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Thakur B, Strenth C, Arnold EM, Schneider FD. Sex Differences in the Association of Depression Symptoms and Cardiovascular Disease in Adults in the United States. Am J Health Promot 2024:8901171241262249. [PMID: 38864762 DOI: 10.1177/08901171241262249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
PURPOSE This study explores the relationship between depression and cardiovascular disease (CVD) in the US adult population, focusing on sex differences. DESIGN Cross-sectional study. SETTING National Health and Nutrition Examination Survey data (2013-2018). PARTICIPANTS A total of 14 699 community-dwelling adults (≥20 years). MEASURE The Patient Health Questionnaire (PHQ-9) depression screening tool assessed depressive symptoms. CVD events included heart failure, coronary heart disease, angina, heart attack, or stroke. ANALYSIS Adjusted prevalence ratios were estimated using a Poisson regression model. RESULTS The study finds a positive association between CVD incidents and both mild to moderate depressive symptoms (aPR:1.42, P = .002) and moderately severe to severe depression (aPR:1.72, P = .024). Overall, females exhibit a 47% lower likelihood of CVD incidents compared to males. However, in a subgroup analysis, increased depressive symptoms correlate with higher CVD incidents in females (aPRs range: 2.09 to 3.43, P < .001) compared to males (aPRs range: 1.45 to 1.77, P < .001). CONCLUSION Depression is associated with increased cardiovascular disease (CVD) risk. Females generally have a lower CVD risk than males, but more severe depressive symptoms elevate CVD risk in females. These findings emphasize the significance of considering sex differences. Further research is needed to understand the underlying mechanisms.
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Affiliation(s)
- Bhaskar Thakur
- Department of Family & Community Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Chance Strenth
- Department of Family & Community Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Frank David Schneider
- Department of Family & Community Medicine, UT Southwestern Medical Center, Dallas, TX, USA
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Chew HSJ, Chew NW, Loong SSE, Lim SL, Tam WSW, Chin YH, Chao AM, Dimitriadis GK, Gao Y, So JBY, Shabbir A, Ngiam KY. Effectiveness of an Artificial Intelligence-Assisted App for Improving Eating Behaviors: Mixed Methods Evaluation. J Med Internet Res 2024; 26:e46036. [PMID: 38713909 PMCID: PMC11109864 DOI: 10.2196/46036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 12/12/2023] [Accepted: 03/12/2024] [Indexed: 05/09/2024] Open
Abstract
BACKGROUND A plethora of weight management apps are available, but many individuals, especially those living with overweight and obesity, still struggle to achieve adequate weight loss. An emerging area in weight management is the support for one's self-regulation over momentary eating impulses. OBJECTIVE This study aims to examine the feasibility and effectiveness of a novel artificial intelligence-assisted weight management app in improving eating behaviors in a Southeast Asian cohort. METHODS A single-group pretest-posttest study was conducted. Participants completed the 1-week run-in period of a 12-week app-based weight management program called the Eating Trigger-Response Inhibition Program (eTRIP). This self-monitoring system was built upon 3 main components, namely, (1) chatbot-based check-ins on eating lapse triggers, (2) food-based computer vision image recognition (system built based on local food items), and (3) automated time-based nudges and meal stopwatch. At every mealtime, participants were prompted to take a picture of their food items, which were identified by a computer vision image recognition technology, thereby triggering a set of chatbot-initiated questions on eating triggers such as who the users were eating with. Paired 2-sided t tests were used to compare the differences in the psychobehavioral constructs before and after the 7-day program, including overeating habits, snacking habits, consideration of future consequences, self-regulation of eating behaviors, anxiety, depression, and physical activity. Qualitative feedback were analyzed by content analysis according to 4 steps, namely, decontextualization, recontextualization, categorization, and compilation. RESULTS The mean age, self-reported BMI, and waist circumference of the participants were 31.25 (SD 9.98) years, 28.86 (SD 7.02) kg/m2, and 92.60 (SD 18.24) cm, respectively. There were significant improvements in all the 7 psychobehavioral constructs, except for anxiety. After adjusting for multiple comparisons, statistically significant improvements were found for overeating habits (mean -0.32, SD 1.16; P<.001), snacking habits (mean -0.22, SD 1.12; P<.002), self-regulation of eating behavior (mean 0.08, SD 0.49; P=.007), depression (mean -0.12, SD 0.74; P=.007), and physical activity (mean 1288.60, SD 3055.20 metabolic equivalent task-min/day; P<.001). Forty-one participants reported skipping at least 1 meal (ie, breakfast, lunch, or dinner), summing to 578 (67.1%) of the 862 meals skipped. Of the 230 participants, 80 (34.8%) provided textual feedback that indicated satisfactory user experience with eTRIP. Four themes emerged, namely, (1) becoming more mindful of self-monitoring, (2) personalized reminders with prompts and chatbot, (3) food logging with image recognition, and (4) engaging with a simple, easy, and appealing user interface. The attrition rate was 8.4% (21/251). CONCLUSIONS eTRIP is a feasible and effective weight management program to be tested in a larger population for its effectiveness and sustainability as a personalized weight management program for people with overweight and obesity. TRIAL REGISTRATION ClinicalTrials.gov NCT04833803; https://classic.clinicaltrials.gov/ct2/show/NCT04833803.
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Affiliation(s)
- Han Shi Jocelyn Chew
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicholas Ws Chew
- Department of Cardiology, National University Hospital, Singapore, Singapore
| | - Shaun Seh Ern Loong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Su Lin Lim
- Department of Dietetics, National University Hospital, Singapore, Singapore
| | - Wai San Wilson Tam
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ariana M Chao
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Georgios K Dimitriadis
- Department of Endocrinology ASO/EASO COM, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Yujia Gao
- Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, National University Hospital, Singapore, Singapore
| | - Jimmy Bok Yan So
- Division of General Surgery (Upper Gastrointestinal Surgery), Department of Surgery, National University Hospital, Singapore, Singapore
| | - Asim Shabbir
- Division of General Surgery (Upper Gastrointestinal Surgery), Department of Surgery, National University Hospital, Singapore, Singapore
| | - Kee Yuan Ngiam
- Division of Thyroid & Endocrine Surgery, Department of Surgery, National University Hospital, Singapore, Singapore
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Suminski RR, Leonard T, Obrusnikova I, Kelly K. The Impact of Health Coaching on Weight and Physical Activity in Obese Adults: A Randomized Control Trial. Am J Lifestyle Med 2024; 18:233-242. [PMID: 38559788 PMCID: PMC10979733 DOI: 10.1177/15598276221114047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Health Coaching (HC) is an evidence-based, patient-centered approach to assisting individuals in achieving their health-related goals. Studies have generally shown positive effects of HC on weight loss in obese adults. However, limitations do exist, that if addressed would further clarify HC's viability as a clinical, obesity treatment approach. To examine the effects of HC on weight loss, moderate-to-vigorous physical activity (MVPA), and psychosocial constructs in obese adults. A randomized control trial with 44 [Mean body mass index (BMI) 36.5] middle-aged, White adults. Participants were randomly assigned to HC (n = 22) or control (n = 22) groups. A certified health coach provided bi-weekly, in-person and telehealth HC for 12 weeks. Percent excess weight loss was 15.7% in HC vs. 2.5% in controls (p< .001). The change in MVPA was significantly greater in HC (+50.3 min/wk) vs controls (+7.1 min/wk). Psychosocial constructs also changed more favorably in HC than controls. Health coaching is an effective approach for weight loss in obese adults. The results of this study support the consideration of HC as a treatment option for obese adults looking to lose weight.
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Affiliation(s)
- Richard R. Suminski
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE, USA
| | - Tara Leonard
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE, USA
| | - Iva Obrusnikova
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE, USA
| | - Kristin Kelly
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE, USA
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Chimoriya R, Mitlehner K, Khoo CL, Osuagwu UL, Thomson R, Si L, Lean M, Simmons D, Piya MK. Translation of a Diabetes Remission Service into Australian Primary Care: Findings from the Evaluation of DiRECT-Australia. J Diabetes Res 2024; 2024:2350551. [PMID: 38361965 PMCID: PMC10869186 DOI: 10.1155/2024/2350551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/02/2023] [Accepted: 01/29/2024] [Indexed: 02/17/2024] Open
Abstract
Background The Diabetes Remission Clinical Trial (DiRECT) study demonstrated that an intensive and structured weight management program in UK primary care resulted in high rates of diabetes remission in adults with recent onset type 2 diabetes mellitus (T2DM). This study was aimed at evaluating the translation of the DiRECT intervention into an Australian primary care setting. Methods All patients enrolled in the DiRECT-Australia Type 2 Diabetes Remission Service in a region of Sydney (Macarthur region, South Western Sydney, Australia) were included. Eligible participants were aged 20-70 years, noninsulin treated, with T2DM of ≤6 years' duration, and body mass index (BMI) ≥ 27 kg/m2. Total diet replacement of 825-853 kcal/day using meal replacements was implemented for 12 weeks, followed by an ongoing structured program until 52 weeks, with regular follow-up with a general practitioner, dietitian, and/or practice nurse. Results Of 39 recruited participants, 32 (82.1%) and 27 (69.2%) completed 12 weeks and 52 weeks of the structured program, respectively. Decrease in weight by -12.0 kg (95% CI: -9.6, -14.4; p < 0.001) and -9.1 kg (95% CI: -5.2, -12.9; p < 0.001) and decrease in glycated haemoglobin (HbA1c) by -1.1% (95% CI: -0.6, -1.6; p < 0.001) and -0.6% (95% CI: -0.1, -1.1; p = 0.013) were observed at 12 and 52 weeks, respectively. At the end of 12 and 52 weeks, 93.8% (30/32) and 55.6% (15/27) of those with follow-up data met the criteria for diabetes remission, respectively. Quality of life and wellbeing scores increased over the course of 12 weeks, remaining significantly higher at 52 weeks. Participants reported they would be willing to pay A$92.50 (95% CI: A$75.80, A$109.30) per fortnight for the low-calorie meal replacement shakes. Conclusions These findings support the feasibility of a structured diabetes remission service in an Australian primary care setting to achieve improvements in glycaemia, weight, and quality of life and wellbeing, and suggest a substantial willingness to pay for diet replacement products among participants.
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Affiliation(s)
- Ritesh Chimoriya
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Kimberly Mitlehner
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Chee L. Khoo
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Healthfocus Family Practice, Ingleburn, NSW, Australia
| | - Uchechukwu Levi Osuagwu
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Bathurst Rural Clinical School (BRCS), Western Sydney University, Bathurst, NSW, Australia
| | - Russell Thomson
- School of Computer, Data and Mathematical Sciences, Western Sydney University, Penrith, Australia
| | - Lei Si
- School of Health Sciences, Western Sydney University, Campbelltown, Australia
| | - Michael Lean
- School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - David Simmons
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Campbelltown and Camden Hospitals, Campbelltown, NSW, Australia
| | - Milan K. Piya
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Campbelltown and Camden Hospitals, Campbelltown, NSW, Australia
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Carr MM, Wolkowicz NR, Cave S, Martino S, Masheb R, Midboe AM. Weight change in a national cohort of U.S. Military Veterans engaged in medication treatment for opioid use disorder. J Psychiatr Res 2023; 168:204-212. [PMID: 37918033 DOI: 10.1016/j.jpsychires.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/27/2023] [Accepted: 10/07/2023] [Indexed: 11/04/2023]
Abstract
Medication treatments for opioid use disorder (MOUD) save lives and improve outcomes for countless individuals. However, data suggest the potential for significant weight gain during methadone treatment and little is known about weight change during buprenorphine treatment. Using Veteran Health Administration administrative data from fiscal year 2017 to fiscal year 2019, two cohorts were created: 1) Veterans diagnosed with opioid use disorder (OUD) taking methadone (N = 1425); and 2) Veterans diagnosed with OUD taking buprenorphine (N = 3756). Linear mixed models were used to analyze weight change during the first MOUD treatment episode in the observation period. Random slopes and intercepts were included in the model to estimate variation in BMI across individuals and time. The data revealed a slight upward trend in BMI over the course of treatment. Specifically, a daily increase of 0.004 for Veterans in methadone treatment and 0.002 for Veterans in buprenorphine treatment was observed. This translates to a gain of about 10 pounds over the course of 1 year of methadone treatment and 5 pounds for 1 year of buprenorphine treatment for a Veteran of average height and weight. The amount of weight gain in methadone treatment is significantly less than other published findings, but nonetheless indicates that assessment and discussions between patients and providers related to weight may be warranted.
