Obesity prevention and the role of hospital and community-based health services: a scoping review

Nurses' obesity knowledge, attitudes and practices in private facilities in Oshana, Namibia

Background

The prevalence of obesity has been rising globally, and this is leading to an increase in other non-communicable diseases. The level of obesity knowledge among nurses may have an impact on how they treat and perceive obese patients.

Aim

The study aimed to ascertain the knowledge, attitudes and practices of nurses regarding obesity at private healthcare facilities located in Namibia's Oshana Region.

Setting

A total of four private healthcare facilities in Namibia's Oshana area served as the study's sites.

Methods

A quantitative cross-sectional research design using proportional stratified random sampling was used to choose 250 respondents for the study. A questionnaire that respondents self-administered was used to gather the data. The reliability and validity of the questionnaire were determined during a pilot study. IBM Statistical Package for the Social Sciences (SPSS) version 27 was used for data analysis.

Results

Of the participants, about two-fifths had a positive attitude (n = 112; 44.8%), slightly less than two-fifths had good practices (n = 96; 38.4%) and more than one-third had good knowledge (n = 97; 39%). There were differences in knowledge mean scores based on age, occupation, sex and educational level.

Conclusion

The results validate the necessity for healthcare facilities to implement nurse education and mentorship initiatives, as well as to recognise and reward nurses who effectively care for patients with obesity.

Contribution

This study added literature on knowledge, attitudes and practices of nurses in private healthcare facilities in Namibia, as well as factors that influence knowledge levels among the nurses.

Equity in Obesity Review

Obesity disproportionately affects racial and ethnic minoritized populations and those of lower socioeconomic status. Similarly, disparities exist in the development of its downstream consequences, such as type 2 diabetes and hypertension. The causes of these disparities are multifactorial and are influenced by structural factors such as segregation and healthcare access, and individual-level factors such as weight stigma. Interventions to decrease disparities in obesity should consider macro-level, community, and individual-level factors that might reduce disparities and improve equity in obesity care. Clinicians must also recognize the chronic nature of obesity, and how bias and stigma may impact patient care.

Diet-Related Disease Prevention in a Rural Australian Setting: Understanding Barriers, Enablers, and the Role of Rural Health Services in Supporting Changes in Local Rural Food Environments

Bold and comprehensive action is needed to prevent diet-related diseases in rural areas, which includes improving food environments to enable healthier dietary practices. Rural health services are integral to the health of rural populations, yet their role in community disease prevention is not swell understood. This study sought to understand health service, local government, and food outlet stakeholders' perspectives on (1) the drivers of unhealthy retail environments in a rural setting; (2) the role of rural health services in supporting changes in local food environments; and to (3) identify characteristics of potential interventions. Two Group Model Building workshops were held with health service and local government leaders (n = 9), and interviews were conducted with local food outlet participants (n = 13). Key themes included 'enablers to healthier food environments', 'barriers to healthier food environments', 'Rural health services are a leading broker of knowledge for healthy food environments', and 'characteristics of desirable healthy food environment interventions.'. Rural health services can play a key role in addressing the current barriers to healthy food environments in rural areas. Effective promotion of healthier diets in rural populations will require consideration of key stakeholder perspectives and the development of further evidence on the role that rural health services can play in improving the healthiness of food environments.

Healthcare Professionals' Perspectives of Nonsurgical Care of Older Inpatients with Class II or III Obesity and Comorbidities: A Qualitative Study

Background

Older people with Class II or III obesity and comorbidities experience complex care needs with frequent hospital admissions. In 2019/20 the National Health Service in England reported a 17% increase in hospital admissions of patients with obesity compared to 2018/19. Gaps in care for this population have been identified.

Purpose

The purpose of this study was to understand the experiences and perspectives of healthcare professionals delivering non-surgical care to older people with Classes II or III obesity admitted to a tertiary care hospital.

