Can certified health professionals treat obesity in a community-based programme? A quasi-experimental study

Physical activity promotion in rural health care settings: A rapid realist review

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Rural communities have a unique health care and physical activity context.

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We conducted a rapid realist review in partnership with knowledge users.

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Check-ins from health care providers may lead to intervention success and are valued by participants.

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A method for tracking progress is an important component of interventions delivered in rural health care settings.

Physical activity promotion in health care settings is poorly understood and has limited uptake among health care providers. The environmental and health care context of rural communities is unique from urban areas and may interact to influence intervention delivery and success. The aim of this rapid realist review was to synthesize knowledge related to the promotion of physical activity in rural health and social care settings. We searched Medline EBSCO, CINAHL, PsychINFO, and SPORTDiscus for relevant publications. We included qualitative or quantitative studies reporting on an intervention to promote physical activity in rural health (e.g., primary or community care) or social (e.g., elder support services) care settings. Studies without a rural focus or well-defined physical activity/exercise component were excluded. Populations of interest included adults and children in the general population or clinical sub-population. Intervention mechanisms from included studies were mapped to the Behaviour Change Wheel (capability, opportunity, motivation (COM-B)). Twenty studies were included in our review. Most interventions focused on older adults or people with chronic disease risk factors. The most successful intervention strategies leading to increased physical activity behaviour included wearable activity trackers, and check-ins or reminders from trusted sources. Interventions with mechanisms categorized as physical opportunity, automatic motivation, and psychological capability were more likely to be successful than other factors of the COM-B model. Successful intervention activities included a method for tracking progress, providing counselling, and follow-up reminders to prompt behaviour change. Cultivation of necessary community partnerships and adaptations for implementation of interventions in rural communities were not clearly described and may support successful outcomes in future studies.

Evaluation of a multiprofessional, nonsurgical obesity treatment program: which parameters indicated life style changes and weight loss?

BACKGROUND

According to the current evidence, behavior modifications are an effective part of a non-surgical multiprofessional obesity treatment program (MOTP). The purpose of the present study was to report changes in weight as well in psychological variables during a one year MOTP. We aimed to identify the associations of emotional state and patients' emotion regulation skills with weight change.

METHODS

Prospective interventional study. Data of participants attending the one year obesity treatment in either a group or individual structured MOTP were analyzed. Weight, BMI (Body Mass Index) and measures on psychosomatic variables, emotion regulation skills, affective state, shame and guilt were collected at baseline, after three months and after one year. Mixed-effects models were used for the statistical analysis of BMI.

RESULTS

We included 238 patients at baseline (t1), 234 after three months (t2) and 179 after one year (t3). A drop in BMI measurements of at least 5% was observed in 20.6% of participants at t2 and 41.4% of participants at t3. After three months, participants showed significant improvements in the following psychosomatic variables: somatisation (p < 0.001), interpersonal sensitivity (p < 0.001), emotion regulation skills (p < 0.01), and attention to emotions (p < 0.05). Most of the improvements could be maintained after one year. BMI reduction was associated with a positive change in emotions, improvements in emotion regulation skills, and a reduction of depressive symptoms, disgust and shame.

CONCLUSIONS

The results indicate that the assessment and treatment of psychological aspects like depression, emotion regulation skills, body awareness, and acceptance should be a vital part of an interdisciplinary MOPT.

TRIAL REGISTRATION

Ethical approval for the present study was obtained from the Bern Kantonal Ethics Committee (KEK-Bern-Study Nr 258/14), Bern, Switzerland.

Assessing the Efficacy of a Group Mediated Nutritional Knowledge Intervention for Individuals with Obesity

Purpose: This study reports on the effect of a group-based nutrition and physical activity intervention program on nutrition knowledge and eating habits in a cohort of people with obesity.

Methods: A quasi-experimental design with pre- and post-test measures. The intervention consisted of physical activity led by certified exercise physiologists and a nutritional education component led by registered dietitians over a 6-month period followed by 6 months of self-management. Participants’ nutrition knowledge and eating habits were assessed using the modified Nutrition Assessment, the Nutrition Knowledge Survey, and the Food Choice Questionnaires at baseline, after the 6-month intervention, and after 6 months of self-management.

Results: Complete data were available for 59 (40%) of participants after 12 months because of attrition. Nutritional knowledge and behaviours improved. Participants reported increasing their consumption of healthy foods during the active intervention and maintained these changes through the self-management phase. Knowledge of healthy foods was improved and a greater likelihood of choosing food for weight control and health properties was reported.

Conclusions: Knowledge and reported consumption of healthier nutrition improved during the active intervention and was maintained during the self-management period for individuals who completed the program. Registered dietitians can play an important role in managing patients with obesity in group settings.

Improving Obesity Prevention and Management in Primary Care in Canada

Obesity is a major risk factor for chronic diseases with significant morbidity, mortality and health care cost. There is concern due to the dramatic increase in overweight and obesity in Canada in the last 20 years. The causes of obesity are multifactorial, with underestimation by patients and healthcare providers of the long-term nature of the condition, and its complexity. Solutions related to prevention and management will require multifaceted strategies involving education, health policy, public health and health systems across the care continuum. We believe that to support such strategies we need to have a strong primary care workforce equipped with appropriate knowledge, skills and attitudes to support persons at risk for, or with, obesity. To achieve this end, significant skills building is required to improve primary care obesity prevention and management efforts. This review will first examine the current state, and then will outline how we can improve.