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Affiliation(s)
- Meagan M Carr
- U.S. Department of Veterans Affairs, VA Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT, 06516, USA; Department of Psychiatry, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06511, USA.
| | - Noah R Wolkowicz
- U.S. Department of Veterans Affairs, VA Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT, 06516, USA; Department of Psychiatry, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06511, USA
| | - Shayna Cave
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Rd, Menlo Park, CA, 94025, USA
| | - Steve Martino
- U.S. Department of Veterans Affairs, VA Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT, 06516, USA; Department of Psychiatry, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06511, USA
| | - Robin Masheb
- U.S. Department of Veterans Affairs, VA Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT, 06516, USA; Department of Psychiatry, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06511, USA
| | - Amanda M Midboe
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Rd, Menlo Park, CA, 94025, USA; Division of Health Policy and Management, University of California Davis-School of Medicine, Davis, CA, USA
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Nilsen MD, Mdala I, Werner EL. Treatment of overweight and obesity in general practice: a cluster randomised trial. BMJ Nutr Prev Health 2023; 6:326-331. [PMID: 38618545 PMCID: PMC11009536 DOI: 10.1136/bmjnph-2023-000721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/06/2023] [Indexed: 04/16/2024] Open
Abstract
Overweight and obesity are among the most serious health problems of our time. A majority of patients with overweight and obesity will first get in touch with health services through primary care. This makes it crucial to develop strategies to enable physicians in primary care to help and treat patients with overweight and obesity. The physicians tend to avoid this subject. The main reason is reported to be lack of knowledge and education, and that they have nothing concrete to offer their patients. We wanted to examine if a simple method with specific measures could be used in Norwegian general practice and achieve meaningful weight loss. 23 physicians and 210 patients participated in the study. The physicians who participated were cluster randomised into either control group or intervention group. The physicians in the control group were told to follow their usual approach, while the physicians in the intervention group followed a fixed plan with specific diets given orally and in writing to the patients. The inclusion criteria for both groups were: body mass index (BMI)>30 kg/m2, or BMI>25 kg/m2 with at least one weight-related condition. Weight was measured at the start, then after 1 year and finally after 2 years in both groups. We found no significant weight loss in the control group. In the intervention group, there was a weight loss of at least 10% by 25.5% after the first year and 24.2% after the entire observation period. 53.5% of the patients lost at least 5% of their weight in the first year and nearly 45% after the entire observation period. We conclude that a simple tool with a specific diet and activity plan is feasible in general practice and may produce significant weight loss. Trial registration number: NCT03000062.
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Affiliation(s)
| | - Ibrahimu Mdala
- Department of General Practice, University of Oslo, Oslo, Norway
| | - Erik L Werner
- Department of General Practice, University of Oslo, Oslo, Norway
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Pianarosa E, O'Neill M, Kornas K, Diemert LM, Tait C, Rosella LC. Modelling population-level and targeted interventions of weight loss on chronic disease prevention in the Canadian population. Prev Med 2023; 175:107673. [PMID: 37597756 DOI: 10.1016/j.ypmed.2023.107673] [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: 03/08/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 08/21/2023]
Abstract
Obesity is a known risk factor for major chronic diseases. Prevention of chronic disease is a top global priority. The study aimed to model scenarios of population-level and targeted weight loss interventions on 10-year projected risk of chronic disease in Canada using a population-level risk prediction algorithm. The validated Chronic Disease Population Risk Tool (CDPoRT) forecasts 10-year risk of chronic disease in the adult population. We applied CDPoRT to the 2013/14 Canadian Community Health Survey to generate prospective chronic disease estimates for adults 20 years and older in Canada (n = 83,220). CDPoRT was used to model the following scenarios: British Columbia's (BC) and Quebec's (QC) provincial population-level weight reduction targets, a population-level intervention that could achieve weight loss, targeted weight loss interventions for overweight and obese groups, and the combination of a population-level and targeted weight loss intervention. We estimated chronic disease risk reductions and number of cases prevented in each scenario compared with the baseline. At baseline, we predicted an 18.4% risk and 4,151,929 new cases of chronic disease in Canada over the 10-year period. Provincial weight loss targets applied to the Canadian population estimated chronic disease reductions of 0.6% (BC) and 0.1% (QC). The population-level intervention estimated a greater reduction in risk (0.2%), compared to the targeted interventions (0.1%). The combined approach estimated a 0.3% reduction in chronic disease risk. Our modelling predicted that population-level approaches that achieve weight loss in combination with targeted weight loss interventions can substantially decrease the chronic disease burden in Canada.
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Affiliation(s)
- Emilie Pianarosa
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada
| | - Meghan O'Neill
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada
| | - Kathy Kornas
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada
| | - Lori M Diemert
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada
| | - Christopher Tait
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada
| | - Laura C Rosella
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada; ICES, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada; Institute for Better Health, Trillium Health Partners, 100 Queensway West, Mississauga, ON L5B 1B8, Canada; Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, Simcoe Hall, 1 King's College Cir, Toronto, ON M5S 1A8, Canada.
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Ee C. The Role of the Primary Care Physician in the Assessment and Management of Polycystic Ovary Syndrome. Semin Reprod Med 2023; 41:20-25. [PMID: 37913787 DOI: 10.1055/s-0043-1776419] [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: 11/03/2023]
Abstract
Polycystic ovary syndrome (PCOS) is a complex and heterogeneous female endocrine disorder with manifestations that span the hormonal, reproductive, metabolic, and psychological. Primary care physicians (PCPs), also known as family physicians or general practitioners, play a key role in the diagnosis, assessment, and management of PCOS. This article outlines the role of the PCP in the timely and accurate diagnosis, provision of information and education, lifestyle and weight management, and management of key features such as hyperandrogenism, irregular cycles, infertility, emotional well-being, and cardiometabolic risk. PCPs play an essential role as the point of first contact for women and adolescents with or at high risk of PCOS, providers of whole-person care and continuity of care, and coordinators of care within a multidisciplinary team. Optimal management of PCOS requires equitable access to primary care. There is a need for systemic approaches to addressing barriers to provision of quality primary care, such as poor remuneration of longer consultations and low awareness of evidence-based guidelines, to women and adolescents with PCOS.
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Affiliation(s)
- Carolyn Ee
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
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Levi J, Wang J, Venter F, Hill A. Estimated minimum prices and lowest available national prices for antiobesity medications: Improving affordability and access to treatment. Obesity (Silver Spring) 2023; 31:1270-1279. [PMID: 36815242 DOI: 10.1002/oby.23725] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/29/2022] [Accepted: 12/20/2022] [Indexed: 02/24/2023]
Abstract
OBJECTIVE Novel antiobesity treatments are highly effective in recent clinical trials. Access to these medications is needed to supplement lifestyle and surgical interventions for millions living with obesity worldwide, but high prices are limiting. This study aimed to review current treatment costs and calculate potential estimated minimum prices (EMPs). METHODS The authors searched national drug price databases across various countries for orlistat, naltrexone-bupropion, topiramate-phentermine, liraglutide, semaglutide, and tirzepatide. EMPs for antiobesity medications were calculated using established methodology, using active pharmaceutical ingredients (API) from the Panjiva database. EMPs were calculated per 30-day course and include costs of active pharmaceutical ingredients, excipients, formulation, taxation, and 10% profit margin. RESULTS National prices of antiobesity medications were significantly higher than calculated EMPs. Semaglutide 30-day course prices ranged from $804 (United States) to $95 (Turkey) while the EMP was $40. Liraglutide prices ranged from $1418 (United States) to $252 (Norway) while the EMP was $50. Some oral treatments could be generically manufactured at very low costs per course ($7 for orlistat; $5 for phentermine/topiramate combination tablets), while naltrexone/bupropion was more expensive ($54). CONCLUSIONS This study shows that certain weight loss treatments can be manufactured and sold profitably at low costs, but prices currently range widely between countries, limiting access for those in need.
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Affiliation(s)
- Jacob Levi
- Intensive Care Medicine, Royal Free Hospital NHS Trust, London, UK
| | - Junzheng Wang
- Medical Sciences Office, Oxford University Clinical Academic Graduate School, University of Oxford, Oxford, UK
| | - Francois Venter
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrew Hill
- Department of Pharmacology and Therapeutics, Liverpool University, Liverpool, UK
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Garvey WT, Cheng M, Ramasamy A, Smolarz BG, Park S, Kumar N, Kim N, DerSarkissian M, Bhak RH, Duh MS, Wu M, Hansen S, Young-Xu Y. Clinical and Cost Benefits of Anti-Obesity Medication for US Veterans Participating in the MOVE! Weight Management Program. Popul Health Manag 2023; 26:72-82. [PMID: 36735596 DOI: 10.1089/pop.2022.0227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Abstract This study investigated the clinical and economic impact of anti-obesity medications (AOMs; orlistat, liraglutide, phentermine/topiramate extended-release [ER], naltrexone ER/bupropion ER) among United States Veterans with obesity participating in Motivating Overweight/Obese Veterans Everywhere! (MOVE!), a government-initiated weight management program. The study population was identified from electronic medical records of the Veterans Health Administration (2010-2020). Clinical indices of obesity and health care resource utilization and costs were evaluated at 6, 12, and 24 months after the initial dispensing of an AOM in the AOM+MOVE! cohort (N = 3732, mean age 57 years, 79% male) or on the corresponding date of an inpatient or outpatient encounter in the MOVE! cohort (N = 7883, mean age 58 years, 81% male). At 6 months postindex, the AOM+MOVE! cohort had better cardiometabolic indices (eg, systolic blood pressure, diastolic blood pressure, total cholesterol, low-density lipoprotein cholesterol, hemoglobin A1c) than the MOVE! cohort, with the trends persisting at 12 and 24 months. The AOM+MOVE! cohort was significantly more likely than the MOVE! cohort to have weight decreases of 5%-10%, 10%-15%, and >15% and lower body mass index at 6, 12, and 24 months. The AOM+MOVE! cohort also had fewer inpatient and emergency department visits than the MOVE! cohort, which was associated with lower mean total medical costs including inpatient costs. These results suggest that combining AOM treatment with the MOVE! program could yield long-term cost savings for the Veterans Affairs network and meaningful clinical improvements for Veterans with obesity.
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Affiliation(s)
- W Timothy Garvey
- UAB Diabetes Research Center, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mu Cheng
- Analysis Group, Inc., Boston, Massachusetts, USA
| | | | | | - Suna Park
- Analysis Group, Inc., Boston, Massachusetts, USA
| | - Neela Kumar
- Novo Nordisk, Inc., Plainsboro, New Jersey, USA
| | - Nina Kim
- Novo Nordisk, Inc., Plainsboro, New Jersey, USA
| | | | | | | | - Melody Wu
- Analysis Group, Inc., Boston, Massachusetts, USA
| | | | - Yinong Young-Xu
- Clinical Epidemiology Program, White River Junction Veterans Affairs Medical Center, White River Junction, Vermont, USA
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Lichtfuss K, Franco-Arellano B, Brady J, Arcand J. An Examination of the Practice Approaches of Canadian Dietitians Who Counsel Higher-Weight Adults Using a Novel Framework: Emerging Data on Non-Weight-Focused Approaches. Nutrients 2023; 15:nu15030631. [PMID: 36771339 PMCID: PMC9921747 DOI: 10.3390/nu15030631] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 01/28/2023] Open
Abstract
Non-weight-focused approaches (NWFAs) may be used by some clinicians when working with higher-weight clients. In contrast to weight-focused approaches (WFAs), NWFAs de-emphasize or negate weight loss and emphasize overall diet quality and physical activity. The extent to which WFAs, NWFAs, or a combination of both WFAs and NWFAs are used by dietitians is unknown in Canada and globally. This study surveyed Canadian Registered Dietitians (RDs) who counsel higher-weight clients to assess which practice approaches are most commonly used, how they view the importance of weight, and how they define "obesity" for the study population. Five practice approaches were initially defined and used to inform the survey: solely weight-focused; moderately weight-focused; those who fluctuate between weight-focused/weight-inclusive approaches (e.g., used both approaches); weight inclusive and; weight liberated. Participants (n = 383; 94.8% women; 82.2% white) were recruited using social media and professional listservs. Overall, 45.4% of participants used NWFAs, 40.5% fluctuated between weight-focused/moderately weight-focused, and 14.1% used weight-focused approaches (solely weight focused and moderately weight focused). Many participants (63%) agreed that weight loss was not important for higher-weight clients. However, 81% of participants received no formal preparation in NWFAs during their education or training. More research is needed to understand NWFAs and to inform dietetic education in support of efforts to eliminate weight stigma and provide inclusive access to care.
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Affiliation(s)
- Kori Lichtfuss
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON L1G 0C5, Canada
| | | | - Jennifer Brady
- School of Nutrition and Dietetics, Acadia University, Wolfville, NS B4P 2R6, Canada
| | - JoAnne Arcand
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON L1G 0C5, Canada
- Correspondence: ; Tel.: +1-(647)-296-8426
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Almeida FA, You W, Brito FA, Alves TF, Goessl C, Wall SS, Seidel RW, Davy BM, Greenawald MH, Hill JL, Estabrooks PA. A randomized controlled trial to test the effectiveness of two technology-enhanced diabetes prevention programs in primary care: The DiaBEAT-it study. Front Public Health 2023; 11:1000162. [PMID: 36908422 PMCID: PMC9998510 DOI: 10.3389/fpubh.2023.1000162] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 02/08/2023] [Indexed: 02/26/2023] Open
Abstract
Objective To evaluate the effectiveness of two technology-enhanced interventions for diabetes prevention among adults at risk for developing diabetes in a primary care setting. Methods The DiaBEAT-it study employed a hybrid 2-group preference (Choice) and 3-group randomized controlled (RCT) design. This paper presents weight related primary outcomes of the RCT arm. Patients from Southwest Virginia were identified through the Carilion Clinic electronic health records. Eligible participants (18 and older, BMI ≥ 25, no Type 2 Diabetes) were randomized to either Choice (n = 264) or RCT (n = 334). RCT individuals were further randomized to one of three groups: (1) a 2-h small group class to help patients develop a personal action plan to prevent diabetes (SC, n = 117); (2) a 2-h small group class plus automated telephone calls using an interactive voice response system (IVR) to help participants initiate weight loss through a healthful diet and regular physical activity (Class/IVR, n = 110); or (3) a DVD with same content as the class plus the same IVR calls over a period of 12 months (DVD/IVR, n = 107). Results Of the 334 participants that were randomized, 232 (69%) had study measured weights at 6 months, 221 (66%) at 12 months, and 208 (62%) at 18 months. Class/IVR participants were less likely to complete weight measures than SC or DVD/IVR. Intention to treat analyses, controlling for gender, race, age and baseline BMI, showed that DVD/IVR and Class/IVR led to reductions in BMI at 6 (DVD/IVR -0.94, p < 0.001; Class/IVR -0.70, p < 0.01), 12 (DVD/IVR -0.88, p < 0.001; Class/IVR-0.82, p < 0.001) and 18 (DVD/IVR -0.78, p < 0.001; Class/IVR -0.58, p < 0.01) months. All three groups showed a significant number of participants losing at least 5% of their body weight at 12 months (DVD/IVR 26.87%; Class/IVR 21.62%; SC 16.85%). When comparing groups, DVD/IVR were significantly more likely to decrease BMI at 6 months (p < 0.05) and maintain the reduction at 18 months (p < 0.05) when compared to SC. There were no differences between the other groups. Conclusions The DiaBEAT-it interventions show promise in responding to the need for scalable, effective methods to manage obesity and prevent diabetes in primary care settings that do not over burden primary care clinics and providers. Registration https://clinicaltrials.gov/ct2/show/NCT02162901, identifier: NCT02162901.
