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Beaumont JD, Ioannou E, Harish K, Elewendu N, Corrigan N, Nield L. "We're one small piece of the puzzle": evaluating the impact of short-term funding for tier two weight management services. Front Public Health 2024; 12:1381079. [PMID: 38841679 PMCID: PMC11150676 DOI: 10.3389/fpubh.2024.1381079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 05/09/2024] [Indexed: 06/07/2024] Open
Abstract
Introduction Overweight and obesity are a global health epidemic and many attempts have been made to address the rising prevalence. In March 2021 the UK government announced £100 million of additional funding for weight management provisions. Of this, £30.5 million was split across local authorities in England to support the expansion of tier two behavioural weight management services for adults. The present work aimed to explore how this funding was used within the Yorkshire and Humber region to consolidate learning, collate best practice, and provide recommendations for future funding use. Method One-hour semi-structured interviews were conducted with 11 weight management service commissioners representing 9 of the 15 local authorities in the region. Interviews were recorded, transcribed and analysed using an established health inequality framework. From this, recommendations were co-developed with the commissioner group to establish best practice for future funding use. Results Commissioners recognised that targeted weight management services were only one small piece of the puzzle for effectively managing obesity. Therefore, recommendations include targeting underserved communities, focussing on early prevention, addressing weight management in a whole systems context, and embracing innovative and holistic approaches to weight management. Discussion Current short-term funding and restrictive commissioning processes of tier two services prevents sustainable and innovative weight management practice which is detrimental to patients, falls short of addressing health inequalities and negatively impacts staff health and wellbeing.
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Affiliation(s)
- Jordan D. Beaumont
- College of Business, Technology and Engineering, Sheffield Hallam University, Sheffield, United Kingdom
| | - Elysa Ioannou
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Sheffield, United Kingdom
| | - Krishna Harish
- College of Business, Technology and Engineering, Sheffield Hallam University, Sheffield, United Kingdom
| | - Nnedinma Elewendu
- College of Social Sciences and Arts, Sheffield Hallam University, Sheffield, United Kingdom
| | - Nicola Corrigan
- Office for Health Improvement and Disparities, Department of Health and Social Care, Blenheim House, Leeds, United Kingdom
| | - Lucie Nield
- College of Business, Technology and Engineering, Sheffield Hallam University, Sheffield, United Kingdom
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Clarke F, Archibald D, MacDonald V, Huc S, Ellwood C. The well now course: a service evaluation of a health gain approach to weight management. BMC Health Serv Res 2021; 21:892. [PMID: 34461890 PMCID: PMC8404319 DOI: 10.1186/s12913-021-06836-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 07/30/2021] [Indexed: 11/10/2022] Open
Abstract
Background The Well Now health and weight course teaches body respect and health gain for all. The course validates peoples’ lived experiences and knowledge through group activities and discussion with the aim of helping people to better understand their food and body stories. Well Now explores different ways of knowing, including the use and limits of body signals, like energy levels, hunger, taste and emotions and helps people keep food and behaviours in perspective by drawing attention to other factors that impact on health and wellbeing. This study undertook a service evaluation of the Well Now course to understand its acceptability for participants and its impact on diet quality, food preoccupation, physical activity and mental wellbeing. Methods This service evaluation combined quantitative pre- and post-course measures with telephone interviews with previous attendees. Paired t-tests were used to determine if there were statistically significant differences in the intended outcomes. Semi-structured qualitative telephone interviews were undertaken with previous attendees 6–12 months after attendance to understand how participants experienced the Well Now course. Results Significant improvements were demonstrated in diet quality, food preoccupation, physical activity and mental wellbeing outcomes. Medium effect sizes are demonstrated for mental wellbeing and diet quality, with smaller effect sizes shown for physical activity and food preoccupation. The weight and Body Mass Index (BMI) of attendees remained stable in this timeframe. The qualitative data corroborates and extends elements of the quantitative outcomes and highlights areas of the course that may benefit from further development and improvement. The findings further indicate that the Well Now approach is largely acceptable for attendees. Conclusions Well Now’s non-judgemental holistic approach facilitates change for those who complete the course, and for those who do not. This health gain approach upholds non-maleficence and beneficence, and this is demonstrated with this service evaluation for both completers and partial completers. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06836-z.
