1
|
Vuong K, Kabir A, Conway DP, Williamson M, Harris MF, Barr ML. Identifying risk factors for developing obesity: a record linkage longitudinal study in metropolitan Sydney using the 45 and Up Study. Fam Pract 2024; 41:680-692. [PMID: 38478922 PMCID: PMC11461147 DOI: 10.1093/fampra/cmae015] [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: 10/10/2024] Open
Abstract
BACKGROUND Primary care clinicians have key responsibilities in obesity prevention and weight management. AIMS We aimed to identify risk factors for developing obesity among people aged ≥45 years. METHODS We conducted a record linkage longitudinal study of residents of metropolitan Sydney, Australia using data from the: (1) 45 and Up Study at baseline (2005-2009) and first follow-up (2012-2015); (2) Medicare claims; (3) Pharmaceutical Benefits Scheme; and (4) deaths registry. We examined risk factors for developing obesity (body mass index [BMI]: 30-40) at follow-up, separately for people within the: (1) healthy weight range (BMI 18.5-<25) and (2) overweight range (BMI 25-<30) at baseline. Covariates included demographics, modifiable behaviours, health status, allied health use, and medication use. Crude and adjusted relative risks were estimated using Poisson regression modelling. RESULTS At follow-up, 1.1% (180/16,205) of those in the healthy weight range group, and 12.7% (1,939/15,266) of those in the overweight range group developed obesity. In both groups, the following were associated with developing obesity: current smoking at baseline, physical functioning limitations, and allied health service use through team care planning, while any alcohol consumption and adequate physical activity were found to be associated with a lower risk of developing obesity. In the healthy weight group, high psychological distress and the use of antiepileptics were associated with developing obesity. In the overweight group, female sex and full-time work were associated with developing obesity, while older age was found to be associated with a lower risk of developing obesity. CONCLUSIONS These findings may inform the targeting of preventive interventions for obesity in clinical practice and broader public health programs.
Collapse
Affiliation(s)
- Kylie Vuong
- School of Medicine and Dentistry, Griffith University, Queensland, Australia
- School of Population Health, University of New South Wales, New South Wales, Australia
| | - Alamgir Kabir
- Centre for Primary Health Care and Equity, University of New South Wales, New South Wales, Australia
| | - Damian P Conway
- Population and Community Health Directorate, South Eastern Sydney Local Health District, New South Wales, Australia
- The Kirby Institute, University of New South Wales, New South Wales, Australia
| | - Margaret Williamson
- Centre for Primary Health Care and Equity, University of New South Wales, New South Wales, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, New South Wales, Australia
| | - Margo L Barr
- Centre for Primary Health Care and Equity, University of New South Wales, New South Wales, Australia
| |
Collapse
|
2
|
Badorrek S, Franklin J, McBride KA, Conway L, Williams K. Primary care practitioner and patient perspectives on care following bariatric surgery: A meta-synthesis of qualitative research. Obes Rev 2024:e13829. [PMID: 39295428 DOI: 10.1111/obr.13829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 07/26/2024] [Accepted: 08/26/2024] [Indexed: 09/21/2024]
Abstract
Primary care is central to ongoing health care following bariatric surgery and patients indicate a preference for receiving follow-up support by their primary care practitioner (PCP). This meta-synthesis investigates the perspectives of both PCPs and patients in post-bariatric surgery care provided by PCPs. The aim was to synthesize themes from qualitative research to recommend improvements in post-bariatric surgery clinical care in primary care settings. Systematic searches of Scopus, Medline, EMBASE, PsycINFO, the Cochrane Library, and Google Scholar resulted in the inclusion of eight papers in the meta-synthesis. Papers were critiqued using the Critical Appraisal Skills Program (CASP) and thematically coded in Quirkos Cloud. Seven themes were reached by author consensus including stigma and judgment; clinician barriers and facilitators; patient-related support needs; communication considerations; patient context or determinants; health care setting; and adapting to life after surgery. PCPs reported barriers including poor communication and guidance from bariatric surgery centers, limited knowledge and training in bariatric patient care, and patients who may have unrealistic outcomes and poor health literacy. Patients seek comprehensive care from their PCP, however, barriers hindering the provision of this care include adverse surgical outcomes, a poor relationship with their PCP, and limited and short-term follow-up care from the PCP. Insights from this meta-synthesis offer actionable recommendations for PCPs and bariatric surgery centers to enhance patient care immediately.