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Affiliation(s)
- Fabio A Almeida
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, United States
| | - Wen You
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Fabiana A Brito
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, United States
| | - Thais F Alves
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, United States
| | - Cody Goessl
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, WI, United States
| | - Sarah S Wall
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, United States
| | - Richard W Seidel
- Department of Psychiatry, Carilion Clinic, Roanoke, VA, United States
| | - Brenda M Davy
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, United States
| | - Mark H Greenawald
- Department of Family and Community Medicine, Carilion Clinic, Roanoke, VA, United States
| | - Jennie L Hill
- Department of Populational Health Sciences, University of Utah, Salt Lake City, UT, United States
| | - Paul A Estabrooks
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, United States
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Parker SM, Barr M, Stocks N, Denney-Wilson E, Zwar N, Karnon J, Kabir A, Nutbeam D, Roseleur J, Liaw ST, McNamara C, Frank O, Tran A, Osborne R, Lau AYS, Harris M. Preventing chronic disease in overweight and obese patients with low health literacy using eHealth and teamwork in primary healthcare (HeLP-GP): a cluster randomised controlled trial. BMJ Open 2022; 12:e060393. [PMID: 36450426 PMCID: PMC9716831 DOI: 10.1136/bmjopen-2021-060393] [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: 12/03/2022] Open
Abstract
OBJECTIVES To evaluate a multifaceted intervention on diet, physical activity and health literacy of overweight and obese patients attending primary care. DESIGN A pragmatic two-arm cluster randomised controlled trial. SETTING Urban general practices in lower socioeconomic areas in Sydney and Adelaide. PARTICIPANTS We aimed to recruit 800 patients in each arm. Baseline assessment was completed by 215 patients (120 intervention and 95 control). INTERVENTION A practice nurse-led preventive health check, a mobile application and telephone coaching. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes were measured at baseline, 6 and 12 months, and included patient health and eHealth literacy, weight, waist circumference and blood pressure. Secondary outcomes included changes in diet and physical activity, preventive advice and referral, blood lipids, quality of life and costs. Univariate and multivariate analyses of difference-in-differences (DiD) estimates for each outcome were conducted. RESULTS At 6 months, the intervention group, compared with the control group, demonstrated a greater increase in Health Literacy Questionnaire domain 8 score (ability to find good health information; mean DiD 0.22; 95% CI 0.01 to 0.44). There were similar differences for domain 9 score (understanding health information well enough to know what to do) among patients below the median at baseline. Differences were reduced and non-statistically significant at 12 months. There was a small improvement in diet scores at 6 months (DiD 0.78 (0.10 to 1.47); p=0.026) but not at 12 months. There were no differences in eHealth literacy, physical activity scores, body mass index, weight, waist circumference or blood pressure. CONCLUSIONS Targeted recruitment and engagement were challenging in this population. While the intervention was associated with some improvements in health literacy and diet, substantial differences in other outcomes were not observed. More intensive interventions and using codesign strategies to engage the practices earlier may produce a different result. Codesign may also be valuable when targeting lower socioeconomic populations. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN 12617001508369) (http://www.ANZCTR.org.au/ACTRN12617001508369.aspx). TRIAL PROTOCOL The protocol for this trial has been published (open access; https://bmjopen.bmj.com/content/8/6/e023239).
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Affiliation(s)
- Sharon M Parker
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Margo Barr
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Nigel Stocks
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | | | - Nicholas Zwar
- Health Sciences & Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Jon Karnon
- Flinders Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Alamgir Kabir
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Don Nutbeam
- Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jackie Roseleur
- Flinders Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Siaw-Teng Liaw
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Carmel McNamara
- College of Nursing and Health Sciences, Flinders University, Adelaide, New South Wales, Australia
| | - Oliver Frank
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - An Tran
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Richard Osborne
- Centre for Global Health and Equity, Swinburne University of Technology, Burwood, Victoria, Australia
| | - Annie Y S Lau
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
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Dhungana RR, Pedisic Z, de Courten M. Implementation of non-pharmacological interventions for the treatment of hypertension in primary care: a narrative review of effectiveness, cost-effectiveness, barriers, and facilitators. BMC PRIMARY CARE 2022; 23:298. [PMID: 36418958 PMCID: PMC9686020 DOI: 10.1186/s12875-022-01884-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The current guidelines for the prevention, detection, evaluation, and management of hypertension recommend six types of non-pharmacological interventions: alcohol reduction, salt intake reduction, increased potassium intake, physical activity, weight loss, and heart-healthy diets. However, the non-pharmacological interventions are still not widely used in primary care. In this paper, we, therefore, reviewed and summarised the evidence on the effectiveness, cost-effectiveness, barriers, and facilitators of non-pharmacological interventions for the treatment of hypertension in primary care. METHODS A thorough literature search was conducted in Embase, Google Scholar, and PubMed databases, to identify the most recent reviews or, in their absence, primary studies on alcohol reduction, salt intake reduction, potassium supplementation, physical activity, weight reduction, heart-healthy diets, and other non-pharmacological interventions for the treatment of hypertension in primary care. RESULTS Alcohol reduction is a non-pharmacological intervention for the treatment of hypertension in primary care with proven effectiveness, feasibility, and acceptability. Interventions for sodium intake reduction, physical activity, and weight reduction are effective but there is insufficient evidence regarding their feasibility and acceptability in primary care settings. Evidence on the effectiveness of potassium intake and heart-healthy diets is limited and inconsistent. There is a lack of evidence on the cost-effectiveness of non-pharmacological interventions in the treatment of hypertension. The most common barriers to deliver such interventions related to healthcare providers include a lack of time, knowledge, self-confidence, resources, clear guidelines, and financial incentives. The most common barriers related to patients include a lack of motivation and educational resources. Less evidence is available on facilitators of implementing non-pharmacological interventions in primary care. Besides, facilitators differed by different types of interventions. CONCLUSIONS Available evidence suggests that more pragmatic, clinically feasible, and logistically simple interventions are required for sodium intake reduction, physical activity, and weight reduction in primary care settings. Future studies should provide further evidence on the effectiveness of weight control, potassium intake, and heart-healthy diets. More research is also needed on cost-effectiveness and facilitators of all types of effective non-pharmacological interventions for the treatment of hypertension in primary care.
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Affiliation(s)
- Raja Ram Dhungana
- Institute for Health and Sport, Victoria University, Melbourne, Australia.
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | - Zeljko Pedisic
- Institute for Health and Sport, Victoria University, Melbourne, Australia
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Mauch CE, Edney SM, Viana JNM, Gondalia S, Sellak H, Boud SJ, Nixon DD, Ryan JC. Precision health in behaviour change interventions: A scoping review. Prev Med 2022; 163:107192. [PMID: 35963310 DOI: 10.1016/j.ypmed.2022.107192] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 07/24/2022] [Accepted: 08/07/2022] [Indexed: 11/09/2022]
Abstract
Precision health seeks to optimise behavioural interventions by delivering personalised support to those in need, when and where they need it. Conceptualised a decade ago, progress toward this vision of personally relevant and effective population-wide interventions continues to evolve. This scoping review aimed to map the state of precision health behaviour change intervention research. This review included studies from a broader precision health review. Six databases were searched for studies published between January 2010 and June 2020, using the terms 'precision health' or its synonyms, and including an intervention targeting modifiable health behaviour(s) that was evaluated experimentally. Thirty-one studies were included, 12 being RCTs (39%), and 17 with weak study design (55%). Most interventions targeted physical activity (27/31, 87%) and/or diet (24/31, 77%), with 74% (23/31) targeting two to four health behaviours. Interventions were personalised via human interaction in 55% (17/31) and digitally in 35% (11/31). Data used for personalising interventions was largely self-reported, by survey or diary (14/31, 45%), or digitally (14/31, 45%). Data was mostly behavioural or lifestyle (20/31, 65%), and physiologic, biochemical or clinical (15/31, 48%), with no studies utilising genetic/genomic data. This review demonstrated that precision health behaviour change interventions remain dependent on human-led, low-tech personalisation, and have not fully considered the interaction between behaviour and the social and environmental contexts of individuals. Further research is needed to understand the relationship between personalisation and intervention effectiveness, working toward the development of sophisticated and scalable behaviour change interventions that have tangible public health impact.
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Affiliation(s)
- Chelsea E Mauch
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Adelaide, SA, Australia.
| | - Sarah M Edney
- Physical Activity and Nutrition Determinants in Asia (PANDA) Programme, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.
| | - John Noel M Viana
- Responsible Innovation Future Science Platform, Commonwealth Scientific and Industrial Research Organisation, Brisbane, QLD, Australia; Australian National Centre for the Public Awareness of Science, Australian National University, Canberra, ACT, Australia.
| | - Shakuntla Gondalia
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Adelaide, SA, Australia; Precision Health Future Science Platform, Commonwealth Scientific and Industrial Research Organisation, Adelaide, SA, Australia; Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, VC, Australia..
| | - Hamza Sellak
- Data61, Commonwealth Scientific and Industrial Research Organisation, Melbourne, VC, Australia.
| | - Sarah J Boud
- Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Dakota D Nixon
- Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Jillian C Ryan
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Adelaide, SA, Australia; Precision Health Future Science Platform, Commonwealth Scientific and Industrial Research Organisation, Adelaide, SA, Australia; School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia.
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Dao MC, Yu Z, Maafs‐Rodríguez A, Moser B, Cuevas AG, Economos CD, Roberts SB. Perceived intrinsic, social, and environmental barriers for weight management in older Hispanic/Latino adults with obesity. Obes Sci Pract 2022; 9:145-157. [PMID: 37034568 PMCID: PMC10073816 DOI: 10.1002/osp4.631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 11/07/2022] Open
Abstract
Background The burden of obesity and chronic disease is increasing in the older US Hispanic/Latino adult population. There is limited evidence on successful weight management strategies as perceived by this population. Assessing barriers and opportunities for weight management using mixed methods is a robust approach to collect in-depth information that can be applied to the development of well-tailored weight management interventions for this population. Objective The objective of this study was to assess perceived individual, interpersonal, and environmental factors that influence weight management in older Hispanic/Latino adults. Methods This community-based cross-sectional study included 23 Hispanic/Latino older (>50y) adults with obesity (BMI >30 kg/m2). Perceived barriers and opportunities for weight management were assessed through validated questionnaires and focus groups. Prospectively registered on ClinicalTrials.gov (NCT03978416) on 7 June 2019. Results In this demographically heterogeneous population, language acculturation was generally low, and the frequency of poor dietary behaviors was high. Participants linked financial strain to lower diet quality, as well as anxiety to uncontrolled eating and food cravings. Social support and trust in healthcare professionals were perceived as priorities for healthy eating. Structural and environmental barriers such as affordability and availability of culturally preferred foods were also identified as influences on food choices and eating behavior. Conclusions This study revealed opportunities for culturally tailored weight management interventions in older Hispanic/Latino adults with obesity. Clinical Trial Registry Number NCT03978416 (ClinicalTrials.gov).
