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Burton D, Gysel S, Tsuyuki RT. Why we need to incorporate obesity medicine into community pharmacies. Can Pharm J (Ott) 2024; 157:3-6. [PMID: 38125629 PMCID: PMC10729715 DOI: 10.1177/17151635231217196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 10/23/2023] [Accepted: 11/13/2023] [Indexed: 12/23/2023]
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Alshehri FS, Alorfi NM. Saudi Adults' Understanding and Views of Weight Management Practices and Obesity. Diabetes Metab Syndr Obes 2023; 16:3513-3531. [PMID: 37954890 PMCID: PMC10637233 DOI: 10.2147/dmso.s433721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/27/2023] [Indexed: 11/14/2023] Open
Abstract
Background and Objective The rising prevalence of overweight and obesity presents a significant global challenge. This study aimed to investigate the understanding and views of weight management practices and obesity among Saudi adults. Methodology A cross-sectional online survey was conducted from October 2022 to January 2023 among adults residing in Saudi Arabia. Participants completed a self-administered 41-item questionnaire designed to assess their understanding and views regarding weight management practices and obesity. Results A total of 1066 participants completed the survey. Gender distribution showed a majority of males (55.7%). Age-wise, the majority fell below 51 years, with 37.7% (young) between 18-24, 32.7% (young adult) between 25-33, and 21.3% (adult) between 34-51. Employment was reported by one-third (n = 315) of respondents, while 22.0% (n = 234) had a history of chronic diseases. Furthermore, 77.3% (n = 824) engaged in regular physical activity.The study results revealed that participants' mean score for understanding obesity was 3.28 ± 2.37 (range 0-6), while the average views score was 28.08 ± 8.79 (range 0-34). Furthermore, females displayed a higher level of understanding compared to males. Employment status also played a significant role, with employed individuals having a better understanding of obesity than those who were unemployed. Moreover, participants with higher qualifications demonstrated a more comprehensive understanding of obesity compared to those with lower qualifications. Additionally, individuals with higher monthly income levels displayed a greater understanding of obesity compared to those with lower incomes. Lastly, participants who engaged in regular physical activity exhibited a higher level of understanding compared to those who were physically inactive. Conclusion The study indicates that factors such as being older, being female, being employed, having higher education and income, and engaging in regular physical activity are associated with increased understanding and favorable views regarding weight management practices and obesity.
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Affiliation(s)
- Fahad S Alshehri
- Department of Pharmacology and Toxicology, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Nasser M Alorfi
- Department of Pharmacology and Toxicology, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
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Brix JM, Andersen B, Aydinkoc-Tuzcu K, Beckerhinn P, Brossard-Eitzinger A, Cavini A, Ciardi C, Clodi M, Eichner M, Erlacher B, Fahrnberger M, Felsenreich DM, Francesconi C, Göbel B, Hölbing E, Hoppichler F, Huber J, Huber SL, Itariu BK, Jandrasitz B, Kiefer FW, Köhler G, Kruschitz R, Ludvik B, Malzner A, Moosbrugger A, Öfferlbauer-Ernst A, Parzer V, Prager G, Resl M, Ress C, Schelkshorn C, Scherer T, Sourji H, Stechemesser L, Stulnig T, Toplak H, Wakolbinger M, Vonbank A, Weghuber D. [Overweight and obesity in adults: general principles of treatment and conservative management]. Wien Klin Wochenschr 2023; 135:706-720. [PMID: 37821694 PMCID: PMC10567802 DOI: 10.1007/s00508-023-02270-9] [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] [Accepted: 08/14/2023] [Indexed: 10/13/2023]
Abstract
The prevalence of overweight and obesity is steadily increasing in Austria as well as internationally. Obesity in particular is associated with multiple health risks, comorbidities, functional disability, and social stigma. Obesity is an independent, complex, chronic disease and should be treated as such by a multidisciplinary team of appropriately qualified personnel. In addition to recent international guidelines, this consensus paper outlines the overall principles of the management of overweight and obesity and provides guidance for the diagnosis and conservative treatment, focusing on lifestyle modifications and pharmacotherapy. Using the "5A" framework of behavioral health intervention, guidelines for a structured, pragmatic, and patient-centered medical care of adults with overweight or obesity are presented.
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Affiliation(s)
- Johanna Maria Brix
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Karl Landsteiner Institut für Adipositas und Stoffwechselerkrankungen, Klinik Landstraße, Wien, Österreich
| | | | - Kadriye Aydinkoc-Tuzcu
- 5. Medizinische Abteilung für Endokrinologie, Rheumatologie und Akutgeriatrie, Klinik Ottakring, Wien, Österreich
| | - Philipp Beckerhinn
- Abteilung für Chirurgie, Landesklinikum Hollabrunn, Hollabrunn, Österreich
| | - Agnes Brossard-Eitzinger
- Universitätsklinik für Innere Medizin I, mit Gastroenterologie Hepatologie, Nephrologie, Stoffwechsel und Diabetologie, Uniklinikum der Paracelsus Medizinischen Privatuniversität, Salzburg, Österreich
| | - Anna Cavini
- kokon – Reha für junge Menschen, Bad Erlach, Österreich
| | - Christian Ciardi
- Abteilung für Innere Medizin, Krankenhaus St. Vinzenz Zams, Zams, Österreich
| | - Martin Clodi
- ICMR – Institute for Cardiovascular and Metabolic Research, Johannes Kepler Universität Linz, Linz, Österreich
- Abteilung für Innere Medizin mit Diabetologie, Gastroenterologie und Hepatologie, Rheumatologie und Intensivmedizin, Konventhospital der Barmherzigen Brüder Linz, Linz, Österreich
| | - Marlies Eichner
- 3. Medizinische Abteilung mit Stoffwechselerkrankungen und Nephrologie, Karl Landsteiner-Institut für Stoffwechselerkrankungen und Nephrologie, Klinik Hietzing, Wien, Österreich
| | - Brigitte Erlacher
- Abteilung Innere Medizin III, Krankenhaus Barmherzige Schwestern, Wien, Österreich
| | | | - Daniel Moritz Felsenreich
- Klinische Abteilung für Viszeralchirurgie, Universitätsklinik für Allgemeinchirurgie, Medizinische Universität Wien, Wien, Österreich
| | | | - Bettina Göbel
- 5. Medizinische Abteilung für Endokrinologie, Rheumatologie und Akutgeriatrie, Klinik Ottakring, Wien, Österreich
| | - Elisabeth Hölbing
- Landeskrankenhaus Hochsteiermark, Standort Leoben, Leoben, Österreich
| | - Friedrich Hoppichler
- Abteilung für Innere Medizin, Krankenhaus der Barmherzigen Brüder Salzburg, Salzburg, Österreich
- Institut SIPCAN – Initiative für ein gesundes Leben, Salzburg, Österreich
| | - Joakim Huber
- Interne Abteilung mit Akutgeriatrie und Palliativmedizin, Franziskus Spital, Standort Landstraße, Wien, Österreich
| | - Simone Leonora Huber
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Karl Landsteiner Institut für Adipositas und Stoffwechselerkrankungen, Klinik Landstraße, Wien, Österreich
| | - Bianca Karla Itariu
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Birgit Jandrasitz
- 3. Medizinische Abteilung mit Stoffwechselerkrankungen und Nephrologie, Karl Landsteiner-Institut für Stoffwechselerkrankungen und Nephrologie, Klinik Hietzing, Wien, Österreich
| | - Florian W. Kiefer
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Gerd Köhler
- Rehabilitationszentrum Aflenz für Stoffwechselerkrankungen mit Schwerpunkt Diabetes mellitus und hochgradige Adipositas, Aflenz, Österreich
| | - Renate Kruschitz
- Abteilung für Innere Medizin, Krankenhaus der Elisabethinen Klagenfurt, Klagenfurt, Österreich