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Affiliation(s)
- Fiona Clarke
- Community Dietetics, RNI, Ness Walk, Inverness, IV3 5SF, UK
| | - Daryll Archibald
- School of Health Sciences, University of Dundee, 11 Airlie Place, Dundee, DD14HJ, UK.
| | - Valerie MacDonald
- Health Improvement Team, Public Health, NHS Highland, Larch House Stoneyfield Business Park, Inverness, IV2 7PA, UK
| | - Sara Huc
- Health Improvement Team, Public Health, NHS Highland, Larch House Stoneyfield Business Park, Inverness, IV2 7PA, UK
| | - Christina Ellwood
- David Anderson Building, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZP, UK
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Hazlehurst JM, Logue J, Parretti HM, Abbott S, Brown A, Pournaras DJ, Tahrani AA. Developing Integrated Clinical Pathways for the Management of Clinically Severe Adult Obesity: a Critique of NHS England Policy. Curr Obes Rep 2020; 9:530-543. [PMID: 33180307 PMCID: PMC7695647 DOI: 10.1007/s13679-020-00416-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2020] [Indexed: 01/11/2023]
Abstract
PURPOSE OF THE REVIEW Pathways for obesity prevention and treatment are well documented, yet the prevalence of obesity is rising, and access to treatment (including bariatric surgery) is limited. This review seeks to assess the current integrated clinical pathway for obesity management in England and determine the major challenges. RECENT FINDINGS Evidence for tier 2 (community-based lifestyle intervention) and tier 3 (specialist weight management services) is limited, and how it facilitates care and improve outcomes in tier 4 remains uncertain. Treatment access, rigidity in pathways, uncertain treatment outcomes and weight stigma seems to be major barriers to improved care. More emphasis must be placed on access to effective treatments, treatment flexibility, addressing stigma and ensuring treatment efficacy including long-term health outcomes. Prevention and treatment should both receive significant focus though should be considered to be largely separate pathways. A simplified system for weight management is needed to allow flexibility and the delivery of personalized care including post-bariatric surgery care for those who need it.
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Affiliation(s)
- Jonathan M Hazlehurst
- Institute of Metabolism and Systems Research, The Medical School, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jennifer Logue
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | | | - Sally Abbott
- Institute of Metabolism and Systems Research, The Medical School, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Department of Bariatric Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Adrian Brown
- Centre for Obesity Research, University College London, London, UK
- National Institute of Health Research, UCLH Biomedical Research Centre, London, UK
| | - Dimitri J Pournaras
- Department of Upper GI Surgery, Southmead Hospital, Bristol, UK
- Bristol Weight Management and Bariatric Service, Southmead Hospital, Bristol, UK
| | - Abd A Tahrani
- Institute of Metabolism and Systems Research, The Medical School, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK.
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
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Barr ML, Tabone LE, Cox SJ, Brode C, Szoka N, Olfert IM, Davisson L, Olfert MD. Bariatric Surgery Outcomes in Appalachia Influenced by Surgery Type, Diabetes, and Depression. Obes Surg 2020; 29:1222-1228. [PMID: 30613934 PMCID: PMC6511994 DOI: 10.1007/s11695-018-03650-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Most effective treatment for morbid obesity and its comorbidities is bariatric surgery. However, research is limited on weight loss and associated outcomes among patients in Appalachia. The objective of this study was to examine demographic and comorbidity influence on surgical outcomes of this population including age, sex, race, state of residence, education, marital status, body mass index (BMI kg/m2), excess body weight (EBW), percent excess weight loss (%EWL), blood pressure, diagnosed depression, diagnosed type 2 diabetes (T2D), Beck Depression Inventory-II (BDI-II), and laboratory values (i.e., hemoglobin A1c). Methods A retrospective electronic medical record (EMR) data extraction was performed on N = 582 patients receiving bariatric surgery (laparoscopic Roux-en-Y gastric bypass [RYGB] and laparoscopic sleeve gastrectomy [SG]) between 10/2013 and 2/2017. Results Patient population was 92.5% Caucasian, 79.3% female, 62.8% married, 45 ± 11.1 years, 75.8% received RYGB, and 24.2% received SG. Average %EWL from baseline to 1-year follow-up was 68.5 ± 18.4% (n = 224). In final descriptive models, surgery type, diagnosed T2D, HbA1c, and depressive symptoms were significant covariates associated with lower %EWL. Conclusions Findings suggest patients completing surgery within an Appalachian region have successful surgical outcomes at 1-year post-surgery, as indicated by significant reductions of > 50% EWL, regardless of other covariates. Results suggest that bariatric programs should consider paying special consideration to patients with T2D or depressive symptoms to improve outcomes. Results have potential to inform future prospective studies and aid in guiding specific interventions tailored to address needs of this unique population.
