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Pommer W, Krautschneider H, Kuhlmann SD, Koplin G, Susewind M, Tsuprykov O. Undetected and undiagnosed comorbidity in patients with obesity undergoing bariatric surgery-Results from the Berlin Bariatric Cohort study. Clin Obes 2024:e12695. [PMID: 39054617 DOI: 10.1111/cob.12695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 06/03/2024] [Accepted: 07/07/2024] [Indexed: 07/27/2024]
Abstract
The quality of general obesity management before bariatric surgery (BS) is rarely investigated. Inadequate information regarding undetected and undiagnosed comorbidities (UUCs) in individuals with obesity may influence the penetration, risks, and outcomes of BS. We conducted a cohort study involving a pre-specified medical check-up in a cooperation between a BS department and an outpatient medical centre. A total of 1068 patients (74.4% women) were enrolled in the study. The mean age was 42.1 years (standard deviation [SD] 11.9) and the mean body mass index (BMI) was 46.1 (SD 6.91). The onset of obesity occurred in 11.4% of patients during childhood, 47.2% during schooltime/adolescence, 41.4% in adulthood. Gender differences were observed: men had higher BMI, systolic blood pressure, and impaired metabolic state (including diabetes, dyslipidemia, and liver disease with p-values <.001 for all). Women had lower haemoglobin levels, impaired iron status, lower albumin levels (p < .001), and increased C-reactive protein levels (p < .05). The prevalence of UUC conditions (percentage of cases) was as follows: arterial hypertension, 53%; decreased cystatin C clearance, 57%; dyslipidemia, 41%; fatty liver, 40%; iron deficiency, 37%; diabetes mellitus, 34%; vitamin D deficiency, 32%; chronic pain syndrome, 23%; liver fibrosis, 12%; obstructive sleep apnea, 10%; and vitamin deficiencies (vitamin B12, folic acid, vitamin K1) <10%. Undiagnosed hypertension was more prevalent in younger women, and nutritional deficits were associated with high BMI in both genders. Older age and high BMI were associated with undiagnosed diabetes and decreased glomerular filtration rate in both genders, and with liver fibrosis in men. UUC are highly prevalent in individuals undergoing BS. A refined assessment is recommended to improve health conditions and outcome in these candidates.
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Affiliation(s)
- Wolfgang Pommer
- Medizinisches Versorgungszentrum (MVZ), Windscheidstrasse, Berlin, Germany
- Charité Universitätsmedizin, Berlin, Germany
| | | | - Susanne D Kuhlmann
- Medizinisches Versorgungszentrum (MVZ), Windscheidstrasse, Berlin, Germany
| | - Gerold Koplin
- Klinik für Minimal-Invasive Chirurgie (MIC), Berlin, Germany
| | - Martin Susewind
- Klinik für Minimal-Invasive Chirurgie (MIC), Berlin, Germany
| | - Oleg Tsuprykov
- IFLB - Institute for Laboratory Medicine Berlin, Berlin, Germany
- Faculty of Medicine, Institute of Mind, Brain and Behavior, HMU Health and Medical University, Potsdam, Germany
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Atlantis E, Chimoriya R, Seifu CN, Peters K, Murphy G, Carr B, Lim D, Fahey P. Enablers and barriers to implementing obesity assessments in clinical practice: a rapid mixed-methods systematic review. BMJ Open 2022; 12:e063659. [PMID: 36446466 PMCID: PMC9710371 DOI: 10.1136/bmjopen-2022-063659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES This systematic review aims to improve our knowledge of enablers and barriers to implementing obesity-related anthropometric assessments in clinical practice. DESIGN A mixed-methods systematic review. DATA SOURCES Medline, Embase and CINAHL to November 2021. ELIGIBILITY CRITERIA Quantitative studies that reported patient factors associated with obesity assessments in clinical practice (general practice or primary care); and qualitative studies that reported views of healthcare professionals about enablers and barriers to their implementation. DATA EXTRACTION AND SYNTHESIS We used random-effects meta-analysis to pool ratios for categorical predictors reported in ≥3 studies expressed as pooled risk ratio (RR) with 95% CI, applied inverse variance weights, and investigated statistical heterogeneity (I2), publication bias (Egger's test), and sensitivity analyses. We used reflexive thematic analysis for qualitative data and applied a convergent integrated approach to synthesis. RESULTS We reviewed 22 quantitative (observational) and 3 qualitative studies published between 2004 and 2020. All had ≥50% of the quality items for risk of bias assessments. Obesity assessment in clinical practice was positively associated with patient factors: female sex (RR 1.28, 95% CI 1.10 to 1.50, I2 99.8%, mostly UK/USA), socioeconomic deprivation (RR 1.21, 95% CI 1.18 to 1.24, I2 73.9%, UK studies), non-white race/ethnicity (RR 1.27, 95% CI 1.03 to 1.57, I2 99.6%) and comorbidities (RR 2.11, 95% CI 1.60 to 2.79, I2 99.6%, consistent across most countries). Obesity assessment was also most common in the heaviest body mass index group (RR 1.55, 95% CI 0.99 to 2.45, I2 99.6%). Views of healthcare professionals were positive about obesity assessments when linked to patient health (convergent with meta-analysis for comorbidities) and if part of routine practice, but negative about their role, training, time, resources and incentives in the healthcare system. CONCLUSIONS Our evidence synthesis revealed several important enablers and barriers to obesity assessments that should inform healthcare professionals and relevant stakeholders to encourage adherence to clinical practice guideline recommendations.
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Affiliation(s)
- Evan Atlantis
- Schoolof Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
- Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
- Discipline of Medicine, Faculty of Medicine and Health, Nepean Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Ritesh Chimoriya
- Schoolof Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
- Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
- Schoolof Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Canaan Negash Seifu
- Schoolof Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Kath Peters
- Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
- Schoolof Nursing and Midwifery, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Gill Murphy
- Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
- Schoolof Nursing and Midwifery, Western Sydney University, Campbelltown, New South Wales, Australia
| | | | - David Lim
- Schoolof Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
| | - P Fahey
- Schoolof Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
- Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
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Znyk M, Zajdel R, Kaleta D. Consulting Obese and Overweight Patients for Nutrition and Physical Activity in Primary Healthcare in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137694. [PMID: 35805379 PMCID: PMC9265845 DOI: 10.3390/ijerph19137694] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/16/2022] [Accepted: 06/21/2022] [Indexed: 11/16/2022]
Abstract
The aim of this study was to evaluate the dietary and physical activity counseling provided to adults by family doctors. Predictors of counseling in primary healthcare were identified. A cross-sectional study was conducted from January 2020 to December 2021 among 896 adult primary care patients in the city of Łódź [Lodz], Poland. Almost 36% of the respondents were advised to change their eating habits, and 39.6% were advised to increase their physical activity. In a multivariate logistic regression analysis, people in poor health with chronic diseases related to overweight and obesity and with two, three or more chronic diseases, respectively, received advice on eating habits from their GP twice and three times more often than people in good health with no chronic conditions (OR = 1.81; p < 0.05 and OR = 1.63; p < 0.05; OR = 3.03; p < 0.001). People in the age groups 30−39 years and 40−49 years (OR = 1.71; p < 0.05 and OR = 1.58; p < 0.05), widowed (OR = 2.94; p < 0.05), with two, three or more chronic diseases (OR = 1.92; p < 0.01 and OR = 3.89; p < 0.001), and subjectively assessing overweight and obesity (OR = 1.61; p < 0.01) had a better chance of receiving advice on physical activity. The study found a higher proportion of advice on diet and physical activity provided to overweight and obese patients by primary care physicians than in other studies; however, still not all receive the necessary counseling. GPs should advise all patients not to become overweight and obese, not only those already affected by the problem.
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Affiliation(s)
- Małgorzata Znyk
- Department of Hygiene and Epidemiology, Medical University of Lodz, Żeligowskiego 7/9, 90-752 Łódź, Poland;
- Correspondence:
| | - Radosław Zajdel
- Department of Computer Science in Economics, University of Lodz, POW 3/5, 90-255 Łódź, Poland;
| | - Dorota Kaleta
- Department of Hygiene and Epidemiology, Medical University of Lodz, Żeligowskiego 7/9, 90-752 Łódź, Poland;
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Welzel FD, Bär J, Stein J, Löbner M, Pabst A, Luppa M, Grochtdreis T, Kersting A, Blüher M, Luck-Sikorski C, König HH, Riedel-Heller SG. Using a brief web-based 5A intervention to improve weight management in primary care: results of a cluster-randomized controlled trial. BMC FAMILY PRACTICE 2021; 22:61. [PMID: 33794781 PMCID: PMC8017625 DOI: 10.1186/s12875-021-01404-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/25/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND The primary health care setting is considered a major starting point in successful obesity management. However, research indicates insufficient quality of weight counseling in primary care. Aim of the present study was to implement and evaluate a 5A online tutorial aimed at improving weight management and provider-patient-interaction in primary health care. The online tutorial is a stand-alone low-threshold minimal e-health intervention for general practitioners based on the 5As guidance for obesity management by the Canadian Obesity Network. METHODS In a cluster-randomized controlled trial, 50 primary care practices included 160 patients aged 18 to 60 years with obesity (BMI ≥ 30). The intervention practices had continuous access to the 5A online tutorial for the general practitioner. Patients of control practices were treated as usual. Primary outcome was the patients' perspective of the doctor-patient-interaction regarding obesity management, assessed with the Patient Assessment of Chronic Illness Care before and after (6/12 months) the training. Treatment effects over time (intention-to-treat) were evaluated using mixed-effects linear regression models. RESULTS More than half of the physicians (57%) wished for more training offers on obesity counseling. The 5A online tutorial was completed by 76% of the physicians in the intervention practices. Results of the mixed-effects regression analysis showed no treatment effect at 6 months and 12 months' follow-up for the PACIC 5A sum score. Patients with obesity in the intervention group scored lower on self-stigma and readiness for weight management compared to participants in the control group at 6 months' follow-up. However, there were no significant group differences for weight, quality of life, readiness to engage in weight management, self-stigma and depression at 12 months' follow-up. CONCLUSION To our knowledge, the present study provides the first long-term results for a 5A-based intervention in the context of the German primary care setting. The results suggest that a stand-alone low-threshold minimal e-health intervention for general practitioners does not improve weight management in the long term. To improve weight management in primary care, more comprehensive strategies are needed. However, due to recruitment difficulties the final sample was smaller than intended. This may have contributed to the null results. TRIAL REGISTRATION The study has been registered at the German Clinical Trials Register (Identifier: DRKS00009241 , Registered 3 February 2016).