Methods

Healthcare professionals delivering non-surgical care to older people admitted with Class II or III obesity with comorbidities were recruited from an Australian tertiary referral hospital. Qualitative semi-structured interviews were conducted with 24 healthcare professionals from seven disciplines between August and December 2019. The interviews were audio-recorded, transcribed, and reviewed by participants for accuracy. Thematic inductive data analysis was deductively mapped to the Theoretical Domains Framework (TDF).

Results

Four major themes of Barriers, Facilitators, Current Practice, and Recommendations and 11 subthemes were identified and mapped to nine domains in the TDF. The Barriers subtheme identified perceived patient related factors, health system issues, and provider issues, while the Facilitators subtheme included a patient centred approach, knowledge, and resources in the subacute setting. The major Current Practice theme explored factors influencing clinical management, and the Recommendations subthemes included engaging patients, access to quality care, education and support, and obesity as a chronic disease.

Conclusion

This novel application of the TDF provided broad insights related to the barriers and facilitators in delivering non-surgical care to this hospital population, from the perspective of healthcare professionals. Understanding how these barriers interact can provide strategies to influence behaviour change and assist in the development of a holistic multidisciplinary model of care.

'Making every contact count' with patients with musculoskeletal conditions: a qualitative exploration of acceptability to physiotherapists

AIM

To qualitatively explore physiotherapists' experiences and acceptability of implementing 'Making Every Contact Count Healthy Conversation Skills' (MECC HCS) in routine practice with patients with musculoskeletal (MSK) conditions.

METHODS

This article reports the second phase of a mixed method, sequential explanatory study. Physiotherapists trained in and delivering MECC HCS in their practice were invited to take part in semi-structured interviews. We hoped to develop a rich, in-depth understanding of their use and perceptions of the brief intervention and to contextualise findings from the first phase of the study. Qualitative data were analysed using Reflexive Thematic Analysis.

RESULTS

Physiotherapists valued MECC HCS as being integral to their practice, promoting a person-centred approach to supporting behaviour change and enhancing self-management in patients with MSK conditions and pain. It was believed that this brief intervention could reduce workload pressure for physiotherapists and have significant wider benefits for health services. Time limitations associated with appointments did, however, pose as a challenge to MECC HCS delivery, and it was felt that more organisational-level support was needed to sustain it.

CONCLUSIONS

These findings support our quantitative data, collected in the first phase of this study. MECC HCS is a highly acceptable brief intervention that can be delivered in physiotherapy care to support behaviour change in patients with MSK conditions. Future roll-out may be optimised within organisations by providing regular refresher training and adopting a MECC champion.

Impact of specialized obesity management services on the reduction in the use of acute hospital services

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.

Going Beyond Management and Maintenance: Occupational Therapy's Role in Primary Prevention for Adults at Risk of Obesity

There is a critical need to address the escalating obesity epidemic by examining new methods of care. Adult obesity has historically been addressed through management and maintenance once an individual is clinically diagnosed as obese. Research and practice demonstrate that significant weight loss can be difficult to achieve and even harder to maintain. Despite this, preventive interventions targeted toward adult obesity have been limited in many health care professions, including occupational therapy. As professionals who are skilled in supporting clients' holistic development of healthy habits and routines, occupational therapists are equipped to play a key role in moving health care practices away from a reactive model of care to a proactive one that emphasizes primary prevention. This column identifies how this issue is aligned with occupational therapy's domain and presents potential examples of interventions to support adult obesity prevention.

Obese patients' dissatisfaction with weight, body image and clinicians' interaction at a district hospital; Gauteng

BACKGROUND

Obesity in South Africa has created a public health crisis that warrants a multilevel intervention. However, patients' perceptions and clinicians' challenges hinder the management of obesity in primary care.

AIM

The study aimed to assess obese patients' dissatisfaction with weight and body image and their perspectives on interaction with clinicians regarding obesity management in a primary care setting.

SETTING

Outpatient department of Dr Yusuf Dadoo District Hospital.

