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Mathew D. Combating weight bias. J Hosp Med 2024; 19:639-641. [PMID: 37916759 DOI: 10.1002/jhm.13232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/15/2023] [Accepted: 10/19/2023] [Indexed: 11/03/2023]
Affiliation(s)
- Don Mathew
- Department of Internal Medicine, University of Pittsburgh Medical Center, Monroeville, Pennsylvania, USA
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Myers J, Werk LN, Hossain MJ, Lawless S. Quality Improvement Project to Promote Identification and Treatment of Children With Obesity Admitted to Hospital. Am J Med Qual 2020; 35:411-418. [PMID: 31941346 DOI: 10.1177/1062860619898534] [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] [Indexed: 11/16/2022]
Abstract
Among children hospitalized for acute problems, comorbid obesity is commonly unaddressed. The objective was to improve identification and initial management of obesity among hospitalized children. In collaboration with nurses and dietitians, pediatric hospitalists of 2 children's hospitals conducted a quality improvement project to improve body mass index (BMI) documentation, obesity diagnosis, diet, and nutrition consultation through clinician education, development of computerized clinical decision-support system tools, and workflow modifications. Participants received monthly performance feedback. Among those with elevated BMI, diagnosis rose to 70.2%; a documented obesity diagnosis was associated with being 35 times more likely (P < .001) to receive at least 1 intervention while hospitalized. Participants reported an increase in skill in (27%), comfort with (27%), and knowledge of (33%) obesity management. Improvement in health care provider recognition and management of obesity in the inpatient setting is achievable. Additional work is needed to identify how best to sustain desired practice patterns.
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Affiliation(s)
- Joseph Myers
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE
| | - Lloyd N Werk
- Nemours Children's Hospital, Orlando, FL.,University of Central Florida, Orlando, FL
| | | | - Stephen Lawless
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE
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Wang'ondu R, Vitale R, Rosenblum H, Pinto-Taylor E, Grossman M, Sharifi M, Gielissen K, Doolittle B. A resident-led project to improve documentation of overweight and obesity in a primary care clinic. J Community Hosp Intern Med Perspect 2019; 9:377-383. [PMID: 31723380 PMCID: PMC6830187 DOI: 10.1080/20009666.2019.1681056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/23/2019] [Indexed: 11/04/2022] Open
Abstract
Background: Although the prevalence of overweight and obesity (OW/OB) has
increased in the last three decades, studies show that these conditions are sub-optimally
documented by physicians. Health information technology tools have varying effects on
improving documentation of OW/OB but often have to be complemented with other
interventions to be effective. Objective: Upon identifying low rates of documentation of diagnoses of
overweight and obesity by resident and attending physicians, despite the use of an
electronic health record (EHR) with automated BMI calculations, we performed a quality
improvement (QI) project to improve documentation of these diagnoses for patients in our
community hospital primary care clinic. Methods: The EHR was reviewed to determine documentation rates by resident
and attending physicians between 1 March 2018 and 31 September 2018. We collected
pre-intervention data, developed interventions, and implemented tests of change using
Plan-Do-Study-Act (PDSA) cycles to improve documentation of OW/OB. Results: Documentation of overweight and obesity diagnoses increased from a
baseline of 46% to 79% over a 20-week period after initiation of our project. Conclusion: We demonstrate the successful implementation of resident-led,
multi-faceted interventions in a team-based QI project to optimize documentation of OW/OB
in the EHR.