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Affiliation(s)
- Makenzie L Barr
- Department of Human Nutrition and Food, Division of Animal and Nutritional Sciences, Davis College of Agriculture, Natural Resources, and Design, West Virginia University, G25 Agriculture Sciences Building, 333 Evansdale Dr, Morgantown, WV, 26506, USA
| | - Lawrence E Tabone
- Department of Surgery, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Stephanie J Cox
- Department of Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Cassie Brode
- Department of Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Nova Szoka
- Department of Surgery, West Virginia University School of Medicine, Morgantown, WV, USA
| | - I Mark Olfert
- Department of Exercise Physiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Laura Davisson
- Department of Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Melissa D Olfert
- Department of Human Nutrition and Food, Division of Animal and Nutritional Sciences, Davis College of Agriculture, Natural Resources, and Design, West Virginia University, G25 Agriculture Sciences Building, 333 Evansdale Dr, Morgantown, WV, 26506, USA.
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Alkharaiji M, Anyanwagu U, Donnelly R, Idris I. Tier 3 specialist weight management service and pre-bariatric multicomponent weight management programmes for adults with obesity living in the UK: A systematic review. Endocrinol Diabetes Metab 2019; 2:e00042. [PMID: 30815571 PMCID: PMC6354755 DOI: 10.1002/edm2.42] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/03/2018] [Accepted: 09/09/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND NHS England has recommended a multidisciplinary weight management services (MWMS-Tier 3 services) for patients requiring specialized management of obesity, including bariatric surgery, but clinical and measurable health-related outcomes from these services remains fragmented. We therefore undertook a systematic review to explore the evidence base of effect on body weight loss and comorbidities outcomes of Tier 3 or UK pre-bariatric MWMPs. METHODS AMED, CINAHL, EMBASE, HMIC, MEDLINE, PsycINFO, PubMed, HDAS search and Google Scholar were searched from January 2000 to September 2017 in a free-text fashion and crossed-references of included studies to identify potential illegibility. Inclusion criteria were as follows: (a) published Tier 3 original study abstracts/articles; (b) intervention studies with before and after data; (c) studies that included any sort of MWMPs conducted on British residents with obesity; and (d) studies included T2DM measurements in a MWMPs. RESULTS In total, 19 studies met the inclusion criteria. The total number of participants analysed was N = 11,735. Baseline accumulative average BMI was calculated at 42.54 kg/m2, weight 117.88 kg and waist circumference 126.9 cm. And at 6 months, 40.73 kg/m2, 112.17 kg and 120.3 cm, respectively. Secondary outcome variables were as improved with reduction in HbA1c, fasting blood sugars, insulin usage and blood pressure. Physical activity increased at 3 months then declined after 6 months with no significant changes in cholesterol levels. CONCLUSION Tier 3 and MWMPs have a short to mid-ranged positive effect on obese patients (BMI ≥30 kg/m2) living in the UK regarding accumulated reduction in weight, glycaemic control, blood pressure and with subtle improvements in physical activity.