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Affiliation(s)
- Maria Carlota Dao
- Energy Metabolism Laboratory Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University. Boston MA United States Durham
- Department of Agriculture University of New Hampshire. Durham Nutritionand Food Systems NH United States Durham
| | - Zihan Yu
- Energy Metabolism Laboratory Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University. Boston MA United States Durham
| | - Ana Maafs‐Rodríguez
- Energy Metabolism Laboratory Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University. Boston MA United States Durham
- Friedman School of Nutrition Science and Policy Tufts University. Boston MA United States Boston
| | - Brandy Moser
- Energy Metabolism Laboratory Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University. Boston MA United States Durham
| | - Adolfo G. Cuevas
- Department of Community Health School of Arts and Sciences Tufts University. Medford MA United States Boston
| | - Christina D. Economos
- Friedman School of Nutrition Science and Policy Tufts University. Boston MA United States Boston
| | - Susan B. Roberts
- Energy Metabolism Laboratory Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University. Boston MA United States Durham
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Lemp JM, Nuthanapati MP, Bärnighausen TW, Vollmer S, Geldsetzer P, Jani A. Use of lifestyle interventions in primary care for individuals with newly diagnosed hypertension, hyperlipidaemia or obesity: a retrospective cohort study. J R Soc Med 2022; 115:289-299. [PMID: 35176215 PMCID: PMC9340092 DOI: 10.1177/01410768221077381] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Lifestyle interventions can be efficacious in reducing cardiovascular disease risk factors and are recommended as first-line interventions in England. However, recent information on the use of these interventions in primary care is lacking. We investigated for how many patients with newly diagnosed hypertension, hyperlipidaemia or obesity, lifestyle interventions were recorded in their primary care electronic health record. DESIGN A retrospective cohort study. SETTING English primary care, using UK Clinical Practice Research Datalink. PARTICIPANTS A total of 770,711 patients who were aged 18 years or older and received a new diagnosis of hypertension, hyperlipidaemia or obesity between 2010 and 2019. MAIN OUTCOME MEASURES Record of lifestyle intervention and/or medication in 12 months before to 12 months after initial diagnosis (2-year timeframe). RESULTS Analyses show varying results across conditions: While 55.6% (95% CI 54.9-56.4) of individuals with an initial diagnosis of hypertension were recorded as having lifestyle support (lifestyle intervention or signposting) within the 2-year timeframe, this number was reduced to 45.2% (95% CI 43.8-46.6) for hyperlipidaemia and 52.6% (95% CI 51.1-54.1) for obesity. For substantial proportions of individuals neither lifestyle support nor medication (hypertension: 12.2%, 95% CI 11.9-12.5; hyperlipidaemia: 32.2%, 95% CI 31.2-33.3; obesity: 43.9%, 95% CI 42.3-45.4) were recorded. Sensitivity analyses confirm that limited proportions of patients had lifestyle support recorded in their electronic health record before they were first prescribed medication (diagnosed and undiagnosed), ranging from 12.1% for hypertension to 19.7% for hyperlipidaemia, and 19.5% for obesity (23.4% if restricted to Orlistat). CONCLUSIONS Limited evidence of lifestyle support for individuals with cardiovascular risk factors (hypertension, hyperlipidaemia, obesity) recommended by national guidelines in England may stem from poor recording in electronic health records but may also represent missed opportunities. Given the link between progression to cardiovascular disease and modifiable lifestyle factors, early support for patients to manage their conditions through non-pharmaceutical interventions by establishing lifestyle modification as first-line treatment is crucial.
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Affiliation(s)
- Julia M Lemp
- Heidelberg Institute of Global Health, Heidelberg University and University Hospital, 69120 Heidelberg, Germany
| | - Meghana Prasad Nuthanapati
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, 37073 Göttingen, Germany
| | - Till W Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University and University Hospital, 69120 Heidelberg, Germany.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA.,Africa Health Research Institute, Somkhele, Mtubatuba, 3935, South Africa
| | - Sebastian Vollmer
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, 37073 Göttingen, Germany
| | - Pascal Geldsetzer
- Heidelberg Institute of Global Health, Heidelberg University and University Hospital, 69120 Heidelberg, Germany.,Division of Primary Care and Population Health, Stanford University, Stanford, CA 94305, USA
| | - Anant Jani
- Heidelberg Institute of Global Health, Heidelberg University and University Hospital, 69120 Heidelberg, Germany.,Oxford Martin School, Oxford University, Oxford OX1 3BD, UK
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Walker R, Ramasamy V, Sturgiss E, Dunbar J, Boyle J. Shared medical appointments for weight loss: a systematic review. Fam Pract 2022; 39:710-724. [PMID: 34536073 DOI: 10.1093/fampra/cmab105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Shared medical appointments (SMAs) may help mitigate some of the barriers for managing obesity in primary care. The primary aim of this systematic review was to measure the effect of weight loss SMAs. METHODS Systematic searches using keywords and Medical Subject Headings for overweight, obesity, and SMAs were conducted in the CENTRAL, Medline Complete, PsycINFO, Scopus, CINAHL, EMBASE, and Web of Science databases with no date limits. Risk of bias was assessed using the Effective Health Practice Project Quality Assessment Tool for Quantitative Studies. RESULTS Fifteen studies involving weight loss SMAs in adults and children were identified. Six studies had controls. Inconsistency in reporting weight loss or weight change in controlled studies meant that data could not be pooled for meta-analysis. Results from individual studies indicated that SMAs can support adult patients to achieve significant weight loss. Women and older adults were more likely to take up SMA invitations. Results from the 5 studies involving children were less conclusive. Studies involving participants of a higher socioeconomic status tended to report lower attrition than studies involving participants who experienced disadvantage. These findings should be interpreted with caution as all but 1 included study was assessed as being weak in quality. CONCLUSIONS Overall, SMAs may be of benefit to address obesity in primary care, particularly for women and older adults. Appropriately designed prospective and controlled studies are required to engage their target audience and to assess whether SMAs are superior to other weight loss options in primary care.
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Affiliation(s)
- Ruth Walker
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
| | - Vijayanand Ramasamy
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
| | - Elizabeth Sturgiss
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Notting Hill, Australia
| | - James Dunbar
- Deakin Rural Health, School of Medicine, Deakin University, Warrnambool, Australia
| | - Jacqueline Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
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Adherence to Self-Care among Patients with Hypertension in Ethiopia: A Systematic Review and Meta-Analysis. Int J Hypertens 2022; 2022:5962571. [PMID: 35879985 PMCID: PMC9308551 DOI: 10.1155/2022/5962571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 03/01/2022] [Accepted: 06/27/2022] [Indexed: 11/17/2022] Open
Abstract
Background Self-care adherence for hypertensive patients is a cornerstone for the control of it and prevention of its complications. However, there are inconsistent findings for self-care adherence of hypertensive patients in Ethiopia. Thus, this systematic review and meta-analysis was done to determine the pooled estimate self-care adherence. Methods This systematic review and meta-analysis was reported based on the Preferred Reporting Items for Systematic Review and Meta-Analysis guideline. An intensive search of online databases such as PubMed (MEDLINE), CINHAL, Google Scholar, and advanced Google search was made to access both published and unpublished articles that report self-care adherence among hypertensive patients in Ethiopia. The pooled estimate was done with STATA version 11 metan commands in a 95% confidence interval. The presence of heterogeneity and publication bias were detected by I2 and Egger's test, respectively. A random-effect model was obtained, and subgroup analysis was done for the management of heterogeneity. Result A total of 24 articles with a total of 7224 participants were included in the final systematic review and meta-analysis. The pooled estimate of overall self-care adherence among hypertensive patients was 36.98% (95% CI: 27.13–46.83). In subgroup analysis, the highest overall self-care adherence was observed in the Amhara region at 53% (95% CI: 46.54, 59.47). The pooled estimate of self-care dimensions such as medication adherence, low-salt diet, physical activity, smoking abstinence, alcohol abstinence, and weight management was 62.71%, 65.96%, 47.28%, 92.53%, 67.59%, and 52.54%, respectively. Conclusion The pooled estimate of good self-care adherence among hypertensive patients was low. From the dimensions of self-care, the lowest level was in physical activity and the highest level was in smoking abstinence. Comparing all regions, the lowest level of overall self-care adherence was observed in Addis Ababa, Tigray region, and South Nations and Nationalities of Ethiopia. Screening of adherence to self-care and health education should be provided to every patient during every visit.
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Mauldin K, May M, Clifford D. The consequences of a weight-centric approach to healthcare: A case for a paradigm shift in how clinicians address body weight. Nutr Clin Pract 2022; 37:1291-1306. [PMID: 35819360 DOI: 10.1002/ncp.10885] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/27/2022] [Accepted: 05/14/2022] [Indexed: 11/10/2022] Open
Abstract
Current healthcare is weight-centric, equating weight and health. This approach to healthcare has negative consequences on patient well-being. The aim of this article is to make a case for a paradigm shift in how clinicians view and address body weight. In this review, we (1) address common flawed assumptions in the weight-centric approach to healthcare, (2) review the weight science literature and provide evidence for the negative consequences of promoting dieting and weight loss, and (3) provide practice recommendations for weight-inclusive care.
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Affiliation(s)
- Kasuen Mauldin
- Department of Nutrition, Food Science, and Packaging, San José State University, San José, California, USA.,Department of Clinical Nutrition, Stanford Health Care, Stanford, California, USA
| | - Michelle May
- Am I Hungry? Mindful Eating Programs and Training, USA.,Department of Psychology, Arizona State University, Tempe, Arizona, USA
| | - Dawn Clifford
- Department of Health Sciences, Northern Arizona University, Flagstaff, Arizona, USA
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Kurz D, McCrea-Robertson S, Nelson-Brantley H, Befort C. Rural engagement in primary care for optimizing weight reduction (REPOWER): A mixed methods study of patient perceptions. PATIENT EDUCATION AND COUNSELING 2022; 105:2371-2381. [PMID: 34865892 DOI: 10.1016/j.pec.2021.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 11/10/2021] [Accepted: 11/27/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To report on patients' satisfaction and experience of care across three different modes of weight loss counseling. METHODS 1407 patients with obesity in the rural Midwest were enrolled to a 2-year weight management trial through their primary care practice and assigned to one of three treatment conditions: in-clinic individual, in-clinic group, phone group counseling. Patients completed surveys assessing seven domains of satisfaction and experience of care at 6 and 24-months. Post-treatment interviews were conducted to add context to survey responses. RESULTS 1295 (92.0%) and 1230 (87.4%) completed surveys at 6 and 24-months, respectively. Patients in phone group counseling reported lower satisfaction than patients who received in-clinic group or in-clinic individual counseling across all domains at 6-months and five out of seven domains at 24-months. Interviews revealed that patients were more satisfied when they received face-to-face counseling and had meaningful interactions with their primary care provider (PCP) about their weight. CONCLUSION Rural patients with obesity have higher satisfaction and experience of care when weight loss counseling is delivered in a face-to-face environment and when their PCP is involved with their treatment. PRACTICE IMPLICATIONS Primary care practices looking to offer weight loss treatment should consider incorporating some level of face-to-face treatment plans that involves meaningful interaction with the PCP.
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Affiliation(s)
- Daniel Kurz
- University of Kansas School of Medicine, Department of Population Health, Kansas City, KS USA.
| | - Stacy McCrea-Robertson
- University of Kansas School of Medicine, Department of Population Health, Kansas City, KS USA
| | | | - Christie Befort
- University of Kansas School of Medicine, Department of Population Health, Kansas City, KS USA
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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: 0] [Impact Index Per Article: 0] [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.
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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
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Praxedes DRS, Silva-Júnior AE, Macena ML, Oliveira AD, Cardoso KS, Nunes LO, Monteiro MB, Melo ISV, Gearhardt AN, Bueno NB. Prevalence of food addiction determined by the Yale Food Addiction Scale and associated factors: A systematic review with meta-analysis. EUROPEAN EATING DISORDERS REVIEW 2022; 30:85-95. [PMID: 34953001 DOI: 10.1002/erv.2878] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To determine, through a systematic review with meta-analysis, the prevalence of food addiction (FA) using the Yale Food Addiction Scale (YFAS) and its derivatives exploring possible factors associated with the prevalence of FA in several contexts. METHODS The following databases were searched: MEDLINE, ScienceDirect, LILACS, PsycArticles, CENTRAL, Greylit.org, and OpenGrey.eu. Studies that assessed FA using YFAS were included. Two independent reviewers assessed the eligibility of each report. Random-effects meta-analysis was performed to calculate the weighted prevalence of FA. Subgroup analyses and meta-regression were conducted to explore sources of heterogeneity. RESULTS Of the 6425 abstracts reviewed, 272 studies were included. The weighted mean prevalence of FA diagnosis was 20% (95% CI: 18%; 21%). The prevalence of FA was higher in individuals with clinical diagnosis of binge eating (55%; 95% CI 34%; 75%). The prevalence in clinical samples was higher compared to non-clinical samples. Two studies included children only and no studies included only elderly people. CONCLUSIONS Food addiction is a topic in which there has been a significant growth in studies. The highest prevalence was found in the group of participants with eating disorders and weight disorders. More studies with children and the elderly are needed.
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Affiliation(s)
| | - André E Silva-Júnior
- Programa de Pós-Graduação em Nutrição, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Mateus L Macena
- Faculdade de Nutrição, Universidade Federal de Alagoas, Maceió, AL, Brazil
| | | | - Kamyla S Cardoso
- Faculdade de Nutrição, Universidade Federal de Alagoas, Maceió, AL, Brazil
| | - Lara O Nunes
- Faculdade de Nutrição, Universidade Federal de Alagoas, Maceió, AL, Brazil
| | - Maíra B Monteiro
- Faculdade de Nutrição, Universidade Federal de Alagoas, Maceió, AL, Brazil
| | - Ingrid Sofia V Melo
- Departamento de Agroindústria, Instituto Federal de Alagoas, Satuba, AL, Brazil
| | - Ashley N Gearhardt
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Nassib Bezerra Bueno
- Faculdade de Nutrição, Universidade Federal de Alagoas, Maceió, AL, Brazil
- Programa de Pós-Graduação em Nutrição, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Choe S, Sa J, Chaput JP, Kim D. Effectiveness of obesity interventions among South Korean children and adolescents and importance of the type of intervention component: a meta-analysis. Clin Exp Pediatr 2022; 65:98-107. [PMID: 34809417 PMCID: PMC8841970 DOI: 10.3345/cep.2021.00409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 10/14/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Various interventions have been tested to prevent or treat childhood obesity in South Korea. However, the overall effect of those interventions is unclear, as very few reviews and meta-analyses were specific to Korean children and adolescents. PURPOSE We aimed to examine the overall effect of obesity interventions among Korean children and adolescents, while also examining differences by sex, age group, baseline weight category, intervention duration, number of intervention components, and type of intervention components. METHODS A meta-analysis was conducted for all intervention studies sampling Korean children and adolescents, with at least one control group and one month of follow-up, published between January 2000 and August 2020. Cohen d was calculated as an effect size for treatment effect, using the standardized difference between intervention group's body mass index (BMI) change and control group's BMI change. RESULTS The final sample included 19 intervention studies with 2,140 Korean children (mean age, 12.2 years). Overall, interventions were strongly favored over their controls (d=1.61; 95% confidence interval [CI], 1.12-2.09). The subgroup analysis showed that interventions with at least one physical activity component (d=2.43; 95% CI, 1.63-3.24) were significantly better than those that did not include physical activity (d=0.02; 95% CI, -0.26 to 0.31). CONCLUSION Type of intervention component appeared important, though no differential association was observed by sex, age, baseline weight category, intervention duration, and number of intervention components. Korean and non-Korean interventions may be substantively different. Additional studies are needed to understand why and how Korean interventions differ from non-Korean interventions.
