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Malik Z, Sohn W, Nanayakkara S, Williams K. Unique dietary and oral hygiene behaviors in a cohort with clinically severe obesity: A cross sectional study. Clin Exp Dent Res 2024; 10:e895. [PMID: 38726729 PMCID: PMC11082831 DOI: 10.1002/cre2.895] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/30/2024] [Accepted: 04/25/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND An association between increased risk of dental caries with increased levels of clinically severe obesity has been reported. Data linking body mass index (BMI) and dietary behaviors, including at-risk dietary factors and oral hygiene habits, are lacking in a cohort with clinically severe obesity. This study aimed to explore the dietary and oral hygiene behaviors in individuals with clinically severe obesity attending a hospital-based obesity service. METHODS Adult patients attending a hospital-based obesity service in Greater Western Sydney with clinically severe obesity were invited to participate in a self-administered survey, which collected data on their nutritional and oral hygiene behaviors. Demographic data (age, gender) and BMI were extracted from the participants' medical records. The primary outcome was the relationship between BMI and frequency of toothbrushing. RESULTS: Of the 82 individuals who consented to participate, 81 (98.8%) completed the study questionnaire. The median BMI of the cohort was 49.1 kg/m2 (interquartile range [IQR]: 43.2-57.3 kg/m2) and median age 51 (IQR: 39-63) years. BMI was not significantly correlated with individual oral health behaviors (p > .05). Many participants reported dietary risk behaviors, which have the potential to influence their oral health. CONCLUSIONS While oral health behaviors were not associated with increasing BMI, patients with clinically severe obesity in this study reported unique dietary behaviors and mixed oral hygiene habits that may complicate nutritional and dental management. Awareness of these behaviors among clinicians including dental professionals is required in this cohort.
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Affiliation(s)
- Zanab Malik
- Faculty of Medicine and HealthThe University of Sydney School of DentistrySurry HillsNew South WalesAustralia
- College of Health, Medicine and WellbeingThe University of Newcastle, School of Health Sciences (Oral Health)OurimbahNew South WalesAustralia
| | - Woosung Sohn
- Faculty of Medicine and HealthThe University of Sydney School of DentistrySurry HillsNew South WalesAustralia
| | - Shanika Nanayakkara
- Faculty of Medicine and HealthThe University of Sydney School of DentistrySurry HillsNew South WalesAustralia
| | - Kathryn Williams
- Nepean Blue Mountains Family Metabolic Health Service, Nepean Blue Mountains Local Health DistrictKingswoodNew South WalesAustralia
- Charles Perkins Centre‐NepeanThe University of SydneySydneyNew South WalesAustralia
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2
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Majstorovic M, Chur-Hansen A, Andrews JM, Burke A. Factors associated with progression or non-progression to bariatric surgery in adults: A systematic review. Obes Rev 2024; 25:e13698. [PMID: 38268336 DOI: 10.1111/obr.13698] [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] [Received: 11/27/2022] [Revised: 11/28/2023] [Accepted: 12/06/2023] [Indexed: 01/26/2024]
Abstract
Access to bariatric surgery is limited, and the factors related to undergoing or not undergoing the procedure are poorly understood. To this end, a systematic review of PubMed, Embase, PsycINFO, and CINAHL was conducted to deduce the factors associated with progression or non-progression to bariatric surgery. Quantitative and qualitative English-language articles ranging in date from database conception to September 2023 were included. Eligible studies employed adult participants (18 years of age or above) who had been referred for bariatric surgery. A total of 57 studies were identified. Fifteen key factors were found, alongside six less frequently studied factors: age, sex, BMI, race and ethnicity, distance to clinic, socio-economic status, insurance coverage, physical health, psychological health, eating history and habits, substance use and smoking, social influence and relationships, pre-surgery process and requirements, surgery-related concerns, choice of surgery, and others (emergency room visitation, COVID-19 virus, health literacy, appearance perceptions, time-off work, and stigma related to surgery). No factors were found to be reliably associated with progression or non-progression to bariatric surgery; however, the nature of these findings is tentative considering methodological flaws and limited research. Further studies are required to elucidate potential inequities in bariatric surgery access and educate policymakers and health professionals.
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Affiliation(s)
- Mia Majstorovic
- The School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Anna Chur-Hansen
- The School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jane M Andrews
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Surgery Program, The Central Adelaide Local Health Network (CALHN), Adelaide, South Australia, Australia
| | - Anne Burke
- The School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
- Psychology Department, CALHN, Adelaide, South Australia, Australia
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Termaat J, Piya MK, McBride KA. Community-based care needs for adults with class III obesity before and after tertiary weight management: An exploratory study. Obes Sci Pract 2024; 10:e732. [PMID: 38213316 PMCID: PMC10782639 DOI: 10.1002/osp4.732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/27/2023] [Accepted: 12/04/2023] [Indexed: 01/13/2024] Open
Abstract
Objective Class 3 obesity (severe obesity) is defined by a body mass index ≥40 kg/m2. Tertiary weight-management programs (WMPs) are hospital-based multidisciplinary services that aim to support individuals with severe obesity. Severe shortage of WMPs has led to waitlists and pressure on clinicians to discharge patients. Community obesity management often fails to support patients in maintaining weight loss/health gains. This study aimed to explore the needs of patients for community-based obesity care. Methods A qualitative study was undertaken via a tertiary WMP in Sydney, Australia. Semi-structured interviews/focus groups explored perceptions of purposively sampled patients and their clinicians on the community-based support needs of people with severe obesity. Data were audio-recorded, transcribed verbatim, and then thematically analyzed. Results Eleven patients and seven clinicians were interviewed. Four themes were identified: the importance of accountability and motivation to maintain weight-loss/health gains; limitations within community-based obesity management for those with severe obesity; perspectives on structured community programs for patients transitioning into/out of tertiary WMPs; and impact of mental health, stigma, and social isolation on engagement with community-based services. Conclusions Community-based programs are needed to support those awaiting access to tertiary WMPs and to help maintain health gains once discharged. Such programs should address issues of social isolation and integrate with current models of tertiary metabolic and primary health care.
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Affiliation(s)
- Jillian Termaat
- School of MedicineWestern Sydney UniversityPenrithNew South WalesAustralia
| | - Milan K. Piya
- School of MedicineWestern Sydney UniversityPenrithNew South WalesAustralia
- South Western Sydney (SWS) Metabolic Rehabilitation and Bariatric ProgramCamden and Campbelltown HospitalsCamdenNew South WalesAustralia
- Translational Health Research InstituteWestern Sydney UniversityPenrithNew South WalesAustralia
| | - Kate A. McBride
- School of MedicineWestern Sydney UniversityPenrithNew South WalesAustralia
- Translational Health Research InstituteWestern Sydney UniversityPenrithNew South WalesAustralia
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Malik Z, Sohn W, Nanayakkara S, Williams K. Poor dental service utilization in those with clinically severe obesity: A neglected issue with solutions needed. Clin Obes 2023; 13:e12608. [PMID: 37348852 DOI: 10.1111/cob.12608] [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: 02/01/2023] [Revised: 05/27/2023] [Accepted: 06/03/2023] [Indexed: 06/24/2023]
Abstract
Data linking body mass index (BMI) and dental service utilization with oral and general health, quality of life, wellbeing, and mental health are lacking. Adult patients with clinically severe obesity attending a hospital-based obesity service in Greater Western Sydney were invited to participate in a cross-sectional survey that collected data on dental utilization and visiting patterns, dental anxiety, and oral health-related quality of life (OHRQoL). General health data were obtained from participants' medical records. Of the 82 individuals who consented to participate, 81 (98.8%) completed the study questionnaire, and 74 (91.3%) answered additional screening questions related to their general wellbeing and mental health. Of the participants, 50 (61.7%) reported that their last dental visit was more than 1 year ago, 43 (53.1%) visited only as needed and 22 (27.2%) participants reported favourable dental visiting patterns. Twenty-four (29.6%) participants reported high levels of dental anxiety, and low levels of OHRQoL compared with national data. Screening questions suggested low general wellbeing and poor mental health in this patient cohort. Within this group, BMI was not significantly correlated with any of the variables of dental service utilization, dental anxiety, OHRQoL, wellbeing, or mental health (p > .05). There was a negative correlation between dental anxiety and dental utilization (p < .05). Patients with clinically severe obesity reported poor dental utilization, low OHRQoL, and high levels of dental anxiety. This study highlighted the frequency of medical complications, lack of wellbeing, and poor mental health, which were evident in this cohort and may complicate dental management.
