secondary outcomes will include key patient-centered outcomes, including quality-of-life, physical and social functioning, mood, and treatment satisfaction. The cost-effectiveness of the peer coach intervention will also be evaluated. If this novel intervention is effective, it could offer a practical and sustainable approach for the delivery of weight loss treatment in primary care that has the potential to improve clinical outcomes for patients, increase treatment options for primary care providers, and reduce obesity-related healthcare utilization and costs.

Media and Its Influence on Obesity

PURPOSE OF REVIEW

To review how the media frames obesity and the effect it has upon on public perceptions.

RECENT FINDINGS

The scientific and public health understanding of obesity increasingly points away from individual behaviors and toward medical and community factors, but diffusion of this knowledge is slow. Growing awareness of the importance of body positivity is driving attention to the harms of weight bias and fat shaming. Health science reporting related to obesity, nutrition, and physical activity tends to perpetuate myths and misunderstandings. Moving forward, greater attention to accurate messages about obesity and evidence-based interventions will be essential for progress to reduce suffering and the impact on public health from this chronic disease.

Knowledge, attitudes, representations and declared practices of nurses and physicians about obesity in a university hospital: training is essential

In the context of a worldwide obesity epidemic, healthcare providers play a key role in obesity management. Knowledge of current guidelines and attitudes to prevent stigmatization are especially important. This study aimed to assess knowledge, attitudes, beliefs, perception of opportunity for intervention, declared practices and need for training and material of nurses and physicians about obesity in a Swiss University Hospital. A total of 834 physicians and nurses filled an online survey. The questionnaire was based on literature, exploratory interviews and expert committee review. It was pre-tested with 15 physicians and nurses. Participants declared a low level of negative attitudes towards individuals living with obesity. However, the results highlighted a lack of knowledge to diagnose obesity in adults and children, as well as confidence and training to care of patients with obesity. One-third of providers did not know how to calculate body mass index. Half of providers felt it was part of their role to take care of patients with obesity, even if 55% of them had the feeling that they did not have adequate training. Nurses and physicians working in a university hospital showed a low level of negative attitudes but a lack of knowledge and skills on obesity management. Training should be improved in this population to insure adequate and coherent messages and equal access to evidence-based treatment for patients living with obesity.

A Narrative Review of Physician Perspectives Regarding the Social and Environmental Determinants of Obesity

PURPOSE OF REVIEW

Diet-related chronic diseases result from individual and non-individual (social, environmental, and macro-level) factors. Recent health policy trends, such as population health management, encourage assessment of the individual and non-individual factors that cause these diseases. In this review, we evaluate the physician's perspective on the individual and non-individual causes and management of obesity.

RECENT FINDINGS

Physicians generally rated individual-level causes (i.e., biology, psychology, and behavior) as more important than social or environmental factors in the development of obesity, and utilized individual-level strategies over social or environmental strategies to manage obesity. This review suggests that clinicians perceive individual characteristics to be more important in the development and management of obesity than social or environmental factors. Additional research is needed to understand why.

Physicians' perspectives on implementing the prevention scheme "Physical Activity on Prescription": Results of a survey in Bavaria

The prevention scheme called "Rezept für Bewegung" (Physical Activity on Prescription, PAP) enables physicians to formally prescribe participation in health-oriented sports programs to their patients. The PAP scheme aims to strengthen the binding character of physicians' patient counselling for physical activity. The research objective was to investigate the physicians' awareness and their use of PAP as a prevention tool in patient counselling, as well as perceived barriers to implementation. A cross-sectional total population mail questionnaire survey was performed in two districts of Bavaria. 2,821 physicians in private practice were contacted; the response rate was 32.7 %. Descriptive data analysis of 923 questionnaires was carried out using SPSS. Only 26.4 % of the respondents (244/923) were familiar with the PAP scheme, and only 7.7 % (71/923) used PAP at least once a month when counselling their patients. Key barriers to implementation include lack of information on the prevention scheme, a limited choice of local matching sports programs and an unclear commitment of health insurances to reimburse patients for participation fees. Every third physician distrusts PAP to be an efficient way of improving physical activity in patients. To foster the implementation of PAP in the future, awareness-raising campaigns and an expansion of sports programs might be helpful. In order to strengthen the physicians' confidence in the effectiveness of preventive patient counselling on physical activity, existing research evidence needs to be spread among physicians.

Australian Healthcare Professionals' Knowledge of and Attitudes toward Binge Eating Disorder

Objective: This study aimed to investigate Australian healthcare practitioners’ knowledge and attitudes toward binge eating disorder (BED).

Method: Participants were 175 healthcare professionals, who were randomized to one of two conditions that assessed diagnostic and treatment knowledge of either comorbid BED and obesity or only obesity via case vignette, as well as weight bias toward obese patients.

Results: Results suggested that participants demonstrated a reluctance to diagnose comorbid BED and obesity, that their knowledge of physical complications associated with BED was limited, and that they indicated a narrow range of evidence-based treatment options. When compared with levels of weight bias expressed by healthcare professionals in previous international studies, Australian clinicians were significantly less biased, however, still largely endorsed ‘negative’ attitudes toward obesity.

Conclusion: Findings suggest that future clinical training in eating disorders should therefore focus not only on diagnostic criteria, physical complications and treatment options, but also on practitioner attitudes toward eating and weight.

Relationship Between Body Mass Index and Obesity Awareness in School Students

BACKGROUND

The primary aim was to assess the prevalence of overweight and obesity among the participants and its relationship to obesity awareness.

METHODS

A cross-sectional study that included intermediate and high schools students was conducted between April 2014 and June 2015. Anthropometric measurements were obtained by the researchers and body mass index (BMI) was calculated. We used the obesity risk knowledge (ORK-10) scale to assess obesity awareness. Participants who answered ≥ 5 out of 10 questions correctly were considered to be aware.

RESULT

A total of 528 students were enrolled (mean age, 15.58 years). The mean BMI was 22.37 kg/m2, and 27.6% were either overweight or obese. The mean ORK-10 score was 3.15 and 25.4% were considered to be aware. Compared to those who were non-aware, participants in the aware group were more likely to be older (P < 0.001), male (P < 0.001), attend high school (P < 0.001), eat dinner with their families (P = 0.021), eat fruit at least daily (P = 0.027), and consider obesity to be a disease (P < 0.001).

CONCLUSION

Only 25.4% of students who participated were considered to be aware about obesity. Those who were aware were more likely to be older male high school students.

Physicians' views and experiences of discussing weight management within routine clinical consultations: A thematic synthesis

OBJECTIVE

To systematically search and synthesise qualitative studies of physicians' views and experiences of discussing weight management within a routine consultation.

METHODS

A systematic search of four electronic databases identified 11,169 articles of which 16 studies met inclusion criteria. Quality was appraised using the Critical Appraisal Skills Programme tool and a thematic synthesis conducted of extracted data.

RESULTS

Four analytical themes were found: (1) physicians' pessimism about patients' weight loss success (2) physicians' feel hopeless and frustrated (3) the dual nature of the physician-patient relationship (4) who should take responsibility for weight management.

CONCLUSION

Despite clinical recommendations barriers remain during consultations between physicians and patients about weight management. Many of these barriers are potentially modifiable.

PRACTICE IMPLICATIONS

Improving training, providing clearer guidelines and placing a greater emphasis on collaboration within and between clinicians will help reduce barriers for both physicians and patients. In particular, there is an urgent need for more specialised training for physicians about weight management to promote knowledge and skills in behaviour change techniques and ways to broach sensitive topics without damaging patient relationships.