Perception of "healthy" body weight by patients with diabetes

Self-reported receipt of healthcare professional's weight management counselling is associated with self-reported weight management behaviours of type 2 diabetes mellitus patients

BACKGROUND

Weight loss has been shown to influence the health outcomes of type 2 diabetes patients. Providing weight management counselling to diabetes patients may help them adopt appropriate weight management behaviours to lose weight. This study determined the association between self-reported receipt of healthcare professional's weight management counselling and the weight management behaviours of type 2 diabetes patients.

METHODS

This cross-sectional study was conducted among 378 type 2 diabetes mellitus patients seeking care from two hospitals. Using a questionnaire, participants' weight management behaviours were assessed as well as receipt of healthcare professional's weight management counselling.

RESULTS

Half (51.3 %) of the participants reported receipt of healthcare professional's weight management counselling in the last 12 months. Half of the participants ever tried to lose weight. Fewer than half of the participants reported modifying their dietary habits (45.5 %) or engaging in exercise (48.7 %) to lose weight. Those who reported receipt of weight management counselling were more likely to report ever trying to lose weight (AOR 43.0, 95 % CI 23.0-81.6; p < 0.001), modifying their dietary habits (AOR 22.5, 95 % CI 13.0-39.19; p < 0.001), and engaging in exercise (AOR 13.0, 95 % CI 7.8-21.7; p < 0.001) to lose weight.

CONCLUSION

Participants engaged in varied weight management behaviours. Receipt of health care professionals' weight management counselling was associated to participants' reported participation in weight management behaviours. Weight management counselling from health care professionals may support the adoption of weight management behaviours in type 2 diabetes mellitus patients.

Demographic factors, weight management behaviours, receipt of healthcare professional's counselling and having knowledge in basic anthropometric measurements associated with underassessment of weight status in overweight and obese type 2 diabetes patients

OBJECTIVES

To describe the prevalence of underassessment of weight status and weight management behaviours and to evaluate how underassessment of weight status is associated with demographic factors, receipt of healthcare professional's weight management counselling, weight management behaviours and having knowledge in basic anthropometric measurements.

METHODS

This cross-sectional study included 222 overweight and obese type 2 diabetes patients. Participants' weight and height were determined using appropriate tools. Demographic characteristics, knowledge in basic anthropometric measurements and self-assessment of weight status were determined using a questionnaire.

RESULTS

They were more overweight (65.8%) than obese (34.2%) participants. Sixty percent reported receipt of weight management counselling from health care professionals. The majority (50.5%) of the participants did not know which category of weight status they were, 30.6% assessed themselves as normal weight and 18.0% assessed themselves as overweight/obese. Prevalence of underassessment was 63.6%. Participants underassessing (2.9% vs. 20%; p=0.004) their weight status were less likely to be able to measure their weight and calculate BMI than their counterparts who accurately self-assessed their weight status. Overweight participants were 3 times more likely to underassess their weight status than obese participants. Underassessment of weight status was less likely in females and in participants who reported receipt of weight management counselling than in those who did not receive weight management counselling.

CONCLUSION

Underassessment of weight status was more common in overweight than in obese participants. Receipt of weight management counselling was associated with having accurate assessment of weight status. Lack of knowledge in anthropometric measurements was widespread.

Self-perceived vs actual and desired weight and body mass index in adult ambulatory general internal medicine patients: a cross sectional study

BACKGROUND

No study has compared patients' self-reported heights and weights (and resultant self-reported body mass indexes [BMIs]) with their actual heights, weights, and BMIs; their self-perceived BMI categories; and their desired weights and BMIs and determined rates of clinicians' documented diagnoses of overweight and obesity in affected patients in a single patient group. The objectives of this study were to make these comparisons, determine patient factors associated with accurate self-perceived BMI categorization, and determine the frequency of clinicians' documented diagnoses of overweight and obesity in affected patients.