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Affiliation(s)
- Siyoung Choe
- Department of Kinesiology and Health, Miami University, Oxford, OH, USA
| | - Jaesin Sa
- Department of Health and Human Performance, University of Tennessee at Chattanooga, Chattanooga, TN, USA
| | - Jean-Philippe Chaput
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Deokjin Kim
- Department of Sport & Health Care, Namseoul University, Cheonan, Korea
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Social Mobile Approaches to Reducing Weight (SMART) 2.0: protocol of a randomized controlled trial among young adults in university settings. Trials 2022; 23:7. [PMID: 34980208 PMCID: PMC8721474 DOI: 10.1186/s13063-021-05938-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background Excess weight gain in young adulthood is associated with future weight gain and increased risk of chronic disease. Although multimodal, technology-based weight-loss interventions have the potential to promote weight loss among young adults, many interventions have limited personalization, and few have been deployed and evaluated for longer than a year. We aim to assess the effects of a highly personalized, 2-year intervention that uses popular mobile and social technologies to promote weight loss among young adults. Methods The Social Mobile Approaches to Reducing Weight (SMART) 2.0 Study is a 24-month parallel-group randomized controlled trial that will include 642 overweight or obese participants, aged 18–35 years, from universities and community colleges in San Diego, CA. All participants receive a wearable activity tracker, connected scale, and corresponding app. Participants randomized to one intervention group receive evidence-based information about weight loss and behavior change techniques via personalized daily text messaging (i.e., SMS/MMS), posts on social media platforms, and online groups. Participants in a second intervention group receive the aforementioned elements in addition to brief, technology-mediated health coaching. Participants in the control group receive a wearable activity tracker, connected scale, and corresponding app alone. The primary outcome is objectively measured weight in kilograms over 24 months. Secondary outcomes include anthropometric measurements; physiological measures; physical activity, diet, sleep, and psychosocial measures; and engagement with intervention modalities. Outcomes are assessed at baseline and 6, 12, 18, and 24 months. Differences between the randomized groups will be analyzed using a mixed model of repeated measures and will be based on the intent-to-treat principle. Discussion We hypothesize that both SMART 2.0 intervention groups will significantly improve weight loss compared to the control group, and the group receiving health coaching will experience the greatest improvement. We further hypothesize that differences in secondary outcomes will favor the intervention groups. There is a critical need to advance understanding of the effectiveness of multimodal, technology-based weight-loss interventions that have the potential for long-term effects and widespread dissemination among young adults. Our findings should inform the implementation of low-cost and scalable interventions for weight loss and risk-reducing health behaviors. Trial registration ClinicalTrials.govNCT03907462. Registered on April 9, 2019
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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.
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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
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Efficacy of Telephone Health Coaching Integration with Standard Multidisciplinary Care for Adults with Obesity Attending a Weight Management Service: A Pilot Study. Nutrients 2021; 13:nu13114078. [PMID: 34836331 PMCID: PMC8625904 DOI: 10.3390/nu13114078] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/08/2021] [Accepted: 11/12/2021] [Indexed: 12/23/2022] Open
Abstract
Australia has one of the highest prevalences of obesity in the developed world with recognised gaps in patient access to obesity services. This non-randomised before and after study investigated the health benefits and patient acceptability of integrating the Get Healthy Service, a state-funded telephone-delivered coaching service in Australia, as an adjunct to multidisciplinary care for adults attending a public obesity service. Forty-one participants received multidisciplinary care alone while 39 participants were subsequently allocated to receive adjunctive treatment with the Get Healthy Service. Weight, body mass index, glycosylated haemoglobin, measurement of hepatic steatosis and liver enzymes were collected at baseline and 6 months. Participant evaluation was obtained post intervention. Statistically significant reductions from baseline were achieved for both control and intervention with respect to weight (−6.7 ± 2.2 kg, p = 0.01; −12.6 ± 3.2, p = 0.002), body mass index (−2.3 ± 0.8, p = 0.01; −4.8 ± 1.2 kg/m2, p = 0.002) and glycosylated haemoglobin (−0.2 ± 0.2%, p = 0.2 (NS); −0.7 ± 0.2%, p = 0.02), respectively. There were no significant differences in steatosis or liver enzymes or in outcomes between control and intervention cohorts. A high level of patient acceptability was reported. Integrating telephone-delivered coaching provided non-inferior care and high levels of patient satisfaction. Telephone coaching aligned with the principles of an obesity service should be trialled to improve patient access to obesity interventions.
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Vaz CL, Carnes N, Pousti B, Zhao H, Williams KJ. A randomized controlled trial of an innovative, user-friendly, interactive smartphone app-based lifestyle intervention for weight loss. Obes Sci Pract 2021; 7:555-568. [PMID: 34631134 PMCID: PMC8488442 DOI: 10.1002/osp4.503] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 01/29/2021] [Accepted: 02/21/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Most electronically delivered lifestyle interventions are labor intensive, requiring logging onto websites and manually recording activity and diet. Cumbersome technology and lack of a human coach may have contributed to the limitations of prior interventions. In response, the current program of research created a comprehensive electronically delivered lifestyle intervention using a user-friendly, interactive, smartphone app-based model, and evaluated it in a randomized controlled trial. METHODS Twenty-eight adults, body mass index 25-42 kg/m2, with smartphones and sedentary jobs, were randomized to the intervention, along with conventional outpatient weight-management visits every 3 months, or to a wait-listed control group that received only weight-management visits. The intervention included wearable activity trackers, smartscales, food photography logs, physician-driven app-based behavioral coaching, and peer support via the app. The prespecified primary outcome was a comparison of change in weight in kilograms, in the intervention versus control group at 6 months. RESULTS At 6 months, the intervention group experienced a statistically significant weight change of -7.16 ± 1.78 kg (mean ± SE, 95% CI -11.05 to -3.26, p < 0.01), which differed from the weight change in controls by -4.16 ± 2.01 kg (95% CI -8.29 to -0.02, p < 0.05, prespecified primary outcome). Weight change in the control group was -3.00 ± 1.05 kg (95% CI -5.27 to -0.73, p < 0.05). Waist circumference and hemoglobin A1c significantly improved (intervention vs. control: p < 0.01, p < 0.05, respectively, prespecified secondary outcomes). Weight change in the intervention group correlated with numbers of food photographs participants shared (rho = -0.86, p < 0.01), numbers of their text messages (rho = -0.80, p < 0.01), number of times and days each participant stepped on the smartscale (rho = -0.73, p < 0.01; rho = -0.608, p < 0.05, respectively), and mean daily step counts (rho = -0.55, p < 0.05). CONCLUSION This app-based electronically delivered lifestyle intervention produced statistically significant, clinically meaningful weight loss and improved metabolic health. Engagement with the intervention correlated strongly with weight loss. Given the limited sample size, larger and longer studies of this intervention are needed.
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Affiliation(s)
- Cherie Lisa Vaz
- Lewis Katz School of Medicine at Temple UniversityPhiladelphiaPennsylvaniaUSA
- Section of Endocrinology, Diabetes and MetabolismTemple University HospitalPhiladelphiaPennsylvaniaUSA
- Temple Faculty Practice Plan (TFPP)PhiladelphiaPennsylvaniaUSA
| | - Nicholas Carnes
- Lewis Katz School of Medicine at Temple UniversityPhiladelphiaPennsylvaniaUSA
| | - Bobak Pousti
- Lewis Katz School of Medicine at Temple UniversityPhiladelphiaPennsylvaniaUSA
| | - Huaqing Zhao
- Lewis Katz School of Medicine at Temple UniversityPhiladelphiaPennsylvaniaUSA
| | - Kevin Jon Williams
- Lewis Katz School of Medicine at Temple UniversityPhiladelphiaPennsylvaniaUSA
- Section of Endocrinology, Diabetes and MetabolismTemple University HospitalPhiladelphiaPennsylvaniaUSA
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Varela C, Oda-Montecinos C, Andrés A, Saldaña C. Effectiveness of web-based feedback interventions for people with overweight and obesity: systematic review and network meta-analysis of randomized controlled trials. J Eat Disord 2021; 9:75. [PMID: 34174949 PMCID: PMC8234624 DOI: 10.1186/s40337-021-00432-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 06/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Web-based delivered interventions have become an innovative option to treat health problems, like obesity. The aim of this systematic review and network meta-analysis was to analyze the effectiveness of web-based behavioral treatments for adults with overweight and obesity. Web-based interventions and comparison interventions (traditional weight control programs) were classified according to the following feedback characteristics: frequency, personalization, and provider (human versus machine). METHOD From the initial 1789 studies, 15 were included in this review. A network meta-analysis was conducted to analyze the efficacy of web-based programs with traditional interventions, considering direct and indirect comparisons. The main outcome was the weight loss mean difference (kg) between baseline and post-treatment. Heterogeneity and consistency assumptions were validated to conduct the network meta-analysis. RESULTS Network meta-analysis showed comparisons between different treatment options. The main results were that Intensive Contact Web-based programs were more effective than wait-list (Mean Difference - 1.86 kg; 95% Confidence Interval: - 3.61, - 0.12). Moreover, Intensive Contact Web-based programs were more effective than the other web-based options and self-help traditional interventions. However, the only significant comparison was Intensive Contact Web-based programs versus Guided Self-Help Web-based programs (Mean Difference - 4.31 kg; 95% Confidence Interval: - 5,22, - 3,41). Intensive Contact Web-based programs were the most effective treatment option according the obtained results, achieving the first place in the ranking provided by the network meta-analysis with 98.5% of probabilities. CONCLUSIONS Intensive Contact Web-based interventions have obtained the first position in the ranking, proving the relevance of frequent, personalized, and professional feedback and their association with a better prognosis for people with overweight and obesity. These results provide relevant information to design more effective treatments for people with overweight and obesity, in a new format especially appropriate for the current situation.
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Affiliation(s)
- Carmen Varela
- Department of Clinical Psychology and Psychobiology, Section of Personality, Assessment and Treatment, Faculty of Psychology, University of Barcelona, Passeig Vall d'Hebrón, 171, P.C. 08035, Barcelona, Cataluña, Spain
| | | | - Ana Andrés
- Faculty of Psychology, Education and Sport Sciences, Blanquerna, Ramon Llull University, Barcelona, Spain
| | - Carmina Saldaña
- Department of Clinical Psychology and Psychobiology, Section of Personality, Assessment and Treatment, Faculty of Psychology, University of Barcelona, Passeig Vall d'Hebrón, 171, P.C. 08035, Barcelona, Cataluña, Spain.
- Institute of Neurosciences, University of Barcelona, Barcelona, Spain.
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Beeken RJ, Scott AM, Sims R, Cleo G, Clifford H, Glasziou P, Thomas R. A Community Jury on initiating weight management conversations in primary care. Health Expect 2021; 24:1450-1458. [PMID: 34153150 PMCID: PMC8369079 DOI: 10.1111/hex.13286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 04/27/2021] [Accepted: 05/14/2021] [Indexed: 11/28/2022] Open
Abstract
Background Current guidelines recommend that patients attending general practice should be screened for excess weight, and provided with weight management advice. Objective This study sought to elicit the views of people with overweight and obesity about the role of GPs in initiating conversations about weight management. Methods Participants with a body mass index ≥25 were recruited from a region in Australia to take part in a Community Jury. Over 2 days, participants (n = 11) deliberated on two interconnected questions: ‘Should GPs initiate discussions about weight management?’ And ‘if so, when: (a) opportunistically, (b) in the context of disease prevention, (c) in the context of disease management or (d) other?’ The jury deliberations were analysed qualitatively to elicit their views and recommendations. Results The jury concluded GPs should be discussing weight management, but within the broader context of general health. The jury were divided about the utility of screening. Jurors felt GPs should initiate the conversation if directly relevant for disease prevention or management, otherwise GPs should provide opportunities for patients to consent to the issue being raised. Conclusion The jury's verdict suggests informed people affected by overweight and obesity believe GPs should discuss weight management with their patients. GPs should feel reassured that discussions are likely to be welcomed by patients, particularly if embedded within a more holistic focus on person‐centred care. Public contribution Members of the public took part in the conduct of this study as jurors, but were not involved in the design, analysis or write‐up.