| | - Bernhard Ludvik
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Karl Landsteiner Institut für Adipositas und Stoffwechselerkrankungen, Klinik Landstraße, Wien, Österreich
| | - Andrea Malzner
- Abteilung für Innere Medizin I, Klinikum Wels Grieskirchen, Standort Wels, Wels, Österreich
| | - Alexander Moosbrugger
- Abteilung für Innere Medizin II, Konventhospital der Barmherzigen Brüder Graz-Marschallgasse, Graz, Österreich
| | - Anna Öfferlbauer-Ernst
- Universitätsklinik für Innere Medizin I, mit Gastroenterologie Hepatologie, Nephrologie, Stoffwechsel und Diabetologie, Uniklinikum der Paracelsus Medizinischen Privatuniversität, Salzburg, Österreich
| | - Verena Parzer
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Karl Landsteiner Institut für Adipositas und Stoffwechselerkrankungen, Klinik Landstraße, Wien, Österreich
| | - Gerhard Prager
- Klinische Abteilung für Viszeralchirurgie, Universitätsklinik für Allgemeinchirurgie, Medizinische Universität Wien, Wien, Österreich
| | - Michael Resl
- ICMR – Institute for Cardiovascular and Metabolic Research, Johannes Kepler Universität Linz, Linz, Österreich
- Abteilung für Innere Medizin mit Diabetologie, Gastroenterologie und Hepatologie, Rheumatologie und Intensivmedizin, Konventhospital der Barmherzigen Brüder Linz, Linz, Österreich
| | - Claudia Ress
- Department für Innere Medizin I, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | | | - Thomas Scherer
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Harald Sourji
- Klinische Abteilung für Endokrinologie und Diabetologie, Medizinische Universität Graz, Graz, Österreich
| | - Lars Stechemesser
- Universitätsklinik für Innere Medizin I, mit Gastroenterologie Hepatologie, Nephrologie, Stoffwechsel und Diabetologie, Uniklinikum der Paracelsus Medizinischen Privatuniversität, Salzburg, Österreich
| | - Thomas Stulnig
- 3. Medizinische Abteilung mit Stoffwechselerkrankungen und Nephrologie, Karl Landsteiner-Institut für Stoffwechselerkrankungen und Nephrologie, Klinik Hietzing, Wien, Österreich
| | - Hermann Toplak
- Klinische Abteilung für Endokrinologie und Diabetologie, Medizinische Universität Graz, Graz, Österreich
| | - Maria Wakolbinger
- Abteilung für Sozial- und Präventivmedizin, Zentrum für Public Health, Medizinische Universität Wien, Wien, Österreich
| | - Alexander Vonbank
- Abteilung für Innere Medizin I, Akademisches Lehrkrankenhaus Feldkirch, Feldkirch, Österreich
| | - Daniel Weghuber
- Universitätsklinik für Kinder- und Jugendheilkunde, Uniklinikum der Paracelsus Medizinischen Privatuniversität, Salzburg, Österreich
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Mayumi Usuda Prado Rocha D, Paula Silva Caldas A, Simões E Silva AC, Bressan J, Hermana Miranda Hermsdorff H. Nut-enriched energy restricted diet has potential to decrease hunger in women at cardiometabolic risk: a randomized controlled trial (Brazilian Nuts Study). Nutr Res 2023; 109:35-46. [PMID: 36577255 DOI: 10.1016/j.nutres.2022.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 11/04/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
Successful weight management represents a challenge to obesity control. Evidence suggests that nut consumption promotes a prolonged satiety response. Therefore, we hypothesize that nuts could be associated with greater weight loss in comparison to a control group, and we evaluate the acute and long-term effects of Brazilian nuts (BN: 15 g of Brazil nuts + 30 g of cashew nuts) included in an energy-restricted intervention on food intake, appetite, and peptide hormones. We conducted an 8-week, randomized, open-label, controlled, parallel-arm clinical trial with 28 women at cardiometabolic risk who received an energy-restricted diet containing BN or an energy-restricted nut-free diet (control). At baseline and after 8 weeks of intervention, subjective postprandial appetite ratings were assessed using a visual analog scale (VAS) before and after consumption (0, 10, 60, 120, 180, and 240 minutes) of a 437-kcal nut-enriched (BN group) or nut-free (control) breakfast meal. Subsequently, an ad libitum lunch was served, and the participants completed another VAS at 280 minutes. Plasma concentrations of ghrelin, glucose-dependent insulinotropic polypeptide, glucagon-like peptide 1, and leptin were measured at fasting and postprandially at 60, 120, and 240 minutes. Last, subsequent reported 24-hour energy intake was assessed in a free-living setting. BN consumption did not have acute effects on food intake, appetite, or peptide hormones. However, after an 8-week intervention, postprandial ghrelin (difference between post- and preintervention area under the curve) decreased in the BN group in comparison to the control (mean difference, 1978 pg/mL/min, 95% CI, 27-3929 pg/mL/min; P = .047) and therefore, an energy-restricted diet containing demonstrated potential to decrease hunger in cardiometabolic risk women.
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Affiliation(s)
| | - Ana Paula Silva Caldas
- Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, 36570-900, MG, Brazil
| | - Ana Cristina Simões E Silva
- Department of Pediatrics, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, 30130-100, MG, Brazil
| | - Josefina Bressan
- Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, 36570-900, MG, Brazil
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Odgers KR, Jurado LFM, Kamienski M. Nurse Practitioner-Led Ketogenic Diet for Adults With Overweight/Obesity. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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6
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Beliveau PJH, McIsaac MA, Mior SA, French SD. An Investigation of Chiropractor-Directed Weight-Loss Interventions: Secondary Analysis of O-COAST. J Manipulative Physiol Ther 2019; 42:353-365. [PMID: 31262578 DOI: 10.1016/j.jmpt.2018.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 06/20/2018] [Accepted: 11/02/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate weight-loss interventions offered by Canadian doctors of chiropractic to their adult patients. METHODS This paper reports a secondary analysis of data from the Ontario Chiropractic Observation and Analysis STudy (Nc = 42 chiropractors, Np = 2162 patient encounters). Multilevel logistic regression was performed to assess the odds of chiropractors initiating or continuing weight management interventions with patients. Two chiropractor variables and 8 patient-level variables were investigated for influence on chiropractor-directed weight management. In addition, the interaction between the effects of patient weight and comorbidity on weight management interventions by chiropractors was assessed. RESULTS Around two-thirds (61.3%) of patients who sought chiropractic care were either overweight or had obesity. Very few patients had weight loss managed by their chiropractor. Among patients with body mass index equal to or greater than 18.5 kg/m2, guideline recommended weight management was initiated or continued by Ontario chiropractors in only 5.4% of encounters. Chiropractors did not offer weight management interventions at different rates among patients who were of normal weight, overweight, or obese (P value = 0.23). Chiropractors who graduated after 2005 who may have been exposed to reforms in chiropractic education to include public health were significantly more likely to offer weight management than chiropractors who graduated between 1995 and 2005 (odds ratio 0.02; 95% CI [0.00-0.13]) or before 1995 (odds ratio 0.08; 95% CI [0.01-0.42]). CONCLUSION The prevalence of weight management interventions offered to patients by Canadian chiropractors in Ontario was low. Health care policy and continued chiropractic educational reforms may provide further direction to improve weight-loss interventions offered by doctors of chiropractic to their patients.