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Affiliation(s)
- Zanab Malik
- Faculty of Medicine and Health, The University of Sydney School of Dentistry, Surry Hills, New South Wales, Australia
- School of Health Sciences (Oral Health), College of Health, Medicine and Wellbeing, The University of Newcastle, New South Wales, Australia
| | - Woosung Sohn
- Faculty of Medicine and Health, The University of Sydney School of Dentistry, Surry Hills, New South Wales, Australia
| | - Shanika Nanayakkara
- Faculty of Medicine and Health, The University of Sydney School of Dentistry, Surry Hills, New South Wales, Australia
| | - Kathryn Williams
- Nepean Blue Mountains Family Metabolic Health Service, Nepean Blue Mountains Local Health District, Kingswood, New South Wales, Australia
- Charles Perkins Centre-Nepean, The University of Sydney, Sydney, New South Wales, Australia
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Williams K, Maston G, Schneuer FJ, Nassar N. Impact of specialized obesity management services on the reduction in the use of acute hospital services. Clin Obes 2023; 13:e12592. [PMID: 37102335 PMCID: PMC10909550 DOI: 10.1111/cob.12592] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 03/01/2023] [Accepted: 03/29/2023] [Indexed: 04/28/2023]
Abstract
Severe obesity affects 4% of Australians and is associated with increased use of healthcare services and higher healthcare costs. This study evaluates the effect of attending a public tertiary obesity service on acute hospital use. This record-linkage study included people aged ≥16 years with severe obesity who attended the Nepean Blue Mountains Family Metabolic Health Service (FMHS), New South Wales, Australia between January 2017, and September 2021. Emergency department (ED) presentations and acute hospital admissions and respective costs in the 1-year and 3-years pre-and-post first FMHS attendance were compared, overall and for adequate attendance (≥5 visits). A total of 640 patients (74% female, 50% <45 years) attended the FMHS, totalling 15 303 occasions of service, average 24 per person. There was a 31.0% and 17.6% reduction in acute admissions and ED presentations, respectively, translating into 34.0% and 23.4% decrease in costs. Adequate engagement was associated with a 48% decreased risk of acute admission (odds ratio 0.52; 95% confidence interval 0.29-0.94). Over 3-years, there was a 19.8% and 20.7% reduction in acute hospital admissions and ED presentations, respectively. Findings indicate that tertiary obesity services reduce acute hospital use. Improved access to specialized obesity management may offload hospitals and contribute to acute healthcare cost avoidance.
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Affiliation(s)
- Kathryn Williams
- Charles Perkins CentreThe University of SydneySydneyNew South WalesAustralia
- Nepean Blue Mountains Family Metabolic Health Service, Nepean Hospital, Nepean Blue Mountains Local Health DistrictKingswoodNew South WalesAustralia
| | - Gabrielle Maston
- Charles Perkins CentreThe University of SydneySydneyNew South WalesAustralia
- Nepean Blue Mountains Family Metabolic Health Service, Nepean Hospital, Nepean Blue Mountains Local Health DistrictKingswoodNew South WalesAustralia
| | - Francisco J. Schneuer
- Child Population and Translational Health Research, The Children's Hospital at Westmead Clinical School, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Natasha Nassar
- Charles Perkins CentreThe University of SydneySydneyNew South WalesAustralia
- Child Population and Translational Health Research, The Children's Hospital at Westmead Clinical School, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
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Kwok C, Forward V, Lister NB, Garnett SP, Baur LA, Jebeile H. Considerations of eating disorder risk during obesity treatment in Australia: Current practice, attitudes and barriers. Obes Res Clin Pract 2023; 17:151-157. [PMID: 36906489 DOI: 10.1016/j.orcp.2023.02.008] [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: 11/28/2022] [Revised: 02/07/2023] [Accepted: 02/23/2023] [Indexed: 03/12/2023]
Abstract
INTRODUCTION People with obesity are vulnerable to eating disorders. It has been suggested that screening for eating disorder risk be part of obesity care. However, it is unclear what current practice entails. OBJECTIVE To explore considerations of eating disorder risk during treatment of obesity, including assessment and intervention strategies used in clinical practice. MATERIALS AND METHODS An online (REDCap) cross-sectional survey was distributed to health professionals working with individuals with obesity in Australia through professional societies and social media. The survey had three sections: 1. Characteristics of Clinician/Practice, 2. Current Practice, 3. Attitudes. Data were summarised using descriptive statistics and free-text comments were independently coded in duplicate to identify themes. RESULTS 59 health professionals completed the survey. Most were dietitians (n = 29), identified as women (n = 45) and worked within a public hospital (n = 30) and/or private practice (n = 29). Overall, 50 respondents reported assessing for eating disorder risk. Most reported that having a history of, or risk factors of eating disorders should not preclude obesity care but emphasised the importance of treatment modification including using a patient-centred approach involving a multidisciplinary team and promoting healthy eating behaviours, with less emphasis on calorie restriction or bariatric surgery. Management approaches did not differ for those with eating disorder risk factors or a diagnosed eating disorder. Clinicians identified the need for additional training and clear referral pathways. CONCLUSION Individualised care, balancing models of care for eating disorders and obesity and further access to training and services will be important in improving care of patients with obesity.
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Affiliation(s)
- Cathy Kwok
- The University of Sydney, Children's Hospital Westmead Clinical School, Corner Hawkesbury Road and Hainsworth Street, Westmead, NSW 2145, Australia
| | - Victoria Forward
- Nutrition and Dietetics Group, Susan Wakil School of Nursing and Midwifery, The University of Sydney, John Hopkins Drive, Camperdown, NSW 2005, Australia
| | - Natalie B Lister
- The University of Sydney, Children's Hospital Westmead Clinical School, Corner Hawkesbury Road and Hainsworth Street, Westmead, NSW 2145, Australia
| | - Sarah P Garnett
- The University of Sydney, Children's Hospital Westmead Clinical School, Corner Hawkesbury Road and Hainsworth Street, Westmead, NSW 2145, Australia; Kids Research, The Children's Hospital at Westmead, Corner Hawkesbury Road and Hainsworth Street, Westmead, NSW 2145, Australia
| | - Louise A Baur
- The University of Sydney, Children's Hospital Westmead Clinical School, Corner Hawkesbury Road and Hainsworth Street, Westmead, NSW 2145, Australia
| | - Hiba Jebeile
- The University of Sydney, Children's Hospital Westmead Clinical School, Corner Hawkesbury Road and Hainsworth Street, Westmead, NSW 2145, Australia.
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Atlantis E, Chimoriya R, Seifu CN, Peters K, Murphy G, Carr B, Lim D, Fahey P. Enablers and barriers to implementing obesity assessments in clinical practice: a rapid mixed-methods systematic review. BMJ Open 2022; 12:e063659. [PMID: 36446466 PMCID: PMC9710371 DOI: 10.1136/bmjopen-2022-063659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES This systematic review aims to improve our knowledge of enablers and barriers to implementing obesity-related anthropometric assessments in clinical practice. DESIGN A mixed-methods systematic review. DATA SOURCES Medline, Embase and CINAHL to November 2021. ELIGIBILITY CRITERIA Quantitative studies that reported patient factors associated with obesity assessments in clinical practice (general practice or primary care); and qualitative studies that reported views of healthcare professionals about enablers and barriers to their implementation. DATA EXTRACTION AND SYNTHESIS We used random-effects meta-analysis to pool ratios for categorical predictors reported in ≥3 studies expressed as pooled risk ratio (RR) with 95% CI, applied inverse variance weights, and investigated statistical heterogeneity (I2), publication bias (Egger's test), and sensitivity analyses. We used reflexive thematic analysis for qualitative data and applied a convergent integrated approach to synthesis. RESULTS We reviewed 22 quantitative (observational) and 3 qualitative studies published between 2004 and 2020. All had ≥50% of the quality items for risk of bias assessments. Obesity assessment in clinical practice was positively associated with patient factors: female sex (RR 1.28, 95% CI 1.10 to 1.50, I2 99.8%, mostly UK/USA), socioeconomic deprivation (RR 1.21, 95% CI 1.18 to 1.24, I2 73.9%, UK studies), non-white race/ethnicity (RR 1.27, 95% CI 1.03 to 1.57, I2 99.6%) and comorbidities (RR 2.11, 95% CI 1.60 to 2.79, I2 99.6%, consistent across most countries). Obesity assessment was also most common in the heaviest body mass index group (RR 1.55, 95% CI 0.99 to 2.45, I2 99.6%). Views of healthcare professionals were positive about obesity assessments when linked to patient health (convergent with meta-analysis for comorbidities) and if part of routine practice, but negative about their role, training, time, resources and incentives in the healthcare system. CONCLUSIONS Our evidence synthesis revealed several important enablers and barriers to obesity assessments that should inform healthcare professionals and relevant stakeholders to encourage adherence to clinical practice guideline recommendations.