Collapse
Affiliation(s)
- Sally Badorrek
- Nepean Family Metabolic Health Service, Nepean Hospital, Kingswood, Australia
- Charles Perkins Centre - Nepean, University of Sydney, Kingswood, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Janet Franklin
- Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
- Metabolism and Obesity Services, Royal Prince Alfred Hospital, Camperdown, Australia
- ENRG, Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | - Kate A McBride
- School of Medicine, Western Sydney University, Penrith, Australia
| | - Laura Conway
- Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
- Department of Endocrinology, Nepean Hospital, Kingswood, Australia
| | - Kathryn Williams
- Nepean Family Metabolic Health Service, Nepean Hospital, Kingswood, Australia
- Charles Perkins Centre - Nepean, University of Sydney, Kingswood, Australia
- Department of Endocrinology, Nepean Hospital, Kingswood, Australia
| |
Collapse
|
3
|
Slater S, Lambkin D, Schumacher T, Williams A, Baillie J. Testing the effectiveness of a novel, evidence-based weight management and lifestyle modification programme in primary care: the Healthy Weight Initiative. J Prim Health Care 2022; 14:64-73. [PMID: 35417339 DOI: 10.1071/hc21065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 02/23/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Primary care prevention strategies that support and provide tools for general practice have the potential to slow and reverse rates of overweight and obesity. Aim To test the effectiveness of a novel 12-week, online, structured, evidence-based weight management and lifestyle modification programme in general practices. Methods Between August 2018 and March 2020, participants with a body mass index (BMI) ≥ 25 were recruited from general practices in the Hunter New England and Central Coast Primary Health Network region of Australia. Practices were randomly assigned to deliver a 'low-intensity' (LI) or 'high-intensity' (HI) variant of the programme. Practitioners were trained in programme delivery. The intervention involved weekly progress and accountability checks and scripted education sessions on evidenced-based nutrition, physical activity and lifestyle modification. The trial included follow-up evaluations at 6 and 12 months. Results In total, 695 participants were recruited from 26 practices. At the end of the 12-week programme, participants in the HI treatment arm lost an average of 3.2 kg (s.d. 3.8) and 29% (50/172) achieved clinically significant weight loss (>5% of initial body weight). Positive results were maintained at evaluations by participants in the HI treatment arm who attended, but only 31% of participants at 6 months and 21% at 12 months were followed up. Discussion Participant engagement and retention and practitioner workload burden are key factors in the design of weight management programmes in primary care. Many lessons can be obtained as a result of this trial, and programme adjustments have been identified to improve its delivery model.