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Affiliation(s)
- Peter J H Beliveau
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada.
| | - Michael A McIsaac
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Silvano A Mior
- University of Ontario Institute of Technology-Canadian Memorial Chiropractic College Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology and Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Simon D French
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada; School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada; Department of Chiropractic, Macquarie University, Sydney, New South Wales, Australia
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Vinturache A, Winn A, Mannion C, Tough S. Women's recall of health care provider counselling on gestational weight gain (GWG): a prospective, population-based study. BMC Pregnancy Childbirth 2019; 19:136. [PMID: 31023254 PMCID: PMC6485057 DOI: 10.1186/s12884-019-2283-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 04/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prenatal care has been validated to provide medical and educational counselling intended to reduce the risk of adverse pregnancy conditions and improve the maternal and fetal outcomes. Prenatal targeted information regarding nutrition, lifestyle, and weight gain is predictive of meeting Institute of Medicine (IOM) 2009 gestational weight gain (GWG) guidelines. There is limited information about women's experiences with these prenatal counselling domains, particularly in women who do not meet GWG recommendations. The objective of this study was to evaluate the impact of women's recall of prenatal counselling and its effect on meeting their GWG within guidelines in a prospective, community-based pregnancy cohort. METHODS A sample of 2909 women with singleton pregnancies was drawn from the prospective community-based pregnancy cohort All Our Families from Alberta, Canada. Women were stratified into three GWG groups, adequate, inadequate, and excessive GWG, based on pre-pregnancy BMI and the adherence to the Institute of Medicine weight gain in pregnancy guidelines. At less than 25 and 34 to 36 weeks' gestation, maternal socio-demographic information and women's recall of prenatal counselling experiences was collected through self-administered questionnaires. Multivariate logistic regression analyses tested GWG strata impact on women's recall of the prenatal counselling advice in eight domains of nutrition, lifestyle, and weight management during pregnancy. RESULTS Adequate GWG was reached by 35.9% of women, 46.5% gained excessive and 17.6% gained inadequate weight. Women who were overweight and obese prior to pregnancy were more likely to gain excessive weight than women who were normal weight (OR 3.3, 95% CI 2.6-4.1; and OR 2.9, 95% CI 2.1-3.9, respectively). Most women reported having no difficulties in finding prenatal care, felt comfortable with their health care provider and were satisfied with the answers received. There was no difference in the recall of prenatal advice received in any of the eight domains of prenatal counselling assessed among women with appropriate and non-optimal GWG. CONCLUSION Women with adequate and non-optimal GWG received comparable prenatal counselling on nutrition, weight gain, and lifestyle modifications. There remain missed opportunities in targeting prenatal counselling advice to women at risk for suboptimal or excessive GWG.
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Affiliation(s)
- Angela Vinturache
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. .,Department of Obstetrics & Gynaecology, St. George's University Hospitals NHS Foundation Trust, London, UK.
| | - Anika Winn
- Faculty of Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cynthia Mannion
- Faculty of Nursing, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Suzanne Tough
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community of Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Aboueid S, Meyer SB. Factors affecting access and use of preventive and weight management care: A public health lens. Healthc Manage Forum 2019; 32:136-142. [PMID: 30943766 DOI: 10.1177/0840470418824345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Obesity is an important risk factor for various chronic diseases. While people with obesity use the health system more and incur higher costs, they may forego using preventive care services (e.g., gynecological cancer screenings) due to issues of service use and service access. The aim of this paper was to use a public health lens to elucidate system level factors that affect healthcare access and utilization for preventive and weight management care by patients with obesity. Some elucidated factors include lack of access to a Primary Care Provider (PCP) and multidisciplinary healthcare settings, gender of the PCP, duration of medical visits and health professionals' attitudes about obesity. We highlight potential strategies for leaders to use when improving access and use of health services by patients with obesity in Canada and the need for future empirical studies in this research area.
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Affiliation(s)
- Stephanie Aboueid
- 1 School of Public Health and Health Systems, Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Samantha B Meyer
- 1 School of Public Health and Health Systems, Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Ghaferi AA, Varban OA. Setting Appropriate Expectations After Bariatric Surgery: Evaluating Weight Regain and Clinical Outcomes. JAMA 2018; 320:1543-1544. [PMID: 30326107 DOI: 10.1001/jama.2018.14241] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Amir A Ghaferi
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Surgery, University of Michigan, Ann Arbor
| | - Oliver A Varban
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Surgery, University of Michigan, Ann Arbor
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Aboueid S, Bourgeault I, Giroux I. Nutrition care practices of primary care providers for weight management in multidisciplinary primary care settings in Ontario, Canada - a qualitative study. BMC FAMILY PRACTICE 2018; 19:69. [PMID: 29788914 PMCID: PMC5964672 DOI: 10.1186/s12875-018-0760-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 05/02/2018] [Indexed: 11/30/2022]
Abstract
Background Despite the recommended guidelines on addressing diet for the management and prevention of obesity in primary care, the literature highlights that their implementation has been suboptimal. In this paper, we provide an in-depth understanding of current nutrition-related weight management practices of primary care providers (PCPs) working in relatively new multidisciplinary health care settings in Ontario. Methods Three types of multidisciplinary primary care settings were included (2 Family Health Teams, 3 Community Health Centres and 1 Nurse Practitioner-Led Clinic). Participants (n = 20) included in this study were nurse practitioners (n = 13) and family physicians (n = 7) supporting care for adult patients (18 years or older). In-depth interviews were transcribed, coded and the content was analyzed using an integrated approach. Results Our analysis showed that most PCPs used anthropometric measures such as weight for screening patients who would benefit from nutrition counselling with a dietitian. The topic of nutrition was generally brought up either during physical examinations, when patients were diagnosed with a chronic disease, or when blood markers were out of normal range. Participants also mentioned that physical examinations are no longer occurring annually, with most PCPs offering episodic care. All participants reported utilizing dietetic referrals, noting the enablers for providing the referral, which included access to an on-site dietitian. Nonetheless, dietetic referrals were mostly used when patients had an obesity-related co-morbidity. Participants mentioned that healthy eating advice was reinforced during follow-up visits with patients only when there was enough time to do so. Electronic Health Records (EHRs) were utilized to facilitate message reinforcement by PCPs, who perceived EHRs to be helpful for viewing what was discussed in the session with the dietitian. Conclusions PCPs mostly used objective measures to screen for patients who would benefit from nutrition counselling rather than diet assessment, which undermines the importance of dietary intake and overemphasizes weight. With physical examinations occurring less frequently, there will be additional missed opportunities for addressing nutrition-related concerns. The presence of a dietitian on site allowed for PCPs to refer patients to nutrition counselling. Having sufficient time during medical visits and EHRs seemed to facilitate message reinforcement by PCPs in follow-up visits with patients. Electronic supplementary material The online version of this article (10.1186/s12875-018-0760-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stephanie Aboueid
- School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - Ivy Bourgeault
- Department of Health Systems, Telfer School of Management, University of Ottawa, 55 Laurier Avenue East, Ottawa, ON, K1N6N5, Canada
| | - Isabelle Giroux
- School of Nutrition Sciences, Faculty of Health Sciences, University of Ottawa, 25 University Private, Ottawa, ON, K1N6N5, Canada
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Sturgiss EA, Elmitt N, Haesler E, van Weel C, Douglas KA. Role of the family doctor in the management of adults with obesity: a scoping review. BMJ Open 2018; 8:e019367. [PMID: 29453301 PMCID: PMC5829928 DOI: 10.1136/bmjopen-2017-019367] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/13/2017] [Accepted: 12/19/2017] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Obesity management is an important issue for the international primary care community. This scoping review examines the literature describing the role of the family doctor in managing adults with obesity. The methods were prospectively published and followed Joanna Briggs Institute methodology. SETTING Primary care. Adult patients. INCLUDED PAPERS Peer-reviewed and grey literature with the keywords obesity, primary care and family doctors. All literature published up to September 2015. 3294 non-duplicate papers were identified and 225 articles included after full-text review. PRIMARY AND SECONDARY OUTCOME MEASURES Data were extracted on the family doctors' involvement in different aspects of management, and whether whole person and person-centred care were explicitly mentioned. RESULTS 110 papers described interventions in primary care and family doctors were always involved in diagnosing obesity and often in recruitment of participants. A clear description of the provider involved in an intervention was often lacking. It was difficult to determine if interventions took account of whole person and person-centredness. Most opinion papers and clinical overviews described an extensive role for the family doctor in management; in contrast, research on current practices depicted obesity as undermanaged by family doctors. International guidelines varied in their description of the role of the family doctor with a more extensive role suggested by guidelines from family medicine organisations. CONCLUSIONS There is a disconnect between how family doctors are involved in primary care interventions, the message in clinical overviews and opinion papers, and observed current practice of family doctors. The role of family doctors in international guidelines for obesity may reflect the strength of primary care in the originating health system. Reporting of primary care interventions could be improved by enhanced descriptions of the providers involved and explanation of how the pillars of primary care are used in intervention development.