METHODS

Cross-sectional study of 213 adult obese patients. A semi-structured questionnaire, a body image assessment tool and patients' medical records were used for data collection.

RESULTS

The study found that, contrary to popular belief, obese patients were dissatisfied with their weight (78.9%) and body image (95.3%). Many felt comfortable while discussing weight reduction with clinicians, although 37.1% reported never engaging with a doctor and 62.9% never interacted with a nurse on the subject. Only 6% reported receiving adequate information on weight reduction measures and 19.7% were followed-up. Clinicians' advice was mainly associated with patients' high body mass index and waist circumference. Doctors were less likely to recommend weight reduction to employed obese women, while nurses were more likely to engage Zulu-speaking patients. Patients were more likely to be followed up if they were young and excessively obese.

CONCLUSION

The study found that most obese patients were dissatisfied with their weight and body image and perceived their interaction with clinicians regarding obesity management as inadequate.Contribution: The study provides an angle of view of challenges in obesity management from patients' perspectives.

Influencing Factors and Symbiotic Mechanism of the Integration of Medical Care and Disease Prevention during the COVID-19 Pandemic: A Cross-Sectional Survey of Public Hospital Employees

Background: The COVID-19 outbreak has accelerated the huge difference between medical care and disease prevention in Chinese medical institutions. This study aimed to investigate the relationship between the symbiotic units, environments, models, and effects of the integration of medical care and disease prevention. Methods: This cross-sectional study involved 762 employees of public hospitals in 11 cities in Zhejiang Province by random stratified sampling. We analyzed the influence paths of elements in the mechanism of integration of medical care and disease prevention and the mediating effect of symbiotic models among symbiotic units, symbiotic environments, and effects on this integration. Results: The path coefficient of the symbiotic unit on the symbiosis model was 0.46 (p < 0.001), the path coefficient of the symbiotic environment on the symbiosis model was 0.52 (p < 0.001). The path coefficient of the symbiotic unit and the environment was 0.91 (p < 0.001). The symbiotic models exhibited a partial mediation effect between symbiotic units and the effect of this integration. Sobel test = 3.27, β = 0.152, and the mediating effect accounted for 34.6%. Conclusions: It is suggested that health policymakers and public hospital managers should provide sufficient symbiotic units, establish collaborative symbiotic models, and improve the effects of integration of medical care and disease prevention in public hospitals.

[Management of obesity in schoolchildren and adolescents]

Pediatric obesity is a pathological process explained by genetic susceptibility, inappropriate diet, sedentary life patterns, and other environmental factors. It is related with psychological disturbances and chronic diseases in childhood or later in adulthood. Obesity prevention must start early in life and requires lifestyle multicomponent intervention (diet, physical activity and behavior), include children, family, and community, and offered in the primary health care service by the healthcare staff (physicians, nurses, dietists, and psychologists). Obesity treatment may include in addition other treatment alternatives. It must be provided by physicians, to simultaneously treat obesity and the associated morbidity. Pediatric obesity is a global problem, and its management has not been effective. Therefore, scientific research must be involved to identify new management options.

Clinical practice guidelines for the prevention of childhood obesity: A systematic review of quality and content

Obesity in childhood is a significant global issue, and prevention is key to reducing prevalence. Healthcare providers can play an important role in the prevention of obesity. The aim of this systematic review was to identify and evaluate clinical practice guidelines (CPGs) for preventing childhood obesity with a focus on the role of medical doctors. Peer-reviewed literature and gray literature sources were searched for CPGs published from 2010 to 2021. Eleven CPGs were identified. Quality was evaluated using the Appraisal of Guidelines for Research and Evaluation Collaboration (AGREE II) instrument; seven CPGs were higher quality and four lower quality. Recommendations within the CPGs covered three main areas: growth monitoring, maintaining a healthy weight, and managing overweight. The importance of involving the whole family and healthy lifestyle behaviors was emphasized. The majority of the CPGs rated poorly in guideline applicability highlighting the need for practical implementation tools. Although our review identified a number of CPGs relevant to the prevention of obesity for doctors working with children and their families, more research is needed to produce high-quality meaningful and applicable CPGs to maximize uptake, implementation, and ultimately, benefit to children and their families.