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Affiliation(s)
- Franziska D Welzel
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany. .,Integrated Research and Treatment Centre (IFB) AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany.
| | - Jonathan Bär
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany
| | - Janine Stein
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany
| | - Margrit Löbner
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany.,Integrated Research and Treatment Centre (IFB) AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany
| | - Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany
| | - Thomas Grochtdreis
- Department of Health Economics and Health Services Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Anette Kersting
- Integrated Research and Treatment Centre (IFB) AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany.,Clinic for Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Matthias Blüher
- Integrated Research and Treatment Centre (IFB) AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany.,Department of Endocrinology, Nephrology, Rheumatology, University Hospital Leipzig, Leipzig, Germany
| | - Claudia Luck-Sikorski
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany.,Integrated Research and Treatment Centre (IFB) AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany.,SRH University of Applied Sciences Gera, Gera, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany
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5
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Orthopaedic patients underestimate their body weight too: a cross-sectional study. INTERNATIONAL ORTHOPAEDICS 2021; 45:1439-1445. [PMID: 33634317 DOI: 10.1007/s00264-021-04995-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 02/17/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The relation between a large body mass and comorbidity, certain types of cancers and musculoskeletal disorders has been extensively documented. However, a high proportion of overweight patients appears unaware of the medical risks of their condition and frequently underestimates their body weight. This observation is prevalent across numerous medical specialties and settings. METHODS This study analysed the misperception of obesity status in a cohort of 1137 patients attending an orthopaedic clinic by means of self-completed questionnaires and objective biometrics. RESULTS Patients displayed a poor estimation of the self-body mass index (34.6%), especially among larger individuals, with 45.15% of pre-obese and 21.17% of obese patients previously attempting weight-loss. A direct association between low educational achievement and obesity rates was observed in orthopaedic patients. DISCUSSION Obesity is a well-known contributor to many conditions, including musculoskeletal diseases. Despite this association, many obese patients consider their body mass as normal. Misperception of self-body weight has been documented in many medical specialities, and this study confirms the same scenario in orthopaedic patients. CONCLUSION The association between self-image distortion and obesity observed in this study may assist in the evaluation and management of obesity cases in orthopaedic clinics.
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Schoof B, Stangenberg M, Mende KC, Thiesen DM, Ntalos D, Dreimann M. Obesity in spontaneous spondylodiscitis: a relevant risk factor for severe disease courses. Sci Rep 2020; 10:21919. [PMID: 33318604 PMCID: PMC7736843 DOI: 10.1038/s41598-020-79012-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 12/01/2020] [Indexed: 01/18/2023] Open
Abstract
Spondylodiscitis is a serious and potentially life-threatening disease. Obesity is a risk factor for many infections, and its prevalence is increasing worldwide. Thus, the aim of this study was to describe characteristics of obese patients with spondylodiscitis and identify risk factors for a severe disease course in obese patients. Between December 2012 and June 2018, clinical records were screened for patients admitted for spondylodiscitis. The final analysis included 191 adult patients (mean age 64.6 ± 14.8 years). Patient data concerning demographics, comorbidities, surgical treatment, laboratory testing, and microbiological workup were analysed using an electronic database. Patients were grouped according to body mass index (BMI) as BMI ≥ 30 kg/m2 or < 30 kg/m2. Seventy-seven patients were classified as normal weight (BMI 18.5-24.9 kg/m2), 65 as preobese (BMI 25-29.9 kg/m2), and 49 as obese (BMI ≥ 30 kg/m2). Obese patients were younger, had a higher revision surgery rate, and showed higher rates of abscesses, neurological failure, and postoperative complications. A different bacterial spectrum dominated by staphylococci species was revealed (p = 0.019). Obese patients with diabetes mellitus had a significantly higher risk for spondylodiscitis (p = 0.002). The mortality rate was similar in both cohorts, as was the spondylodiscitis localisation. Obesity, especially when combined with diabetes mellitus, is associated with a higher proportion of Staphylococcus aureus infections and is a risk factor for a severe course of spondylodiscitis, including higher revision rates and sepsis, especially in younger patients.
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Affiliation(s)
- Benjamin Schoof
- Division of Spine Surgery, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Martin Stangenberg
- Division of Spine Surgery, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Klaus Christian Mende
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Darius Maximilian Thiesen
- Division of Spine Surgery, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Dimitris Ntalos
- Division of Spine Surgery, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Marc Dreimann
- Division of Spine Surgery, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Gong X, Wang X, Shi T, Shi J, Yu W, Zhou L, Chen N, Huang J, Wang Z. Disease composition and epidemiological characteristics of primary care visits in Pudong New Area, Shanghai: a longitudinal study, 2016-2018. BMJ Open 2020; 10:e040878. [PMID: 33203636 PMCID: PMC7674101 DOI: 10.1136/bmjopen-2020-040878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES This study aims to analyse the disease composition of primary care visits rather than specialist visits, the former of which had scarcely been studied. We adopted specific disease classification (International Statistical Classification of Diseases and Related Health Problems, 10th Revision), disease system and communicable/non-communicable/injury disease classification, and variations of sex and age were also analysed. SETTING We extracted data from all community health service centres (CHSCs) and community health service stations in Pudong, Shanghai, from 2016 to 2018 using the electronic health record systems of the Pudong health information centre. PARTICIPANTS Our data included all 46 720 972 primary care visits from 2016 to 2018 in CHSCs in Pudong. RESULTS We found that the top five diseases in primary care visits continued to be primary hypertension, problems related to medical facilities, chronic ischaemic heart disease, unspecified diabetes mellitus and acute upper respiratory infection. Lipoprotein metabolism disorder visits continued to increase over the study years. The numbers and proportions of patients with hypertension and unspecified diabetes were higher among men than women, and other cerebrovascular diseases were higher among women than men. The top five disease systems were circulatory system diseases, respiratory system diseases, endocrine/nutritional/metabolic diseases, factors influencing health status and digestive system diseases. The rankings of respiratory system and endocrine/nutritional/metabolic diseases rose over time. Non-communicable diseases (NCDs) accounted for approximately 90% of the primary care visits-a much higher percentage than other causes. The top five NCDs in primary care visits were cardiovascular and circulatory diseases, musculoskeletal disorders, diabetes, digestive diseases and urogenital diseases. Compared with women, men suffered from cardiovascular diseases at an earlier age. CONCLUSIONS Different from specialist visits, common diseases, especially NCDs, were the main disease composition of current primary healthcare visits while the former focused on intractable diseases such as tumours, indicating that primary healthcare had played the role of gatekeeper of the healthcare system.
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Affiliation(s)
- Xin Gong
- Heart Failure Department, Shanghai East Hospital affiliated to Tongji University School of Medicine, Shanghai, China
| | - Xiaoli Wang
- Pudong Health Information Center, Pudong Institute for Health Development, Shanghai, China
| | - Tianxing Shi
- Pudong Health Information Center, Pudong Institute for Health Development, Shanghai, China
| | - Jianwei Shi
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenya Yu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liang Zhou
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ning Chen
- School of Medicine, Tongji University, Shanghai, China
| | - Jiaoling Huang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhaoxin Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Baillargeon JP, St-Cyr-Tribble D, Xhignesse M, Brown C, Carpentier AC, Fortin M, Grant A, Simoneau-Roy J, Langlois MF. Impact of an educational intervention combining clinical obesity preceptorship with electronic networking tools on primary care professionals: a prospective study. BMC MEDICAL EDUCATION 2020; 20:361. [PMID: 33054845 PMCID: PMC7556981 DOI: 10.1186/s12909-020-02248-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 09/23/2020] [Indexed: 06/11/2023]
Abstract
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.
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Affiliation(s)
- Jean-Patrice Baillargeon
- Division of Endocrinology, Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec J1H 5N4 Canada
| | | | - Marianne Xhignesse
- Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Québec J1H 5N4 Canada
| | - Christine Brown
- Division of Endocrinology, Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec J1H 5N4 Canada
| | - André C. Carpentier
- Division of Endocrinology, Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec J1H 5N4 Canada
| | - Martin Fortin
- Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Québec J1H 5N4 Canada
- Family Medicine Group, Centre Intégré Universitaire de Santé et de services sociaux du Saguenay-Lac St-Jean, Chicoutimi, Québec G7H 5H6 Canada
| | - Andrew Grant
- Department of Biochemistry, Collaborative Research for Effective Diagnosis research unit, Université de Sherbrooke, Sherbrooke, Québec J1H 5N4 Canada
| | - Judith Simoneau-Roy
- Department of Pediatrics, Université de Sherbrooke, Sherbrooke, Québec J1H 5N4 Canada
| | - Marie-France Langlois
- Division of Endocrinology, Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec J1H 5N4 Canada
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Schwenke M, Luppa M, Pabst A, Welzel FD, Löbner M, Luck-Sikorski C, Kersting A, Blüher M, Riedel-Heller SG. Attitudes and treatment practice of general practitioners towards patients with obesity in primary care. BMC FAMILY PRACTICE 2020; 21:169. [PMID: 32807094 PMCID: PMC7433134 DOI: 10.1186/s12875-020-01239-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 08/02/2020] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Maria Schwenke
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany. .,Integrated Research and Treatment Centre (IFB) Adiposity Diseases, Leipzig University Medical Center, Leipzig, Germany.
| | - Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany
| | - Franziska D Welzel
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany
| | - Margrit Löbner
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany
| | - Claudia Luck-Sikorski
- Integrated Research and Treatment Centre (IFB) Adiposity Diseases, Leipzig University Medical Center, Leipzig, Germany.,SRH University of Applied Health Sciences, Gera, Germany
| | - Anette Kersting
- Clinic for Psychosomatic Medicine and Psychotherapy, University Hospital Leipzig, University of Leipzig, Leipzig, Germany
| | - Matthias Blüher
- Integrated Research and Treatment Centre (IFB) Adiposity Diseases, Leipzig University Medical Center, Leipzig, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany.,Institute of General Medicine, University of Leipzig, Leipzig, Germany
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10
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Liu N, Birstler J, Venkatesh M, Hanrahan LP, Chen G, Funk LM. Weight Loss for Patients With Obesity: An Analysis of Long-Term Electronic Health Record Data. Med Care 2020; 58:265-272. [PMID: 31876663 PMCID: PMC7218679 DOI: 10.1097/mlr.0000000000001277] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Numerous studies have reported that losing as little as 5% of one's total body weight (TBW) can improve health, but no studies have used electronic health record data to examine long-term changes in weight, particularly for adults with severe obesity [body mass index (BMI) ≥35 kg/m]. OBJECTIVE To measure long-term weight changes and examine their predictors for adults in a large academic health care system. RESEARCH DESIGN Observational study. SUBJECTS We included 59,816 patients aged 18-70 years who had at least 2 BMI measurements 5 years apart. Patients who were underweight, pregnant, diagnosed with cancer, or had undergone bariatric surgery were excluded. MEASURES Over a 5-year period: (1) ≥5% TBW loss; (2) weight loss into a nonobese BMI category (BMI <30 kg/m); and (3) predictors of %TBW change via quantile regression. RESULTS Of those with class 2 or 3 obesity, 24.2% and 27.8%, respectively, lost at least 5% TBW. Only 3.2% and 0.2% of patients with class 2 and 3 obesity, respectively, lost enough weight to attain a BMI <30 kg/m. In quantile regression, the median weight change for the population was a net gain of 2.5% TBW. CONCLUSIONS Although adults with severe obesity were more likely to lose at least 5% TBW compared with overweight patients and patients with class 1 obesity, sufficient weight loss to attain a nonobese weight class was very uncommon. The pattern of ongoing weight gain found in our study population requires solutions at societal and health systems levels.