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Affiliation(s)
- Rebecca J Beeken
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Anna M Scott
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Qld, Australia
| | - Rebecca Sims
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Qld, Australia
| | - Gina Cleo
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Qld, Australia
| | - Helen Clifford
- Gold Coast Hospital and Health Service, Public Health Unit, Gold Coast, Qld, Australia
| | - Paul Glasziou
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Qld, Australia
| | - Rae Thomas
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Qld, Australia
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Chew HSJ, Ang WHD, Lau Y. The potential of artificial intelligence in enhancing adult weight loss: a scoping review. Public Health Nutr 2021; 24:1993-2020. [PMID: 33592164 PMCID: PMC8145469 DOI: 10.1017/s1368980021000598] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/12/2021] [Accepted: 02/03/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To present an overview of how artificial intelligence (AI) could be used to regulate eating and dietary behaviours, exercise behaviours and weight loss. DESIGN A scoping review of global literature published from inception to 15 December 2020 was conducted according to Arksey and O'Malley's five-step framework. Eight databases (CINAHL, Cochrane-Central, Embase, IEEE Xplore, PsycINFO, PubMed, Scopus and Web of Science) were searched. Included studies were independently screened for eligibility by two reviewers with good interrater reliability (k = 0·96). RESULTS Sixty-six out of 5573 potential studies were included, representing more than 2031 participants. Three tenets of self-regulation were identified - self-monitoring (n 66, 100 %), optimisation of goal setting (n 10, 15·2 %) and self-control (n 10, 15·2 %). Articles were also categorised into three AI applications, namely machine perception (n 50), predictive analytics only (n 6) and real-time analytics with personalised micro-interventions (n 10). Machine perception focused on recognising food items, eating behaviours, physical activities and estimating energy balance. Predictive analytics focused on predicting weight loss, intervention adherence, dietary lapses and emotional eating. Studies on the last theme focused on evaluating AI-assisted weight management interventions that instantaneously collected behavioural data, optimised prediction models for behavioural lapse events and enhance behavioural self-control through adaptive and personalised nudges/prompts. Only six studies reported average weight losses (2·4-4·7 %) of which two were statistically significant. CONCLUSION The use of AI for weight loss is still undeveloped. Based on the current study findings, we proposed a framework on the applicability of AI for weight loss but cautioned its contingency upon engagement and contextualisation.
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Affiliation(s)
- Han Shi Jocelyn Chew
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
| | - Wei How Darryl Ang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
| | - Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
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Tong H, Morris E, Jebb SA, Koutoukidis DA. Identifying and measuring the behavioural, dietary, and physical activity components of weight management consultations delivered by general practice nurses in routine care. BMC FAMILY PRACTICE 2021; 22:65. [PMID: 33827433 PMCID: PMC8028812 DOI: 10.1186/s12875-021-01403-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 02/24/2021] [Indexed: 11/25/2022]
Abstract
Background Many people with obesity receive weight loss consultations by general practice nurses (GPNs) in routine primary care. This exploratory study aimed to characterise the components of these consultations, including behaviour change techniques (BCTs), and dietary and physical activity recommendations. Methods We analysed audio recordings of weight management consultations conducted by 8 GPNs as part of the ‘usual care’ group in a randomised controlled trial (ISRCTN75092026). Consultations were coded against three taxonomies to classify BCTs, dietary recommendations, and physical activity recommendations. Associations between coded content and weight loss were assessed. Differences in the content of consultations where weight loss was < 5% or ≥ 5% from baseline weight at 6 months were explored. Results One hundred and fifty audio recordings were available from 53 out of 140 (38%) participants in the usual care group. Participants had on average 3 (SD = 1) recorded consultations over 3 months, lasting 14 (SD = 7) minutes each. Weight change at 3, 6, and 12 months was -3.6% (SD = 4.3), -5.5% (SD = 6.0) and -4.2% (SD = 6.5) for participants with audio recordings. GPNs used 3.9 (SD = 1.6) of 93 BCTs, 3.3 (SD = 2.7) of 30 dietary recommendations and 1.4 (SD = 1.2) of 10 physical activity recommendations per consultation. The most commonly employed BCTs were feedback on outcome of behaviour (80.0%), problem solving (38.0%), and social reward (34.3%). The most common dietary recommendations were about portion size (31.3%), nutrients (28.0%), and balanced diet (19.7%). The main physical activity recommendation was about walking (30.3%). There was no association between weight loss and the number of dietary recommendations, physical activity recommendations, or BCTs used per consultation, or per participant. Social reward was the only technique used significantly more in consultations of participants that lost ≥ 5% of their baseline weight at 6 months. Conclusions The study provides a new method that could be used to describe the content of weight management consultations. Specific dietary or physical activity recommendations and BCTs were used infrequently and inconsistently in this group of GPNs. Although replication is required in larger samples, this may point to a weakness in current practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01403-1.
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Affiliation(s)
- Heather Tong
- Nuffield Department of Primary Care Health Sciences, University, of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Elizabeth Morris
- Nuffield Department of Primary Care Health Sciences, University, of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University, of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Dimitrios A Koutoukidis
- Nuffield Department of Primary Care Health Sciences, University, of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK. .,NIHR Oxford Biomedical Research Centre, Oxford, UK.
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Canuto R, Garcez A, de Souza RV, Kac G, Olinto MTA. Nutritional intervention strategies for the management of overweight and obesity in primary health care: A systematic review with meta-analysis. Obes Rev 2021; 22:e13143. [PMID: 33006421 DOI: 10.1111/obr.13143] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/17/2020] [Accepted: 08/22/2020] [Indexed: 12/29/2022]
Abstract
A systematic review with meta-analysis (MA) was conducted to synthesize the effectiveness of nutrition intervention strategies for managing overweight and obesity in the adult population attending primary health care. Relevant articles were searched in the PubMed, Embase, Web of Science, Cochrane and LILACS databases from inception to January 2020. Seventy studies were identified: 45 randomized controlled trials (RCTs) and 25 uncontrolled before-after studies (UBAs). The MA of nutritional intervention revealed a reduced average estimate of the effect on weight in RCTs (weighted mean differences [WMD] = -1.80 kg, 95% confidence interval [CI], -2.40 to -1.19), BMI (WMD = -0.80 kg/m2 , 95% CI, -1.11 to -0.49), and WC (WMD = -2.28 cm, 95% CI, -3.06 to -1.49); and for UBAs showed reductions in weight (WMD = -4.17 kg; 95% CI, -5.18 to -1.70), BMI (WMD = -1.26 kg/m2 ; 95% CI, -1.81 to -0.72) and (WMD = -2.90 cm; 95%CI, -4.21 to -1.59). There was no association between treatment effect and follow-up for both designs. Nutritional interventions alone yielded a higher but nonsignificant average reduction on weight when compared with combined components intervention. Interventions delivered through individual or group sessions showed a similar positive effect on weight decrease. The dietary prescription approach yielded a greater effect on weight loss than did the behavioural approaches but only in UBA studies.
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Affiliation(s)
- Raquel Canuto
- Postgraduate Program in Food, Nutrition and Health, Federal University of Rio Grande do Sul, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil.,Postgraduate Graduate Program in Nutrition Sciences, Federal University of Health Science of Porto Alegre, UFCSPA, Porto Alegre, Rio Grande do Sul, Brazil
| | - Anderson Garcez
- Postgraduate Graduate Program in Nutrition Sciences, Federal University of Health Science of Porto Alegre, UFCSPA, Porto Alegre, Rio Grande do Sul, Brazil.,Postgraduate Program in Collective Health, University of Vale do Rio dos Sinos, UNISINOS, São Leopoldo, Rio Grande do Sul, Brazil
| | | | - Gilberto Kac
- Institute of Nutrition, Federal University of Rio de Janeiro, UFRJ, Rio de Janeiro, Rio Grande do Sul, Brazil
| | - Maria Teresa Anselmo Olinto
- Postgraduate Program in Food, Nutrition and Health, Federal University of Rio Grande do Sul, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil.,Postgraduate Program in Collective Health, University of Vale do Rio dos Sinos, UNISINOS, São Leopoldo, Rio Grande do Sul, Brazil
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Groarke JM, Richmond J, Mc Sharry J, Groarke A, Harney OM, Kelly MG, Walsh JC. Acceptability of a Mobile Health Behavior Change Intervention for Cancer Survivors With Obesity or Overweight: Nested Mixed Methods Study Within a Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e18288. [PMID: 33591290 PMCID: PMC7925146 DOI: 10.2196/18288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/23/2020] [Accepted: 07/27/2020] [Indexed: 01/29/2023] Open
Abstract
Background A significant proportion of cancer survivors have overweight or obesity. Although this has negative implications for health, weight management is not a standard component of oncology aftercare. Mobile health (mHealth) technology, in combination with behavior change techniques (BCTs), has the potential to support positive lifestyle changes. Few studies have been carried out with cancer survivors; therefore, the acceptability of these tools and techniques requires further investigation. Objective The aim of this study is to examine the acceptability of a behavior change intervention using mHealth for cancer survivors with a BMI of 25 or more and to gather constructive feedback from participants. Methods The intervention consisted of educational sessions and an 8-week physical activity goal setting intervention delivered using mobile technology (ie, Fitbit activity monitor plus SMS contact). In the context of a two-arm randomized controlled trial, semistructured interviews were conducted to assess the retrospective acceptability of the intervention from the perspective of the recipients. The theoretical framework for the acceptability of health care interventions was used to inform a topic guide. The interviews were transcribed and analyzed using thematic analysis. A quantitative survey was also conducted to determine the acceptability of the intervention. A total of 13 participants were interviewed, and 36 participants completed the quantitative survey. Results The results strongly support the acceptability of the intervention. The majority of the survey respondents held a positive attitude toward the intervention (35/36, 97%). In qualitative reports, many of the intervention components were enjoyed and the mHealth components (ie, Fitbit and goal setting through text message contact) were rated especially positively. Responses were mixed as to whether the burden of participating in the intervention was high (6/36, 17%) or low (5/36, 14%). Participants perceived the intervention as having high efficacy in improving health and well-being (34/36, 94%). Most respondents said that they understood how the intervention works (35/36, 97%), and qualitative data show that participants’ understanding of the aim of the intervention was broader than weight management and focused more on moving on psychologically from cancer. Conclusions On the basis of the coherence of responses with theorized aspects of intervention acceptability, we are confident that this intervention using mHealth and BCTs is acceptable to cancer survivors with obesity or overweight. Participants made several recommendations concerning the additional provision of social support. Future studies are needed to assess the feasibility of delivery in clinical practice and the acceptability of the intervention to those delivering the intervention. International Registered Report Identifier (IRRID) RR2-10.2196/13214
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Affiliation(s)
- Jenny M Groarke
- Centre for Improving Health-Related Quality of Life, School of Psychology, Queen's University Belfast, Belfast, United Kingdom
| | | | - Jenny Mc Sharry
- School of Psychology, National University of Ireland, Galway, Galway, Ireland
| | - AnnMarie Groarke
- School of Psychology, National University of Ireland, Galway, Galway, Ireland
| | - Owen M Harney
- School of Psychology, National University of Ireland, Galway, Galway, Ireland
| | | | - Jane C Walsh
- School of Psychology, National University of Ireland, Galway, Galway, Ireland
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Jessen-Winge C, Ilvig PM, Fritz H, Brandt CJ, Lee K, Christensen JR. What a weight loss programme should contain if people with obesity were asked - a qualitative analysis within the DO:IT study. BMC Public Health 2021; 21:28. [PMID: 33407271 PMCID: PMC7789717 DOI: 10.1186/s12889-020-09850-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/05/2020] [Indexed: 12/31/2022] Open
Abstract
Background Currently 1.9 billion adults worldwide are estimated to be overweight or obese. In Denmark the municipalities hold the responsibility to deliver weight loss programmes to overweight and obese citizens. There is a tendency to assume that weight loss programmes that show positive effects in specialized hospital settings are directly transferrable to municipal settings. However, municipality-based weight loss programmes have not produced clinically significant reductions in body weight. One reason for this may be that much research evidence regarding obesity programming neglects the perspectives of people with obesity. The first step in developing a weight loss programme designed for municipal settings is to understand what people with obesity want and need from a programme. The aim of this study was to examine what people with obesity find important in a weight loss programme for weight loss and weight maintenance. Methods We used a qualitative, explorative, descriptive design with individual interviews. We included men and women age 17 and older with a BMI ≥ 25 kg/m2. Participants were recruited from the wait lists of 13 municipality programmes and through Facebook posts. Data were analyzed using content analysis. Results Thirty-four participants with overweight or obesity were individually interviewed (ages between 19 and 74). Findings suggest that weight loss programmes should; a) support participants in structuring days; b) consider the use of replacement activities to reduce cognitive and emotional burden; c) aide individuals to increase self-efficacy and; d) include family and friends as well as health professionals and peers in the weight loss process. Diet and exercise, while important, should be balanced with other meaningful activities in everyday life. Conclusion Participants in this study wished to balance weight loss related activities with overall everyday life as well as finding the believe in their ability to lose weight in social relations.
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Affiliation(s)
- Christina Jessen-Winge
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psycomotore therapy, University College Copenhagen, Sigurdsgade 26, 2200, Copenhagen, Denmark. .,Department of Public Health, University of Southern Denmark, JB Winsløwsvej 9A, 5000, Odense C, Denmark.
| | - Pia Maria Ilvig
- Department of Public Health, University of Southern Denmark, JB Winsløwsvej 9A, 5000, Odense C, Denmark
| | - Heather Fritz
- Department of Health Care sciences, Occupational Therapy Program, Wayne State University, 259 Mack Ave, Detroit, MI, 48201, USA
| | - Carl J Brandt
- Department of Public Health, University of Southern Denmark, JB Winsløwsvej 9A, 5000, Odense C, Denmark
| | - Kim Lee
- Department of Public Health, University of Southern Denmark, JB Winsløwsvej 9A, 5000, Odense C, Denmark.,Department of Occupational Therapy, University College South, Degnevej 16, 6705, Esbjerg, Denmark
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The degree of engagement of overweight/obese adult women in the recommended activities of the Chilean "Vida Sana" program is directly correlated with its effectiveness. NUTR HOSP 2021; 38:807-813. [PMID: 33703910 DOI: 10.20960/nh.03461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Introduction: the Chilean Ministry of Health implements the Vida Sana (VS) program with the objective of reducing risk factors for chronic diseases in overweight/obese (OW/OB) individuals, aged 2-64. Objective: to determine the effectiveness of VS in OW/OB women (20-44 yrs) in terms of their engagement in the recommended activities. These consist of participating in a minimum number each of three core activities (psychologist consultations, lifestyle workshops, and physical activity sessions) during 6 months, to obtain a 5 % weight loss and improved physical fitness (PF). Methods: a retrospective study involving secondary analyses of the 2017 VS database (n = 5,179 OW/OB women). We determined effectiveness by: a) comparing changes in weight and PF in participants who achieved one or both outcomes, using t-tests and tests of proportions, and b) assessing the probability of achieving the program´s goal, according to participation in 1, 2, or 3 core activities, individually and jointly, using the OR (95 % CI) and trend analysis. Results: around 32 %, 88 %, and 29 % of women achieved 5 % weight loss, improved PF, and both, respectively. The high percentage of women who improved PF was due to a permissive criterion. Although 20 % of women attained the program´s goal with 0 engagement, among participants, the ORs (95 % CI) for achieving the program´s goal when engaging in 1, 2, or 3 core activities were 1.55 (CI 1.2-2.03), 2.34 (1.76-3.11), and 3.5 (2.21-5.53), respectively. Conclusion: effectiveness parallels degree of engagement in the recommended activities of VS. A characterization of a program´s participation rate is crucial for improving its effectiveness.