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Affiliation(s)
- Elizabeth A Sturgiss
- Academic Unit of General Practice, Australian Nation University Medical School, Canberra, Australia
| | - Nicholas Elmitt
- Academic Unit of General Practice, Australian Nation University Medical School, Canberra, Australia
| | - Emily Haesler
- Academic Unit of General Practice, Australian Nation University Medical School, Canberra, Australia
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
- School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Chris van Weel
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Health Services Research and Policy, Australian National University, Canberra, Australia
| | - Kirsty A Douglas
- Academic Unit of General Practice, Australian Nation University Medical School, Canberra, Australia
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12
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Plourde G. Case Report #4—External and Internal Risk Factors. Prostate Cancer 2018. [DOI: 10.1016/b978-0-12-815966-8.00004-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Preliminary examination of metabolic syndrome response to motivational interviewing for weight loss as compared to an attentional control and usual care in primary care for individuals with and without binge-eating disorder. Eat Behav 2017; 26:108-113. [PMID: 28226308 PMCID: PMC5545172 DOI: 10.1016/j.eatbeh.2017.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 02/09/2017] [Accepted: 02/13/2017] [Indexed: 12/18/2022]
Abstract
Motivational interviewing (MI) treatment for weight loss is being studied in primary care. The effect of such interventions on metabolic syndrome or binge eating disorder (BED), both highly related to excess weight, has not been examined in primary care. This study conducted secondary analyses from a randomized controlled trial to test the impact of MI for weight loss in primary care on metabolic syndrome. 74 adult participants with overweight/obesity recruited through primary care were randomized to 12weeks of either MI, an attentional control, or usual care. Participants completed measurements for metabolic syndrome at pre- and post-treatment. There were no statistically significant differences in metabolic syndrome rates at pre-, X2(2)=0.16, p=0.921, or post-, X2(2)=0.852, p=0.653 treatment. The rates in metabolic syndrome, however, decreased for MI (10.2%) and attentional control (13.8%) participants, but not for usual care. At baseline, metabolic syndrome rates did not differ significantly between participants with BED or without BED across treatments. At post-treatment, participants with BED were significantly more likely to meet criteria for metabolic syndrome than participants without BED, X2(1)=5.145, p=0.023, phi=0.273. Across treatments, metabolic syndrome remitted for almost a quarter of participants without BED (23.1%) but for 0% of those with BED. These preliminary results are based on a small sample and should be interpreted with caution, but they are the first to suggest that relatively low intensity MI weight loss interventions in primary care may decrease metabolic syndrome rates but not for individuals with BED.
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Torti J, Luig T, Borowitz M, Johnson JA, Sharma AM, Campbell-Scherer DL. The 5As team patient study: patient perspectives on the role of primary care in obesity management. BMC FAMILY PRACTICE 2017; 18:19. [PMID: 28178930 PMCID: PMC5299769 DOI: 10.1186/s12875-017-0596-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/26/2017] [Indexed: 12/04/2022]
Abstract
Background Over 60% of people have overweight or obesity, but only a third report receiving counselling from primary care providers. We explored patients’ perspectives on the role of primary care in obesity management and their experience with existing resources, with a view to develop an improved understanding of this perspective, and more effective management strategies. Methods Qualitative study employing semi-structured interviews and thematic analysis, with a sample of 28 patients from a cohort of 255 patients living with obesity and receiving care to support their weight management in a large Primary Care Network of family practices in Alberta. Results Four illustrative themes emerged: (1) the patient-physician relationship plays an important role in the adequacy of obesity management; (2) patients have clear expectations of substantive conversations with their primary care team; (3) complex conditions affect weight and patients require assistance tailored to individual obesity drivers; (4) current services provide support in important ways (accessibility, availability, accountability, affordability, consistency of messaging), but are not yet meeting patient needs for individual plans, advanced education, and follow-up opportunities. Conclusions Patients have clear expectations that their primary care physician asks them about weight within a supportive therapeutic relationship. They see obesity as a complex phenomenon with multiple drivers. They want their healthcare providers to assess and address their root causes - not simplistic advice to “eat less, move more”. Patients felt that the current services were positive resources, but expressed needs for tailored weight management plans, and longer-term follow-up.
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Affiliation(s)
- Jacqueline Torti
- Department of Family Medicine, University of Alberta, Clinical Research Unit, Edmonton, AB, Canada, T6G 2E1.,School of Public Health, University of Alberta, Edmonton, AB, Canada, T6G 2E3
| | - Thea Luig
- Department of Family Medicine, University of Alberta, Clinical Research Unit, Edmonton, AB, Canada, T6G 2E1.,Department of Medicine, Division of Endocrinology, University of Alberta, Edmonton, AB, Canada, T6G 2E1
| | - Michelle Borowitz
- Department of Anthropology, University of Alberta, Edmonton, AB, Canada, T6G 2H4
| | - Jeffrey A Johnson
- School of Public Health, University of Alberta, Edmonton, AB, Canada, T6G 2E3
| | - Arya M Sharma
- Department of Medicine, Division of Endocrinology, University of Alberta, Edmonton, AB, Canada, T6G 2E1
| | - Denise L Campbell-Scherer
- Department of Family Medicine, University of Alberta, Clinical Research Unit, Edmonton, AB, Canada, T6G 2E1. .,Department of Medicine, Obesity Research & Management, University of Alberta, Li Ka Shing Building, Rm. 1-116, 87th Avenue and 112th Street, Edmonton, AB, T6G 2E1, Canada.
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Blaz DA, Peterson J. Weight Loss Outcomes Associated With the Use of the Army H.E.A.L.T.H. Weight Management Program in Overweight Military Service Members and Veterans. J Nurse Pract 2016. [DOI: 10.1016/j.nurpra.2016.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
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.
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Affiliation(s)
- Denise Campbell-Scherer
- Clinical Research Unit, 2-004 Li Ka Shing Ctr, University of Alberta, 87 Ave and 112st, Edmonton, AB, T6G 2E1, Canada.
| | - Arya Mitra Sharma
- 1-116 Li Ka Shing Ctr, University of Alberta, 87th Avenue and 112th Street, Edmonton, AB, T6G 2E1, Canada
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Mohammad S, Ahmad J. Management of obesity in patients with type 2 diabetes mellitus in primary care. Diabetes Metab Syndr 2016; 10:171-181. [PMID: 27117509 DOI: 10.1016/j.dsx.2016.01.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 01/09/2016] [Indexed: 01/06/2023]
Abstract
AIMS Obesity and being overweight is the most powerful risk factor accounting for 80-90% of patients with type 2 diabetes mellitus (T2DM). The epidemic of obesity is driving the diabetes epidemic to alarming levels and primary care is becoming an important setting for obesity management in T2DM in India. Yet many primary care providers feel ill-equipped or inadequately supported to address obesity in patients with diabetes. This article reviews the most recent and strongest evidence-based strategies that may aid physicians in management of obesity in patients with T2DM in primary care. MATERIAL AND METHODS A systematic literature search of MEDLINE using the search terms Obesity, Obesity in T2DM, weight loss and Primary Care was conducted. The American Diabetes Association, National Institute for Health, National Institute of Health and Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN) and World Health Organization websites were also searched. Most studies in this area are observational in design with few randomized controlled trials (RCTs). Articles and studies involving meta-analysis or RCTs were preferred over other types. RESULTS AND CONCLUSION Effective weight management treatment in T2DM patient can be implemented in the primary care setting. Evidence based individualized lifestyle and pharmacologic measures supported by behavioral intervention and counseling with appropriate and informed surgical referrals has the potential to improve the success of weight management within primary care.