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Affiliation(s)
- Natalie Liu
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726
| | - Jen Birstler
- Department of Biostatistics and Medical Informatics, University of Wisconsin, 610 Walnut St, Madison, WI 53726
| | - Manasa Venkatesh
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726
| | - Lawrence P. Hanrahan
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726
| | - Guanhua Chen
- Department of Biostatistics and Medical Informatics, University of Wisconsin, 610 Walnut St, Madison, WI 53726
| | - Luke M. Funk
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792
- William S. Middleton Memorial VA, 2500 Overlook Terrace, Madison, WI 53705
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11
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Welzel FD, Stein J, Pabst A, Luppa M, Kersting A, Blüher M, Luck-Sikorski C, König HH, Riedel-Heller SG. Five A's counseling in weight management of obese patients in primary care: a cluster-randomized controlled trial (INTERACT). BMC FAMILY PRACTICE 2018; 19:97. [PMID: 29935541 PMCID: PMC6015469 DOI: 10.1186/s12875-018-0785-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 05/31/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Obesity is one of the most prevalent health problems in western societies. However, it seems not effectively managed in the healthcare system at present. Originating from smoking cessation a tool called the 5As for obesity management has been drafted and adapted by the Canadian Obesity Network (CON) to improve weight counseling and provider-patient-interaction. This paper describes the rationale and design of the INTERACT study. The objective of the INTERACT study is to evaluate the effectiveness and intervention costs of a 5As eLearning program for obesity management aimed specifically at general practitioners (GPs). METHODS The INTERACT study is a cluster randomized controlled trial aimed at implementing and evaluating an online-tutorial for obesity management based on the 5As approach in cooperating primary health care practices. Effectiveness of the 5As intervention will be evaluated by assessing patients and doctors perspectives on obesity management in primary care before and after the training. GPs in the intervention group will get access to the 5As obesity management online-tutorial while GPs in the control group will be assigned to a waiting list. Outcome measures for patients and GPs will be compared between the intervention group (treatment as usual + training of the GP) and the control group (treatment as usual). Hierarchical regression models will be used to analyze effects over time pre- and post-intervention. DISCUSSION The 5As present physicians with a simple mnemonic for patient counseling in the primary care context. While the use of the 5As in weight counseling seems to be associated with improved doctor-patient interaction and motivation to lose weight, intervention studies assessing the effectiveness of a short 5A eLearning tutorial for physicians on secondary outcomes, such as weight development, are lacking. TRIAL REGISTRATION The study has been registered at the German Clinical Trials Register ( DRKS00009241 ; date of registration: 03.02.2016).
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Affiliation(s)
- Franziska D. Welzel
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany
- Integrated Research and Treatment Centre (IFB) AdiposityDiseases, University Hospital Leipzig, Leipzig, Germany
| | - Janine Stein
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany
| | - Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany
| | - Anette Kersting
- Integrated Research and Treatment Centre (IFB) AdiposityDiseases, University Hospital Leipzig, Leipzig, Germany
- Clinic for Psychosomatic Medicine and Psychotherapy, University Hospital Leipzig, University of Leipzig, Leipzig, Germany
| | - Matthias Blüher
- Integrated Research and Treatment Centre (IFB) AdiposityDiseases, University Hospital Leipzig, Leipzig, Germany
| | - Claudia Luck-Sikorski
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany
- Integrated Research and Treatment Centre (IFB) AdiposityDiseases, University Hospital Leipzig, Leipzig, Germany
- University of Applied Sciences SRH Gera, Gera, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Steffi G. Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany
- Institute of General Medicine, University of Leipzig, Leipzig, Germany
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12
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Abstract
Human activity recognition (HAR) is widely applied to many industrial applications. In the context of Industry 4.0, driven by the same demand of machines' self-organizing ability, HAR can also be adopted in elderly healthcare. However, HAR should be adaptive to the application scenarios in elderly healthcare. In this paper, we propose a nonintrusive activity recognition method that can be applied to long-term and unobtrusive monitoring for elderlies. The method is robust to obstruction and nontarget object interference. Skeleton sequence is estimated from RGB images. Based on two activity continuity metrics, an interframe matching algorithm is proposed to filter nontarget objects. In order to make full use of spatial-temporal information, we propose a novel activity encoding method based on the interframe joints distances. A convolutional neural network is used to learn the distinguishing features automatically. A specific data augmentation method is designed to avoid the overfitting problem on small-scale datasets. The experiments are performed on two public activity datasets and a newly released noisy activity dataset (NAD). The NAD contains obstruction, nontarget object interference. The experimental results show that the proposed method achieves the state-of-the-art performance while only using one ordinary camera. The proposed method is robust to a realistic environment.
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13
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Sturgiss EA, Elmitt N, Haesler E, van Weel C, Douglas KA. Role of the family doctor in the management of adults with obesity: a scoping review. BMJ Open 2018; 8:e019367. [PMID: 29453301 PMCID: PMC5829928 DOI: 10.1136/bmjopen-2017-019367] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/13/2017] [Accepted: 12/19/2017] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Obesity management is an important issue for the international primary care community. This scoping review examines the literature describing the role of the family doctor in managing adults with obesity. The methods were prospectively published and followed Joanna Briggs Institute methodology. SETTING Primary care. Adult patients. INCLUDED PAPERS Peer-reviewed and grey literature with the keywords obesity, primary care and family doctors. All literature published up to September 2015. 3294 non-duplicate papers were identified and 225 articles included after full-text review. PRIMARY AND SECONDARY OUTCOME MEASURES Data were extracted on the family doctors' involvement in different aspects of management, and whether whole person and person-centred care were explicitly mentioned. RESULTS 110 papers described interventions in primary care and family doctors were always involved in diagnosing obesity and often in recruitment of participants. A clear description of the provider involved in an intervention was often lacking. It was difficult to determine if interventions took account of whole person and person-centredness. Most opinion papers and clinical overviews described an extensive role for the family doctor in management; in contrast, research on current practices depicted obesity as undermanaged by family doctors. International guidelines varied in their description of the role of the family doctor with a more extensive role suggested by guidelines from family medicine organisations. CONCLUSIONS There is a disconnect between how family doctors are involved in primary care interventions, the message in clinical overviews and opinion papers, and observed current practice of family doctors. The role of family doctors in international guidelines for obesity may reflect the strength of primary care in the originating health system. Reporting of primary care interventions could be improved by enhanced descriptions of the providers involved and explanation of how the pillars of primary care are used in intervention development.
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Affiliation(s)
- Elizabeth A Sturgiss
- Academic Unit of General Practice, Australian Nation University Medical School, Canberra, Australia
| | - Nicholas Elmitt
- Academic Unit of General Practice, Australian Nation University Medical School, Canberra, Australia
| | - Emily Haesler
- Academic Unit of General Practice, Australian Nation University Medical School, Canberra, Australia
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
- School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Chris van Weel
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Health Services Research and Policy, Australian National University, Canberra, Australia
| | - Kirsty A Douglas
- Academic Unit of General Practice, Australian Nation University Medical School, Canberra, Australia
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14
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Oldham M, Robinson E. Visual body size norms and the under-detection of overweight and obesity. Obes Sci Pract 2018; 4:29-40. [PMID: 29479462 PMCID: PMC5818735 DOI: 10.1002/osp4.143] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/20/2017] [Accepted: 11/21/2017] [Indexed: 02/01/2023] Open
Abstract
Objectives The weight status of men with overweight and obesity tends to be visually underestimated, but visual recognition of female overweight and obesity has not been formally examined. The aims of the present studies were to test whether people can accurately recognize both male and female overweight and obesity and to examine a visual norm-based explanation for why weight status is underestimated. Methods The present studies examine whether both male and female overweight and obesity are visually underestimated (Study 1), whether body size norms predict when underestimation of weight status occurs (Study 2) and whether visual exposure to heavier body weights adjusts visual body size norms and results in underestimation of weight status (Study 3). Results The weight status of men and women with overweight and obesity was consistently visually underestimated (Study 1). Body size norms predicted underestimation of weight status (Study 2) and in part explained why visual exposure to heavier body weights caused underestimation of overweight (Study 3). Conclusions The under-detection of overweight and obesity may have been in part caused by exposure to larger body sizes resulting in an upwards shift in the range of body sizes that are perceived as being visually 'normal'.
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Affiliation(s)
- M. Oldham
- Psychological SciencesUniversity of LiverpoolLiverpoolUK
| | - E. Robinson
- Psychological SciencesUniversity of LiverpoolLiverpoolUK
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15
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Control of cardiovascular risk factors and its determinants in the general population- findings from the STAAB cohort study. BMC Cardiovasc Disord 2017; 17:276. [PMID: 29096615 PMCID: PMC5669014 DOI: 10.1186/s12872-017-0708-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 10/24/2017] [Indexed: 01/30/2023] Open
Abstract
Background While data from primary care suggest an insufficient control of vascular risk factors, little is known about vascular risk factor control in the general population. We therefore aimed to investigate the adoption of adequate risk factor control and its determinants in the general population free of cardiovascular disease (CVD). Methods Data from the Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB) Cohort Study, a population-based study of inhabitants aged 30 to 79 years from the general population of Würzburg (Germany), were used. Proportions of participants without established CVD meeting targets for risk factor control recommended by 2016 ESC guideline were identified. Determinants of the accumulation of insufficiently controlled vascular risk factors (three or more) were assessed. Results Between December 2013 and April 2015, 1379 participants without CVD were included; mean age was 53.1 ± 11.9 years and 52.9% were female; 30.8% were physically inactive, 55.2% overweight, 19.3% current smokers. Hypertension, dyslipidemia, and diabetes mellitus were prevalent in 31.8%, 57.6%, and 3.9%, respectively. Treatment goals were not reached despite medication in 52.7% of hypertensive, in 37.3% of hyperlipidemic and in 44.0% of diabetic subjects. Insufficiently controlled risk was associated with male sex (OR 1.94, 95%CI 1.44–2.61), higher age (OR for 30–39 years vs. 70–79 years 4.01, 95%CI 1.94–8.31) and lower level of education (OR for primary vs. tertiary 2.15, 95%CI 1.48–3.11). Conclusions In the general population, prevalence of vascular risk factors was high. We found insufficient identification and control of vascular risk factors and a considerable potential to improve adherence to cardiovascular guidelines for primary prevention. Further studies are needed to identify and overcome patient- and physician-related barriers impeding successful control of vascular risk factors in the general population. Electronic supplementary material The online version of this article (10.1186/s12872-017-0708-x) contains supplementary material, which is available to authorized users.
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16
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Robinson E. Overweight but unseen: a review of the underestimation of weight status and a visual normalization theory. Obes Rev 2017; 18:1200-1209. [PMID: 28730613 PMCID: PMC5601193 DOI: 10.1111/obr.12570] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 04/28/2017] [Accepted: 05/09/2017] [Indexed: 11/26/2022]
Abstract
Although overweight and obesity are widespread across most of the developed world, a considerable body of research has now accumulated, which suggests that adiposity often goes undetected. A substantial proportion of individuals with overweight or obesity do not identify they are overweight, and large numbers of parents of children with overweight or obesity fail to identify their child as being overweight. Lay people and medical practitioners are also now poor at identifying overweight and obesity in others. A visual normalization theory of the under-detection of overweight and obesity is proposed. This theory is based on the notion that weight status is judged relative to visual body size norms. Because larger body sizes are now common, this has caused a recalibration to the range of body sizes that are perceived as being 'normal' and increased the visual threshold for what constitutes 'overweight'. Evidence is reviewed that indicates this process has played a significant role in the under-detection of overweight and obesity. The public health relevance of the under-detection of overweight and obesity is also discussed.