Collapse
Affiliation(s)
- Scott Slater
- Hunter New England and Central Coast Primary Health Network, 11/125 Bull Street, Newcastle West, NSW 2302, Australia
| | - David Lambkin
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Tracy Schumacher
- Department of Rural Health, Faculty of Health and Medicine, The University of Newcastle, Tamworth, NSW, Australia
| | - Annabelle Williams
- Hunter New England and Central Coast Primary Health Network, 11/125 Bull Street, Newcastle West, NSW 2302, Australia
| | - John Baillie
- Hunter New England and Central Coast Primary Health Network, 11/125 Bull Street, Newcastle West, NSW 2302, Australia
| |
Collapse
|
4
|
Harding C, Seal A, Mills N. Evaluation of a Lifestyle and Weight Management Program Within Rural General Practice. J Prim Care Community Health 2022; 13:21501319221084166. [PMID: 35289212 PMCID: PMC8928353 DOI: 10.1177/21501319221084166] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Australia has one of the highest rates of obesity in the developed world. In response to increasing rates of overweight and obesity in rural Australia, one regional primary health network commissioned the development of a multi-faceted weight and lifestyle management program, addressing nutrition, physical activity, and psychological approaches to behavioral change. This study evaluated the success of the program that was implemented in multiple general practices within regional New South Wales. Methods: De-identified data were received from 16 general practices that participated in the Murrumbidgee Lifestyle and Weight Management Program (MLWMP). Patient weight outcome and functional status measures were determined using descriptive statistics (SPSS). Results: Mean body mass index (BMI) of the 1217 participants was 37.4 kg/m2 and 75% of participants were female. Almost 40% of participants who had a BMI ≥ 40 kg/m2 had been diagnosed with a mental health condition. Upon completion of the program at 6 months, participants had lost an average of 3.2 kg. Over 31% of participants had lost at least 5% of their initial weight and 40% had reduced their waist circumference by at least 5 cm. Overall health and functional status measures were significantly higher upon program completion. There were significant improvements in quality of life measures regardless of level of weight loss during the program. Conclusions: The MLWMP, implemented in general practices within rural and regional Australia, had positive effects on both practices and participants demonstrating the value of intervention programs in primary care. Participants achieved a modest reduction in BMI, waist circumference, and weight. Further work is needed to determine the longer-term success of the program.
Collapse
Affiliation(s)
- Catherine Harding
- School of Medicine Sydney, Rural Clinical School, The University of Notre Dame Australia, Wagga Wagga, NSW, Australia
| | - Alexa Seal
- School of Medicine Sydney, Rural Clinical School, The University of Notre Dame Australia, Wagga Wagga, NSW, Australia
| | - Narelle Mills
- Murrumbidgee Primary Health Network, Wagga Wagga, NSW, Australia
| |
Collapse
|
5
|
Hilder J, Gray L, Stubbe M, Duncan S, Dowell AC. 'Water dripping on a stone': a feasibility study of a healthy weight management conversation approach in routine general practice consultations. Fam Pract 2021; 38:246-252. [PMID: 33184641 DOI: 10.1093/fampra/cmaa122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Primary health care has an important role to play in the management of weight and yet discussions of healthy weight management do not occur optimally, indicating a need for simple tools and training in brief weight counselling. The 'FABS' approach (focusing on four topic areas: Food, Activity, Behaviour and Support) was developed to address this. OBJECTIVES To explore the feasibility of the 'FABS' approach within routine general practice consultations and its effectiveness in facilitating healthy weight conversations. METHOD The FABS approach was run for a trial period in five New Zealand general practices. The approach entailed staff training, the addition to the practice patient management system of a template outlining potential topics for discussion and a patient handout. GPs were asked to use the approach with any adult patient with a body mass index of over 28 kg/m2. A descriptive analysis of anonymized quantitative practice data was conducted, with limited qualitative data from an online clinician questionnaire and interviews with GPs and patients. RESULTS Over 4 months, the template was opened 862 times by 27 clinicians in 830 patient consultations. All FABS topics were raised at least once. Physical activity was raised most frequently, followed by two food-related topics. There was variation between practices and between GPs. GPs tended to raise more topics within a single consultation than the training recommended. The limited clinician survey results and patient interviews also indicated positive responses to the approach. CONCLUSIONS It is possible to provide an infrastructure for healthy weight conversation approaches within general practice so that patients receive supportive and consistent messages on a regular basis. General practice is an appropriate setting for this due to the ongoing relationships with patients and team-based approach, but there is a need for effective training and education to ensure appropriate and effectively delivery.