The detection rate and influencing factors of high-risk groups of cardiovascular disease in Anhui, China: A cross-sectional study of 99,821 residents

Objective

To investigate the detection rate and influencing factors of high-risk population of cardiovascular disease in Anhui province.

Methods

From March 2017 to August 2019, the residents aged 35-75 years old were selected using the multi-stage stratified cluster sampling method in 8 counties and districts of Anhui Province, and questionnaire survey, anthropometric measurement, and collection of biological samples were carried out among them.

Results

A total of 99,821 residents in Anhui Province were finally investigated, and among them 21,426 residents were detected to be high-risk groups of cardiovascular disease. The detection rate of high-risk groups was 21.46%. According to the high-risk types, the high-risk groups can be clustered. 74.57% of them had only one high-risk type, 22.57% of them had two high-risk types, and 2.86% had three or more high-risk types. The results of Generalized Linear Mixed Model (GLMM) showed that male, age ≥45 years old, not married, occupation as a farmer, annual family income <25,000 yuan, drinking, overweight and obesity, pre-central obesity and central obesity, snoring, feeling fatigued, sleepiness, and self-reported history of diabetes were more likely to be risk factors of cardiovascular disease (all P value < 0.05).

Conclusion

The detection rate of high-risk groups of cardiovascular disease in Anhui Province is relatively high. Individualized intervention measures as well as comprehensive prevention and control strategies should be adopted focusing on the distribution characteristics of risk factors of high-risk groups.

Developing weight navigation program to support personalized and effective obesity management in primary care settings: protocol for a quality improvement program with an embedded single-arm pilot study

BACKGROUND

Primary care providers (PCPs) are expected to help patients with obesity to lose weight through behavior change counseling and patient-centered use of available weight management resources. Yet, many PCPs face knowledge gaps and clinical time constraints that hinder their ability to successfully support patients' weight loss. Fortunately, a small and growing number of physicians are now certified in obesity medicine through the American Board of Obesity Medicine (ABOM) and can provide personalized and effective obesity treatment to individual patients. Little is known, however, about how to extend the expertise of ABOM-certified physicians to support PCPs and their many patients with obesity.

AIM

To develop and pilot test an innovative care model - the Weight Navigation Program (WNP) - to integrate ABOM-certified physicians into primary care settings and to enhance the delivery of personalized, effective obesity care.

METHODS

Quality improvement program with an embedded, 12-month, single-arm pilot study. Patients with obesity and ≥1 weight-related co-morbidity may be referred to the WNP by PCPs. All patients seen within the WNP during the first 12 months of clinical operations will be compared to a matched cohort of patients from another primary care site. We will recruit a subset of WNP patients (n = 30) to participate in a remote weight monitoring pilot program, which will include surveys at 0, 6, and 12 months, qualitative interviews at 0 and 6 months, and use of an electronic health record (EHR)-based text messaging program for remote weight monitoring.

DISCUSSION

Obesity is a complex chronic condition that requires evidence-based, personalized, and longitudinal care. To deliver such care in general practice, the WNP leverages the expertise of ABOM-certified physicians, health system and community weight management resources, and EHR-based population health management tools. The WNP is an innovative model with the potential to be implemented, scaled, and sustained in diverse primary care settings.

Healthcare professionals' perceptions of childhood obesity in Iquitos, Peru: a qualitative study

Background

Childhood obesity is an urgent worldwide concern associated with increased morbidity in adulthood. Healthcare professionals (HCPs) are well placed to influence childhood obesity trends and implement interventions. English-language studies regarding HCPs’ perceptions of childhood obesity are limited to high-income countries. Peru is an upper-middle-income country with regional disparities in childhood obesity prevalence. This qualitative study aims to explore HCPs’ perceptions of childhood obesity in Iquitos, Peru, where prevalence is relatively low.