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Affiliation(s)
- Mohammed Alkharaiji
- Department of Surgery, Graduate Entry Medical SchoolRoyal Derby Hospital, University of NottinghamDerbyUK
- Faculty of Public Health, College of HealthThe Saudi Electronic UniversityRiyadhSaudi Arabia
| | - Uchenna Anyanwagu
- Department of Surgery, Graduate Entry Medical SchoolRoyal Derby Hospital, University of NottinghamDerbyUK
| | - Richard Donnelly
- Department of Surgery, Graduate Entry Medical SchoolRoyal Derby Hospital, University of NottinghamDerbyUK
| | - Iskandar Idris
- Department of Surgery, Graduate Entry Medical SchoolRoyal Derby Hospital, University of NottinghamDerbyUK
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Jawed S, Atta K, Tariq S, Amir F. How good is the obesity associated with blood groups in a cohort of female university going students? Pak J Med Sci 2018; 34:452-456. [PMID: 29805425 PMCID: PMC5954396 DOI: 10.12669/pjms.342.13633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objective: To find out frequency of obesity in female University students in Faisalabad and to investigate its association with blood groups of ABO system. Methods: A cross sectional study was conducted with a sample size of 200 female University students, recruited from the Faisalabad based institutes from May 2017 to July 2017. Relevant information was taken by administering questionnaire. Height in meters and weight in kg were taken by stadiometer. BMI was calculated using formula BMI=weight in kg/height m2. Blood groups were determined by classic (antigen-antibody agglutination test). The data was analyzed through SPSS 20. Descriptive were presented as mean± SD and association of BMI with blood groups was assessed by regression analysis. P value ≤0.05 deemed statistically significant. Results: Out of students, 192 attempted the questionnaire and participated in study (96% response rate), 30% of the 192 females were obese, distribution of ABO blood group showed 43%, followed by O, A and AB. 90% were Rh positive and 10% were Rh negative. Blood group O showed a trend towards obesity and blood group AB showed a trend towards lean body. Conclusion: The blood group O showed the significant positive association with obesity. Population with blood group O showed greatest susceptibility to be overweight and obese.
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Affiliation(s)
- Shireen Jawed
- Dr. Shireen Jawed, MBBS, M.Phil. Associate Professor, Physiology Department, Aziz Fatima Medical College, Faisalabad, Pakistan
| | - Komal Atta
- Dr. Komal Atta, MBBS, M.Phil. Assistant Professor, Physiology/Sr.Coordinator School of Optometry, The University of Faisalabad, Faisalabad, Pakistan
| | - Saba Tariq
- Dr. Saba Tariq, MBBS, M.Phil. Assistant Professor, Pharmacology and Therapeutics University Medical and Dental College, Faisalabad, Pakistan
| | - Farah Amir
- Dr. Farah Amir, MBBS, M.Phil. Professor, Physiology Department Aziz Fatima Medical College, Faisalabad, Pakistan
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Steele T, Narayanan RP, James M, James J, Mazey N, Wilding JPH. Evaluation of Aintree LOSS, a community-based, multidisciplinary weight management service: outcomes and predictors of engagement. Clin Obes 2017; 7:368-376. [PMID: 28871633 DOI: 10.1111/cob.12216] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/26/2017] [Accepted: 07/19/2017] [Indexed: 11/30/2022]
Abstract
Aintree LOSS is a community-based, multidisciplinary weight management programme for patients with severe and complex obesity, focusing on a flexible and individualized service with follow-up for up to 2 years. We evaluated all 2472 patients referred to the service between October 2009 and 2013. Demographic data were recorded at baseline, with the Index of Multiple Deprivation (IMD) used to measure socioeconomic deprivation. Weight was recorded at each visit. Mean body mass index at baseline was 45.6 (standard deviation 6.8), and 58.9% of patients lived in areas in the most deprived decile nationally. Of 2315 appropriate referrals, 1249 (55.1%) attended >2 visits; mean final weight loss was 3.50 ± 8.55 kg, and 24.1% achieved ≥5% weight loss. Of the patients, 754 (33.3%) attended for over 6 months; mean final weight loss was 4.94 ± 10 kg, and 34% achieved 5% weight loss. Multivariate logistic regression analysis showed increasing age, residence in a less deprived area and sleep apnoea to be independently associated with attendance for >6 months, and there was a linear relationship between 6-month attendance and deprivation quintile. Year-on-year analyses showed improvement in engagement over time, coinciding with efforts to improve access to the service. This work shows a multidisciplinary, community-based weight loss programme prioritizing a fully flexible and individualized approach functioning effectively in real-world practice. Maintaining engagement remains a challenge in weight loss programmes, and our results suggest younger patients living in areas with greater deprivation should be a target for efforts to improve engagement.
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Affiliation(s)
- T Steele
- Obesity and Endocrinology Research, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - R P Narayanan
- Obesity and Endocrinology Research, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - M James
- Aintree Weight Management Services, Aintree University Hospital, Liverpool, UK
| | - J James
- Aintree Weight Management Services, Aintree University Hospital, Liverpool, UK
| | - N Mazey
- Brownlow Group Practice, Liverpool, UK
| | - J P H Wilding
- Obesity and Endocrinology Research, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
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