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Affiliation(s)
- Evan Atlantis
- Schoolof Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
- Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
- Discipline of Medicine, Faculty of Medicine and Health, Nepean Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Ritesh Chimoriya
- Schoolof Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
- Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
- Schoolof Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Canaan Negash Seifu
- Schoolof Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Kath Peters
- Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
- Schoolof Nursing and Midwifery, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Gill Murphy
- Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
- Schoolof Nursing and Midwifery, Western Sydney University, Campbelltown, New South Wales, Australia
| | | | - David Lim
- Schoolof Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
| | - P Fahey
- Schoolof Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
- Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
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Burns R, Firman E, Huang HCC. Assessing service provision and outcomes at the Canberra Obesity Management Service: A retrospective chart review. Obesity (Silver Spring) 2022; 30:2146-2155. [PMID: 36321271 DOI: 10.1002/oby.23575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/25/2022] [Accepted: 08/25/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aimed to evaluate the multidisciplinary care model of the Canberra Obesity Management Service (COMS) with regard to patient demographics and clinical outcomes, particularly in comparison with previous COMS outcome reviews. METHODS A retrospective chart review was carried out on all patients attending an initial assessment at COMS between July 2018 and June 2019. Existing patients attending follow-up reviews were excluded so as to avoid repeating analyses of data from previous COMS reviews. Patient data were recorded and deidentified and underwent descriptive analyses. RESULTS A total of 234 patients with a mean age of 45.6 (SD = 13.9) years, mean BMI of 50.1 kg/m2 (SD = 8.5), and a female majority (72.2%) were analyzed. Of the 165 patients who attended follow-up appointments, 27.9% experienced ≥10% weight loss (46/165). Sleeve gastrectomy was associated with the largest mean weight reduction (15.6% at 6 months [n = 18]). CONCLUSIONS Compared with previous COMS studies, both the throughput and proportion of participants achieving clinically meaningful weight reduction were observed to have increased. Further studies assessing service cost-effectiveness, the development of standardized treatment pathways, and the use of a systematic data collection system would be valuable in allowing comparison between outcomes with similar obesity services in Australia and internationally.
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Affiliation(s)
- Ryan Burns
- Canberra Obesity Management Service, Canberra Health Services, Canberra, Australian Capital Territory, Australia
| | - Elise Firman
- Canberra Obesity Management Service, Canberra Health Services, Canberra, Australian Capital Territory, Australia
- Department of Health, Canberra, Australian Capital Territory, Australia
- Gold Coast Public Health Unit, Gold Coast Hospital and Health Service, Carrara, Queensland, Australia
| | - Hsin-Chia Carol Huang
- Canberra Obesity Management Service, Canberra Health Services, Canberra, Australian Capital Territory, Australia
- Respiratory and Sleep Medicine, Canberra Health Services, Canberra, Australian Capital Territory, Australia
- College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
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Tan MM, Jin X, Taylor C, Low AK, Le Page P, Martin D, Li A, Joseph D, Kormas N. Long-Term Trajectories in Weight and Health Outcomes Following Multidisciplinary Publicly Funded Bariatric Surgery in Patients with Clinically Severe Obesity (≥ 3 Associated Comorbidities): A Nine-Year Prospective Cohort Study in Australia. J Clin Med 2022; 11:4466. [PMID: 35956083 PMCID: PMC9369852 DOI: 10.3390/jcm11154466] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/18/2022] [Accepted: 07/23/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Real-world data on long-term (> 5 years) weight loss and obesity-related complications after newer bariatric surgical procedures are currently limited. The aim of this longitudinal study was to examine the effectiveness and sustainability of bariatric surgery in a cohort with clinically severe obesity in a multidisciplinary publicly funded service in two teaching hospitals in New South Wales, Australia. Methods: Patients were adults with complex clinically severe obesity with a BMI ≥ 35 kg/m2 and at least three significant obesity-related comorbidities, who underwent bariatric surgeries between 2009 and 2017. Detailed obesity-related health outcomes were reported from annual clinical data and assessments for up to 9 years of follow-up. Data were also linked with the national joint replacement registry. Results: A total of 65 eligible patients were included (mean, 7; range, 3−12 significant obesity-related comorbidities); 53.8% female; age 54.2 ± 11.2 years, with baseline BMI 52.2 ± 12.5 kg/m2 and weight 149.2 ± 45.5 kg. Most underwent laparoscopic sleeve gastrectomy (80.0%), followed by laparoscopic adjustable gastric banding (10.8%) and one anastomosis gastric bypass (9.2%). Substantial weight loss was maintained over 9 years of follow-up (p < 0.001 versus baseline). Significant total weight loss (%TWL ± SE) was observed (13.2 ± 2.3%) following an initial 1-year preoperative intensive lifestyle intervention, and ranged from 26.5 ± 2.3% to 33.0 ± 2.0% between 1 and 8 years following surgery. Type 2 diabetes mellitus (T2DM), osteoarthritis-related joint pain and depression/severe anxiety were the most common metabolic, mechanical and mental health comorbidities, with a baseline prevalence of 81.5%, 75.4% and 55.4%, respectively. Clinically significant composite cumulative rates of remission and improvement occurred in T2DM (50.0−82.0%) and hypertension (73.7−82.9%) across 6 years. Dependence on continuous positive airway pressure treatment in patients with sleep-disordered breathing fell significantly from 63.1% to 41.2% in 6 years. Conclusion: Bariatric surgery using an intensive multidisciplinary approach led to significant long-term weight loss and improvement in obesity-related comorbidities among the population with clinically complex obesity. These findings have important implications in clinical care for the management of the highest severity of obesity and its medical consequences. Major challenges associated with successful outcomes of bariatric surgery in highly complex patients include improving mental health in the long run and reducing postoperative opioid use. Long-term follow-up with a higher volume of patients is needed in publicly funded bariatric surgery services to better monitor patient outcomes, enhance clinical data comparison between services, and improve multidisciplinary care delivery.
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Affiliation(s)
- Michelle M.C. Tan
- Boden Initiative, Central Clinical School, Sydney School of Medicine, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia;
- Department of Endocrinology & Metabolism, Concord Repatriation General Hospital, Sydney Local Health District, Concord, NSW 2139, Australia
- Diabetes, Metabolism & Obesity Translational Research Unit, Camden Hospital, South Western Sydney Local Health District, Camden, NSW 2570, Australia
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, NSW 2050, Australia
| | - Xingzhong Jin
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Kensington, NSW 2052, Australia;
- Institute of Bone and Joint Research, Kolling Institute, The University of Sydney, St Leonards, NSW 2064, Australia
| | - Craig Taylor
- Upper GI Surgery Department, Concord Repatriation General Hospital, Sydney Local Health District, Concord, NSW 2139, Australia; (C.T.); (P.L.P.); (D.M.); (D.J.)
| | - Adrian K. Low
- Department of Orthopaedic Surgery, Faculty of Medicine and Health, The University of Sydney, Sydney Adventist Hospital, Wahroonga, NSW 2076, Australia;
| | - Philip Le Page
- Upper GI Surgery Department, Concord Repatriation General Hospital, Sydney Local Health District, Concord, NSW 2139, Australia; (C.T.); (P.L.P.); (D.M.); (D.J.)
| | - David Martin
- Upper GI Surgery Department, Concord Repatriation General Hospital, Sydney Local Health District, Concord, NSW 2139, Australia; (C.T.); (P.L.P.); (D.M.); (D.J.)