Methods

Twenty-one HCPs with child healthcare experience were purposively recruited from two primary healthcare centres. Semi-structured, individual interviews were conducted with a translator and audio recorded. Transcribed data were analysed using thematic analysis.

Results

Eight themes were identified and divided into four categories: (1) HCPs’ perceptions and attitudes towards childhood obesity (level of concern regarding childhood obesity, perceived consequences of childhood obesity); (2) Factors which HCPs perceive to be important in the development of childhood obesity (parental factors, contextual factors); (3) HCPs’ perceptions of their role in childhood obesity prevention and management (educating parents about childhood obesity, regular monitoring of child growth); and (4) Barriers and facilitators in childhood obesity prevention and management (in healthcare, in schools).

Conclusions

HCPs had a low level of concern regarding childhood obesity in Iquitos and prioritised undernutrition. Parental factors were perceived to be the most influential in the development of childhood obesity. HCPs perceived themselves to have minimal influence due to prevailing positive views of excess weight and difficulties engaging parents. Educating parents about childhood obesity was felt to be essential to prevention and management although regular monitoring of child growth and home healthcare visits were viewed as useful additional measures. This study can help to inform the development of targeted public health strategies which are sensitive to local contexts and could prevent the upward childhood obesity trends evident elsewhere in Peru.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07519-z.

Medical Data Acquisition and Internet of Things Technology-Based Cerebral Stroke Disease Prevention and Rehabilitation Nursing Mobile Medical Management System

This research was aimed at exploring the application value of a mobile medical management system based on Internet of Things technology and medical data collection in stroke disease prevention and rehabilitation nursing. In this study, on the basis of radio frequency identification (RFID) technology, the signals collected by the sensor were filtered by the optimized median filtering algorithm, and a rehabilitation nursing evaluation model was established based on the backpropagation (BP) neural network. The performance of the medical management system was verified in 32 rehabilitation patients with hemiplegia after stroke and 6 healthy medical staff in the rehabilitation medical center of the hospital. The results showed that the mean square error (MSE) and peak signal-to-noise ratio (PSNR) of the median filtering algorithm after optimization were significantly higher than those before optimization (P < 0.05). When the number of neurons was 23, the prediction accuracy of the test set reached a maximum of 89.83%. Using traingda as the training function, the model had the lowest training time and root mean squared error (RMSE) value of 2.5 s and 0.29, respectively, which were significantly lower than the traingd and traingdm functions (P < 0.01). The error percentage and RMSE of the model reached a minimum of 7.56% and 0.25, respectively, when the transfer functions of both the hidden and input layers were tansig. The prediction accuracy in stages III~VI was 90.63%. It indicated that the mobile medical management system established based on Internet of Things technology and medical data collection has certain application value for the prevention and rehabilitation nursing of stroke patients, which provides a new idea for the diagnosis, treatment, and rehabilitation of stroke patients.

Obesity and Diet Predict Attitudes towards Health Promotion in Pre-Registered Nurses and Midwives