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Dao MC, Das SK, Silver RE, Roberts SB. Association of counselor weight status and demographics with participant weight loss in a structured lifestyle intervention. Obes Res Clin Pract 2021; 15:69-72. [DOI: 10.1016/j.orcp.2020.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 07/13/2020] [Accepted: 11/20/2020] [Indexed: 11/26/2022]
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Jessen-Winge C, Ilvig PM, Thilsing T, Lee K, Fritz H, Christensen JR. Health professionals' perceptions of weight loss programmes and recommendations for future implementation: a qualitative study. BMJ Open 2020; 10:e039667. [PMID: 33208329 PMCID: PMC7677371 DOI: 10.1136/bmjopen-2020-039667] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Obesity is an increasing public health challenge and most weight loss programmes are still inadequate to support sustainable weight loss. One reason for the continued lack of success might be the dominant biomedical, individualised approach to weight loss. Holistic approaches that focus on overall health and well-being in addition to weight loss are increasingly recommended. In Denmark, health professionals in the municipalities are responsible for developing and conducting weight loss programmes. The objective of this study was to explore what health professional's perceived as an ideal, holistic weight loss programme that could be feasibly implemented in the municipalities. DESIGN A phenomenological-hermeneutical qualitative study was performed using semistructured interviews. SETTING Thirty-two Danish municipalities were weight loss programmes are developed and conducted. PARTICIPANTS Thirty-five health professionals with experience conducting weight loss programmes. RESULTS Three themes emerged from the analysis: Support from the social network are important both during and after a weight loss, Changing the self-belief by positive discussions and doing activities, Maintaining changes through daily life. CONCLUSION Future municipal weight loss programmes should emphasise overall health and well-being instead of weight loss and adopt a holistic approach including a focus on social relationships, meaningful activities and successes as part of a balanced daily life.
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Affiliation(s)
- Christina Jessen-Winge
- Department of Public Health, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
- Department of Health, University College Copenhagen, Kobenhavn, Denmark
| | - Pia Marie Ilvig
- Department of Public Health, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Trine Thilsing
- Department of Public Health, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Kim Lee
- Department of Public Health, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Heather Fritz
- Department of occupational therapy, Wayne State University, Detroit, Michigan, USA
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Holt G, Hughes D. A study using semi-structured interview and Delphi survey to explore the barriers and enabling factors that influence access and utilisation of weight management services for people living with morbid obesity: A patient and professional perspective. J Hum Nutr Diet 2020; 34:215-223. [PMID: 33170550 DOI: 10.1111/jhn.12832] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/30/2020] [Accepted: 10/11/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND A quarter of the United Kingdom's population are living with obesity, a disease that causes an estimated 30 000 deaths each year. This coincides with an under-utilisation of weight management services across the country with the majority of patients with morbid obesity having no record of any weight loss intervention at all. This study explores the factors that influence patient access to weight management services. METHODOLOGY Expert opinion was obtained using semi-structured interviews and the Delphi methodology. Participants were selected from primary and secondary healthcare settings. Healthcare professionals (HCPs) had experience working in weight management services or in services dealing with obesity-related comorbidities. Patients had experience in attending a variety weight management services. RESULTS Nineteen participants completed all aspects of the study. The main barriers included negative perceptions, low mood/depression, obesity not being considered as a serious disease, lack of access to services for housebound patients and disproportionate commissioning. Suggested facilitating factors to improve access included the education of all HCPs about obesity, improving HCP communication with patients, and broadening the number of HCP's that are able to refer to weight management services. CONCLUSIONS Future services must prioritise the education of all HCPs and the public to combat the stigma of obesity and its impact on health. National commissioning guidelines in partnership with advocates of obesity should seek to streamline referral pathways, broaden referral sources and increase the availability of specialist services. Awareness of these factors when designing future weight management services will help to improve their utilisation.
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Affiliation(s)
- Guy Holt
- East Midlands Bariatric & Metabolic Institute, Royal Derby Hospital (University Hospitals of Derby and Burton), Derby, UK
| | - David Hughes
- East Midlands Bariatric & Metabolic Institute, Royal Derby Hospital (University Hospitals of Derby and Burton), Derby, UK
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Effectiveness of Lifestyle Intervention for Type 2 Diabetes in Primary Care: the REAL HEALTH-Diabetes Randomized Clinical Trial. J Gen Intern Med 2020; 35:2637-2646. [PMID: 31965526 PMCID: PMC7458982 DOI: 10.1007/s11606-019-05629-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 12/20/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Intensive lifestyle interventions (LI) improve outcomes in obesity and type 2 diabetes but are not currently available in usual care. OBJECTIVE To compare the effectiveness and costs of two group LI programs, in-person LI and telephone conference call (telephone LI), to medical nutrition therapy (MNT) on weight loss in primary care patients with type 2 diabetes. DESIGN A randomized, assessor-blinded, practice-based clinical trial in three community health centers and one hospital-based practice affiliated with a single health system. PARTICIPANTS A total of 208 primary care patients with type 2 diabetes, HbA1c 6.5 to < 11.5, and BMI > 25 kg/m2 (> 23 kg/m2 in Asians). INTERVENTIONS Dietitian-delivered in-person or telephone group LI programs with medication management or MNT referral. MAIN MEASURES Primary outcome: mean percent weight change. SECONDARY OUTCOMES 5% and 10% weight loss, change in HbA1c, and cost per kilogram lost. KEY RESULTS Participants' mean age was 62 (SD 10) years, 45% were male, and 77% were White, with BMI 35 (SD 5) kg/m2 and HbA1c 7.7 (SD 1.2). Seventy were assigned to in-person LI, 72 to telephone LI, and 69 to MNT. The mean percent weight loss (95% CI) at 6 and 12 months was 5.6% (4.4-6.8%) and 4.6% (3.1-6.1%) for in-person LI, 4.6% (3.3-6.0%) and 4.8% (3.3-6.2%) for telephone LI, and 1.1% (0.2-2.0%) and 2.0% (0.9-3.0%) for MNT, with statistically significant differences between each LI arm and MNT (P < 0.001) but not between LI arms (P = 0.63). HbA1c improved in all participants. Compared with MNT, the incremental cost per kilogram lost was $789 for in-person LI and $1223 for telephone LI. CONCLUSIONS In-person LI or telephone group LI can achieve good weight loss outcomes in primary care type 2 diabetes patients at a reasonable cost. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02320253.
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Salemonsen E, Førland G, Saetre Hansen B, Holm AL. Beneficial self-management support and user involvement in Healthy Life Centres-A qualitative interview study in persons afflicted by overweight or obesity. Health Expect 2020; 23:1376-1386. [PMID: 32864853 PMCID: PMC7696113 DOI: 10.1111/hex.13129] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 07/23/2020] [Accepted: 08/05/2020] [Indexed: 12/12/2022] Open
Abstract
Background Relapse is high in lifestyle interventions involving behavioural change and weight loss maintenance. The purpose of lifestyle self‐management interventions offered at Healthy Life Centres (HLCs) is to empower the participants, leading to self‐management and improved health. Exploring beneficial self‐management support and user involvement in HLCs is critical for quality, improving effectiveness and guiding approaches to lifestyle change support in overweight and obesity. Objective The aim of this study was to explore how persons afflicted by overweight or obesity attending lifestyle interventions in Norwegian HLCs experience beneficial self‐management support and user involvement. Method Semi‐structured in‐depth interviews were conducted with 13 service users (5 men and 8 women). Data were analysed using qualitative content analysis. Results One main theme was identified: regaining self‐esteem and dignity through active involvement and long‐term self‐worth support in partnership with others. This main theme comprised four themes: (a) self‐efficacy through active involvement and better perceived health, (b) valued through health‐care professionals (HPs) acknowledgement, equality and individualized support, (c) increased motivation and self‐belief through fellowship and peer support; and (d) maintenance of lifestyle change through accessibility and long‐term support. Conclusion Service users’ active involvement, acknowledgement and long‐term self‐worth support from HPs and peers seem to support self‐management and user involvement and may be some of the successful ingredients to lifestyle change. However, prolonged follow‐up support is needed. A collectivistic and long‐term perspective can integrate the importance of significant others and shared responsibility.
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Affiliation(s)
- Elin Salemonsen
- Department of Health and Caring Science, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Haugesund, Norway
| | - Georg Førland
- Department of Health and Caring Science, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Haugesund, Norway
| | | | - Anne Lise Holm
- Department of Health and Caring Science, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Haugesund, Norway
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Trujillo-Garrido N, Bernal-Jiménez MÁ, Santi-Cano MJ. Evaluation of Obesity Management Recorded in Electronic Clinical History: A Cohort Study. J Clin Med 2020; 9:E2345. [PMID: 32717839 PMCID: PMC7465947 DOI: 10.3390/jcm9082345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/15/2020] [Accepted: 07/21/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The prevalence of obesity is increasing worldwide. Because of their close proximity to the population, primary care physicians and nurses are in a unique position to motivate and advise patients with obesity on a healthy diet and increased physical activity. Drawing from information recorded in electronic clinical records, we evaluated how the general recommendations included in obesity guidelines are being implemented in routine clinical practice. METHODS This study drew from the following data from a cohort of 209 patients with obesity that attended primary care consultations: electronic clinical records, body mass index (BMI), waist circumference (WC), cardiovascular risk factors, comorbidities and whether their health professional documented compliance with the recommendations of the evidence-based obesity guidelines in their electronic history. RESULTS Only 25.4% of the clinical records met all the criteria established in the therapeutic guidelines regarding diet prescription, 1.4% for physical activity and 1.5% for behavioral change activities. The patients whose records mentioned diet prescription and physical activity and who received follow-up consultations for both factors had lower average BMI and WC, although this relationship was not significant after adjusting for baseline. CONCLUSIONS We found that only a small number of records in the electronic clinical histories followed the evidence-based obesity guidelines. Recording dietetic prescription and physical exercise in the patient's clinical record is associated with better control of obesity.
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Affiliation(s)
- Nuria Trujillo-Garrido
- Faculty of Nursing, University of Cádiz, 11207 Cádiz, Spain;
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), 11003 Cádiz, Spain;
| | - María Ángeles Bernal-Jiménez
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), 11003 Cádiz, Spain;
- Faculty of Nursing and Physiotherapy, University of Cádiz, 11009 Cádiz, Spain
| | - María J. Santi-Cano
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), 11003 Cádiz, Spain;
- Faculty of Nursing and Physiotherapy, University of Cádiz, 11009 Cádiz, Spain
- Research Group on Nutrition: Molecular, Pathophysiological and Social Issues, University of Cádiz, 11009 Cádiz, Spain
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Is It Time to Rethink Our Weight Loss Paradigms? BIOLOGY 2020; 9:biology9040070. [PMID: 32252392 PMCID: PMC7235705 DOI: 10.3390/biology9040070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 12/11/2022]
Abstract
Strategies aiming to promote weight loss usually include anything that results in an increase in energy expenditure (exercise) or a decrease in energy intake (diet). However, the probability of losing weight is low and the probability of sustained weight loss is even lower. Herein, we bring some questions and suggestions about the topic, with a focus on exercise interventions. Based on the current evidence, we should look at how metabolism changes in response to interventions instead of counting calories, so we can choose more efficient models that can account for the complexity of human organisms. In this regard, high-intensity training might be particularly interesting as a strategy to promote fat loss since it seems to promote many physiological changes that might favor long-term weight loss. However, it is important to recognize the controversy of the results regarding interval training (IT), which might be explained by the large variations in its application. For this reason, we have to be more judicious about how exercise is planned and performed and some factors, like supervision, might be important for the results. The intensity of exercise seems to modulate not only how many calories are expended after exercise, but also where they came from. Instead of only estimating the number of calories ingested and expended, it seems that we have to act positively in order to create an adequate environment for promoting healthy and sustainable weight loss.
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Williams AJ, Barter T, Sharpe RA. Lessons from a publicly funded tier 2 healthy weight programme in Cornwall, UK. J Public Health (Oxf) 2020; 42:e96-e104. [PMID: 31220298 DOI: 10.1093/pubmed/fdz037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 02/13/2019] [Accepted: 03/19/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The UK has one of the highest prevalence rates of obesity worldwide. Public health departments have a duty to provide some obesity treatment and prevention services. With evidence of effective programmes lacking, we investigate lessons learned from a healthy weight programme in Cornwall, UK. METHODS Data from the 12-week multi-component adult healthy weight management programme were obtained for 2012-2016. Descriptive statistics and statistical tests were used to describe participants' demographics, health status and anthropometric measures to explore the enrolment and retention of the programme as well as the impact. RESULTS A total of 1872 adults were referred into the programme. Overall, 646 completed the programme and, 48.8% achieved the programme's aim of a >3% reduction in weight. Those who completed and met the programme aim tended to have had healthier outcomes at baseline. CONCLUSIONS For those who engage with the programme the impact can be meaningful. However, <1% of the population of Cornwall with overweight or obesity enroled in the programme, and those who benefitted most might have been in least need. Providing services that meet the needs of the population is challenging when a variety of services is needed, and the evidence base is poor.