- Hepatobiliary & Upper GIT Surgery Department, Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, NSW 2050, Australia
| | - Ang Li
- Boden Initiative, Central Clinical School, Sydney School of Medicine, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia;
- NHMRC Centre of Research Excellence in Healthy Housing, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010, Australia
| | - David Joseph
- Upper GI Surgery Department, Concord Repatriation General Hospital, Sydney Local Health District, Concord, NSW 2139, Australia; (C.T.); (P.L.P.); (D.M.); (D.J.)
- Hepatobiliary & Upper GIT Surgery Department, Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, NSW 2050, Australia
| | - Nic Kormas
- Department of Endocrinology & Metabolism, Concord Repatriation General Hospital, Sydney Local Health District, Concord, NSW 2139, Australia
- Diabetes, Metabolism & Obesity Translational Research Unit, Camden Hospital, South Western Sydney Local Health District, Camden, NSW 2570, Australia
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Atlantis E, John JR, Hocking SL, Peters K, Williams K, Dugdale P, Fahey P. Development and internal validation of the Edmonton Obesity Staging System-2 Risk screening Tool (EOSS-2 Risk Tool) for weight-related health complications: a case-control study in a representative sample of Australian adults with overweight and obesity. BMJ Open 2022; 12:e061251. [PMID: 35732401 PMCID: PMC9226953 DOI: 10.1136/bmjopen-2022-061251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Excess weight and related health complications remain under diagnosed and poorly treated in general practice. We aimed to develop and validate a brief screening tool for determining the presence of unknown clinically significant weight-related health complications for potential application in general practice. DESIGN We considered 14 self-reported candidate predictors of clinically significant weight-related health complications according to the Edmonton Obesity Staging System (EOSS score of ≥2) and developed models using multivariate logistic regression across training and test data sets. The final model was chosen based on the area under the receiver operating characteristic curve and the Hosmer-Lemeshow statistic; and validated using sensitivity, specificity and positive predictive value. SETTING AND PARTICIPANTS We analysed cross-sectional data from the Australian Health Survey 2011-2013 sample aged between 18 and 65 years (n=7518) with at least overweight and obesity. RESULTS An EOSS≥2 classification was present in 78% of the sample. Of 14 candidate risk factors, 6 (family history of diabetes, hypertension, high sugar in blood/urine, high cholesterol and self-reported bodily pain and disability) were automatically included based on definitional or obvious correlational criteria. Three variables were retained in the final multivariate model (age, self-assessed health and history of depression/anxiety). The EOSS-2 Risk Tool (index test) classified 89% of those at 'extremely high risk' (≥25 points), 67% of those at 'very high risk' (7-24 points) and 42% of those at 'high risk' (<7 points) of meeting diagnostic criteria for EOSS≥2 (reference). CONCLUSION The EOSS-2 Risk Tool is a simple, safe and accurate screening tool for diagnostic criteria for clinically significant weight-related complications for potential application in general practice. Research to determine the feasibility and applicability of the EOSS-2 Risk Tool for improving weight management approaches in general practice is warranted.
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Affiliation(s)
- Evan Atlantis
- School of Health Sciences, Western Sydney University, Penrith South, New South Wales, Australia
- Discipline of Medicine, Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - James Rufus John
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia
| | - S L Hocking
- The Boden Collaboration for Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Kath Peters
- School of Health Sciences, Western Sydney University, Penrith South, New South Wales, Australia
| | - Kathryn Williams
- Charles Perkins Centre - Nepean, The University of Sydney, Nepean, New South Wales, Australia
- Nepean Blue Mountains Family Metabolic Heath Service, The Nepean Blue Mountains Local Health District, Nepean, New South Wales, Australia
| | - Paul Dugdale
- College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - P Fahey
- School of Health Sciences, Western Sydney University, Penrith South, New South Wales, Australia
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Chen J, Kaur H, Jaques J, Rock Z, Dean CM, Lord RV, Preda V. Association of clinically significant weight loss with number of patient visits and months of attendance at an Australian multidisciplinary weight management clinic. Clin Obes 2022; 12:e12520. [PMID: 35343053 PMCID: PMC9285583 DOI: 10.1111/cob.12520] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/06/2022] [Accepted: 03/13/2022] [Indexed: 11/29/2022]
Abstract
Despite the obesity epidemic, there are relatively few multidisciplinary obesity services in Australia, and only limited data on the effectiveness of these services. The aim of this study was to evaluate the effectiveness of a university hospital-based weight management clinic-the 'Healthy Weight Clinic' in supporting patients to achieve clinically significant weight loss (≥5% reduction in body weight), weight maintenance, and changes in body composition. A retrospective review was conducted to determine weight and associated health outcomes in patients who attended an initial consultation in the first 2 years of the clinic-between March 2017 and March 2019. Follow up was at least 1 year for all patients. Patients who underwent bariatric surgery were excluded. Of 213 total patients, 172 patients attended more than one follow-up consultation for lifestyle modification. Mean weight change and percentage total weight change at last follow-up was -6.2 kg (SD 7.4) and - 6.0% (SD 6.9), respectively. For every additional clinic follow-up, there was 21.4% increased odds of achieving clinically significant weight loss, and for every additional month of follow-up, there was 10.1% increased odds of achieving clinically significant weight loss. Twenty percent of patients (34/172) maintained ≥5% of initial body weight loss for at least 1 year. Body composition measurements were also favourable, with significant changes in percentage skeletal muscle mass of +0.8% (SD 1.5) and in percentage fat mass by -1.4% (SD 3.2). Regular support in a structured holistic multidisciplinary obesity service enables patients to achieve clinically meaningful weight loss and improved skeletal muscle mass to body fat ratio, and maintain this loss for at least 1 year. Improved weight loss was associated with more patient visits and longer duration of attendance at the clinic.
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Affiliation(s)
- Juliana Chen
- Healthy Weight Clinic, MQ HealthMacquarie University HospitalSydneyNew South WalesAustralia
- Department of Clinical Medicine, Faculty of Medicine and Health SciencesMacquarie UniversitySydneyNew South WalesAustralia
- Discipline of Nutrition and Dietetics, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, Charles Perkins CentreThe University of SydneyCamperdownNew South WalesAustralia
| | - Harpreet Kaur
- Department of Clinical Medicine, Faculty of Medicine and Health SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Joanna Jaques
- Healthy Weight Clinic, MQ HealthMacquarie University HospitalSydneyNew South WalesAustralia
- Department of Clinical Medicine, Faculty of Medicine and Health SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Zoe Rock
- Department of Clinical Medicine, Faculty of Medicine and Health SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Catherine M. Dean
- Department of Health Sciences, Faculty of Medicine and Health SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Reginald V. Lord
- Healthy Weight Clinic, MQ HealthMacquarie University HospitalSydneyNew South WalesAustralia
- Department of Surgery, School of MedicineUniversity of Notre DameSydneyNew South WalesAustralia
| | - Veronica Preda
- Healthy Weight Clinic, MQ HealthMacquarie University HospitalSydneyNew South WalesAustralia
- Department of Clinical Medicine, Faculty of Medicine and Health SciencesMacquarie UniversitySydneyNew South WalesAustralia
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12
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Kodsi R, Chimoriya R, Medveczky D, Grudzinskas K, Atlantis E, Tahrani AA, Kormas N, Piya MK. Clinical Use of the Edmonton Obesity Staging System for the Assessment of Weight Management Outcomes in People with Class 3 Obesity. Nutrients 2022; 14:967. [PMID: 35267942 PMCID: PMC8912843 DOI: 10.3390/nu14050967] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 11/17/2022] Open
Abstract
We aimed to assess weight loss and metabolic outcomes by severity of weight-related complications following an intensive non-surgical weight management program (WMP) in an Australian public hospital. A retrospective cohort study of all patients aged ≥18 years with body mass index (BMI) ≥ 40 enrolled in the WMP during March 2018−March 2019 with 12-month follow-up information were stratified using the Edmonton Obesity Staging System (EOSS). Of 178 patients enrolled in the WMP, 112 (62.9%) completed at least 12 months’ treatment. Most patients (96.6%) met EOSS-2 (56.7%) or EOSS-3 (39.9%) criteria for analysis. Both groups lost significant weight from baseline to 12 months; EOSS-2: 139.4 ± 31.8 kg vs. 131.8 ± 31.8 kg (p < 0.001) and EOSS-3: 141.4 ± 24.2 kg vs. 129.8 ± 24.3 kg (p < 0.001). After adjusting for baseline age, sex and employment status, mean weight loss was similar but a greater proportion of EOSS-3 achieved >10% weight loss compared to EOSS-2, (40% vs. 15.9%, p = 0.024). Changes in metabolic parameters including HbA1c, BP and lipids did not differ between EOSS-2 and 3. Despite increased clinical severity, adult patients with class 3 obesity achieved clinically meaningful weight loss and similar improvements in metabolic parameters compared to patients with less severe complications after 12 months in an intensive non-surgical WMP.