Nurses and midwives are integral to public health promotion; in the UK, they are advised to act as role models by their governing body, but overweight or obesity rates are high. We explored whether obesity and dietary habits are related to attitudes towards healthy role modelling and health promotion practice. A total of 346 pre-registered UK nurses and midwives (92.6% female; 18–53 years) completed an online survey. Items included body composition, dietary habits assessed by the Lifestyle Behaviour Questionnaire (LBQ), attitudes towards being role models for health (RA: role attitudes) and attitudes toward health promotion practice (ATHPP): 33.8% of the sample self-reported as overweight or obese; 67.6% did not consume 5-a-day portions of fruit/veg; 31.5% reported a healthy diet; and 89.6% believed their diet could be healthier. Positive RA was significantly linked to health promotion engagement (HP) (ß = 0.33, p < 0.001). Positive ATHPP was significantly predicted by lower BMI (ß = −0.08, p = 0.078), positive RA (ß = 0.67, p < 0.001), lower HP (ß = −0.25, p < 0.001) and male gender (ß = 0.09, p = 0.02). Greater confidence in patients valuing healthcare professional’s advice was predicted by healthier diet (ß = 0.11, p = 0.03), lower BMI (ß = −0. 16, p < 0.01), more positive RA (ß = 0.14, p < 0.01) as well as HP engagement during training (ß = 0.20, p < 0.01). One’s own motivation to promote health, similarly to ATHPP, was predicted by RA (ß = 0.17, p = 0.001) and previous HP engagement (ß = 0.39, p < 0.001). Findings show that overweight and obesity are prevalent in pre-registered nurses and midwives; the majority did not consume a healthy diet. Individual’s body composition, diet and attitudes towards role modelling are positively associated with their attitudes towards, and confidence in, health promotion practice. Experiences of health promotion practice during training can have either a positive or a negative influence on attitudes. Mentors and educators could actively promote healthy lifestyles for pre-registered nurses and midwives and facilitate more opportunities for health promotion practice during placements, which includes time for reflection.

Primary Health Care Intervention Reduces Added Sugars Consumption During Childhood

OBJECTIVE

To investigate the effectiveness of a training program for health workers regarding infant feeding practices to reduce sugar consumption in children.

DESIGN

A cluster randomized trial was conducted at 20 health centers in southern Brazil randomly assigned to an intervention (n = 9) or control (n = 11) group.

PARTICIPANTS

The 715 pregnant women enrolled were assessed when their children were aged 6 months, 3 years, and 6 years.

INTERVENTION

A training session for primary care workers based on the Brazilian National Guidelines for Children.

MAIN OUTCOME MEASURE

Mothers were asked when sugar was first offered to children. Added sugars intake was obtained from dietary recalls.

ANALYSIS

The effectiveness of the intervention was modeled using generalized estimation equations and Poisson regression with robust variance.

RESULTS

Children attending intervention health centers had a 27% reduced risk of sugar introduction before 4 months of age (relative risk, 0.73; 95% confidence interval [CI], 0.61-0.87) as well as lower added sugars consumption (difference, -6.36 g/d; 95% CI, -11.49 to -1.23) and total daily energy intake (difference, -116.90 kcal/d; 95% CI, -222.41 to -11.40) at 3 years of age.

CONCLUSIONS AND IMPLICATIONS

Health care worker training in infant feeding guidelines may be an effective intervention to delay the introduction of added sugars and lower the subsequent intake of added sugars in infants and toddlers.

Exploring healthcare professionals' views of the acceptability of delivering interventions to promote healthy infant feeding practices within primary care: a qualitative interview study

OBJECTIVE

Early-life nutrition plays a key role in establishing healthy lifestyles and preventing chronic disease. This study aimed to (1) explore healthcare professionals' (HCP) opinions on the acceptability of and factors influencing the delivery of interventions to promote healthy infant feeding behaviours within primary care and (2) identify proposed barriers/enablers to delivering such interventions during vaccination visits, to inform the development of a childhood obesity prevention intervention.

DESIGN

A qualitative study design was employed using semi-structured telephone interviews. Data were analysed using qualitative content analysis; findings were also mapped to the Theoretical Framework of Acceptability (TFA).

SETTING

Primary care in Ireland.

PARTICIPANTS

Twenty-one primary care-based HCP: five practice nurses, seven general practitioners, three public health nurses, three community dietitians and three community medical officers.

RESULTS

The acceptability of delivering interventions to promote healthy infant feeding within primary care is influenced by the availability of resources, HCP's roles and priorities, and factors relating to communication and relationships between HCP and parents. Proposed barriers and enablers to delivering interventions within vaccination visits include time constraints v. opportunistic access, existing relationships and trust between parents and practice nurses, and potential communication issues. Barriers/enablers mapped to TFA constructs of Affective Attitude, Perceived Effectiveness and Self-Efficacy.

