Collaboration and Negotiation: The Key to Therapeutic Lifestyle Change

A Review of Plant-Based Diets for Obesity Management

OBJECTIVE

Obesity is the most prevalent chronic disease in the United States with over 70% of the American population suffering from overweight/obesity. Recently, the popularity of plant-based diets (PBDs) has grown, with individuals adopting these diets for ethical, health and environmental reasons. Our aim is to evaluate the effect of a PBD on weight loss among patients who are overweight or obese.

METHODS

A literature review of PBDs for the treatment of obesity was conducted using PubMed and Scopus. Our search yielded 27 intervention trials (3361 participants) and 6 metanalyses (9168 participants, 61 trials).

RESULTS

Among the intervention trials evaluated, 75% showed a significant increase in weight loss or decrease in weight in the intervention group, on average -5.0 kg (range -1.8 to -12.1 kg). Other outcomes included energy intake (-420 Kcal/d), systolic blood pressure (-3.78 mmHg), fasting plasma glucose (-2.0 mmol/L), hemoglobin A1c (-0.5%, -3.4 mmol/L), total cholesterol (-0.40 mmol/L), low-density lipoprotein (-0.38 mmol/L), triglyceride levels (+0.13 mmol/L), and fiber intake (+10.8 g/d). The 6 meta-analyses showed weight loss (average -2.9 kg, range -2.02 kg to -4.1 kg), body mass index reduction, and improvements in hemoglobin A1c, low-density lipoprotein, and total cholesterol.

CONCLUSION

PBDs result in significant weight loss and improve metabolic outcomes. PBDs offer a sustainable approach to long-term weight loss maintenance. Health care providers should encourage open discussions with their patients regarding their dietary habits to assist them in setting feasible lifestyle goals and consider shared medical appointments to support patients in transitioning to PBDs.

Empathy and Language in the Clinician Patient Relationship: Improving the Translation of Evidence to Practice

For clinicians, effective communication goes beyond the delivery of scientific information to include an understanding of who the patient is and what they value; treating them with respect; and acknowledging their emotional and social realities. Recognizing our own implicit biases and cultivating a more mindful approach to the impact of language, especially around weight and food, and using verbal and nonverbal approaches to convey empathic concern can improve our relationships with our patients. Patients who feel seen and respected are more likely to follow through with recommendations including dietary change, leading to improved health and quality of life.

Do Health Professionals Sufficiently Address Patients' Disposition Toward Changing Their Nutritional and Physical Activity Habits? Findings from a Pilot Study among People with Type 2 Diabetes in Northern Italy

The aim of our study was to evaluate the disposition of individuals with type 2 diabetes mellitus (DM2) toward changing their nutritional and physical activity habits and associated factors—particularly their perceptions about interacting and communicating with four health professions. Working with a local patients’ association, we invited 364 individuals with DM2, all at least 18 years old, to complete a paper-based survey with questions addressing their experiences of interacting and communicating with general practitioners, nurses, dieticians and diabetologists and about their readiness to change targeted habits, their health literacy and their clinical status. Of the 109 questionnaires collected, 100 were eligible for descriptive and inferential statistical analysis. Regarding nutritional habits, the highest percentage of participants were at the maintenance stage (26%), whereas regarding physical activity habits the highest percentage of participants were at the preparation stage (31%). Significant differences between the habits emerged for four of the five stages and for two psychological processes. The precontemplation stage was most associated with communication-related variables, whereas the maintenance stage was associated with higher health literacy for both habits, and waist-to-height ratio was associated with several stages of change and psychological processes for physical activity habits. Considering aggregated stages (i.e., active or passive stage), significant differences were observed for all psychological processes except readiness to change nutritional habits. Logistic regression analysis revealed associations of the active stage with higher self-efficacy and lower discrepancy processes for both habits. Nutritional habits were associated with normal HbA1c values and physical activity habits with high cholesterol. Understanding the combination of the stages of change and how they relate to psychological processes can afford meaningful insights into the potential internal and external communication skills of health professions and should be examined as possible elements for a patient evaluation model.