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Affiliation(s)
- Raymond Kodsi
- South Western Sydney Metabolic Rehabilitation and Bariatric Program (SWS MRBP), Camden and Campbelltown Hospitals, Camden, NSW 2570, Australia; (R.K.); (K.G.); (N.K.)
| | - Ritesh Chimoriya
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (R.C.); (D.M.)
| | - David Medveczky
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (R.C.); (D.M.)
| | - Kathy Grudzinskas
- South Western Sydney Metabolic Rehabilitation and Bariatric Program (SWS MRBP), Camden and Campbelltown Hospitals, Camden, NSW 2570, Australia; (R.K.); (K.G.); (N.K.)
| | - Evan Atlantis
- School of Health Sciences, Western Sydney University, Campbelltown, NSW 2560, Australia;
- Discipline of Medicine, Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Nepean, NSW 2747, Australia
| | - Abd A. Tahrani
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, UK;
- Centre for Endocrinology, Diabetes and Metabolism (CEDAM), Birmingham Health Partners, Birmingham B15 2TT, UK
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Trust, Birmingham B15 2TT, UK
| | - Nic Kormas
- South Western Sydney Metabolic Rehabilitation and Bariatric Program (SWS MRBP), Camden and Campbelltown Hospitals, Camden, NSW 2570, Australia; (R.K.); (K.G.); (N.K.)
| | - Milan K. Piya
- South Western Sydney Metabolic Rehabilitation and Bariatric Program (SWS MRBP), Camden and Campbelltown Hospitals, Camden, NSW 2570, Australia; (R.K.); (K.G.); (N.K.)
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (R.C.); (D.M.)
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13
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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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14
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Atlantis E, John JR, Fahey PP, Hocking S, Peters K. Clinical usefulness of brief screening tool for activating weight management discussions in primary cARE (AWARE): A nationwide mixed methods pilot study. PLoS One 2021; 16:e0259220. [PMID: 34710172 PMCID: PMC8553075 DOI: 10.1371/journal.pone.0259220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/18/2021] [Indexed: 11/18/2022] Open
Abstract
Objective The Edmonton Obesity Staging System (EOSS) is based on weight related health complications among individuals with overweight and obesity requiring clinical intervention. We aimed to assess the clinical usefulness of a new screening tool based on the EOSS for activating weight management discussions in general practice. Methods We enrolled five General Practitioners (GPs) and 25 of their patients located nationwide in metropolitan areas of Australia to test the feasibility, acceptability, and accuracy of the new ‘EOSS-2 Risk Tool’, using cross-sectional and qualitative study designs. Diagnostic accuracy of the tool for the presence of EOSS ≥2 criteria was based on clinical information collected prospectively. To assess feasibility and applicability, we explored the views of GP and patient participants by thematic analysis of transcribed verbatim and de-identified data collected by semi-structured telephone interviews. Results Nineteen (76%) patients were aged ≥45 years, five (20%) were male, and 20 (80%) were classified with obesity. All 25 patients screened positive for EOSS ≥2 criteria by the tool. Interviews with patients continued until data saturation was reached resulting in a total of 23 interviews. Our thematic analysis revealed five themes: GP recognition of obesity as a health priority (GPs expressed strong interest in and understanding of its importance as a health priority); obesity stigma (GPs reported the tool helped them initiate health based and non-judgmental conversations with their patients); patient health literacy (GPs and patients reported increased awareness and understanding of weight related health risks), patient motivation for self-management (GPs and patients reported the tool helped focus on self-management of weight related complications), and applicability and scalability (GPs stated it was easy to use, relevant to a range of their patient groups, and scalable if integrated into existing patient management systems). Conclusion The EOSS-2 Risk Tool is potentially clinically useful for activating weight management discussions in general practice. Further research is required to assess feasibility and applicability.
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Affiliation(s)
- Evan Atlantis
- School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia
- Discipline of Medicine, Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Nepean, New South Wales, Australia
- * E-mail:
| | - James Rufus John
- BestSTART-SWS, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- Academic Unit of Child Psychiatry, School of Psychiatry, Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
- Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia
| | - Paul Patrick Fahey
- School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia
| | - Samantha Hocking
- The Boden Collaboration for Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Kath Peters
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
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15
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The Impact of Morbid Obesity on the Health Outcomes of Hospital Inpatients: An Observational Study. J Clin Med 2021; 10:jcm10194382. [PMID: 34640400 PMCID: PMC8509550 DOI: 10.3390/jcm10194382] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/15/2021] [Accepted: 09/23/2021] [Indexed: 11/16/2022] Open
Abstract
Morbid obesity poses a significant burden on the health-care system. This study determined whether morbid obesity leads to worse health-outcomes in hospitalised patients. This retrospective-study examined nutritional data of all inpatients aged 18-79 years, with a body-mass-index (BMI) ≥ 18.5 kg/m2 admitted over a period of 4 years at two major hospitals in Australia. Patients were divided into 3 groups for comparison: normal/overweight (BMI 18.5-29.9 kg/m2), obese (BMI 30-39.9 kg/m2) and morbidly-obese (BMI ≥ 40 kg/m2). Outcome measures included length-of-hospital-stay (LOS), in-hospital mortality, and 30-day readmissions. Multilevel-mixed-effects regression was used to compare clinical outcomes between the groups after adjustment for potential confounders. Of 16,579 patients, 1004 (6.1%) were classified as morbidly-obese. Morbidly-obese patients had a significantly longer median (IQR) LOS than normal/overweight patients (5 (2, 12) vs. 5 (2, 11) days, p value = 0.012) and obese-patients (5 (2, 12) vs. 5 (2, 10) days, p value = 0.036). After adjusted-analysis, morbidly-obese patients had a higher incidence of a longer LOS than normal/overweight patients (IRR 1.04; 95% CI 1.02-1.07; p value < 0.001) and obese-patients (IRR 1.13; 95% CI 1.11-1.16; p value < 0.001). Other clinical outcomes were similar between the different groups. Morbid obesity leads to a longer LOS in hospitalised patients but does not adversely affect other clinical outcomes.
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16
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Piya MK, Chimoriya R, Yu W, Grudzinskas K, Myint KP, Skelsey K, Kormas N, Hay P. Improvement in Eating Disorder Risk and Psychological Health in People with Class 3 Obesity: Effects of a Multidisciplinary Weight Management Program. Nutrients 2021; 13:nu13051425. [PMID: 33922623 PMCID: PMC8146717 DOI: 10.3390/nu13051425] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/01/2021] [Accepted: 04/20/2021] [Indexed: 01/06/2023] Open
Abstract
This study aimed to evaluate the risk of eating disorders, psychological distress, and health-related quality of life (HRQoL) in people with class 3 obesity (body mass index (BMI) ≥ 40 kg/m2), and the effect of multidisciplinary weight management over 12 months. This retrospective cohort study included all adults with class 3 obesity who enrolled in a weight management program from March 2018 to December 2019. Questionnaires included the Eating Disorder Examination Questionnaire Short (EDE-QS), Kessler Psychological Distress Scale (K10), and 36-Item Short Form Survey (SF-36) for HRQoL. Physical and Mental Component Summary scores (PCS and MCS) were derived from the SF-36. Of 169 participants who completed 12 months in the program, 65.7% (n = 111) completed questionnaires at baseline and 12 months, with 6.0 ± 6.8% weight loss over this period. Compared to baseline, there was significant improvement at 12 months in EDE-QS (15.7 ± 6.6 vs. 13.6 ± 6.2, p = 0.002), K10 (25.7 ± 9.7 vs. 21.2 ± 9.4, p < 0.001), PCS (29.4 ± 10.1 vs. 36.1 ± 10.9, p < 0.001), and MCS scores (40.2 ± 12.4 vs. 44.0 ± 13.4, p = 0.001). All, apart from EDE-QS scores, remained significant after adjusting for weight change. This study highlights the importance of multidisciplinary management in people with class 3 obesity to help reduce eating disorder risk and psychological distress, and improve HRQoL, in addition to weight loss.