CONCLUSIONS

This study provides a valuable insight into HCP perspectives of delivering prevention-focused infant feeding interventions within primary care settings. While promising, factors such as coordination and clarity of HCP roles and resource allocation need to be addressed to ensure acceptability of interventions to HCP involved in delivery.

Prevention of Gestational Diabetes: The Role of Dietary Intake, Physical Activity, and Weight before, during, and between Pregnancies

Gestational diabetes mellitus (GDM) is the most common complication of pregnancy and a significant clinical and public health problem with lifelong and intergenerational adverse health consequences for mothers and their offspring. The preconception, early pregnancy, and interconception periods represent opportune windows to engage women in preventive and health promotion interventions. This review provides an overview of findings from observational and intervention studies on the role of diet, physical activity, and weight (change) during these periods in the primary prevention of GDM. Current evidence suggests that supporting women to increase physical activity and achieve appropriate weight gain during early pregnancy and enabling women to optimize their weight and health behaviors prior to and between pregnancies have the potential to reduce rates of GDM. Translation of current evidence into practice requires further development and evaluation of co-designed interventions across community, health service, and policy levels to determine how women can be reached and supported to optimize their health behaviors before, during, and between pregnancies to reduce GDM risk.

The obesity paradigm and the role of health services in obesity prevention: a grounded theory approach

Background

Health services have a clear role in the treatment of obesity and diseases linked to obesity but a less well-established role in prevention, particularly in hospital and community-based health services.

Methods

The aim of this research was to examine whether and how hospital and community-based health services incorporate adult obesity prevention into policy and practice. The case study setting was an Australian based health service. Grounded theory informed all aspects of the research including participant recruitment, data collection and data analysis. A systems approach guided the analysis of diverse perspectives, relationships and interconnections within the study context.

Results

The prevailing paradigm within the health service is that obesity is a matter of choice. This dominant perspective combined with a disease focused medical model overly simplifies the complex issue of obesity and reinforces the paradigm which treats obesity as a matter of individual responsibility. A focus on individual change hinders health services from playing an effective role in obesity prevention and leads to unintended consequences, including increasing stigma.

Conclusions

Health service responses to obesity and its prevention compound the negative elements associated with obesity for individuals and are ineffective in creating positive change at individual or a societal level. An alternative systems-level approach is needed to align health service responses with contemporary approaches that address obesity prevention as a complex problem.

Predictors of Dietitian Referrals in Hospitals

Dietitian involvement has considerable benefits for hospitalized patients, resulting in better health outcomes and improved quality of life. However, dietitian referral routines are often inappropriate in hospitals. The aim of this study was to identify predictors for dietitian referrals in hospitalized patients. This study was performed on data collected in an annually conducted cross-sectional study (in the years 2017, 2018, 2019). A standardized questionnaire was used to collect data, and logistic regression and a generalized estimating equation (GEE) model were used to calculate the associations between the patient characteristics and dietitian referrals. In the final GEE model, the following predictors for dietitian referrals remained significant: diabetes diagnosis (OR 1.80), cancer diagnosis (OR 1.76), digestive disease diagnosis (OR 2.03), presence of a pressure injury (OR 1.58), risk of malnutrition based on body mass index (BMI) and weight loss (OR 1.72), risk of malnutrition based on the malnutrition universal screening tool (MUST) (2.55), and the application of any malnutrition screening at admission to hospital (2.20). Total dietitian referral rate was 16.8%. The highest rate of dietitian referrals was found in patients with a risk of malnutrition (37%). This study included a large sample of hospitalized adult patients and revealed a low dietitian referral rate among these patients. These results indicate that dietitian involvement in hospitalized patients with nutrition-related conditions urgently needs to be improved.