Identifying patterns and predictors of lifestyle modification in electronic health record documentation using statistical and machine learning methods

Just under half of the 85.7 million US adults with hypertension have uncontrolled blood pressure using a hypertension threshold of systolic pressure ≥ 140 or diastolic pressure ≥ 90. Uncontrolled hypertension increases risks of death, stroke, heart failure, and myocardial infarction. Guidelines on hypertension management include lifestyle modification such as diet and exercise. In order to improve hypertension control, it is important to identify predictors of lifestyle modification assessment or advice to tailor future interventions using these effective, low-risk interventions. Electronic health record data from 14,360 adult hypertension patients at an academic medical center were analyzed using statistical and machine learning methods to identify predictors and timing of lifestyle modification. Multiple variables were statistically significant in analysis of lifestyle modification documentation at multiple time points. Random Forest was the best machine learning method to classify lifestyle modification documentation at any time with Area Under the Receiver Operator Curve (AUROC) 0.831. Logistic regression was the best machine learning method for classifying lifestyle modification documentation at ≤3 months with an AUROC of 0.685. Analyzing narrative and coded data from electronic health records can improve understanding of timing of lifestyle modification and patient, clinic and provider characteristics that are correlated with or predictive of documentation of lifestyle modification for hypertension. This information can inform improvement efforts in hypertension care processes, treatment implementation, and ultimately hypertension control.

Effects of a Workplace-Based Virtual-Run Intervention Among University Employees

Virtual runs (real running or walking activities using online recording platforms) have been popular in the digital age and could have the potential to promote physical activity (PA) in workplaces. We investigated the effects of a virtual-run intervention (VRI) on PA and body compositions among university employees. A three-phase intervention was conducted over 6 months: 0 (pre-intervention), 1 (during intervention), and 2 (post-intervention). Exercise stages of change were assessed in phases 0 and 2. Body compositions (body weight, body mass index, fat mass, percentage of fat mass, fat-free mass, and percentage of fat-free mass) were assessed in phases 0, 1, and 2. Running and walking times were recorded through a mobile application. Forty-seven participants completed the VRI. The number of participants at the maintenance stage increased from 34.04% in phase 0 (n = 16) to 63.83% in phase 2 (n = 30). None of the changes in body compositions were significant (p > 0.05). The median running and walking time among participants at the maintenance stage was 151.85 (interquartile range, 109.15) min/week. Future research should focus on approaches to improve the efficacy of VRIs and their effects on health outcomes.

Barriers and facilitators of effective health education targeting people with mental illness: a theory-based ethnographic study

BACKGROUND

Health education is particularly important for people with mental illness because they are at higher risk of becoming overweight or obese and developing type 2 diabetes than are members of the general population. However, little is known about how to provide health education activities that promote engagement and motivation among people with mental illness.

METHODS

This study used ethnographic methods to examine barriers and facilitators of effective health education targeting people with mental illness by applying the concept of flow as a theoretical framework. Flow refers to immersion in an activity and is related to motivation. Data were collected through participant observation during eight health-educating activities and were thematically analysed using the concept of flow. Fieldwork was carried out between May and July 2015 in Denmark.

RESULTS

Barriers to flow included: 1) information overload, particularly of biomedical rationales for behaviour change; 2) a one-size-fits-all approach that failed to address the needs and preferences of the target group; and 3) one-way communication allowing little time for reflection. Educators promoted a state of flow when they spoke less and acted outside of a traditional expert role, thus engaging participants in the activity. Flow was facilitated when educators were attentive and responsive to people with mental illness, and when they stimulated reflection about health and health behaviour through open-ended questions, communication tools and in small group exercises.

CONCLUSIONS

This study suggests that more focus should be paid to training of educators in terms of skills to involve and engage people with mental illness in health education activities.

The Art and Science of Group Visits in Lifestyle Medicine

Lifestyle medicine group sessions present a promising approach to clinical care. Based on decades of work in shared medical appointments and group visits for diabetes and other chronic conditions, a lifestyle medicine group session has the potential to provide a fresh and rewarding way of interacting with patients that fuels the practitioner and feeds patients' needs to spend time with the lifestyle medicine practitioner, connect with him or her, connect with others, learn the latest recommendations regarding healthy habits, practice these behaviors, and discuss their obstacles, motivations, and strategies for healthy living. The lifestyle medicine group session discussed in this article is a combination of group coaching, education, and group support.

Optimizing Lifestyle Medicine Health Care Delivery Through Enhanced Interdisciplinary Education

While few may argue about the importance of healthy lifestyle choices on the effects of chronic health conditions, many would highlight the challenge that its practical integration poses in daily clinical practice. The field of lifestyle medicine aims to assist individuals and communities to adopt and sustain healthy behaviors. It is a powerful yet often underutilized tool. This article illustrates the importance of joint multidisciplinary efforts in the effective practice of lifestyle medicine. Furthermore it stresses the importance of equipping healthcare providers with the tools and education necessary to deliver consistent, and high quality holistic care.