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Affiliation(s)
- Milan K. Piya
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (R.C.); (K.P.M.); (P.H.)
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden Hospital, Camden, NSW 2570, Australia; (W.Y.); (K.G.); (K.S.); (N.K.)
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia
- Correspondence:
| | - Ritesh Chimoriya
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (R.C.); (K.P.M.); (P.H.)
| | - William Yu
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden Hospital, Camden, NSW 2570, Australia; (W.Y.); (K.G.); (K.S.); (N.K.)
| | - Kathy Grudzinskas
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden Hospital, Camden, NSW 2570, Australia; (W.Y.); (K.G.); (K.S.); (N.K.)
| | - Kyaw Phone Myint
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (R.C.); (K.P.M.); (P.H.)
| | - Kathryn Skelsey
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden Hospital, Camden, NSW 2570, Australia; (W.Y.); (K.G.); (K.S.); (N.K.)
| | - Nic Kormas
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden Hospital, Camden, NSW 2570, Australia; (W.Y.); (K.G.); (K.S.); (N.K.)
| | - Phillipa Hay
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (R.C.); (K.P.M.); (P.H.)
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden Hospital, Camden, NSW 2570, Australia; (W.Y.); (K.G.); (K.S.); (N.K.)
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia
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Thakur A, Sharma D, Gupta B, Kramadhari N, Rajagopal R, Simmons D, Piya MK. Severe obesity in a specialist type 2 diabetes outpatient clinic: an Australian retrospective cohort study. BMC Endocr Disord 2021; 21:55. [PMID: 33757476 PMCID: PMC7988916 DOI: 10.1186/s12902-021-00722-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/11/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Obesity is a major risk factor for the development of type 2 diabetes (T2DM) and its complications. Significant weight loss has been shown to improve glycaemia in people with T2DM and obesity. National and international guidelines recommend considering bariatric surgery for body mass index (BMI) ≥ 35 kg/m2. We assessed the proportion of people with T2DM meeting criteria for surgery, how many had been offered a bariatric/obesity service referral, and compared the characteristics of people with BMI ≥ 35 kg/m2 and BMI < 35 kg/m2. METHODS Retrospective data were collected for all people with T2DM aged ≥18 years, attending a hospital specialist diabetes outpatient service over three calendar years, 2017-2019. RESULTS Of 700 people seen in the service, 291 (42%) had BMI ≥ 35 kg/m2 (the "BMI ≥ 35 group") and met criteria for bariatric surgery, but only 54 (19%) of them were offered referral to an obesity service. The BMI ≥ 35 group was younger than those with a BMI < 35 kg/m2 (56.1 ± 14.8 vs 61.4 ± 14.6 years, p < 0.001) (mean ± SD), with similar diabetes duration (11.0 ± 9.0 vs 12.3 ± 8.9 years, p = 0.078), and there was no significant difference in initial HbA1c (75 ± 27 vs 72 ± 26 mmol/mol, p = 0.118) (9.0 ± 2.5 vs 8.7 ± 2.4%) or proportion treated with insulin (62% vs 58%). There was more GLP1 agonist use in the BMI ≥ 35 group (13% vs 7%, p = 0.003) but similar rates of SGLT2 inhibitor use (25% vs 21%, p = 0.202). The BMI ≥ 35 group received more new medication and/or dose adjustments (74% vs 66%, p = 0.016). Only 29% in the BMI ≥ 35 kg group achieved HbA1c < 53 mmol/mol (7.0%). CONCLUSIONS In spite of frequently meeting the criteria for bariatric surgery and not achieving glycaemic targets, people with T2DM in this specialist clinic received limited medical or surgical management of their obesity. This study suggests opportunities for improvement in care of people with T2DM at several levels including increased referrals from T2DM services to weight management/bariatric services, as well as an increased use of GLP1 agonists and SGLT2 inhibitors where appropriate. Our data support the need to prioritise obesity management in the treatment of type 2 diabetes.
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Affiliation(s)
- Arunav Thakur
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, 2560, Australia
| | - Dharmesh Sharma
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, 2560, Australia
| | - Bhavya Gupta
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, 2560, Australia
| | - Nikitha Kramadhari
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, 2560, Australia
| | - Rohit Rajagopal
- Macarthur Diabetes Service, Camden and Campbelltown Hospitals, Campbelltown, New South Wales, 2560, Australia
| | - David Simmons
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, 2560, Australia
- Macarthur Diabetes Service, Camden and Campbelltown Hospitals, Campbelltown, New South Wales, 2560, Australia
| | - Milan Kumar Piya
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, 2560, Australia.
- Macarthur Diabetes Service, Camden and Campbelltown Hospitals, Campbelltown, New South Wales, 2560, Australia.
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18
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Atlantis E, Sahebolamri M, Cheema BS, Williams K. Usefulness of the Edmonton Obesity Staging System for stratifying the presence and severity of weight-related health problems in clinical and community settings: A rapid review of observational studies. Obes Rev 2020; 21:e13120. [PMID: 32812345 DOI: 10.1111/obr.13120] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/19/2020] [Accepted: 07/20/2020] [Indexed: 12/12/2022]
Abstract
This rapid review aimed to examine the usefulness of the Edmonton Obesity Staging System (EOSS) for stratifying the presence and severity of weight-related health problems in clinical and community settings. We searched PubMed, CINAHL and ProQuest for records from 2009 to May 2020. We considered observational studies in participants with overweight or obesity that investigated the risk of any clinical outcome associated with increasing EOSS. We reviewed and appraised 20 observational studies (cohort = 4, case series = 7, cross-sectional = 9) published between 2011 and 2020. Of 12 studies in clinical populations, the EOSS was most consistently associated with an increased risk of postoperative complications following bariatric surgery, especially for EOSS 3-4, and inversely associated with weight loss, treatment time and resolution of hypertension following bariatric surgery and clinical weight management. Of eight studies in community populations, the EOSS most consistently predicted mortality outcomes, especially for EOSS 3, and was associated with polypharmacy, service use and poorer work outcomes. Studies reported diverse EOSS definitions and outcomes, which slightly weakens the overall evidence base. The EOSS should be routinely used for predicting risks and benefits of surgical and nonsurgical weight management, but it should be applied with caution for population health planning.
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Affiliation(s)
- Evan Atlantis
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia.,School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Mehdi Sahebolamri
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia.,Department of Endocrinology (Obesity), Nepean Hospital, Nepean Blue Mountains Local Health District, Kingswood, New South Wales, Australia
| | - Birinder S Cheema
- School of Health Sciences and the National Institute of Complementary Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Kathryn Williams
- Department of Endocrinology (Obesity), Nepean Hospital, Nepean Blue Mountains Local Health District, Kingswood, New South Wales, Australia.,Charles Perkins Centre-Nepean, The University of Sydney, Kingswood, New South Wales, Australia
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19
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Atlantis E, Fahey P, Williams K, Edwards S, Samaras K, Dugdale P, Shi Z, Sharma AM. Comparing the predictive ability of the Edmonton Obesity Staging System with the body mass index for use of health services and pharmacotherapies in Australian adults: A nationally representative cross-sectional study. Clin Obes 2020; 10:e12368. [PMID: 32419298 DOI: 10.1111/cob.12368] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/19/2020] [Accepted: 04/24/2020] [Indexed: 12/11/2022]
Abstract
We assessed the value of the Edmonton Obesity Staging System (EOSS) compared with the body mass index (BMI) for determining associations with use of health services and pharmacotherapies in a nationally representative sample of participants in the 2011-2013 Australian Health Survey. A subsample of participants aged 18 years or over, with at least overweight (BMI ≥ 25 kg/m2 ) or central obesity (waist measurement of ≥102 cm for men; ≥88 cm for women), and who had provided physical measurements (n = 9730) were selected for analysis. For statistical significance of each predictor, we used logistic regression for model comparisons with the BMI and EOSS separately, and adjusted for covariates. For relative explanatory ability, we used the Nagelkerke pseudo R2 , receiver operating characteristic curve, and area under curve statistic. The EOSS was significantly better than the BMI for predicting polypharmacy and most of the health service use variables. Conversely, the BMI was significantly better than the EOSS for predicting having discussed lifestyle changes relevant to weight loss with the primary care physician. Clinicians, health care professionals, consumers, and policy makers should consider the EOSS a more accurate predictor of polypharmacy and health service use than the BMI in adults with overweight or obesity.