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Affiliation(s)
- E. Robinson
- Department of Psychological SciencesUniversity of LiverpoolLiverpoolUK
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17
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Meyer MR, Barton M. Estrogens and Coronary Artery Disease: New Clinical Perspectives. ADVANCES IN PHARMACOLOGY 2016; 77:307-60. [PMID: 27451102 DOI: 10.1016/bs.apha.2016.05.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In premenopausal women, endogenous estrogens are associated with reduced prevalence of arterial hypertension, coronary artery disease, myocardial infarction, and stroke. Clinical trials conducted in the 1990s such as HERS, WHI, and WISDOM have shown that postmenopausal treatment with horse hormone mixtures (so-called conjugated equine estrogens) and synthetic progestins adversely affects female cardiovascular health. Our understanding of rapid (nongenomic) and chronic (genomic) estrogen signaling has since advanced considerably, including identification of a new G protein-coupled estrogen receptor (GPER), which like the "classical" receptors ERα and ERβ is highly abundant in the cardiovascular system. Here, we discuss the role of estrogen receptors in the pathogenesis of coronary artery disease and review natural and synthetic ligands of estrogen receptors as well as their effects in physiology, on cardiovascular risk factors, and atherosclerotic vascular disease. Data from preclinical and clinical studies using nonselective compounds activating GPER, which include selective estrogen receptor modulators such as tamoxifen or raloxifene, selective estrogen receptor downregulators such as Faslodex™ (fulvestrant/ICI 182,780), vitamin B3 (niacin), green tea catechins, and soy flavonoids such as genistein or resveratrol, strongly suggest that activation of GPER may afford therapeutic benefit for primary and secondary prevention in patients with or at risk for coronary artery disease. Evidence from preclinical studies suggest similar efficacy profiles for selective small molecule GPER agonists such as G-1 which are devoid of uterotrophic activity. Further clinical research in this area is warranted to provide opportunities for future cardiovascular drug development.
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Affiliation(s)
- M R Meyer
- Triemli City Hospital, Zürich, Switzerland.
| | - M Barton
- Molecular Internal Medicine, University of Zürich, Zürich, Switzerland.
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18
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Lous J, Freund KS. Predictors of weight loss in young adults who are over-weight or obese and have psychosocial problems: a post hoc analysis. BMC FAMILY PRACTICE 2016; 17:43. [PMID: 27068690 PMCID: PMC4827173 DOI: 10.1186/s12875-016-0437-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 03/22/2016] [Indexed: 11/24/2022]
Abstract
Background The aim of this study is in a general practice trial setting to identify predictive factors for weight loss after 1 year among young adults who are over-weight or obese and who have several psychosocial problems. Methods Twenty-eight general practitioners recruited 495 patients aged 20–45 years with psychosocial problems for a randomized general preventive study to increase self-efficacy to achieve a self-prioritised goal for a better life by discussions of resources and barriers for reaching the goal. The present study is a post hoc analysis of possible predictors of weight loss among all 218 patients who have over-weight or obesity. A 23-pages questionnaire was completed before and 1 year after randomization. 111 patients had a one-hour preventive health consultation with their general practitioners focused on life coaching and a follow-up consultation within 3 months, and 107 patients had no preventive consultation. Results Twenty-two patients stated during the preventive consultation that weight loss was a prioritised goal. They had a mean weight loss of 4.7 kgs compared with 1.6 kgs in the group without this goal and 1.6 kgs in the group without preventive consultation. In a logistic regression model, predictors of weight loss or no weight loss were a) pre-interventional consideration of weight loss within 30 days, b) having weight loss as a prioritised goal for improved quality of life, c) being female, d) being in the oldest half of participants, and e) having many psychosocial problems. In a linear regression model, the predictors together explained about 11 % of the weight loss. Important predictors were: obesity (explained 4 %), pre-interventional consideration of weight loss within 30 days (3 %), and having a preventive health consultation with weight loss as a prioritised goal (2 %). Conclusions Pre-interventional consideration of weight loss within 30 days and having weight loss as a prioritised goal during the health consultation were two important predictors for weight loss. By structured interventions focussing on the patients’ priorities, self-chosen goals, their resources and barriers for reaching the goals, changes may be obtained; especially in participants with many problems who often do not accept participation in procedures on risks. ClinicalTrials gov Registration NCT 01231256, Aug. 22. 2010.
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Affiliation(s)
- Jørgen Lous
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløwvej 9A, DK-5000, Odense, Denmark.
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19
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Barton M, Husmann M, Meyer MR. Accelerated Vascular Aging as a Paradigm for Hypertensive Vascular Disease: Prevention and Therapy. Can J Cardiol 2016; 32:680-686.e4. [PMID: 27118295 DOI: 10.1016/j.cjca.2016.02.062] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 02/22/2016] [Accepted: 02/23/2016] [Indexed: 12/21/2022] Open
Abstract
Aging is considered the most important nonmodifiable risk factor for cardiovascular disease and death after age 28 years. Because of demographic changes the world population is expected to increase to 9 billion by the year 2050 and up to 12 billion by 2100, with several-fold increases among those 65 years of age and older. Healthy aging and prevention of aging-related diseases and associated health costs have become part of political agendas of governments around the world. Atherosclerotic vascular burden increases with age; accordingly, patients with progeria (premature aging) syndromes die from myocardial infarctions or stroke as teenagers or young adults. The incidence and prevalence of arterial hypertension also increases with age. Arterial hypertension-like diabetes and chronic renal failure-shares numerous pathologies and underlying mechanisms with the vascular aging process. In this article, we review how arterial hypertension resembles premature vascular aging, including the mechanisms by which arterial hypertension (as well as other risk factors such as diabetes mellitus, dyslipidemia, or chronic renal failure) accelerates the vascular aging process. We will also address the importance of cardiovascular risk factor control-including antihypertensive therapy-as a powerful intervention to interfere with premature vascular aging to reduce the age-associated prevalence of diseases such as myocardial infarction, heart failure, hypertensive nephropathy, and vascular dementia due to cerebrovascular disease. Finally, we will discuss the implementation of endothelial therapy, which aims at active patient participation to improve primary and secondary prevention of cardiovascular disease.
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Affiliation(s)
- Matthias Barton
- Molecular Internal Medicine, University of Zürich, Zürich, Switzerland.
| | - Marc Husmann
- Division of Angiology, University Hospital Zürich, Zürich, Switzerland
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Bryant J, Yoong SL, Sanson-Fisher R, Mazza D, Carey M, Walsh J, Bisquera A. Is identification of smoking, risky alcohol consumption and overweight and obesity by General Practitioners improving? A comparison over time. Fam Pract 2015; 32:664-71. [PMID: 26477009 DOI: 10.1093/fampra/cmv078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Detection of lifestyle risk factors by GPs is the first step required for intervention. Despite significant investment in preventive health care in general practice, little is known about whether GP detection of lifestyle risk factors have improved over time. OBJECTIVES To examine whether sensitivity and specificity of GP detection of smoking, risky alcohol consumption and overweight and obesity has increased in patients presenting to see their GP, by comparing results from four Australian studies conducted between 1982 and 2011. METHODS Demographic characteristics of patient and GP samples and the prevalence, sensitivity and specificity of detection of each risk factor were extracted from published studies. Differences between GP and patient sample characteristics were examined. To identify trends over time in prevalence of risk factors, sensitivity and specificity of detection across studies and the Cochran-Armitage test for trend were calculated for each risk factor for the overall sample and by male and female subgroups. RESULTS There were no statistically significant changes in the sensitivity of GP detection of smoking or overweight or obesity over time. Specificity of detection of smoking increased from 64.7% to 98% (P < 0.0001) and decreased for overweight or obesity from 92% to 89% (P = 0.01). There was a small decrease in the sensitivity of detection of alcohol consumption (P = 0.02) and an increase in specificity (P = 0.01). CONCLUSIONS Despite significant investment to increase GP detection and intervention for lifestyle risk factors, accurate detection of smoking, risky alcohol consumption and overweight and obesity occurs for less than two-thirds of all patients.
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Affiliation(s)
- Jamie Bryant
- Priority Research Centre for Health Behaviour, University of Newcastle, Hunter Medical Research Institute, HMRI Building, University of Newcastle, Callaghan, NSW 2308,
| | - Sze Lin Yoong
- Hunter New England Population Health, c/o Booth Building, Wallsend, NSW 2287
| | - Rob Sanson-Fisher
- Priority Research Centre for Health Behaviour, University of Newcastle, Hunter Medical Research Institute, HMRI Building, University of Newcastle, Callaghan, NSW 2308
| | - Danielle Mazza
- Department of General Practice, School of Primary Health Care, Monash University, Building 1, 270 Ferntree Gully Rd, Notting Hill, VIC 3168 and
| | - Mariko Carey
- Priority Research Centre for Health Behaviour, University of Newcastle, Hunter Medical Research Institute, HMRI Building, University of Newcastle, Callaghan, NSW 2308
| | - Justin Walsh
- Priority Research Centre for Health Behaviour, University of Newcastle, Hunter Medical Research Institute, HMRI Building, University of Newcastle, Callaghan, NSW 2308
| | - Alessandra Bisquera
- Clinical Research Design IT and Statistical Support Unit, Hunter Medical Research Institute, HMRI Building, University of Newcastle, Callaghan, NSW 2308, Australia
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Ossolinski G, Jiwa M, McManus A. Weight management practices and evidence for weight loss through primary care: a brief review. Curr Med Res Opin 2015; 31:2011-20. [PMID: 26288258 DOI: 10.1185/03007995.2015.1082993] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The optimal role for primary care in the management of overweight and obesity is yet to be determined. This review examines current weight management practices in primary care and summarizes the evidence for weight loss interventions based in primary care settings. RESEARCH DESIGN AND METHODS PubMed was searched for literature on weight management in primary care published from 2000 onwards. Forty-one articles were included. RESULTS The prevalence of overweight and obesity is high among primary care patients, yet frequently under-diagnosed by general practitioners. When diagnosed, weight management practices are highly variable. Evidence supporting effective long term interventions for weight loss in primary care is limited. Consistency of outcome measures, explicit reporting of attrition rates and assessment of motivation at inclusion are critical for interpreting results. CONCLUSIONS An approach to weight management that includes the involvement of disciplines other than general practice appears to be more successful. Further research is required to determine the most effective approach in primary care.
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Affiliation(s)
- Gemma Ossolinski
- a a Department of Medical Education , Curtin University , Perth , Western Australia
| | - Moyez Jiwa
- b b Melbourne Clinical School, Sydney School of Medicine, University of Notre Dame Australia Melbourne , Victoria, Australia
| | - Alexandra McManus
- c c Centre of Excellence Science, Seafood & Health, Faculty of Health Sciences, Curtin University , Perth , Western Australia
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22
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Calderón-Larrañaga A, Hernández-Olivan P, González-Rubio F, Gimeno-Feliu LA, Poblador-Plou B, Prados-Torres A. Multimorbidity and weight loss in obese primary care patients: longitudinal study based on electronic healthcare records. BMJ Open 2015; 5:e006227. [PMID: 25783419 PMCID: PMC4368983 DOI: 10.1136/bmjopen-2014-006227] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 11/25/2014] [Accepted: 01/16/2015] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To analyse the association between cardiovascular and mental comorbidities of obesity and weight loss registered in the electronic primary healthcare records. DESIGN AND SETTING Longitudinal study of a cohort of adult patients assigned to any of the public primary care centres in Aragon, Spain, during 2010 and 2011. PARTICIPANTS Adult obese patients for whom data on their weight were available for 2010 (n=62,901), and for both 2010 and 2011 (n=42,428). OUTCOMES Weight loss (yes/no) was calculated based on the weight difference between the first value registered in 2010 and the last value registered in 2011. Multivariate logistic regression models were adjusted for individuals' age, sex, total number of chronic comorbidities, type of obesity and length of time between both weight measurements. RESULTS According to the recorded clinical information, 9 of 10 obese patients showed at least one chronic comorbidity. After adjusting for covariates, weight loss seemed to be more likely among obese patients with a diagnosis of diabetes and/or dementia and less likely among those with hypertension, anxiety and/or substance use problems (p<0.05). The probability of weight loss was also significantly higher in male patients with more severe obesity and older age. CONCLUSIONS An increased probability of weight loss over 1 year was observed in older obese male patients, especially among those already manifesting high levels of obesity and severe comorbidities such as diabetes and/or dementia. Yet patients with certain psychological problems showed lower rates of weight reduction. Future research should clarify if these differences persist beyond potential selective weight documentation in primary care, to better understand the trends in weight reduction among obese patients and the underlying role of general practitioners regarding such trends.