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Affiliation(s)
- A J Williams
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro TR1 3HD, UK
| | - T Barter
- Wellbeing and Public Health Service, Cornwall Council, Truro TR1 3AY, UK
| | - R A Sharpe
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro TR1 3HD, UK.,Wellbeing and Public Health Service, Cornwall Council, Truro TR1 3AY, UK
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Jessen-Winge C, Ilvig PM, Jonsson H, Fritz H, Lee K, Christensen JR. Obesity treatment: a role for occupational therapists? Scand J Occup Ther 2020; 28:471-478. [PMID: 31944148 DOI: 10.1080/11038128.2020.1712472] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Half of the Danish population is overweight or obese. Obesity can negatively impact health and daily life. The Danish National Board of Health´s guidelines for weight loss programmes to the Danish municipalities, recommends multidisciplinary teams, including occupational therapy, and interventions targeting diet, exercise, psychosocial coping, and everyday life. AIM To describe the structure and content of obesity programmes offered by the 98 municipalities in Denmark, including details such as the health professionals, programme recipients, dose, structure, content, and the role of occupational therapists. METHOD A quantitative content analysis was conducted on 234 published Danish municipal weight loss programmes. Programme descriptions were identified through internet searches using both sundhed.dk and Google.com. RESULTS Various health professionals conducted the programmes, and five involved occupational therapists. Programmes targeted children, adolescent and adults. Dose, structure and content were heterogeneous. CONCLUSION The majority of the programmes were neither evidence-based, nor did they follow recommendations from Danish National Board of Health. Few programmes addressed the role of habits or social participation. Occupational therapists appear to be under-utilized as providers of the programmes. SIGNIFICANCE Occupational therapists have a role to play in weight loss programmes, because of their training in activity analysis and their consideration of people, environments, and occupations. These components are included in the recommendations about psychosocial aspects and everyday life from the Danish National Board of Health.
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Affiliation(s)
- Christina Jessen-Winge
- Department of Occupational Therapy, Institute of Physiotherapy and Occupational Therapy, University College Copenhagen, Copenhagen, Denmark
| | - Pia Maria Ilvig
- The Research Initiative for Activity Studies and Occupational Therapy, The Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Hans Jonsson
- The Research Initiative for Activity Studies and Occupational Therapy, The Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
| | - Heather Fritz
- Department of Health Care Sciences, Occupational Therapy Program, Wayne State University, Detroit, MI, USA
| | - Kim Lee
- The Research Initiative for Activity Studies and Occupational Therapy, The Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Department of Occupational Therapy, University College South, Esbjerg, Denmark
| | - Jeanette Reffstrup Christensen
- The Research Initiative for Activity Studies and Occupational Therapy, The Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Langston K, Ross LJ, Byrnes A, Hay R. Secondary-prevention behaviour-change strategy for high-risk patients: Benefits for all classes of body mass index. Nutr Diet 2020; 77:499-507. [PMID: 31919951 DOI: 10.1111/1747-0080.12605] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 11/01/2019] [Accepted: 11/29/2019] [Indexed: 10/25/2022]
Abstract
AIM Research is needed to support the long-term benefits of lifestyle interventions for management of high-risk patients with different BMI classifications. This prospective multicentre study assessed two-year outcomes of hospital-referred patients (BMI 25-61 kg/m2 ) attending a dietitian-led multidisciplinary Healthy Eating and Lifestyle Behaviour-Change Program in group or individual formats in hospital outpatient settings. METHODS Bodyweight, quality of life (Short Form-12) and intuitive eating (Intuitive Eating Scale) data were collected at pre-intervention, post-intervention and 2 years. Outcomes were reported in BMI classes. RESULTS At pre-intervention (n = 493), 11% had pre-obesity, 25% obesity class I, 30% obesity class II and 34% obesity class III. Characteristics of participants with available data at post-intervention (n = 290) and 2 years (n = 178) were comparable (P > .05). Significant mean weight loss was seen at post-intervention (-2.0 ± 0.4 kg, P < .001, n = 290) and 2 years (-4.3 ± 0.5 kg, P < .001, n = 178). All BMI classes had significant weight losses (P < .05). Participants with higher obesity (classes II and III) had greater improvements in mental quality of life (P < .05) and initial weight reductions (P < .05) than those with lower classes. However, those with obesity class I had the greatest long-term weight reductions and significant improvements in physical quality of life at 2 years (P < .05). All BMI classes reported similar improvements in intuitive eating. No effect was found for differences in intervention format, duration or setting (P > .05). CONCLUSIONS The results support dietitian-led multidisciplinary lifestyle interventions for multidisciplinary management of high-risk patients of all BMI classes.
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Affiliation(s)
- Keanne Langston
- Nutrition & Dietetics, School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Lynda J Ross
- Nutrition & Dietetics, School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia.,Nutrition and Dietetics Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Menzies Health Institute Queensland, Southport, Queensland, Australia
| | - Angela Byrnes
- Nutrition & Dietetics, School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia.,Nutrition and Dietetics Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Robin Hay
- Nutrition and Dietetics Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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McHale CT, Cecil JE, Laidlaw AH. An analysis of directly observed weight communication processes between primary care practitioners and overweight patients. PATIENT EDUCATION AND COUNSELING 2019; 102:2214-2222. [PMID: 31378309 DOI: 10.1016/j.pec.2019.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 06/18/2019] [Accepted: 07/09/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To analyse weight-related communication prevalence and processes (content/context) between primary care practitioners (PCPs) and overweight patients within routine primary healthcare consultations. METHODS Consultations between 14 PCPs and 218 overweight patients (BMI ≥ 25 kg/m2) were video recorded. Weight communication was coded using the Roter Interaction Analysis System (RIAS) and the novel St Andrews Issue Response Analysis System (SAIRAS). Communication code frequencies were analysed. RESULTS Weight discussion occurred in 25% of consultations with overweight patients; 26% of these had weight-related consultation outcomes (e.g. weight-related counselling and referrals, stated weight-related intention from patients). Weight discussions were more likely to occur if PCPs provided space to patient attempts to discuss weight (p = 0.013). Longer weight discussions (p < 0.001) and contextualising weight as problematic when PCP/patient-initiated weight discussion (p < 0.001) were associated with weight-related consultation outcomes. CONCLUSION Weight was rarely discussed with overweight patients, however PCP space provision to patient weight-discussion initiation attempts increased weight discussion. When weight was discussed, increased time and/or contextualising weight as a problem increased the likelihood of weight-related consultation outcomes. PRACTICAL IMPLICATION PCP use of specific communication approaches when discussing, contextualising and responding to patient weight may facilitate weight-related discussion and consultation outcomes and could lead to more effective patient weight management.
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Affiliation(s)
- Calum T McHale
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, Medical and Biological Sciences Building, North Haugh, St Andrews, Fife, KY16 9TF, UK.
| | - Joanne E Cecil
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, Medical and Biological Sciences Building, North Haugh, St Andrews, Fife, KY16 9TF, UK
| | - Anita H Laidlaw
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, Medical and Biological Sciences Building, North Haugh, St Andrews, Fife, KY16 9TF, UK
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Wu J, Davis-Ajami ML, Lu ZK. Real-world impact of ongoing regular exercise in overweight and obese US adults with diabetes on health care utilization and expenses. Prim Care Diabetes 2019; 13:430-440. [PMID: 30808561 DOI: 10.1016/j.pcd.2019.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 01/17/2019] [Accepted: 02/02/2019] [Indexed: 02/03/2023]
Abstract
AIMS To assess the effect of regular exercise on health care utilization patterns and expenses in a real-world national sample of overweight and obese US adults with diabetes. METHODS Medical Expenditure Panel Survey data (2010-2015) identified adults with diabetes and a body mass index (kg/m2) ≥25. Two groups were created: exercise (moderate or vigorous physical activity >30min at least five times weekly) and non-exercise groups. OUTCOMES MEASURED average total health care expenses (per-person per-annum) and the likelihood of hospitalization. RESULTS Among 5140 overweight and obese adults with diabetes, 49.1% reported exercising at least five times weekly. The exercise group showed lower medical care and prescription drug utilization than the non-exercise group (p<0.001). Total unadjusted health expenses in the exercise group were $5651 lower than the non-exercise group (p<0.001). After controlling for socioeconomic and health-related variables, regular exercise reduced total health care expenses by 22.1% (p<0.001) and the likelihood of hospitalization by 28% (p=0.001). CONCLUSIONS Reduced hospitalization and health care expenses were associated with regular exercise (≥30min at least five times weekly) in overweight and obese adults with diabetes.
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Affiliation(s)
- Jun Wu
- Presbyterian College School of Pharmacy, 307 North Broad Street, Clinton, SC 29325, United States.
| | - Mary Lynn Davis-Ajami
- Indiana University School of Nursing, 1033 East Third Street, Bloomington, IN 47405, United States.
| | - Zhiqiang K Lu
- University of South Carolina College of Pharmacy, 715 Sumter Street, Columbia, SC 29208, United States.
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Clark DO, Keith N, Weiner M, Xu H. Outcomes of an RCT of videoconference vs. in-person or in-clinic nutrition and exercise in midlife adults with obesity. Obes Sci Pract 2019; 5:111-119. [PMID: 31019728 PMCID: PMC6469332 DOI: 10.1002/osp4.318] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 11/29/2018] [Accepted: 12/03/2018] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE New communication technologies have shown some promise in lifestyle weight loss interventions but may be most effective when leveraging face-to-face communications. The study reported here sought to test whether weight loss programme attendance and outcomes are greater when offered in-person at community sites or remotely via videoconference vs. in Federally Qualified Health Centers (FQHCs). In a three-arm randomized trial among 150 FQHC adults, intervention delivery in community-sites or via videoconference was tested against a clinic-based lifestyle intervention (enhanced usual care [EUC]). METHODS Twice weekly, a nutrition topic was reviewed, and exercise sessions were held in a 20-week programme delivered either in community settings or via videoconference. The primary outcome was the proportion of participants losing more than 2 kg at 6 (end of treatment) and 12 months in intent-to-treat analyses. RESULTS Mean (SD) age was 53 years, 82% were women, 65% were African-American, 50% reported $18,000 or less household income and 49% tested low in health literacy, and mean (SD) body mass index was 39 kg m-2. The proportion losing more than 2 kg of weight in the community site, videoconference and EUC groups was 33%, 34% and 24%, respectively, at 6 months and 29%, 34% and 29% at 12 months. No differences reached significance. Attendance was poor in all groups; 45% of community site, 58% of videoconference and 16% of EUC participants attended at least one session. CONCLUSION Videoconference and community-based delivery were as effective as an FQHC-based weight loss programme.
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Affiliation(s)
- D. O. Clark
- Indiana University Center for Aging ResearchIndianapolisINUSA
- Regenstrief Institute, Inc.IndianapolisINUSA
- Department of Medicine, Division of General Internal Medicine and GeriatricsIndiana University School of MedicineIndianapolisINUSA
| | - N. Keith
- Indiana University Center for Aging ResearchIndianapolisINUSA
- Regenstrief Institute, Inc.IndianapolisINUSA
- School of Health and Human SciencesIndiana University‐Purdue University IndianapolisIndianapolisINUSA
| | - M. Weiner
- William M. Tierney Center for Health Services ResearchIndiana University School of Medicine, Regenstrief Institute, Inc.IndianapolisINUSA
| | - H. Xu
- Department of BiostatisticsIndiana University School of MedicineIndianapolisINUSA
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Assessment of the Effectiveness of a Computerised Decision-Support Tool for Health Professionals for the Prevention and Treatment of Childhood Obesity. Results from a Randomised Controlled Trial. Nutrients 2019; 11:nu11030706. [PMID: 30917561 PMCID: PMC6471646 DOI: 10.3390/nu11030706] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 03/14/2019] [Accepted: 03/22/2019] [Indexed: 02/07/2023] Open
Abstract
We examined the effectiveness of a computerised decision-support tool (DST), designed for paediatric healthcare professionals, as a means to tackle childhood obesity. A randomised controlled trial was conducted with 65 families of 6–12-year old overweight or obese children. Paediatricians, paediatric endocrinologists and a dietitian in two children’s hospitals implemented the intervention. The intervention group (IG) received personalised meal plans and lifestyle optimisation recommendations via the DST, while families in the control group (CG) received general recommendations. After three months of intervention, the IG had a significant change in dietary fibre and sucrose intake by 4.1 and −4.6 g/day, respectively. In addition, the IG significantly reduced consumption of sweets (i.e., chocolates and cakes) and salty snacks (i.e., potato chips) by −0.1 and −0.3 portions/day, respectively. Furthermore, the CG had a significant increase of body weight and waist circumference by 1.4 kg and 2.1 cm, respectively, while Body Mass Index (BMI) decreased only in the IG by −0.4 kg/m2. However, the aforementioned findings did not differ significantly between study groups. In conclusion, these findings indicate the dynamics of the DST in supporting paediatric healthcare professionals to improve the effectiveness of care in modifying obesity-related behaviours. Further research is needed to confirm these findings.
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