Collapse
Affiliation(s)
- Jo Hilder
- Department of Primary Health Care and General Practice, University of Otago Wellington, Wellington, New Zealand
| | - Lesley Gray
- Department of Primary Health Care and General Practice, University of Otago Wellington, Wellington, New Zealand
| | - Maria Stubbe
- Department of Primary Health Care and General Practice, University of Otago Wellington, Wellington, New Zealand
| | | | - Anthony C Dowell
- Department of Primary Health Care and General Practice, University of Otago Wellington, Wellington, New Zealand
| |
Collapse
|
6
|
Kitunen A, Rundle-Thiele S, Carins J. Segmenting Young Adult University Student's Eating Behaviour: A Theory-Informed Approach. Nutrients 2019; 11:nu11112793. [PMID: 31731796 PMCID: PMC6893594 DOI: 10.3390/nu11112793] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 09/26/2019] [Accepted: 11/14/2019] [Indexed: 12/20/2022] Open
Abstract
The purpose of this paper is to extend behavioural theory and segmentation application. Specifically, this paper draws on three segmentation bases and behavioural theory that extends focus beyond individual psychological predispositions to form segments within the healthy eating context for young adult university students (20–35 years) in Queensland, Australia. Participants were invited to take part in an online survey via email and through face to face intercept to ensure a diverse cross section was obtained. Structural equation modelling revealed that the Motivation, Opportunity, and Ability (MOA) framework can be utilised to explain healthful eating behaviour and two-step cluster analysis uncovered two distinct segments with education, motivation to eat healthily and Turconi’s eating behaviour scores being the most important variables within the wider multivariate segment formation. This paper contributes to literature in the following ways. First, it confirms the importance of behavioural bases in segment formation and supports inclusion of other bases, namely demographics and psychographics. Next, it provides evidence of the value of including behavioural theory, which extends focus beyond what individuals think to understand how the environment may support them. Finally, this paper demonstrates that the MOA framework together with eating behaviour and demographic factors (education) can produce theoretically informed segments.
Collapse
Affiliation(s)
- Anna Kitunen
- Social Marketing @ Griffith, Griffith University, 170 Kessels Road, Nathan, QLD 4111, Australia; (S.R.-T.); (J.C.)
- Correspondence: ; Tel.: +61-737-357-673
| | - Sharyn Rundle-Thiele
- Social Marketing @ Griffith, Griffith University, 170 Kessels Road, Nathan, QLD 4111, Australia; (S.R.-T.); (J.C.)
| | - Julia Carins
- Social Marketing @ Griffith, Griffith University, 170 Kessels Road, Nathan, QLD 4111, Australia; (S.R.-T.); (J.C.)
- Food and Nutrition, Land Division, Defence Science and Technology, Scottsdale, TAS 7260, Australia
| |
Collapse
|
7
|
Opie CA, Glenister K, Wright J. Is social exposure to obesity associated with weight status misperception? Assessing Australians ability to identify overweight and obesity. BMC Public Health 2019; 19:1222. [PMID: 31484511 PMCID: PMC6727423 DOI: 10.1186/s12889-019-7556-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/27/2019] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Overweight and obesity prevalence has increased significantly over the past two decades, currently impacting greater than 60% of Australians. It is unclear if a social perception of a healthy weight has been obscured by the increase in prevalence and thus has become inconsistent with the medical definitions. METHODS An electronic questionnaire was distributed via email and social media using the authors' informal networks. Australian adults were eligible to participate. Participants were asked to categorise their own body size using medically accepted words and previously published silhouettes, before identifying underweight, healthy weight, overweight or obesity in a series ofsilhouettes. RESULTS Eight hundred six questionnaires were completed, a majority of participants had attained a high level of education and were employed female health professionals. Under half the studied population had a Body Mass Index (BMI) corresponding to overweight or obese categories (n = 349, 47%). Accuracy in self-perceived weight status using medicalised words was higher among respondents with BMI corresponding to the healthy weight category (n = 311, 85%) and overweight category (n = 133, 74%) than for respondents with BMI corresponding to obesity (n = 79, 45%) or underweight (n = 5, 31%). A majority of respondents were able to accurately self-perceive their weight status using silhouettes (n = 469, 70%). Females were significantly more likely to be accurate in their self-perception than males, using both medicalised words (p = < 0.001) and silhouettes (p = 0.045). Respondents with a BMI corresponding to the obese category were significantly more likely to be accurate with weight status self-perception using silhouettes than words (87% versus 46% respectively, p = < 0.001). Less than half (41%) of respondents accurately perceived silhouettes corresponding to an overweight BMI and less than one in ten respondents (9%) accurately perceived the lower limit of the silhouettes corresponding to an obese BMI. CONCLUSIONS Repondents were challenged to accurately perceive silhouettes corresponding to an obese BMI in themselves and others. Weight status misperception was more likely to exist among those with a BMI less than 18.5 or 30 or more (underweight BMI and obese BMI). Accuracy decreased as BMI increased. Respondents with a BMI in the obese category were significantly more likely to accurately self-perceive their weight status using silhouettes than medicalised words. Silhouettes may act as an effective visual cue in initiating weight related discussions.