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Affiliation(s)
- Evan Atlantis
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
- School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Paul Fahey
- School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
| | - Kathryn Williams
- Charles Perkins Centre - Nepean, The University of Sydney, Sydney, New South Wales, Australia
- Department of Endocrinology (Obesity), Nepean Hospital, Nepean Blue Mountains Local Health District, Sydney, New South Wales, Australia
| | - Suzanne Edwards
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Katherine Samaras
- Diabetes and Metabolism Division, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- Department of Endocrinology, St Vincent's Hospital, Sydney, New South Wales, Australia
- St Vincent's Clinic School, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Paul Dugdale
- Medical School, Australian National University, Australian Capital Territory, Australia
| | - Zumin Shi
- Human Nutrition Department, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Arya M Sharma
- Department of Medicine, Division of Endocrinology, University of Alberta, Edmonton, Alberta, Canada
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20
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Mackenzie RM, Ells LJ, Simpson SA, Logue J. Core outcome set for behavioural weight management interventions for adults with overweight and obesity: Standardised reporting of lifestyle weight management interventions to aid evaluation (STAR-LITE). Obes Rev 2020; 21:e12961. [PMID: 31756274 PMCID: PMC7050499 DOI: 10.1111/obr.12961] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 09/26/2019] [Indexed: 12/30/2022]
Abstract
Behavioural weight management interventions in research studies and clinical practice differ in length, advice, frequency of meetings, staff, and cost. Few real-world programmes have published patient outcomes and those that have used different ways of reporting information, making it impossible to compare interventions and develop the evidence base. To address this issue, we have developed a core outcome set for behavioural weight management intervention programmes for adults with overweight and obesity. Outcomes were identified via systematic review of the literature. A representative expert group was formed comprising people with experience of adult weight management services. An online Delphi process was employed to reach consensus as to which outcomes should be measured and reported and which definitions/instruments should be utilised. The expert group identified eight core outcomes and 12 core processes for reporting by weight management services. Eleven outcomes and five processes were identified as optional. The most appropriate definitions/instruments for measuring each outcome/process were also agreed. Our core outcome set will ensure consistency of reporting. This will allow behavioural weight management interventions to be compared, revealing which interventions work best for which members of the population and helping inform development of adult behavioural weight management interventions.
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Affiliation(s)
- Ruth M. Mackenzie
- Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowUK
| | - Louisa J. Ells
- School of Health and Social CareTeesside UniversityMiddlesbroughUK
| | | | - Jennifer Logue
- Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowUK
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Medveczky DM, Kodsi R, Skelsey K, Grudzinskas K, Bueno F, Ho V, Kormas N, Piya MK. Class 3 Obesity in a Multidisciplinary Metabolic Weight Management Program: The Effect of Preexisting Type 2 Diabetes on 6-Month Weight Loss. J Diabetes Res 2020; 2020:9327910. [PMID: 32832564 PMCID: PMC7422012 DOI: 10.1155/2020/9327910] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/24/2020] [Accepted: 07/10/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Class 3 obesity (BMI ≥ 40 kg/m2) is a growing health problem worldwide associated with considerable comorbidity including Type 2 diabetes mellitus (T2DM). The multidisciplinary medical management of obesity can be difficult in T2DM due to potential weight gain from medications including sulphonylureas and insulin. However, newer weight-neutral/losing diabetes medications can aid additional weight loss. The aim of this study was to compare weight loss outcomes of patients with and without T2DM, and in patients with T2DM, to compare diabetes outcomes and change in medications at 6 months. METHODS All patients entering a multidisciplinary weight management metabolic program in a publicly funded hospital clinic in Sydney between March 2018 and March 2019, with BMI ≥ 40 kg/m2 and aged ≥18 years were included. Data was collected from patient clinical and electronic notes at baseline and 6 months. RESULTS Of the 180 patients who entered the program, 53.3% had T2DM at baseline. There was no difference in percentage weight loss in those with or without T2DM (4.2 ± 4.9% vs. 3.6 ± 4.7%, p = 0.35). Additionally, T2DM patients benefited from a 0.47% reduction in HbA1c (p < 0.01) and a reduction in the number of medications from baseline to 6 months (1.8 ± 1.0/patient vs. 1.0 ± 1.2/patient, p < 0.001). T2DM patients who started on weigh-neutral/losing medications in the program lost more weight than those started on weight-gaining medications (7.7 ± 5.3% vs. 2.4 ± 3.8%, p = 0.015). CONCLUSIONS Patients with class 3 obesity had significant weight loss at 6 months in this program. Patients with T2DM at baseline had comparable weight loss at 6 months, a significant improvement in glycaemic control, and a reduction in diabetes medication load. Additionally, patients with T2DM who were started on weight-neutral/losing medications lost significantly more weight than those started on weight-gaining medications, and these medications should be preferentially used in class 3 obesity and comorbid T2DM.
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Affiliation(s)
| | - Raymond Kodsi
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden Hospital, NSW, Australia
| | - Kathryn Skelsey
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden Hospital, NSW, Australia
| | - Kathy Grudzinskas
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden Hospital, NSW, Australia
| | - Flavia Bueno
- School of Medicine, Western Sydney University, NSW, Australia
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden Hospital, NSW, Australia
| | - Vincent Ho
- School of Medicine, Western Sydney University, NSW, Australia
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden Hospital, NSW, Australia
| | - Nic Kormas
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden Hospital, NSW, Australia
| | - Milan K. Piya
- School of Medicine, Western Sydney University, NSW, Australia
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden Hospital, NSW, Australia
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Atlantis E, Langford K, Piya M, Ho V, Skelsey K, Rickards L, Edwards S, Kormas N. Physical capacity outcomes in patients with severe obesity after 12 months of physician-led multidisciplinary team care: A case series from a public hospital clinical obesity service. Clin Obes 2019; 9:e12337. [PMID: 31475476 DOI: 10.1111/cob.12337] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/20/2019] [Accepted: 08/14/2019] [Indexed: 01/21/2023]
Abstract
Impaired physical capacity is common in people with severe levels of obesity. We aimed to investigate changes in physical capacity outcomes in patients with severe obesity following 12 months of physician-led multidisciplinary care from a "real world" Australian public hospital setting using a case series study design. We extracted data from medical records for all of the eligible patients referred to our clinical obesity service from 2010 to 2015 (69 of 239). We found significant (P < .05) pre-test/post-test (mean ± SD) improvements in the 6-minute walk test (6MWT) (339 ± 120 to 417 ± 112 m); 30-second sit-to-stand test (11 ± 4 to 15 ± 6 counts) and sit-and-reach test (-12 ± 13 to -8 ± 15 cm). Using linear mixed-effects models adjusting for repeated measurements over time (baseline vs 12 months) and testing for potential predictors, we found: mean 6MWT was associated with 12-month time period (56 m), body mass index (BMI, -3 m), no walking aid over 12 months (106 m) and no opioid analgesics (75 m); mean sit-to-stand was associated with 12-month time period (3 counts), age at referral (-0.2 counts), BMI (-0.2 counts), and diabetes (3 counts); and mean sit-and-reach was associated with 12-month time period (5 cm), female gender (5 cm) and total medications (-0.9 cm). Using causal mediation analysis, our results show that total exercise classes partially mediates change in walking capacity among those with cardiovascular disease. Our study shows that significant and clinically important improvements in physical capacity outcomes in patients with severe obesity can be achieved following 12 months of intensive specialist obesity services, such as ours.