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Affiliation(s)
- Amaia Calderón-Larrañaga
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- University of Zaragoza, Zaragoza, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, Zaragoza, Spain
| | | | - Francisca González-Rubio
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- University of Zaragoza, Zaragoza, Spain
- Delicias Sur Health Centre, Zaragoza, Spain
| | - Luis A Gimeno-Feliu
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- University of Zaragoza, Zaragoza, Spain
- San Pablo Health Centre, Zaragoza, Spain
| | - Beatriz Poblador-Plou
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, Zaragoza, Spain
| | - Alexandra Prados-Torres
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- University of Zaragoza, Zaragoza, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, Zaragoza, Spain
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Baillargeon JP, St-Cyr-Tribble D, Xhignesse M, Grant A, Brown C, Langlois MF. Impact of an integrated obesity management system on patient's care - research protocol. BMC OBESITY 2014; 1:19. [PMID: 26217506 PMCID: PMC4511011 DOI: 10.1186/s40608-014-0019-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 08/13/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND The majority of obese subjects are treated by primary care physicians (PCPs) who often feel uncomfortable with the management of obesity. In a previous study, we successfully developed, implemented and evaluated an obesity management system based on training and coaching of health professionals of family medicine groups (FMGs) by a team of experts in obesity management. Using a pre/post design, this study suggested a positive impact on health professionals' perceptions and reported obesity care. The current research project is aimed at evaluating the impact on obesity screening and care of this integrated obesity management system. We hypothesize that our program combining preceptorships with a virtual community and on-site coaching will improve: (1) management and weight loss of obese/overweight subjects treated by PCPs for hypertension, type 2 diabetes or impaired glucose tolerance; and (2) screening and initial management of obesity among a regular follow-up group of patients of PCPs who practice in FMGs. METHODS/DESIGN Ten FMGs will be approached for a practice monitoring project and will be randomised to receive the intervention developed in our previous project or will only be provided clinical practice guidelines. In the participating FMGs, we will enrol 22 patients per FMG with weight related targeted disease and 24 patients with regular follow-up. These patients will be evaluated for the care they received regarding screening and/or management of obesity using medical chart reviews, and will fill out a questionnaire on their lifestyle and satisfaction. They will also be examined for anthropometric measures, vital signs, blood markers for chronic diseases and physical fitness. The same patients will be assessed again after 18 months. The impact of the program on health professionals will be evaluated at baseline, and at 1 year. Qualitative data will also be collected from both professional and patient participants. Direct and indirect costs and QALYs will be evaluated as indicators of cost-effectiveness. DISCUSSION In the context of the dramatic increase in obesity prevalence and the low perception of PCPs' self-efficacy, providing efficient strategies to PCPs and interdisciplinary health care teams for management of obesity is crucial. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT00991640.
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Affiliation(s)
- Jean-Patrice Baillargeon
- Division of Endocrinology, Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec Canada
| | | | - Marianne Xhignesse
- Department of Family and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Québec Canada
| | - Andrew Grant
- Department of Biochemistry, Université de Sherbrooke, Sherbrooke, Québec Canada
| | - Christine Brown
- Division of Endocrinology, Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec Canada
| | - Marie-France Langlois
- Division of Endocrinology, Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec Canada
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Yoong SL, Carey M, Sanson-Fisher R, D'Este C. Prevalence and correlates of overweight and obesity in adult Australian general practice patients. Aust N Z J Public Health 2014; 37:586. [PMID: 24892158 DOI: 10.1111/1753-6405.12117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Sauer H, Krumm A, Weimer K, Horing B, Mazurak N, Gulewitsch MD, Hellmond F, Dammann D, Binder W, Linse P, Zipfel S, Ehehalt S, Binder G, Demircioglu A, Muth ER, Enck P, Mack I. PreDictor Research in Obesity during Medical care - weight Loss in children and adolescents during an INpatient rehabilitation: rationale and design of the DROMLIN study. J Eat Disord 2014; 2:7. [PMID: 24764531 PMCID: PMC3984741 DOI: 10.1186/2050-2974-2-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 02/25/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Obesity in adults and children is increasing worldwide at alarming rates. Obese children and adolescents are likely to become obese adults with increased risk of a number of comorbidities. In addition to preventing the development of obesity at young age, it is necessary to individualize the therapy of already obese children and adolescents in order to increase the likelihood of weight loss and maintenance. Therefore, the aim of this study is to identify predictors which play a significant role in successful weight loss and weight loss maintenance in children and adolescents. METHODS/DESIGN Over a one year period, 60 obese children and adolescents between 9 to 17 years of age shall be recruited at an inpatient children rehabilitation facility in Germany. They will be investigated twice within a few days following admission and prior to discharge. The study will be an integrated component of an established inpatient weight-loss and in part psychosomatic therapy. The collected data can be grouped into four clusters: 1) demographic, sociometric and psychometric data, 2) objective and subjective parameters of body condition, 3) autonomic nervous system regulated functions and 4) objective and subjective parameters for eating behavior. Primary outcome is the change of the body mass index standard deviation score (BMI-SDS). In order to evaluate the data appropriately, all examinations will be also conducted in a normal-weight reference group, matched for age and gender. DISCUSSION For some of the collected parameters the time span between measures may be too short. Therefore, a 6 months, 1 year and 2 year follow-up will be performed for evaluating the different predictors and their influence in regard to a successful intervention. Further middle- and long-term follow-up studies are planned. TRIAL REGISTRATION The study protocol was approved by the Ethics Committee of the University Hospital Tübingen, Germany. This study is registered at the German Clinical Trials Register (DRKS) with the clinical trial number DRKS00005122.
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Affiliation(s)
- Helene Sauer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Anna Krumm
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Katja Weimer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Björn Horing
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Nazar Mazurak
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Marco D Gulewitsch
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Frank Hellmond
- Fachkliniken Wangen i.A., Children Rehabilitation Hospital for Respiratory Diseases, Allergies and Psychosomatics, Wangen i.A., Germany
| | - Dirk Dammann
- Fachkliniken Wangen i.A., Children Rehabilitation Hospital for Respiratory Diseases, Allergies and Psychosomatics, Wangen i.A., Germany
| | - Walter Binder
- Fachkliniken Wangen i.A., Children Rehabilitation Hospital for Respiratory Diseases, Allergies and Psychosomatics, Wangen i.A., Germany
| | - Peter Linse
- Fachkliniken Wangen i.A., Children Rehabilitation Hospital for Respiratory Diseases, Allergies and Psychosomatics, Wangen i.A., Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Stefan Ehehalt
- Public Health Department of Stuttgart, Department of Pediatrics, Dental Health Care, Health Promotion and Social Services, Stuttgart, Germany
| | - Gerhard Binder
- Department of Pediatric Endocrinology and Diabetology, University Children's Hospital, Tübingen, Germany
| | - Aydin Demircioglu
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Eric R Muth
- Department of Psychology, Clemson University, Clemson, South Carolina, USA
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, Medical Hospital, Frondsbergstrasse 23, 72070 Tübingen, Germany
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Yoong SL, Carey ML, Sanson-Fisher RW, D'Este CA, Mackenzie L, Boyes A. A cross-sectional study examining Australian general practitioners' identification of overweight and obese patients. J Gen Intern Med 2014; 29:328-34. [PMID: 24101533 PMCID: PMC3912305 DOI: 10.1007/s11606-013-2637-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Revised: 08/23/2013] [Accepted: 09/10/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Overweight and obese patients attempt weight loss when advised to do so by their physicians; however, only a small proportion of these patients report receiving such advice. One reason may be that physicians do not identify their overweight and obese patients. OBJECTIVES We aimed to determine the extent that Australian general practitioners (GP) recognise overweight or obesity in their patients, and to explore patient and GP characteristics associated with non-detection of overweight and obesity. METHODS Consenting adult patients (n = 1,111) reported weight, height, demographics and health conditions using a touchscreen computer. GPs (n = 51) completed hard-copy questionnaires indicating whether their patients were overweight or obese. We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for GP detection, using patient self-reported weight and height as the criterion measure for overweight and obesity. For a subsample of patients (n = 107), we did a sensitivity analysis with patient-measured weight and height. We conducted an adjusted, multivariable logistic regression to explore characteristics associated with non-detection, using random effects to adjust for correlation within GPs. RESULTS Sensitivity for GP assessment was 63 % [95 % CI 57-69 %], specificity 89 % [95 % CI 85-92 %], PPV 87 % [95 % CI 83-90 %] and NPV 69 % [95 % CI 65-72 %]. Sensitivity increased by 3 % and specificity was unchanged in the sensitivity analysis. Men (OR: 1.7 [95 % CI 1.1-2.7]), patients without high blood pressure (OR: 1.8 [95 % CI 1.2-2.8]) and without type 2 diabetes (OR: 2.4 [95 % CI 1.2-8.0]) had higher odds of non-detection. Individuals with obesity (OR: 0.1 [95 % CI 0.07-0.2]) or diploma-level education (OR: 0.3 [95%CI 0.1-0.6]) had lower odds of not being identified. No GP characteristics were associated with non-detection of overweight or obesity. CONCLUSIONS GPs missed identifying a substantial proportion of overweight and obese patients. Strategies to support GPs in identifying their overweight or obese patients need to be implemented.
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Affiliation(s)
- Sze Lin Yoong
- Priority Research Centre for Health Behaviour and Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW, 2308, Australia,
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27
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Assessing undergraduate osteopaths in the identification of patients' excess body weight. INT J OSTEOPATH MED 2013. [DOI: 10.1016/j.ijosm.2013.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Dent R, Blackmore A, Peterson J, Habib R, Kay GP, Gervais A, Taylor V, Wells G. Changes in body weight and psychotropic drugs: a systematic synthesis of the literature. PLoS One 2012; 7:e36889. [PMID: 22719834 PMCID: PMC3376099 DOI: 10.1371/journal.pone.0036889] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Psychotropic medication use is associated with weight gain. While there are studies and reviews comparing weight gain for psychotropics within some classes, clinicians frequently use drugs from different classes to treat psychiatric disorders. OBJECTIVE To undertake a systematic review of all classes of psychotropics to provide an all encompassing evidence-based tool that would allow clinicians to determine the risks of weight gain in making both intra-class and interclass choices of psychotropics. METHODOLOGY AND RESULTS We developed a novel hierarchical search strategy that made use of systematic reviews that were already available. When such evidence was not available we went on to evaluate randomly controlled trials, followed by cohort and other clinical trials, narrative reviews, and, where necessary, clinical opinion and anecdotal evidence. The data from the publication with the highest level of evidence based on our hierarchical classification was presented. Recommendations from an expert panel supplemented the evidence used to rank these drugs within their respective classes. Approximately 9500 articles were identified in our literature search of which 666 citations were retrieved. We were able to rank most of the psychotropics based on the available evidence and recommendations from subject matter experts. There were few discrepancies between published evidence and the expert panel in ranking these drugs. CONCLUSION Potential for weight gain is an important consideration in choice of any psychotropic. This tool will help clinicians select psychotropics on a case-by-case basis in order to minimize the impact of weight gain when making both intra-class and interclass choices.