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Affiliation(s)
- Ruth Wang'ondu
- Departments of Internal Medicine and Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Rebecca Vitale
- Departments of Internal Medicine and Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Hannah Rosenblum
- Departments of Internal Medicine and Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Emily Pinto-Taylor
- Departments of Internal Medicine and Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Matthew Grossman
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Mona Sharifi
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Katherine Gielissen
- Departments of Internal Medicine and Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Benjamin Doolittle
- Departments of Internal Medicine and Pediatrics, Yale University School of Medicine, New Haven, CT, USA.,Departments of General Medicine, Yale University School of Medicine, New Haven, CT, USA
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Harris CM, Kotwal S, Kisuule F. Response to "Underdocumentation of Obesity by Medical Residents Highlights Challenges to Effective Obesity Care". Obesity (Silver Spring) 2018; 26:1668. [PMID: 30307133 PMCID: PMC6202228 DOI: 10.1002/oby.22302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 07/30/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Ché Matthew Harris
- Johns Hopkins University School of Medicine, Johns Hopkins
Bayview Medical Center, 5200 Eastern Avenue, Baltimore, MD 21224
| | - Susrutha Kotwal
- Johns Hopkins University School of Medicine, Johns Hopkins
Bayview Medical Center, 5200 Eastern Avenue, Baltimore, MD 21224
| | - Flora Kisuule
- Johns Hopkins University School of Medicine, Johns Hopkins
Bayview Medical Center, 5200 Eastern Avenue, Baltimore, MD 21224
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Srivastava G, Johnson ED, Earle RL, Kadambi N, Pazin DE, Kaplan LM. Reply to "Response to Harris et al.". Obesity (Silver Spring) 2018; 26:1669. [PMID: 30358149 DOI: 10.1002/oby.22299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 08/14/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Gitanjali Srivastava
- Obesity, Metabolism and Nutrition Institute, Gastrointestinal Unit and MGH Weight Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Erica D Johnson
- Obesity, Metabolism and Nutrition Institute, Gastrointestinal Unit and MGH Weight Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rebecca L Earle
- Obesity, Metabolism and Nutrition Institute, Gastrointestinal Unit and MGH Weight Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nitya Kadambi
- Obesity, Metabolism and Nutrition Institute, Gastrointestinal Unit and MGH Weight Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Dorothy E Pazin
- Obesity, Metabolism and Nutrition Institute, Gastrointestinal Unit and MGH Weight Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lee M Kaplan
- Obesity, Metabolism and Nutrition Institute, Gastrointestinal Unit and MGH Weight Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Akinyemiju T, Meng Q, Vin-Raviv N. Association between body mass index and in-hospital outcomes: Analysis of the nationwide inpatient database. Medicine (Baltimore) 2016; 95:e4189. [PMID: 27428218 PMCID: PMC4956812 DOI: 10.1097/md.0000000000004189] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE Over one-third of American adults (36%) are obese and more than two-thirds (69%) are overweight. The impact of obesity on hospitalization outcomes is not well understood. OBJECTIVE To examine the association between body mass index (BMI) and overall, cancer, chronic obstructive pulmonary disease (COPD), asthma, and cardiovascular disease (CVD)-specific in-hospital mortality; postsurgical complications; and hospital length of stay (LOS). DESIGN Cross-sectional study. SETTING Representative sample of US hospitals included in the Health Cost and Utilization Project Nationwide Inpatient Sample database. PARTICIPANTS We obtained data for patients admitted with a primary diagnosis of cancer, COPD, asthma, and CVD. MAIN OUTCOME In-hospital mortality, postsurgical complications, and hospital LOS. RESULTS A total of 800,417 patients were included in this analysis. A higher proportion of Blacks (26.8%; 12.5%) and Whites (23.3%; 8.7%) had BMI of 40 to 49.9 and ≥50, respectively, compared with Hispanics (20.4%; 7.3%). Compared with normal BMI patients, the odds of in-hospital mortality increased 3.6-fold (odds ratio [OR] 3.62, 95% confidence interval [CI]: 3.37-3.89) for preobese patients, 6.5-fold (OR: 6.52, 95% CI: 5.79-7.34) for patients with BMI: 30 to 31.9, 7.5-fold (OR: 7.57, 95% CI: 6.67-8.59) for patients with BMI: 34 to 35.9, and 1.6- fold (OR: 1.77, 95% CI: 1.56-1.79) for patients with BMI ≥ 50. Compared with normal BMI patients, preobese and overweight patients had shorter hospital stays (β preobese: -1.58, 95% CI: -1.63, -1.52); however, no clear trends were observed for postsurgical complications. CONCLUSIONS The majority of hospitalized patients in this analysis had a BMI > 30, and higher BMI was associated with increased risk of mortality and longer hospital stay.