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Affiliation(s)
- Evan Atlantis
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
- School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Kiri Langford
- Campbelltown and Camden Hospitals, Campbelltown, New South Wales, Australia
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Milan Piya
- Campbelltown and Camden Hospitals, Campbelltown, New South Wales, Australia
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Vincent Ho
- Campbelltown and Camden Hospitals, Campbelltown, New South Wales, Australia
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Kathryn Skelsey
- Campbelltown and Camden Hospitals, Campbelltown, New South Wales, Australia
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Lachlan Rickards
- Campbelltown and Camden Hospitals, Campbelltown, New South Wales, Australia
| | - Suzanne Edwards
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Nic Kormas
- Campbelltown and Camden Hospitals, Campbelltown, New South Wales, Australia
- Concord Repatriation General Hospital, Sydney, New South Wales, Australia
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23
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Atlantis E, Lin F, Anandabaskaran S, Fahey P, Kormas N. A predictive model for non-completion of an intensive specialist obesity service in a public hospital: a case-control study. BMC Health Serv Res 2019; 19:748. [PMID: 31651309 PMCID: PMC6814104 DOI: 10.1186/s12913-019-4531-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 09/12/2019] [Indexed: 11/10/2022] Open
Abstract
Background Despite the growing evidence base supporting intensive lifestyle and medical treatments for severe obesity, patient engagement in specialist obesity services is difficult to achieve and poorly understood. To address this knowledge gap, we aimed to develop a model for predicting non-completion of a specialist multidisciplinary service for clinically severe obesity, termed the Metabolic Rehabilitation Programme (MRP). Method Using a case-control study design in a public hospital setting, we extracted data from medical records for all eligible patients with a body mass index (BMI) of ≥35 kg/m2 with either type 2 diabetes or fatty liver disease referred to the MRP from 2010 through 2015. Non-completion status (case definition) was coded for patients whom started but dropped-out of the MRP within 12 months. Using multivariable logistic regression, we tested the following baseline predictors hypothesised in previous research: age, gender, BMI, waist circumference, residential distance from the clinic, blood pressure, obstructive sleep apnoea (OSA), current continuous positive airway pressure (CPAP) therapy, current depression/anxiety, diabetes status, and medications. We used receiver operating characteristics and area under the curve to test the performance of models. Results Out of the 219 eligible patient records, 78 (35.6%) non-completion cases were identified. Significant differences between non-completers versus completers were: age (47.1 versus 54.5 years, p < 0.001); residential distance from the clinic (21.8 versus 17.1 km, p = 0.018); obstructive sleep apnoea (OSA) (42.9% versus 56.7%, p = 0.050) and CPAP therapy (11.7% versus 28.4%, p = 0.005). The probability of non-completion could be independently associated with age, residential distance, and either OSA or CPAP. There was no statistically significant difference in performance between the alternate models (69.5% versus 66.4%, p = 0.57). Conclusions Non-completion of intensive specialist obesity management services is most common among younger patients, with fewer complex care needs, and those living further away from the clinic. Clinicians should be aware of these potential risk factors for dropping out early when managing outpatients with severe obesity, whereas policy makers might consider strategies for increasing access to specialist obesity management services.
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Affiliation(s)
- Evan Atlantis
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia. .,School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia.
| | - Fang Lin
- Campbelltown and Camden Hospitals, Campbelltown, New South Wales, Australia
| | - Sulak Anandabaskaran
- Campbelltown and Camden Hospitals, Campbelltown, New South Wales, Australia.,Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Paul Fahey
- School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
| | - Nic Kormas
- Campbelltown and Camden Hospitals, Campbelltown, New South Wales, Australia.,Concord Repatriation General Hospital, Concord, New South Wales, Australia
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Brightman L, Huang HCC, Dugdale P. Determining patient attendance, access to interventions and clinical outcomes in a publicly funded obesity programme: Results from the Canberra Obesity Management Service. Clin Obes 2019; 9:e12325. [PMID: 31207135 DOI: 10.1111/cob.12325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 04/02/2019] [Accepted: 04/30/2019] [Indexed: 11/29/2022]
Abstract
Multi-disciplinary specialist services have a crucial role in the management of patients with obesity. As demand for these services increases, so too does the need to monitor individual service performance and compare outcomes across multiple sites. This paper reports on results from the publicly funded Canberra Obesity Management Service. A descriptive observational study was conducted on new patients who attended an initial medical review from July 2016 to June 2017. Baseline characteristics, comorbidities, attendance, service utilization and outcomes were collated until June 2018. Of the 162 patients identified, 64% continued to attend beyond initial medical review. Dietetics was the most commonly accessed allied health service, followed by exercise physiology and psychology. Very low-energy diet was the most commonly trialled intensive intervention, followed by pharmacotherapy and bariatric surgery. Mean baseline weight for those who continued beyond initial medical review was 142.0 kg (SD 26.6 kg), with a mean weight change of -6.2 kg (SD 10.2 kg) and a mean change in percentage body weight of -5% (SD 7%). Clinically significant weight loss was achieved in 36% of these patients, with a further 47% achieving weight stabilization. Mean Depression, Anxiety and Stress Scale scores reduced from 8-6-8 to 7-5-5, and mean Epworth Sleepiness Scale scores decreased from 8/24 to 6/24. Polysomnography referrals were made for 37% of all new patients, 87% of whom were diagnosed with varying degrees of obstructive sleep apnoea. We present these findings in the hope that they may serve as an example for data collection, individual service monitoring and comparison across multiple obesity services.
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Affiliation(s)
- Louise Brightman
- Obesity Management Service, Canberra Health Services, Canberra, Australia
| | - Hsin-Chia Carol Huang
- Obesity Management Service, Canberra Health Services, Canberra, Australia
- Respiratory and Sleep Medicine, The Canberra Hospital, Canberra, Australia
- College of Health and Medicine, Australian National University, Canberra, Australia
| | - Paul Dugdale
- Obesity Management Service, Canberra Health Services, Canberra, Australia
- College of Health and Medicine, Australian National University, Canberra, Australia
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Ramachandran D, Atlantis E, Markovic T, Hocking S, Gill T. Standard baseline data collections in obesity management clinics: A Delphi study with recommendations from an expert panel. Clin Obes 2019; 9:e12301. [PMID: 30761766 DOI: 10.1111/cob.12301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/22/2018] [Accepted: 01/08/2019] [Indexed: 02/06/2023]
Abstract
We aimed to develop an expert consensus on standardizing data collections in specialist obesity management clinics in Australia. A panel of 16 experts participated in a structured consensus-driven Delphi process to reach agreement on a minimum set of baseline patient data collections for consideration in specialist obesity services. The panel included surgeons, clinicians, allied health professionals (dietician, exercise physiologist, psychologist), a bariatric nurse and obesity researchers. We produced a recommended list of core and useful data items that should comprise the baseline patient data set. Consensus was achieved for recommended measures of demographic, anthropometric, biochemical, weight-loss history, medication, medical history and comorbidity data items using a 70% agreement threshold. In this iterative process, there was also consideration of specific data items for patients referred for bariatric surgery. We present the first expert panel consensus on recommendations for a minimum and standard set of baseline patient data collections in obesity management services in Australia. These may be relevant to other countries with similar obesity management service models. Implementation of these recommendations should facilitate data pooling for clinical audits and research collaborations across clinics seeking to improve the quality of specialist obesity care.
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Affiliation(s)
- Divya Ramachandran
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney School of Public Health, University of Sydney, Sydney, Australia
- Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Evan Atlantis
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
- School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Tania Markovic
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney School of Public Health, University of Sydney, Sydney, Australia
- Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Metabolism and Obesity Services, Royal Prince Alfred Hospital, Sydney, Australia
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Samantha Hocking
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney School of Public Health, University of Sydney, Sydney, Australia
- Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Metabolism and Obesity Services, Royal Prince Alfred Hospital, Sydney, Australia
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Timothy Gill
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney School of Public Health, University of Sydney, Sydney, Australia
- Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Ramachandran D, Atlantis E, Hocking S, Markovic T, Gill T. Standardised baseline data collections in obesity management services in Australia: Recommendations from an expert panel. Obes Res Clin Pract 2019. [DOI: 10.1016/j.orcp.2018.11.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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