Collapse
Affiliation(s)
- C. A. Opie
- Department of Rural Health, The University of Melbourne, Graham Street, Shepparton, Victoria 3630 Australia
- Echuca Regional Health, Research Department, 226 Service Street, Echuca, Victoria 3564 Australia
| | - K. Glenister
- Department of Rural Health, The University of Melbourne, Graham Street, Shepparton, Victoria 3630 Australia
| | - J. Wright
- Department of Rural Health, The University of Melbourne, Graham Street, Shepparton, Victoria 3630 Australia
| |
Collapse
|
8
|
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: 18] [Impact Index Per Article: 3.0] [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.
Collapse
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
| |
Collapse
|
9
|
Opie CA, Haines HM, Ervin KE, Glenister K, Pierce D. Why Australia needs to define obesity as a chronic condition. BMC Public Health 2017; 17:500. [PMID: 28535781 PMCID: PMC5442589 DOI: 10.1186/s12889-017-4434-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 05/15/2017] [Indexed: 11/22/2022] Open
Abstract
Background In Australia people with a diagnosed chronic condition can be managed on unique funded care plans that allow the recruitment of a multidisciplinary team to assist in setting treatment goals and adequate follow up. In contrast to the World Health Organisation, the North American and European Medical Associations, the Australian Medical Association does not recognise obesity as a chronic condition, therefore excluding a diagnosis of obesity from qualifying for a structured and funded treatment plan. Body The Australian guidelines for management of Obesity in adults in Primary Care are structured around a five step process -the ‘5As’: Ask & Assess, Advise, Assist and Arrange’. This article aims to identify the key challenges and successes associated with the ‘5As’ approach, to better understand the reasons for the gap between the high Australian prevalence of overweight and obesity and an actual diagnosis and treatment plan for managing obesity. It argues that until the Australian health system follows the international lead and defines obesity as a chronic condition, the capacity for Australian doctors to diagnose and initiate structured treatment plans will remain limited and ineffective. Conclusion Australian General Practitioners are limited in their ability manage obesity, as the current treatment guidelines only recognise obesity as a risk factor rather than a chronic condition.
Collapse
Affiliation(s)
- C A Opie
- Department of Rural Health Graham Street Shepparton Victoria, The University of Melbourne, Victoria, 3630, Australia.
| | - H M Haines
- Department of Rural Health Graham Street Shepparton Victoria, The University of Melbourne, Victoria, 3630, Australia
| | - K E Ervin
- Department of Rural Health Graham Street Shepparton Victoria, The University of Melbourne, Victoria, 3630, Australia
| | - K Glenister
- Department of Rural Health Graham Street Shepparton Victoria, The University of Melbourne, Victoria, 3630, Australia
| | - D Pierce
- Department of Rural Health Graham Street Shepparton Victoria, The University of Melbourne, Victoria, 3630, Australia
| |
Collapse
|