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Affiliation(s)
| | - Jamal Ahmad
- Centre for Diabetes & Endocrinology, Faculty of Medicine, J. N. Medical College Hospital, A.M.U, Aligarh 202 002, India.
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Ogunleye A, Osunlana A, Asselin J, Cave A, Sharma AM, Campbell-Scherer DL. The 5As team intervention: bridging the knowledge gap in obesity management among primary care practitioners. BMC Res Notes 2015; 8:810. [PMID: 26695407 PMCID: PMC4689048 DOI: 10.1186/s13104-015-1685-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/10/2015] [Indexed: 01/25/2023] Open
Abstract
Background Despite opportunities for didactic education on obesity management, we still observe low rates of weight management visits in our primary care setting. This paper describes the co-creation by front-line interdisciplinary health care providers and researchers of the 5As Team intervention to improve obesity prevention and management in primary care. Methods We describe the theoretical foundations, design, and core elements of the 5AsT intervention, and the process of eliciting practitioners’ self-identified knowledge gaps to inform the curricula for the 5AsT intervention. Themes and topics were identified through facilitated group discussion and a curriculum relevant to this group of practitioners was developed and delivered in a series of 12 workshops. Result The research question and approach were co-created with the clinical leadership of the PCN; the PCN committed internal resources and a practice facilitator to the effort. Practice facilitation and learning collaboratives were used in the intervention For the content, front-line providers identified 43 topics, related to 13 themes around obesity assessment and management for which they felt the need for further education and training. These needs included: cultural identity and body image, emotional and mental health, motivation, setting goals, managing expectations, weight-bias, caregiver fatigue, clinic dynamics and team-based care, greater understanding of physiology and the use of a systematic framework for obesity assessment (the “4Ms” of obesity). The content of the 12 intervention sessions were designed based on these themes. There was a strong innovation values fit with the 5AsT intervention, and providers were more comfortable with obesity management following the intervention. The 5AsT intervention, including videos, resources and tools, has been compiled for use by clinical teams and is available online at http://www.obesitynetwork.ca/5As_Team. Conclusions Primary care interdisciplinary practitioners perceive important knowledge gaps across a wide range of topics relevant to obesity assessment and management. This description of the intervention provides important information for trial replication. The 5AsT intervention may be a useful aid for primary care teams interested to improve their knowledge of obesity prevention and management. Clinical Trials.gov (NCT01967797)
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Affiliation(s)
- Ayodele Ogunleye
- Department of Medicine, Obesity Research and Management University of Alberta, Li Ka Shing Center for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada. .,Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, AB, T6G 2T4, Canada.
| | - Adedayo Osunlana
- Department of Medicine, Obesity Research and Management University of Alberta, Li Ka Shing Center for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada.
| | - Jodie Asselin
- Department of Medicine, Obesity Research and Management University of Alberta, Li Ka Shing Center for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada. .,Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, AB, T6G 2T4, Canada.
| | - Andrew Cave
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, AB, T6G 2T4, Canada.
| | - Arya Mitra Sharma
- Department of Medicine, Obesity Research and Management University of Alberta, Li Ka Shing Center for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada.
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Al-Ozairi E, Al Kandari J, AlHaqqan D, AlHarbi O, Masters Y, Syed AA. Obesity surgery and Ramadan: a prospective analysis of nutritional intake, hunger and satiety and adaptive behaviours during fasting. Obes Surg 2015; 25:523-9. [PMID: 25595382 DOI: 10.1007/s11695-014-1373-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Fasting for religious or lifestyle reasons poses a challenge to people who have undergone bariatric surgery. A total fast (abstaining from all forms of nourishment including liquids) during long summer days puts these patients at risk of dehydration and poor calorie and nutrient intake. METHODS We undertook telephone surveys of 24-h food recall, hunger and satiety scores, medication use, adverse symptoms and depression scores on a fasting day in Ramadan and a non-fasting day subsequently. RESULTS We studied 207 participants (166 women) who had undergone sleeve gastrectomy. The mean (standard error) age was 35.2 (0.7) years. Men and women consumed 20.4 % (P = 0.018) and 16.9 % (P < 0.001) fewer calories and 44.8 % (P < 0.001) and 32.4 % (P < 0.001) less protein during fasting, respectively. There was no significant difference in the intake of fluids or incidence of adverse gastrointestinal, hypoglycaemic and sympathoadrenal symptoms. Of participants on pharmacotherapy, 89.5 % took their prescribed medications; 86.3 % made no changes to the doses, but 80.4 % changed the timing of the medications. Both women and men reported feeling less hungry and a preference for savoury foods during Ramadan. There was no difference in depression and work impairment scores. CONCLUSIONS Fasting was well tolerated in persons who had undergone sleeve gastrectomy. It may be advisable to raise awareness about dietary protein intake and managing medications appropriately during fasting.
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Affiliation(s)
- Ebaa Al-Ozairi
- Faculty of Medicine, Department of Medicine, Kuwait University, P.O. Box 24923, 13110, Kuwait City, Kuwait,
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Abstract
PURPOSE OF REVIEW This review demonstrates the need for enhancing strategic approaches to the prevention and control of hypertension, a global health issue. RECENT FINDINGS An epidemic of chronic noncommunicable diseases is threatening national healthcare systems' sustainability and the economy of many countries. Increased blood pressure is the leading risk for premature death and disability and accounts for approximately 10% of healthcare spending. Four of nine recent United Nations' targets for reducing chronic noncommunicable diseases relate directly or indirectly to hypertension. The expanded chronic care model provides a comprehensive framework for developing hypertension prevention and control strategies. The model addresses the roles of healthy public policy, healthy living environments, healthy communities, reorientation of health services delivery toward management of chronic illness, support for improving clinical decisions, enhanced skills of people to prevent and self-manage chronic disease, partnerships of stakeholders and information systems to track the impact of interventions and identify care 'gaps'. The authors advocate that hypertension organizations can lead aspects of hypertension strategy development and implementation. SUMMARY Prevention and control of hypertension requires a strategic approach that could have a central role for hypertension experts and the hypertension community.