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Affiliation(s)
- Robert Dent
- Weight Management Clinic, Ottawa Hospital, Ontario, Canada.
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Barton M, Baretella O, Meyer MR. Obesity and risk of vascular disease: importance of endothelium-dependent vasoconstriction. Br J Pharmacol 2012; 165:591-602. [PMID: 21557734 PMCID: PMC3315033 DOI: 10.1111/j.1476-5381.2011.01472.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 04/04/2011] [Accepted: 04/25/2011] [Indexed: 12/11/2022] Open
Abstract
UNLABELLED Obesity has become a serious global health issue affecting both adults and children. Recent devolopments in world demographics and declining health status of the world's population indicate that the prevalence of obesity will continue to increase in the next decades. As a disease, obesity has deleterious effects on metabolic homeostasis, and affects numerous organ systems including heart, kidney and the vascular system. Thus, obesity is now regarded as an independent risk factor for atherosclerosis-related diseases such as coronary artery disease, myocardial infarction and stroke. In the arterial system, endothelial cells are both the source and target of factors contributing to atherosclerosis. Endothelial vasoactive factors regulate vascular homeostasis under physiological conditions and maintain basal vascular tone. Obesity results in an imbalance between endothelium-derived vasoactive factors favouring vasoconstriction, cell growth and inflammatory activation. Abnormal regulation of these factors due to endothelial cell dysfunction is both a consequence and a cause of vascular disease processes. Finally, because of the similarities of the vascular pathomechanisms activated, obesity can be considered to cause accelerated, 'premature' vascular aging. Here, we will review some of the pathomechanisms involved in obesity-related activation of endothelium-dependent vasoconstriction, the clinical relevance of obesity-associated vascular risk, and therapeutic interventions using 'endothelial therapy' aiming at maintaining or restoring vascular endothelial health. LINKED ARTICLES This article is part of a themed section on Fat and Vascular Responsiveness. To view the other articles in this section visit http://dx.doi.org/10.1111/bph.2012.165.issue-3.
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Affiliation(s)
- Matthias Barton
- Molecular Internal Medicine, University of Zurich, Zurich, Switzerland.
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Taylor AW, Price K, Gill TK, Adams R, Pilkington R, Carrangis N, Shi Z, Wilson D. RETRACTED ARTICLE: Multimorbidity: not just an older person's issue. Results from an Australian biomedical study. Soc Psychiatry Psychiatr Epidemiol 2011; 46:351. [PMID: 21076915 DOI: 10.1007/s00127-010-0309-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Accepted: 10/18/2010] [Indexed: 11/25/2022]
Affiliation(s)
- Anne W Taylor
- South Australian Department of Health, Population Research and Outcome Studies, PO Box 287, Rundle Mall, Adelaide, SA, 5000, Australia.
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Clark JM, Chang HY, Bolen SD, Shore AD, Goodwin SM, Weiner JP. Development of a claims-based risk score to identify obese individuals. Popul Health Manag 2010; 13:201-7. [PMID: 20443698 DOI: 10.1089/pop.2009.0051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Obesity is underdiagnosed, hampering system-based health promotion and research. Our objective was to develop and validate a claims-based risk model to identify obese persons using medical diagnosis and prescription records. We conducted a cross-sectional analysis of de-identified claims data from enrollees of 3 Blue Cross Blue Shield plans who completed a health risk assessment capturing height and weight. The final sample of 71,057 enrollees was randomly split into 2 subsamples for development and validation of the obesity risk model. Using the Johns Hopkins Adjusted Clinical Groups case-mix/predictive risk methodology, we categorized study members' diagnosis (ICD) codes. Logistic regression was used to determine which claims-based risk markers were associated with a body mass index (BMI) > or = 35 kg/m(2). The sensitivities of the scores > or =90(th) percentile to detect obesity were 26% to 33%, while the specificities were >90%. The areas under the receiver operator curve ranged from 0.67 to 0.73. In contrast, a diagnosis of obesity or an obesity medication alone had very poor sensitivity (10% and 1%, respectively); the obesity risk model identified an additional 22% of obese members. Varying the percentile cut-point from the 70(th) to the 99(th) percentile resulted in positive predictive values ranging from 15.5 to 59.2. An obesity risk score was highly specific for detecting a BMI > or = 35 kg/m(2) and substantially increased the detection of obese members beyond a provider-coded obesity diagnosis or medication claim. This model could be used for obesity care management and health promotion or for obesity-related research.
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Affiliation(s)
- Jeanne M Clark
- Division of General Internal Medicine, Department of Medicine, The Johns Hopkins University, Baltimore, Maryland, USA.
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Segal JB, Clark JM, Shore AD, Dominici F, Magnuson T, Richards TM, Weiner JP, Bass EB, Wu AW, Makary MA. Prompt Reduction in Use of Medications for Comorbid Conditions After Bariatric Surgery. Obes Surg 2009; 19:1646-56. [DOI: 10.1007/s11695-009-9960-1] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Accepted: 08/14/2009] [Indexed: 02/05/2023]
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Miksch A, Hermann K, Rölz A, Joos S, Szecsenyi J, Ose D, Rosemann T. Additional impact of concomitant hypertension and osteoarthritis on quality of life among patients with type 2 diabetes in primary care in Germany - a cross-sectional survey. Health Qual Life Outcomes 2009; 7:19. [PMID: 19250524 PMCID: PMC2662813 DOI: 10.1186/1477-7525-7-19] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Accepted: 02/27/2009] [Indexed: 01/22/2023] Open
Abstract
Background Patients with type 2 diabetes are likely to have comorbid conditions which represent a high burden for patients and a challenge for primary care physicians. The aim of this cross-sectional survey was to assess the impact of additional comorbidities on quality of life within a large sample of patients with type 2 diabetes in primary care. Methods A cross-sectional survey within a large sample (3.546) of patients with type 2 diabetes in primary care was conducted. Quality of life (QoL) was assessed by means of the Medical Outcome Study Short Form (SF-36), self reported presence of comorbid conditions was assessed and groups with single comorbidities were selected. QoL subscales of these groups were compared to diabetes patients with no comorbidities. Group comparisons were made by ANCOVA adjusting for sociodemographic covariates and the presence of depressive disorder. Results Of 3546 questionnaires, 1532 were returned, thereof 1399 could be analysed. The mean number of comorbid conditions was 2.1. 235 patients declared to have only hypertension as comorbid condition, 97 patients declared to have osteoarthritis only. Patients suffering from diabetes and hypertension reached similar scores like diabetic patients with no comorbidities. Patients with diabetes and osteoarthritis reached remarkable lower scores in all subscales. Compared to patients with diabetes alone these differences were statistically significant in the subscales representing pain and physical impairment. Conclusion The impact of osteoarthritis as an often disabling and painful condition on QoL in patients with type 2 diabetes is higher than the impact of hypertension as common but often asymptomatic comorbidity. Individual care of patients with chronic conditions should aim at both improving QoL and controlling risk factors for severe complications.
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Affiliation(s)
- Antje Miksch
- Department of general practice and health services research, University Hospital of Heidelberg, Heidelberg, Germany.
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Idelevich E, Kirch W, Schindler C. Current pharmacotherapeutic concepts for the treatment of obesity in adults. Ther Adv Cardiovasc Dis 2009; 3:75-90. [DOI: 10.1177/1753944708098226] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Obesity is one of the greatest public health challenges of the twenty-first century. The World Health Organization (WHO) reports that in 2005 approximately 1.6 billion adults were overweight and at least 400 million adults were obese. The prevalence of obesity is still continuing to increase dramatically. Overweight and obese people carry a higher risk for a variety of cardiovascular diseases including hypertension, coronary heart disease, stroke and peripheral occlusive artery disease. Weight loss is considered to be the initial step which helps to prevent or to control the clinical consequences of obesity. In a great number of patients who are not able to reduce weight by means of non-pharmacological measures, drug therapy can assist in reaching the weight management targets. Drug treatment should only be considered as part of a systematic weight management program including dietary and lifestyle changes. This review summarizes current pharmacotherapeutic concepts for the treatment of obesity in adults focusing on efficacy and safety of anti-obesity drugs.
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Affiliation(s)
- Evgeny Idelevich
- Institute of Clinical Pharmacology, Medical Faculty, Technical University of Dresden, Dresden, Germany,
| | - Wilhelm Kirch
- Institute of Clinical Pharmacology, Medical Faculty, Technical University of Dresden, Dresden, Germany
| | - Christoph Schindler
- Institute of Clinical Pharmacology, Medical Faculty, Technical University of Dresden, Dresden, Germany
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Study of the knowledge, attitudes and practices of physicians towards obesity management in primary health care in Bahrain. Public Health Nutr 2009; 12:1791-8. [PMID: 19161645 DOI: 10.1017/s1368980008004564] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AIM To examine the opinions of physicians in Bahrain regarding their role in obesity control, and to evaluate their knowledge, attitudes and practices towards obesity prevention and management in primary health care. DESIGN A cross-sectional survey of physicians in Bahrain. A single-stage cluster sample was used, which included twelve health centres and 107 physicians. Ninety-seven physicians participated in the study with a 90% response rate. A self-administered questionnaire was used to measure physicians' knowledge and practices, their perceived role and potential limitations. Correction for design effect and finite population were considered in the analysis. RESULTS The majority of physicians in Bahrain (92%) were aware of the obesity epidemic and 60% of them felt capable of assuming a major role in obesity control, regardless of their negative views towards the success rates of weight management. Only 36% agreed that they had effective weight-management practices. They were knowledgeable about weight-loss goals and showed a reasonable level of obesity identification, especially as part of chronic disease care (71%). Physicians reported a high rate of utilization of various weight-loss strategies, except for pharmacotherapy and surgery. The major barriers identified in patient care included time constraints (91%), lack of specialty clinics (81%), absence of guidelines (78%) and an inadequate number of dietitians (71%). Sixty-four per cent reported that training in lifestyle counselling and behaviour modification are important requirements. CONCLUSIONS Physicians in Bahrain showed a reasonable level of interest in participating in obesity prevention and management. It seems that there would be a good opportunity for better practice if physicians were supported with appropriate training and the constraints of their working environment were adequately addressed.