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Affiliation(s)
- Tomi Akinyemiju
- Department of Epidemiology, University of Alabama at Birmingham
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
- Correspondence: Tomi Akinyemiju, Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama (e-mail: )
| | - Qingrui Meng
- Department of Epidemiology, University of Alabama at Birmingham
| | - Neomi Vin-Raviv
- University of Northern Colorado Cancer Rehabilitation Institute, Greeley, Colorado
- School of Social Work, College of Health and Human Sciences, Colorado State University, Fort Collins, Colorado, USA
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Moran A, Lederer A, Johnson Curtis C. Use of Nutrition Standards to Improve Nutritional Quality of Hospital Patient Meals: Findings from New York City's Healthy Hospital Food Initiative. J Acad Nutr Diet 2015; 115:1847-54. [PMID: 26320410 DOI: 10.1016/j.jand.2015.07.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 07/16/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Most hospital patient meals are considered regular-diet meals; these meals are not required to meet comprehensive nutrition standards for a healthy diet. Although programs exist to improve nutrition in hospital food, the focus is on retail settings such as vending machines and cafeterias vs patient meals. New York City's Healthy Hospital Food Initiative (HHFI) provides nutrition standards for regular-diet meals that hospitals can adopt, in addition to retail standards. OBJECTIVE This study was undertaken to describe regular-diet patient menus before and after implementation of the HHFI nutrition standards. DESIGN The study involved pre- and post- menu change analyses of hospitals participating in the HHFI between 2010 and 2014. PARTICIPANTS/SETTING Eight New York City hospitals, selected based on voluntary participation in the HHFI, were included in the analyses. MAIN OUTCOME MEASURES Nutritional content of regular-diet menus were compared with the HHFI nutrition standards. STATISTICAL ANALYSES PERFORMED Nutrient analysis and exact Wilcoxon signed-rank tests were used for the analysis of the data. RESULTS At baseline, no regular-diet menu met all HHFI standards, and most exceeded the daily limits for percentage of calories from fat (n=5), percentage of calories from saturated fat (n=5), and milligrams of sodium (n=6), and they did not meet the minimum grams of fiber (n=7). Hospitals met all key nutrient standards after implementation, increasing fiber (25%, P<0.01) and decreasing sodium (-19%, P<0.05), percentage of calories from fat (-24%, P<0.01), and percentage of calories from saturated fat (-21%, P<0.05). A significant increase was seen in fresh fruit servings (667%, P<0.05) and decreases in full-fat and reduced-fat milk servings (-100%, P<0.05), refined grain servings (-35%, P<0.05), and frequency of desserts (-92%, P<0.05). CONCLUSIONS Regular diet menus did not comply with the HHFI nutrition standards at baseline. Using the HHFI framework, hospitals significantly improved the nutritional quality of regular-diet patient menus. The standards were applied across hospitals of varying sizes, locations, menu types, and food service operations, indicating feasibility of this framework in a range of hospital settings.
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Følling IS, Kulseng B, Helvik AS. Overweight, obesity and related conditions: a cross-sectional study of adult inpatients at a Norwegian hospital. BMC Res Notes 2014; 7:115. [PMID: 24571809 PMCID: PMC3939633 DOI: 10.1186/1756-0500-7-115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 02/21/2014] [Indexed: 01/22/2023] Open
Abstract
Background Overweight, obesity and associated conditions are major public health concerns in Norway. The prevalence of overweight and obesity in the general population in Norway is increasing, but there are limited data on how the situation is in hospitals. This study aimed to find the prevalence of overweight and obesity, and explore the associations of overweight, obesity and its related medical conditions in an adult in-patient sample at specified somatic and psychiatric departments at St. Olavs Hospital, Trondheim. Results A total of 497 patients participated. The mean BMI for the total sample at screening was 25.4 kg/m2. The prevalence of overweight and obesity was 45.1%. There was a higher association of overweight and obesity among patients aged 40–59 years (OR: 1.7) compared to those being younger. There was no significant difference between the somatic and the psychiatric samples. In the somatic sample overweight and obesity was associated with obesity-related conditions for both genders (OR: 2.0 and 2.1, respectively), when adjusted for age. Conclusion The substantial prevalence of overweight and obese patients may pose a threat to future hospital services. To further address the burden of overweight and obesity in hospitals, we need more knowledge about consequences of length of stay, use of resources and overall cost.
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Affiliation(s)
- Ingrid Sørdal Følling
- Department of Health Sciences, North-Trøndelag University College, Røstad, 7600 Levanger, Norway.
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Obesity—Who Is Responsible? South Med J 2010; 103:493. [DOI: 10.1097/smj.0b013e3181d99410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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