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Brauer P, Gorber SC, Shaw E, Singh H, Bell N, Shane AR, Jaramillo A, Tonelli M. Recommendations for prevention of weight gain and use of behavioural and pharmacologic interventions to manage overweight and obesity in adults in primary care. CMAJ 2015; 187:184-195. [PMID: 25623643 PMCID: PMC4330141 DOI: 10.1503/cmaj.140887] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Paula Brauer
- Family Relations and Applied Nutrition (Brauer), University of Guelph, Guelph, Ont.; Public Health Agency of Canada (Connor Gorber, Shane, Jaramillo), Ottawa, Ont.; Department of Family Medicine (Shaw), McMaster University, Hamilton, Ont.; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Bell) University of Alberta, Edmonton, Alta.; Department of Medicine, University of Calgary (Tonelli), Calgary, Alta
| | - Sarah Connor Gorber
- Family Relations and Applied Nutrition (Brauer), University of Guelph, Guelph, Ont.; Public Health Agency of Canada (Connor Gorber, Shane, Jaramillo), Ottawa, Ont.; Department of Family Medicine (Shaw), McMaster University, Hamilton, Ont.; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Bell) University of Alberta, Edmonton, Alta.; Department of Medicine, University of Calgary (Tonelli), Calgary, Alta
| | - Elizabeth Shaw
- Family Relations and Applied Nutrition (Brauer), University of Guelph, Guelph, Ont.; Public Health Agency of Canada (Connor Gorber, Shane, Jaramillo), Ottawa, Ont.; Department of Family Medicine (Shaw), McMaster University, Hamilton, Ont.; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Bell) University of Alberta, Edmonton, Alta.; Department of Medicine, University of Calgary (Tonelli), Calgary, Alta
| | - Harminder Singh
- Family Relations and Applied Nutrition (Brauer), University of Guelph, Guelph, Ont.; Public Health Agency of Canada (Connor Gorber, Shane, Jaramillo), Ottawa, Ont.; Department of Family Medicine (Shaw), McMaster University, Hamilton, Ont.; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Bell) University of Alberta, Edmonton, Alta.; Department of Medicine, University of Calgary (Tonelli), Calgary, Alta
| | - Neil Bell
- Family Relations and Applied Nutrition (Brauer), University of Guelph, Guelph, Ont.; Public Health Agency of Canada (Connor Gorber, Shane, Jaramillo), Ottawa, Ont.; Department of Family Medicine (Shaw), McMaster University, Hamilton, Ont.; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Bell) University of Alberta, Edmonton, Alta.; Department of Medicine, University of Calgary (Tonelli), Calgary, Alta
| | - Amanda R.E. Shane
- Family Relations and Applied Nutrition (Brauer), University of Guelph, Guelph, Ont.; Public Health Agency of Canada (Connor Gorber, Shane, Jaramillo), Ottawa, Ont.; Department of Family Medicine (Shaw), McMaster University, Hamilton, Ont.; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Bell) University of Alberta, Edmonton, Alta.; Department of Medicine, University of Calgary (Tonelli), Calgary, Alta
| | - Alejandra Jaramillo
- Family Relations and Applied Nutrition (Brauer), University of Guelph, Guelph, Ont.; Public Health Agency of Canada (Connor Gorber, Shane, Jaramillo), Ottawa, Ont.; Department of Family Medicine (Shaw), McMaster University, Hamilton, Ont.; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Bell) University of Alberta, Edmonton, Alta.; Department of Medicine, University of Calgary (Tonelli), Calgary, Alta
| | - Marcello Tonelli
- Family Relations and Applied Nutrition (Brauer), University of Guelph, Guelph, Ont.; Public Health Agency of Canada (Connor Gorber, Shane, Jaramillo), Ottawa, Ont.; Department of Family Medicine (Shaw), McMaster University, Hamilton, Ont.; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Bell) University of Alberta, Edmonton, Alta.; Department of Medicine, University of Calgary (Tonelli), Calgary, Alta
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Bruins J, Jörg F, Bruggeman R, Slooff C, Corpeleijn E, Pijnenborg M. The effects of lifestyle interventions on (long-term) weight management, cardiometabolic risk and depressive symptoms in people with psychotic disorders: a meta-analysis. PLoS One 2014; 9:e112276. [PMID: 25474313 PMCID: PMC4256304 DOI: 10.1371/journal.pone.0112276] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 10/04/2014] [Indexed: 12/21/2022] Open
Abstract
AIMS The aim of this study was to estimate the effects of lifestyle interventions on bodyweight and other cardiometabolic risk factors in people with psychotic disorders. Additionally, the long-term effects on body weight and the effects on depressive symptoms were examined. MATERIAL AND METHODS We searched four databases for randomized controlled trials (RCTs) that compared lifestyle interventions to control conditions in patients with psychotic disorders. Lifestyle interventions were aimed at weight loss or weight gain prevention, and the study outcomes included bodyweight or metabolic parameters. RESULTS The search resulted in 25 RCTs -only 4 were considered high quality- showing an overall effect of lifestyle interventions on bodyweight (effect size (ES) = -0.63, p<0.0001). Lifestyle interventions were effective in both weight loss (ES = -0.52, p<0.0001) and weight-gain-prevention (ES = -0.84, p = 0.0002). There were significant long-term effects, two to six months post-intervention, for both weight-gain-prevention interventions (ES = -0.85, p = 0.0002) and weight loss studies (ES = -0.46, p = 0.02). Up to ten studies reported on cardiometabolic risk factors and showed that lifestyle interventions led to significant improvements in waist circumference, triglycerides, fasting glucose and insulin. No significant effects were found for blood pressure and cholesterol levels. Four studies reported on depressive symptoms and showed a significant effect (ES = -0.95, p = 0.05). CONCLUSION Lifestyle interventions are effective in treating and preventing obesity, and in reducing cardiometabolic risk factors. However, the quality of the studies leaves much to be desired.
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Affiliation(s)
- Jojanneke Bruins
- University of Groningen, University Medical Center Groningen, University Center Psychiatry, Rob Giel Research center, Groningen, The Netherlands
| | - Frederike Jörg
- University of Groningen, University Medical Center Groningen, University Center Psychiatry, Rob Giel Research center, Groningen, The Netherlands
- Friesland Mental Health Services, Research Department, Leeuwarden, Friesland, The Netherlands
| | - Richard Bruggeman
- University of Groningen, University Medical Center Groningen, University Center Psychiatry, Rob Giel Research center, Groningen, The Netherlands
| | - Cees Slooff
- University of Groningen, University Medical Center Groningen, University Center Psychiatry, Rob Giel Research center, Groningen, The Netherlands
- GGZ Drenthe, Department of Psychotic Disorders, Assen, Drenthe, The Netherlands
| | - Eva Corpeleijn
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, The Netherlands
| | - Marieke Pijnenborg
- GGZ Drenthe, Department of Psychotic Disorders, Assen, Drenthe, The Netherlands
- University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, Groningen, The Netherlands
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Barnes RD, White MA, Martino S, Grilo CM. A randomized controlled trial comparing scalable weight loss treatments in primary care. Obesity (Silver Spring) 2014; 22:2508-16. [PMID: 25298016 PMCID: PMC4236282 DOI: 10.1002/oby.20889] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 08/14/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Primary-care (PC) settings may be an opportune place to deliver obesity interventions. Scalable interventions utilizing motivational interviewing (MI), supported by Internet resources, may overcome obstacles to effective obesity treatment dissemination. This study was a randomized controlled trial testing two Web-supported interventions, motivational interviewing (MIC) and nutrition psychoeducation (NPC), an attention-control intervention, in comparison with usual care (UC). METHODS Eighty-nine overweight/obese patients, with and without binge eating disorder (BED), were randomly assigned to MIC, NPC, or UC for 3 months in PC. Patients were assessed independently at post-treatment and at 3-month follow-up. RESULTS Weight, triglyceride levels, and depression scores decreased significantly in NPC when compared to UC but not MIC; UC and MIC did not differ significantly. Weight loss results maintained at 3-month follow-up: approximately 25% MIC and NPC patients achieved at least 5% weight loss which did not differ by BED status. Fidelity ratings were high and treatment adherence was associated with weight loss. CONCLUSIONS This is the first randomized controlled trial in PC testing MI for weight loss to include an attention-control intervention (NPC). NPC, but not MIC, showed a consistent pattern of superior benefits relative to UC. BED status was not associated, but treatment adherence was associated, with weight loss outcomes.