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Perkonigg A, Owashi T, Stein MB, Kirschbaum C, Wittchen HU. Posttraumatic stress disorder and obesity: evidence for a risk association. Am J Prev Med 2009; 36:1-8. [PMID: 18976880 DOI: 10.1016/j.amepre.2008.09.026] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Revised: 07/11/2008] [Accepted: 09/08/2008] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is evidence from cross-sectional studies that posttraumatic stress disorder (PTSD) may be associated with obesity. The aim of this study was to examine prospective longitudinal associations between PTSD and obesity in a community sample. METHODS A prospective, longitudinal, epidemiologic study with a representative community sample of adolescents and young adults (N=3021, aged 14-24 years at baseline) was conducted in Munich, Germany. Participants were assessed four times between 1995 and 2005 with the Munich-Composite International Diagnostic Interview. Associations between obesity (BMI > or =30) and DSM-IV PTSD were evaluated in 2007, using cross-sectional and prospective data during young adulthood. RESULTS The cumulative lifetime incidence of obesity in the sample at 10-year follow-up during young adulthood was 4.3% (women, 4.6%; men, 4.0%). Among women but not among men, obesity was associated with a lifetime history of PTSD (OR=3.8; 95% CI=1.4, 10.7) in the cross-sectional analyses. Prospective longitudinal analyses from 4-year follow-up to 10-year follow-up confirmed that obesity was predicted by antecedent subthreshold and full PTSD (OR=3.0; 95% CI=1.3, 7.0) among women but not among men. There were no associations between other mental disorders and obesity in the prospective analyses. CONCLUSIONS The findings indicate a possible causal pathway for the onset of obesity in females with PTSD symptoms. These findings need replication with regard to the pathophysiologic and behavioral mechanisms underlying this relationship.
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Affiliation(s)
- Axel Perkonigg
- Department of Clinical Psychology and Psychotherapy, Technical University of Dresden, Dresden, Germany.
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Tham M, Young D. The role of the General Practitioner in weight management in primary care--a cross sectional study in General Practice. BMC FAMILY PRACTICE 2008; 9:66. [PMID: 19077319 PMCID: PMC2614998 DOI: 10.1186/1471-2296-9-66] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2008] [Accepted: 12/15/2008] [Indexed: 11/10/2022]
Abstract
Background Obesity has become a global pandemic, considered the sixth leading cause of mortality by the WHO. As gatekeepers to the health system, General Practitioners are placed in an ideal position to manage obesity. Yet, very few consultations address weight management. This study aims to explore reasons why patients attending General Practice appointments are not engaging with their General Practitioner (GP) for weight management and their perception of the role of the GP in managing their weight. Methods In February 2006, 367 participants aged between 17 and 64 were recruited from three General Practices in Melbourne to complete a waiting room self – administered questionnaire. Questions included basic demographics, the role of the GP in weight management, the likelihood of bringing up weight management with their GP and reasons why they would not, and their nominated ideal person to consult for weight management. Physical measurements to determine weight status were then completed. The statistical methods included means and standard deviations to summarise continuous variables such as weight and height. Sub groups of weight and questionnaire answers were analysed using the χ2 test of significant differences taking p as < 0.05. Results The population sample had similar obesity co-morbidity rates to the National Heart Foundation data. 74% of patients were not likely to bring up weight management when they visit their GP. Negative reasons were time limitation on both the patient's and doctor's part and the doctor lacking experience. The GP was the least likely person to tell a patient to lose weight after partner, family and friends. Of the 14% that had been told by their GP to lose weight, 90% had cardiovascular obesity related co-morbidities. GPs (15%) were 4th in the list of ideal persons to manage weight after personal trainer Conclusion Patients do not have confidence in their GPs for weight management, preferring other health professionals who may lack evidence based training. Concurrently, GPs target only those with obesity related co-morbidities. Further studies evaluating GPs' opinions about weight management, effective strategies that can be implemented in primary care and the co-ordination of the team approach need to be done.
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Affiliation(s)
- Marlene Tham
- University of Melbourne, Department of General Practice, 200 Berkeley Street, Carlton, Victoria 3053, Australia.
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Anderson P. Reducing overweight and obesity: closing the gap between primary care and public health. Fam Pract 2008; 25 Suppl 1:i10-6. [PMID: 18796703 DOI: 10.1093/fampra/cmn060] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Although overweight and obesity are major risk factors for ill health and premature death, leading to significant increases in workload and prescribing costs, primary health care providers continue to find managing overweight and obesity a difficult business. OBJECTIVES Six questions are addressed in an attempt to close the gap between primary care activities and public health goals to reduce overweight and obesity: what is overweight and obesity; what is the health impact of overweight and obesity; is individually directed advice effective in reducing overweight and obesity; can we increase the involvement of primary care in reducing overweight and obesity; how can public health actions complement the role of primary care; and how do we chose cost-effective interventions? METHOD Systematic reviews and key texts were identified from literature searches to provide a narrative summary to answer the six questions. RESULTS Overweight is defined as a body mass index (BMI) of > or = 25 and obesity as a BMI of > or = 30 where BMI = weight (kg)/height (m(2)). There is a positive relationship between the level of BMI and a wide range of conditions, including cancers and cardiovascular diseases. There is evidence that individually directed advice can reduce overweight and obesity or its risk. There is mixed evidence for the effectiveness of strategies in increasing the involvement of primary care in reducing overweight and obesity. There are many examples of public health actions that complement the role of primary care in reducing overweight and obesity. Overall cost-effective policy analyses have not been done per se for overweight and obesity but have shown that a combination of personal and non-personal interventions can be effective and cost-effective in reducing cardiovascular events. CONCLUSION The gap between primary care and public health in reducing overweight and obesity can be closed, but it requires sustained political support and investment.
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Schuster RJ, Tasosa J, Terwoord NA. Translational research--implementation of NHLBI Obesity Guidelines in a primary care community setting: the Physician Obesity Awareness Project. J Nutr Health Aging 2008; 12:764S-769S. [PMID: 19043654 DOI: 10.1007/bf03028627] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Greater than 65 percent of the United States (US) population is overweight, with 32 percent obese. It is a problem in both developed and developing nations. While guidelines exist, counseling by physicians about obesity and weight loss is inconsistent, and physician approaches to obesity management have limited success. This study attempted to increase involvement in translating proven research into practice to improve physician awareness and improve outcomes of overweight/obesity. Twenty-one physicians in a suburban, middle class population in the Midwestern United States participated. METHODS Physician obesity awareness, weight, height, BMI, blood pressure, lipids, and glycohemoglobin were measured from 641 patients at baseline and were compared to 631 at 12-month follow-up. All 21 physicians received academic detailing and were presented with their clinical outcomes. Ten physicians received an Enhanced Intervention. They were additionally asked to place a sticker in the chart of their overweight or obese patients. RESULTS Fifty-three percent of physicians were not comfortable discussing obesity with their patients at baseline, decreasing to 0% at followup (p=0.041). Reference to obesity management by Intervention physicians increased from 2.4% to 9.2% (p=0.001) while for Enhanced Intervention physicians documentation increased from 3.9% to 15.6% (p=0.002). Those patients in the Enhanced Intervention group lost an average of 6.19 lbs (3.3%) (p=0.083) during the one year period versus 4.6 lbs (2.5%) (p=0.20) in the Intervention group. The BMI dropped 1.2 in the Intervention group and 0.72 in the Enhanced Intervention group. The data from both groups was pooled at both baseline and follow-up. The average weight of patients decreased from 185.7 lbs to 180.3 lbs (excluding outliers weighing>311 lbs). This 5.4 pound loss was significant (p=0.027). The BMI decreased from 30.1 to 29.1 (p=0.095). Cardiovascular co-morbidities improved. CONCLUSION Obesity and overweight have a very high prevalence in a primary care community based settings. Clinicians are not comfortable diagnosing and managing obese and overweight patients. A combination of academic detailing and presentation of outcomes to physicians will improve their awareness and result in improved clinical outcomes including weight loss.
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Affiliation(s)
- R J Schuster
- Wright State University Boonshoft School of Medicine, Center for Global Health Systems, Management, and Policy, 3123 Research Blvd., Suite 200, Kettering, OH 45420, USA.
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Hauner H, Bramlage P, Lösch C, Jöckel KH, Moebus S, Schunkert H, Wasem J. Overweight, obesity and high waist circumference: regional differences in prevalence in primary medical care. DEUTSCHES ARZTEBLATT INTERNATIONAL 2008; 105:827-33. [PMID: 19578419 DOI: 10.3238/arztebl.2008.0827] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Accepted: 08/04/2008] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The prevalence of obesity and elevated waist circumference in Germany is high. However, there are insufficient data on the situation in primary care and on regional distribution to support medical preventive measures. METHODS The German Metabolic and Cardiovascular Risk Project (GEMCAS) is a national cross-sectional study including 1511 primary care practices and 35 869 patients. Height, weight, waist circumference, laboratory values, and type 2 diabetes were documented. RESULTS The crude prevalence of obesity was 23.9% (95% CI 23.4 to 24.3) (standardized 22.8% [95% CI 22.3 to 23.2]), with a minimum in Bremen (19.8% [95% CI 15.1 to 24.5]) and a maximum in Saxony-Anhalt (28.3% [95% CI 25.4 to 31.1]). The crude prevalence of high waist circumference (> 102/88 cm) was 39.5% (95% CI 39.0 to 40.0) (standardized 36.5% [95% CI 36.0 to 36.9]), with a minimum in Hamburg (30.5% [95% CI 26.2 to 34.8]) and a maximum in Saxony-Anhalt (42.1% [95% CI 39.2 to 45.1]). The prevalence of obesity as assessed by BMI was higher in men than in women, but greater in women as assessed by waist circumference. Nationwide, 50 out of every 100 patients with obesity had type 2 diabetes, and 32 of 100 patients with a high waist circumference had type 2 diabetes. CONCLUSIONS The prevalence of obesity is higher in northeastern Germany than in the southwest. Overall, abdominal obesity is considerably more frequent than obesity based on BMI. Surprisingly, a high prevalence of obesity in some federal states does not automatically mean a higher number of people with type 2 diabetes.
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Hauner H, Bramlage P, Lösch C, Steinhagen-Thiessen E, Schunkert H, Wasem J, Jöckel KH, Moebus S. Prevalence of obesity in primary care using different anthropometric measures--results of the German Metabolic and Cardiovascular Risk Project (GEMCAS). BMC Public Health 2008; 8:282. [PMID: 18694486 PMCID: PMC2518927 DOI: 10.1186/1471-2458-8-282] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2008] [Accepted: 08/11/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obesity is one of the greatest challenges in primary health care. The BMI describes fat mass and waist circumference (WC) fat distribution and total metabolic and cardiovascular risk. It was aim of the present study to assess the prevalence of a) overweight and obesity and b) an increased and high WC in adults seeking primary care in Germany and to describe the associations of both measures with cardiovascular risk factors and prognosis. METHODS This was a point prevalence study with 1,511 primary care physicians and 35,869 adult patients in 2005. Bodyweight, height and waist circumference was measured and blood samples taken to determine the presence of cardiovascular risk factors, including lipids, blood pressure, fasting glucose, low physical activity, smoking and family history of myocardial infarction. We calculated rate ratios stratified for age and gender. RESULTS There was a high prevalence of overweight (45.7% male [95%CI 44.9-46.5]; 30.6% female [95%CI 30.0-31.2]) and obesity (24.7% male [95%CI 24.0-25.4]; 23.3% female [95%CI 22.8-23.9]). 36.4% of male [95%CI 35.6-37.2] and 41.5% of female [95%CI 40.8-42.1] had a high WC (male > 102, female > 88 cm). A high WC in addition to an overweight BMI identified patients with more risk factors (male: mean of 3.93 risk factors (RF) at a WC > 102 cm vs. 2.88 RF in patients < or = 94 cm; female 3.58 RF at a WC > 88 cm vs. 2.41 RF < or = 80 cm). CONCLUSION There is a high prevalence of obesity (24.7% of male and 23.3% of female) and, in particular, abdominal obesity (36.4% of male and 41.5% of female) in adults attending a primary care physician in Germany. The determination of the BMI is sufficient to assess risk in normal weight and obese patients, while a high WC identifies high risk patients from within the overweight group.