Prevention of noncommunicable diseases by interventions in the preconception period: A FIGO position paper for action by healthcare practitioners

With the increase in obesity prevalence among women of reproductive age globally, the risks of type 2 diabetes, gestational diabetes, pre-eclampsia, and other conditions are rising, with detrimental effects on maternal and newborn health. The period before pregnancy is increasingly recognized as crucial for addressing weight management and reducing malnutrition (both under- and overnutrition) in both parents to reduce the risk of noncommunicable diseases (NCDs) in the mother as well as the passage of risk to her offspring. Healthcare practitioners, including obstetricians, gynecologists, midwives, and general practitioners, have an important role to play in supporting women in planning a pregnancy and achieving healthy nutrition and weight before pregnancy. In this position paper, the FIGO Pregnancy Obesity and Nutrition Initiative provides an overview of the evidence for preconception clinical guidelines to reduce the risk of NCDs in mothers and their offspring. It encourages healthcare practitioners to initiate a dialogue on women's health, nutrition, and weight management before conception. While acknowledging the fundamental importance of the wider social and environmental determinants of health, this paper focuses on a simple set of recommendations for clinical practice that can be used even in short consultations. The recommendations can be contextualized based on local cultural and dietary practices as part of a system-wide public health approach to influence the wider determinants as well as individual factors influencing preconception health.

Obesity: Assessment and prevention: Module 23.2 from Topic 23 "Nutrition in obesity"

Obesity is one the major health problems of today showing an increasing prevalence among most countries. It is associated with increased risk of several diseases. The importance of early life strategies in the prevention of obesity is well established, whereas, in general, breastfed infants tend to have a lower body mass index (BMI) than formula-fed infants. There seem to be a series of behavioral and hormonal mechanisms that explain this difference. Lifestyle plays a crucial role in the development of overweight and/or obesity and targeted lifestyle modifications have an important impact on preventing obesity. In particular, sedentary behavior (viewing television, playing video games, doing cognitive work, and listening to music) and reduced overall physical activity along with shorter sleep duration promote the overconsumption of dietary macronutrients leading to obesity; at the same time physical activity or exercise in a sufficient dose seems to better facilitate long-term maintenance of new lower body weight. There is enough discussion about a potential effect of nutrients on obesity. Nevertheless, the most the crucial parameter regarding weight loss and prevention of obesity is to achieve a negative energy balance. In regard to specific diet regimes, again energy balance rather that any specific macronutrients composition and/or favoring of low glycemic index products, seems to be have a stronger effect on maintenance of lower weight after 12 months. It has to be noted, that for specific sup groups, obesity or overweight might be showing some favorable trends in survival. In particular, "obesity paradox" (OP) refers to an overall prognosis that is no worse and may even be better in some groups than non-obese patients. The OP could be explained by the fact that current classifications of obesity based on BMI may place together, in the same category, subjects with very different clinical and biochemical characteristics.

Auyeung A, Doyle F. A Systematic Review Protocol of the Barriers to Both Physical Activity and Obesity Counselling in the Secondary Care Setting as Reported by Healthcare Providers

Physical activity and obesity counselling have both been gaining increasing interest in preventive health and treatment. However, most healthcare professionals do not provide advice on these topics nearly as often as they should. There are many reasons for this. Common barriers for the provision of brief advice on physical activity and obesity in both primary and secondary care are lack of time, motivation and knowledge. Systematic reviews have been published on the barriers of physical activity and obesity counselling in the primary care setting, but there is no published work on the barriers present in secondary care. This systematic review aims to assess all published data that discuss the barriers of physical activity and obesity counselling as noted by healthcare providers in secondary care. Four databases will be searched using the same search strategy, and the findings will be compiled using the COM-B model to explore the frequency of a reported barrier. This systematic review will be beneficial not only to practicing healthcare providers, but also the educational and managerial staff of secondary care facilities, as it may highlight the need for further training to fill gaps in the provision of preventive healthcare.