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Affiliation(s)
| | - Marney A. White
- Department of Psychiatry, Yale School of Medicine
- Chronic Disease Epidemiology, Yale School of Public Health
| | - Steve Martino
- Department of Psychiatry, Yale School of Medicine
- VA Connecticut Healthcare System
| | - Carlos M. Grilo
- Department of Psychiatry, Yale School of Medicine
- Department of Psychology, Yale University
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Chaput JP, Ferraro ZM, Prud'homme D, Sharma AM. Widespread misconceptions about obesity. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2014; 60:973-984. [PMID: 25392431 PMCID: PMC4229150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Jean-Philippe Chaput
- Assistant Professor of Pediatrics at the University of Ottawa and Junior Research Chair in Healthy Active Living and Obesity Research at the Children's Hospital of Eastern Ontario Research Institute in Ottawa.
| | - Zachary M Ferraro
- Researcher at the Children's Hospital of Eastern Ontario Research Institute
| | - Denis Prud'homme
- Professor of Human Kinetics, Associate Vice President of Research, and Scientific Director of the Institut de recherche de l'Hôpital Montfort in Ottawa
| | - Arya M Sharma
- Scientific Director of the Canadian Obesity Network and Professor and Endowed Chair in Obesity Research and Management at the University of Alberta in Edmonton
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25
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Kunyk D, Els C, Papadakis S, Selby P. Tobacco use disorder treatment in primary care: implementing a clinical system pathway in Alberta. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2014; 60:646-655. [PMID: 25022640 PMCID: PMC4096266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To test a team-based, site-specific, multicomponent clinical system pathway designed for enhancing tobacco use disorder treatment by primary care physicians. DESIGN A prospective cohort study. SETTING Sixty primary care sites in Alberta. PARTICIPANTS A convenience sample of 198 primary care physicians from the population of 2857. MAIN OUTCOME MEASURES Data collection occurred between September 2010 and February 2012 on 3 distinct measures. Twenty-four weeks after the intervention, audits of the primary care practices assessed the adoption and sustainability of 10 tobacco clinical system pathway components, a survey measured changes in physicians' treatment intentions, and patient chart reviews examined changes in physicians' consistency with the treatment algorithm. RESULTS The completion rate by physicians was 89.4%. An intention-to-treat approach was undertaken for statistical analysis. Intervention uptake was demonstrated by positive changes at 4 weeks in how many of the 10 clinical system measures were performed (mean [SD] = 4.22 [1.60] vs 8.57 [1.46]; P < .001). Physicians demonstrated significant favourable changes in 9 of the 12 measures of treatment intention (P < .05). The 18 282 chart reviews documented significant increases in 6 of the 8 algorithm components. CONCLUSION Our findings suggest that the provision of a tobacco clinical system pathway that incorporates other members of the health care team and builds on existing office infrastructures will support positive and sustainable changes in tobacco use disorder treatment by physicians in primary care. This study reaffirms the substantive and important role of supporting how treatment is delivered in physicians' practices.
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Affiliation(s)
- Diane Kunyk
- Assistant Professor in the Faculty of Nursing, Adjunct Professor in the John Dossetor Health Ethics Centre, and Associate Researcher in the Centre for Effective Business Management of Addiction Treatment at the University of Alberta in Edmonton.
| | - Charl Els
- Academic faculty member in the Faculty of Medicine and Dentistry, the School of Public Health, and the John Dossetor Health Ethics Centre at the University of Alberta
| | - Sophia Papadakis
- Assistant Professor in the Division of Cardiology in the Faculty of Medicine at the University of Ottawa in Ontario and Program Director for the Chaplin CVD Prevention Network Primary Care Smoking Cessation Program in the Division of Prevention and Rehabilitation at the Ottawa Heart Institute
| | - Peter Selby
- Chief of the Addictions Program and Clinician Scientist at the Centre for Addiction and Mental Health in Toronto, Ont, Associate Professor in the Department of Family and Community Medicine, the Department of Psychiatry, and the Dalla Lana School of Public Health at the University of Toronto, and Principal Investigator at the Ontario Tobacco Research Unit
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Plourde G, Karelis AD. Current issues in the identification and treatment of metabolically healthy but obese individuals. Nutr Metab Cardiovasc Dis 2014; 24:455-459. [PMID: 24529490 DOI: 10.1016/j.numecd.2013.12.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 12/06/2013] [Accepted: 12/09/2013] [Indexed: 12/23/2022]
Abstract
A unique subset of obese individuals who appear to be protected from the development of metabolic disturbances has been identified in the medical literature and is termed metabolically healthy but obese (MHO). Part of the issue is that there are no clear accepted criteria on the definition of MHO and the biological mechanisms to explain this phenotype are still unknown which render findings and/or conclusions difficult to interpret and making the application of this concept difficult in clinical practice. With the current definitions, the true prevalence of the MHO phenotype in the general population varies widely from approximately 3-57% of obese adults. In several prospective studies, the MHO individual has been associated with a similar risk of developing type 2 diabetes, cardiovascular disease and mortality when compared to healthy normal weight subjects; however, there is evidence to refute this concept. Furthermore, the current evidence cannot confirm that MHO subjects are permanently protected from the risk of developing metabolic disturbances associated with obesity. Currently, no standard practice guidelines for the treatment of MHO can be proposed, however, a regular surveillance of the waist circumference and cardio-metabolic risk factors such as elevated triglycerides, glycaemia, HOMA, C-reactive protein and low HDL, as well as the prevention of any further weight gain seem to represent the most prudent and sound attitude in the management of MHO subjects.
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Affiliation(s)
- G Plourde
- Drug Safety Unit - Director's Office, Center for Evaluation of Radiopharmaceuticals and Biotherapeutics, Biologic and Genetic Therapies Directorate, Health Canada, Ottawa, Ontario, Canada; The School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
| | - A D Karelis
- Department of Kinanthropology, Université du Québec à Montréal, Montréal, Québec, Canada
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A weight loss program in a chiropractic practice: a retrospective analysis. Complement Ther Clin Pract 2014; 20:125-9. [PMID: 24767958 DOI: 10.1016/j.ctcp.2013.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Revised: 11/17/2013] [Accepted: 11/19/2013] [Indexed: 11/20/2022]
Abstract
CONTEXT Obesity is a global problem and places individuals at risk for developing chronic metabolic disorders. The need for investigating simple, effective and sustaining approaches to weight loss cannot be overstated. METHODS We performed a retrospective file analysis of patient files attending a 13-week weight loss program. Inclusion for analysis were files of adults (i.e., >18 years) completing the program consisting of chiropractic adjustments/spinal manipulative therapy augmented with diet/nutritional intervention, exercise and one-on-one counseling. RESULTS Sixteen of 30 people (i.e., 53.33%) completed the program. Statistically and clinically significant changes were noted in weight and BMI measures based on pre-treatment (average weight = 190.46 lbs. and BMI = 30.94 kg/m(2)) and comparative measurements (average weight = 174.94 lbs. and BMI = 28.50 kg/m(2)). CONCLUSION A cohort of patients under enrolled in a weight loss program was described. This provides supporting evidence on the effectiveness of a multi-modal approach to weight loss implemented in a chiropractic clinic.
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Grunfeld E, Manca D, Moineddin R, Thorpe KE, Hoch JS, Campbell-Scherer D, Meaney C, Rogers J, Beca J, Krueger P, Mamdani M. Improving chronic disease prevention and screening in primary care: results of the BETTER pragmatic cluster randomized controlled trial. BMC FAMILY PRACTICE 2013; 14:175. [PMID: 24252125 PMCID: PMC4225577 DOI: 10.1186/1471-2296-14-175] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 11/07/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Primary care provides most of the evidence-based chronic disease prevention and screening services offered by the healthcare system. However, there remains a gap between recommended preventive services and actual practice. This trial (the BETTER Trial) aimed to improve preventive care of heart disease, diabetes, colorectal, breast and cervical cancers, and relevant lifestyle factors through a practice facilitation intervention set in primary care. METHODS Pragmatic two-way factorial cluster RCT with Primary Care Physicians' practices as the unit of allocation and individual patients as the unit of analysis. The setting was urban Primary Care Team practices in two Canadian provinces. Eight Primary Care Team practices were randomly assigned to receive the practice-level intervention or wait-list control; 4 physicians in each team (32 physicians) were randomly assigned to receive the patient-level intervention or wait-list control. Patients randomly selected from physicians' rosters were stratified into two groups: 1) general and 2) moderate mental illness. The interventions involved a multifaceted, evidence-based, tailored practice-level intervention with a Practice Facilitator, and a patient-level intervention involving a one-hour visit with a Prevention Practitioner where patients received a tailored 'prevention prescription'. The primary outcome was a composite Summary Quality Index of 28 evidence-based chronic disease prevention and screening actions with pre-defined targets, expressed as the ratio of eligible actions at baseline that were met at follow-up. A cost-effectiveness analysis was conducted. RESULTS 789 of 1,260 (63%) eligible patients participated. On average, patients were eligible for 8.96 (SD 3.2) actions at baseline. In the adjusted analysis, control patients met 23.1% (95% CI: 19.2% to 27.1%) of target actions, compared to 28.5% (95% CI: 20.9% to 36.0%) receiving the practice-level intervention, 55.6% (95% CI: 49.0% to 62.1%) receiving the patient-level intervention, and 58.9% (95% CI: 54.7% to 63.1%) receiving both practice- and patient-level interventions (patient-level intervention versus control, P < 0.001). The benefit of the patient-level intervention was seen in both strata. The extra cost of the intervention was $26.43CAN (95% CI: $16 to $44) per additional action met. CONCLUSIONS A Prevention Practitioner can improve the implementation of clinically important prevention and screening for chronic diseases in a cost-effective manner.