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Affiliation(s)
- Hans Hauner
- Else Kröner-Fresenius-Zentrum für Ernährungsmedizin, Technical University Munich, Klinikum rechts der Isar, Ismaninger Str. 22, 81675 München, Germany.
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The Need for a Concerted Effort to Address Global Obesity. TOP CLIN NUTR 2008. [DOI: 10.1097/01.tin.0000333554.38627.1f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Szecsenyi J, Rosemann T, Joos S, Peters-Klimm F, Miksch A. German diabetes disease management programs are appropriate for restructuring care according to the chronic care model: an evaluation with the patient assessment of chronic illness care instrument. Diabetes Care 2008; 31:1150-4. [PMID: 18299443 DOI: 10.2337/dc07-2104] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE With the introduction of diabetes disease management programs (DMPs) in Germany, there is a necessity to evaluate whether patients receive care that is congruent to the Chronic Care Model (CCM) and evidence-based behavioral counseling. We examined differences as perceived and experienced by patients with type 2 diabetes between those enrolled in a DMP compared with patients receiving usual care in two federal states of Germany. RESEARCH DESIGN AND METHODS A random, heterogeneous sample of 3,546 patients (59.3% female) received a mailed questionnaire from their regional health fund, including the German version of the Patient Assessment of Chonic Illness Care (PACIC) instrument, which had additional items for behavioral advice (5A). Two weeks later, a general reminder was sent out. RESULTS A total of 1,532 questionnaires were returned (response rate 42.2%), and valid data could be obtained for 1,399 patients. Mean age of responders was 70.3 years, of which 53.6% were female. Overall, patients enrolled in a DMP scored significantly higher (3.21 of a possible 5) than patients not enrolled in a DMP (2.86) (P < 0.001). Significant differences in the same direction were found on all five subscales of the PACIC. For the 5A scales, similar differences were found for all five subscales plus the sum score (P < 0.001; mean for DMP = 3.08, mean for non-DMP = 2.78). CONCLUSIONS DMPs, as currently established in primary care in Germany, may impact provided care significantly. The changes in daily practice that have been induced by the DMPs are recognized by patients as care that is more structured and that to a larger extent reflects the core elements of the CCM and evidence-based counseling compared with usual care.
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Affiliation(s)
- Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital of Heidelberg, Vosstrasse 2, D-69115 Heidelberg, Germany.
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Stephens GS, Blanken SE, Greiner KA, Chumley HS. Visual prompt poster for promoting patient-physician conversations on weight loss. Ann Fam Med 2008; 6 Suppl 1:S33-6. [PMID: 18195306 PMCID: PMC2203383 DOI: 10.1370/afm.780] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE This study investigated the effect of a simple visual prompt in the form of a poster on the occurrence of patient-physician weight loss conversations during routine office encounters in a primary care outpatient clinic. METHODS We conducted a 2-phase study in a family medicine residency program outpatient clinic in August and September 2006. During the first phase, lasting 5 days, we surveyed all nonpregnant adult patients (preintervention group) about weight loss. We then implemented a visual prompt in the form of a colorful poster (11 x 17 inches) in both English and Spanish. The poster read "Do you want to lose weight? Ask your doctor today!" and included a picture of a bathroom scale. During the second phase, also lasting 5 days, we again surveyed all nonpregnant adult patients (postintervention group). RESULTS Analyses were based on 283 patients in the preintervention group and 386 patients in the postintervention group. The mean body mass index, obtained from medical records, did not differ significantly between groups (31 vs 32 kg/m2, respectively). Fully 60% of patients in the postintervention group recalled seeing the poster during their visit; however, the percentage of patients who reported discussing weight loss with their physician did not differ between the preintervention and postintervention groups overall (29% vs 27%), among the two-thirds of patients who wanted to lose weight (26% vs 23%), or when only postintervention patients who saw the poster were included in the comparison (29% vs 29%). The large majority of patients in both groups who had such discussions--82% and 77%--indicated that they found them useful; the difference between groups was not significant. CONCLUSION A simple visual prompt in the form of a poster directed at patients did not increase the occurrence of conversations between patients and their physicians about weight loss.
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Affiliation(s)
- Gillian S Stephens
- Department of Community and Family Medicine, Saint Louis University, St Louis, Missouri 63104, USA.
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Schindler C, Bramlage P, Thoenes M, Bramlage C, Kirch W. Cardiovascular risk in obese hypertensive patients taking various antihypertensive drugs. Clin Drug Investig 2007; 27:707-17. [PMID: 17803346 DOI: 10.2165/00044011-200727100-00006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Obese patients often present with multiple co-morbid conditions, including hypertension, which are associated with an increased cardiovascular (CV) risk. We aimed to assess the risk factor profiles of primary-care patients with obesity and hypertension in order to estimate their fatal CV risk in total and according to use of various antihypertensive drugs. METHODS This was a post-hoc analysis of data from a recent observational study involving 72 479 hypertensive patients in 6989 general practices across Germany. Almost all patients (92.3%) were overweight or obese. The 10-year risk for fatal CV events was determined using the SCORE algorithm as published by the European Society of Cardiology. RESULTS Overall, 68% of patients had one or more diseases or conditions in addition to obesity and hypertension. The 10-year fatal CV risk was lowest in the youngest normal weight group (1.7%), and highest in the oldest obese group (26%). Men had a higher risk than women, and risk rose with increasing age. The risk factor profile appeared to differ between patients treated with various antihypertensive classes, e.g. angiotensin II type 1 receptor antagonists were associated with lower risk, diuretics with higher risk. There were moderate differences within drug classes. CONCLUSIONS According to this cross-sectional data, fatal CV risk is strongly increased in obese patients, especially in men and in older age groups. While there were strong associations between use of certain drugs and metabolic risk markers and overall fatal CV risk, the causality of these associations remains to be determined.
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Baillargeon JP, Carpentier A, Donovan D, Fortin M, Grant A, Simoneau-Roy J, St-Cyr-Tribble D, Xhignesse M, Langlois MF. Integrated obesity care management system -implementation and research protocol. BMC Health Serv Res 2007; 7:163. [PMID: 17927835 PMCID: PMC2151949 DOI: 10.1186/1472-6963-7-163] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2007] [Accepted: 10/10/2007] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Nearly 50% of Canadians are overweight and their number is increasing rapidly. The majority of obese subjects are treated by primary care physicians (PCPs) who often feel uncomfortable with the management of obesity. The current research proposal is aimed at the development and implementation of an innovative, integrated, interdisciplinary obesity care management system involving both primary and secondary care professionals. METHODS We will use both action and evaluative research in order to achieve the following specific objectives. The first one is to develop and implement a preceptorship-based continuing medical education (CME) program complemented by a web site for physicians and nurses working in Family Medicine Groups (FMGs). This CME will be based on needs assessment and will be validated by one FMG using questionnaires and semi structured interviews. Also, references and teaching tools will be available for participants on the web site. Our second objective is to establish a collaborative intra and inter-regional interdisciplinary network to enable on-going expertise update and networking for FMG teams. This tool consists of a discussion forum and monthly virtual meetings of all participants. Our third objective is to evaluate the implementation of our program for its ability to train 8 FMGs per year, the access and utilization of electronic tools and the participants' satisfaction. This will be measured with questionnaires, web logging tools and group interviews. Our fourth objective is to determine the impact for the participants regarding knowledge and expertise, attitudes and perceptions, self-efficacy for the management of obesity, and changes in FMG organization for obesity management. Questionnaires and interviews will be used for this purpose. Our fifth objective is to deliver transferable knowledge for health professionals and decision-makers. Strategies and pitfalls of setting up this program will also be identified. CONCLUSION This project is relevant to health system's decision-makers who are confronted with an important increase in the prevalence of obesity. It is therefore critical to develop strategies allowing the management of obesity in the 1st line setting. Results of this research project could therefore influence health care organization in the field of obesity but also eventually for other chronic diseases.
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Affiliation(s)
- Jean-Patrice Baillargeon
- Division of Endocrinology, Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - André Carpentier
- Division of Endocrinology, Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Denise Donovan
- Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Martin Fortin
- Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Unité de médecine de famille, Centre de Santé et de services sociaux de Chicoutimi, Chicoutimi, Québec, Canada
| | - Andrew Grant
- Department of Biochemistry, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Judith Simoneau-Roy
- Department of Pediatrics, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Denise St-Cyr-Tribble
- École des sciences infirmières, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Mariane Xhignesse
- Unité de médecine de famille, Centre de Santé et de services sociaux de Chicoutimi, Chicoutimi, Québec, Canada
| | - Marie-France Langlois
- Division of Endocrinology, Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
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Abstract
Evidence-based guidance recommends that primary care health practitioners should deliver brief interventions to their patients to change behaviours to reduce overweight and obesity. This cross-sectional study investigates UK general practitioners' (GPs) and practice nurses' communication about overweight with their overweight and obese patients. Forty general practitioners and 47 practice nurses in two inner-London primary care organizations completed a questionnaire about past practice and concerns. When there was no identified medical problem, 38% of GPs and 14% of practice nurses reported raising the issue on less than 50% of occasions. Practice nurses were more likely than GPs to raise the issue of weight, both when there was no medical problem and when there was a medical problem. When they did raise the issue of overweight, only 9% did so in the context of presenting possible solutions to weight loss or in discussions about health promotion. Fifty two per cent of GPs and 28% of practice nurses had concerns about raising the issue of overweight; the most common being that patients would react emotionally to the message. These results suggest that there is considerable room for improvement in the frequency with which primary care practitioners address the questions of weight in their overweight patients, especially amongst doctors. Training to increase skills and confidence in communicating about weight is recommended.
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Affiliation(s)
- Susan Michie
- Psychology, University College London, London, UK.
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Müller M, Kurth BM. Prävention von Übergewicht bei Kindern und Jugendlichen. PRAVENTION UND GESUNDHEITSFORDERUNG 2007. [DOI: 10.1007/s11553-007-0083-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Karampoiki V, Flores FJR, Altinoz H, Chojnacka M, Karentzou I, Dambrosio M, Colichi C, Oxiuzova T, Kanavoura E, de Sousa BAMDSA, Ivanova D, Mauri J, Alexiou G, Mauri D, Kamposioras K, Maragkaki A, Peponi C. Screening Evaluation System--Europe (SESy_Europe) met skin cancer screening. Cent Eur J Public Health 2007; 15:71-3. [PMID: 17645221 DOI: 10.21101/cejph.a3411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Skin tumors are the most frequent malignancies in the white population worldwide and have reached the proportion of an epidemic disease. Since non-melanocytic skin cancers can be cured when timely detected, given that still malignant melanoma may have good prognosis if early diagnosed, and considering the key role of primary care in cancer screening advising and implementation, the international PACMeR study group (trial_01.3) adjourned SESy_Europe database in a version comprehensive of skin-malignancies screening indexing. The novel database provides standardized pre-codified translations of 2,331 parameters in eight languages (English, French, German, Greek, Italian, Romanian, Spanish and Turkish) and records the time elapsed from last skin examination, cause and frequency of skins examinations and stratifies skin cancer risk patterns by a systematic registering of risk factors. A comprehensive indexing of skin cancer screening practices among European countries may in fact turn helpful in programming future health policy and tailoring interventions.
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General practitioners’ opportunities for preventing ill health in healthy vs morbid obese adults: a general population study on consultations. J Public Health (Oxf) 2007. [DOI: 10.1007/s10389-006-0086-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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