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Affiliation(s)
- Eva Grunfeld
- Department of Family Community Medicine, University of Toronto, 500 University Avenue, Toronto, Ontario M5G 1V7, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Donna Manca
- Department of Family Medicine, University of Alberta, 901 College Plaza, Edmonton, Alberta T6G 2C8, Canada
| | - Rahim Moineddin
- Department of Family Community Medicine, University of Toronto, 500 University Avenue, Toronto, Ontario M5G 1V7, Canada
| | - Kevin E Thorpe
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 193 Yonge Street, Toronto, Ontario M5B 1M8, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Jeffrey S Hoch
- Centre for Excellence in Economic Analysis Research, The Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond Street, Toronto M5B 1W8, Canada
- Pharmacoeconomics Research Unit, Cancer Care Ontario, Toronto, Canada
- Institute for Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Denise Campbell-Scherer
- Department of Family Medicine, University of Alberta, 901 College Plaza, Edmonton, Alberta T6G 2C8, Canada
| | - Christopher Meaney
- Department of Family Community Medicine, University of Toronto, 500 University Avenue, Toronto, Ontario M5G 1V7, Canada
| | - Jess Rogers
- Centre for Effective Practice, 203 College Street, Suite 402, Toronto M5T 1P9, Canada
| | - Jaclyn Beca
- Centre for Excellence in Economic Analysis Research, The Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond Street, Toronto M5B 1W8, Canada
- Pharmacoeconomics Research Unit, Cancer Care Ontario, Toronto, Canada
| | - Paul Krueger
- Department of Family Community Medicine, University of Toronto, 500 University Avenue, Toronto, Ontario M5G 1V7, Canada
| | - Muhammad Mamdani
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 193 Yonge Street, Toronto, Ontario M5B 1M8, Canada
- Institute for Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
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Affiliation(s)
- Mathew John
- Department of Endocrinology, Providence Endocrine and Diabetes Specialty Centre, Haryana, India
| | - Koshy George
- Obesity Solutions, Nanthencode, Trivandrum, India
| | - Sanjay Kalra
- Bharti Hospital and B.R.I.D.E., Karnal, Haryana, India
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Tang X, Liu G, Kang J, Hou Y, Jiang F, Yuan W, Shi J. Obesity and risk of hip fracture in adults: a meta-analysis of prospective cohort studies. PLoS One 2013; 8:e55077. [PMID: 23593112 PMCID: PMC3625172 DOI: 10.1371/journal.pone.0055077] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 12/18/2012] [Indexed: 12/22/2022] Open
Abstract
Background Many observational studies assessed the association between obesity and risk of hip fracture in adults, but reported controversial results. Our goal was to evaluate the association between obesity and risk of hip fracture in adults by conducting a meta-analysis of prospective cohort studies. Methods Three databases, PubMed, Embase and Web of Science, were searched through May 2012 to identify eligible cohort studies. Either a fixed- or a random-effects model was used to calculate the pooled relative risk (RR) with its 95% confidence interval (95%CI). Results Fifteen prospective cohort studies involving a total 3,126,313 participants were finally included into this meta-analysis. Overall, adults with obesity compared with the normal weight group had a significantly decreased risk of hip fracture (RR: 0.66, 95% CI 0.57 to 0.77, P<0.001). Meta-analyses by the adjusted status of RRs also suggested adults with obesity compared with the reference group had a significantly decreased risk of hip fracture (adjusted RR: 0.48, 95% CI 0.39 to 0.58, P<0.001; unadjusted RR: 0.66, 95% CI 0.56 to 0.78, P<0.001). Subgroup analyses by gender suggested individuals with obesity had a significantly decreased risk for developing hip fracture compared with the reference group in both men (RR 0.54, 95% CI 0.48 to 0.60, P<0.001) and women (RR 0.70, 95% CI 0.58 to 0.84, P<0.001). No evidence of publication bias was observed in this meta-analysis. Conclusions This meta-analysis of prospective cohort studies suggests that obesity significantly decreases the risk of hip fracture in adults, and obesity is probably a protective factor of hip fracture in adults.
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Affiliation(s)
- Xianye Tang
- Orthopaedic Department, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Gang Liu
- Orthopaedic Department, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jian Kang
- Orthopaedic Department, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yang Hou
- Orthopaedic Department, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Fungui Jiang
- Department of Orthopaedics, People's Hospital of Wujiang City, Wujiang, China
| | - Wen Yuan
- Orthopaedic Department, Changzheng Hospital, Second Military Medical University, Shanghai, China
- * E-mail: (JS); (WY)
| | - Jiangang Shi
- Orthopaedic Department, Changzheng Hospital, Second Military Medical University, Shanghai, China
- * E-mail: (JS); (WY)
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Plourde G. Six As model of counseling in obesity. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2013; 59:353. [PMID: 23585597 PMCID: PMC3625074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Orlowski M, Adkins S, Ellison S, Choh A, Terwoord N, Schuster R. Assessment and Management of Adult Obesity in a Primary Care Practice. WORLD MEDICAL & HEALTH POLICY 2013. [DOI: 10.1002/wmh3.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Cosentino G, Conrad AO, Uwaifo GI. Phentermine and topiramate for the management of obesity: a review. Drug Des Devel Ther 2011; 7:267-78. [PMID: 23630412 PMCID: PMC3623549 DOI: 10.2147/dddt.s31443] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Obesity is now a major public health concern worldwide with increasing prevalence and a growing list of comorbidities and complications. The morbidity, mortality and reduced productivity associated with obesity and its complications result in a major burden to health care costs. Obesity is a complex chronic medical syndrome often with multiple different etiologic factors in individual patients. The long term successful management of obesity remains particularly challenging and invariably requires a multifaceted approach including lifestyle and behavioral modification, increased physical activity, and adjunctive pharmacotherapy. Bariatric surgery remains a last resort though at present it has the best results for achieving sustained robust weight loss. Obesity pharmacotherapy has been very limited in its role for long term obesity management because of the past history of several failed agents as well as the fact that presently available agents are few, and generally utilized as monotherapy. The recent FDA approval of the fixed drug combination of phentermine and extended release topiramate (topiramate-ER) (trade name Qsymia™) marks the first FDA approved combination pharmacotherapeutic agent for obesity since the Phen-Fen combination of the 1990s. This review details the history and clinical trial basis for the use of both phentermine and topiramate in obesity therapeutics as well as the results of clinical trials of their combination for obesity treatment in humans. The initial clinical approval trials offer evidence that this fixed drug combination offers synergistic potential for effective, robust and sustained weight loss with mean weight loss of at least 10% of baseline achieved and sustained for up to 2 years in over 50% of subjects treated. It is anticipated that this agent will be the first in a new trend of multi-agent combination therapy for the chronic adjunctive management of obesity.
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Affiliation(s)
- Gina Cosentino
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Ariane O Conrad
- Xavier University of Louisiana College of Pharmacy, New Orleans, LA, USA
| | - Gabriel I Uwaifo
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
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