RESULTS

A total of 508 consecutive adult general internal medicine outpatients (257 women, 251 men; mean age, 62.9 ± 14.9 years) seen at Mayo Clinic in Rochester, Minnesota, between November 9 and 20, 2009, completed a questionnaire in which they reported their heights, weights, self-perceived BMI categories ("underweight," "about right," "overweight," or "obese"), and desired weights. These self-reported data were compared to actual heights, actual weights, and actual BMI categories (measured after the questionnaire was completed). Overall, 70% of the patients were overweight or obese. The average self-reported weight was significantly lower than the average actual weight (80.3 ± 20.1 kg vs 81.9 ± 21.1 kg; P < .001). The average self-reported BMI was significantly lower than the average actual BMI (27.6 ± 5.7 kg/m(2) vs 28.3 ± 6.1 kg/m(2); P < .001). Overall, 32% of patients had obesity; however, only 6% perceived they were obese. Accuracy of self-perceived BMI category decreased with higher actual BMI category (P < .001 for trend). Female sex, higher education level, smoking status, and lower BMI were associated with higher accuracy of self-perceived BMI category. Desired weight loss increased with higher self-perceived and actual BMI categories (P < .001 for trends). Of the 165 patients who actually were obese, only 40 (24%) had obesity documented as a diagnosis in their medical records by their clinicians. Statistical tests used were the paired t test, the Pearson χ2 test, the Cochrane-Armitage trend test, the Wald test of marginal homogeneity, analysis of variance, and univariate and multivariate logistic regression.

CONCLUSIONS

Many obese patients inaccurately perceive their BMI categories; accuracy decreases with increasing BMI. Clinicians should inform patients of their BMIs and prescribe treatment plans for those with overweight and obesity.

Distorted self-perceived weight status and underestimation of weight status in diabetes mellitus type 2 patients

OBJECTIVES

Diabetes mellitus type 2 (DM 2) patients' self-perception of their weight status is very critical in diabetes care. We sought to investigate perception of weight status in a sample of 200 DM 2 patients attending an outpatient clinic at a Teaching Hospital and compared it with their BMI-measured weight status, with a focus on underestimation of their weight status. Factors associated with underestimation of weight status in this sample were also explored.

METHODS

Using a cross-sectional design, anthropometric and clinical variables were assessed using appropriate tools. Questionnaires were used to collect socio-demographic data and self-perception of weight status. Self-perceived weight status was compared to BMI-measured weight status by cross-tabulation, Kappa statistics of agreement and χ2 for trend analysis. Both univariate and multiple logistic regression analysis were conducted to identify factors associated with underestimation of weight status.

RESULTS

The prevalence of general overweight/obesity and abdominal obesity was 32.0% (n = 64) and 58.0% (n = 116) respectively. Generally, 58.0% (n = 116) of the participants had a distorted weight perceived weight status in which 77.6% (n = 90) underestimated their weight status. Factors associated with underestimation of weight status were being overweight/obese (AOR = 22.9, 95% CI = 8.30-63.07, p<0.001), not married (AOR = 3.7, 95% CI = 1.50-9.17, p = 0.005) and never tried to lose weight (AOR = 6.9, 95% CI = 2.35-19.97, p<0.001). Participants aged over 40 years and those being hyperglycaemic were not significantly associated to underestimation of weight status.

CONCLUSION

We found a substantial discordance between BMI-measured and self-perceived weight status. Factors that were associated with underestimation of weight status were being; overweight/obese, not married and never tried to lose weight. Diabetes patients should be provided with information about weight guidelines.

Factors related to weight loss attempt among Dominican immigrants

To assess weight loss attempt among a Latino immigrant population from the Dominican Republic we analyzed data on 585 overweight and obese Dominicans from a cross-sectional survey using Chi-square statistics, Student's t-tests, and logistic regression models. We found 58% of the overweight and obese tried to lose weight. Female gender (OR 2.28, CI 1.53-3.39), overweight perception (OR 2.37, CI 1.57-3.60) and weight loss advice from health professionals (OR 1.90, CI 1.24-2.91) were strongly associated with weight loss attempt. Individuals with diabetes were more likely to receive advice to lose weight (OR 2.58, CI 1.18-5.63; yet, they were more satisfied with their weight (40.5 vs. 27.8%, p < 0.021), and no difference in their weight loss attempt (p = 0.849) was detected compared to individuals without diabetes. We conclude a significant proportion of overweight and obese Dominican immigrants do not attempt to lose weight. Overweight perception and, except among individuals with diabetes, weight loss advice were strong inducements to weight loss attempt.

Underassessment of weight and weight management in patients with diabetes: one more reason in support of weight management advice

AIMS

The purpose of this study was to determine whether underassessment of weight affects weight management behaviors of overweight and obese individuals with diabetes and to determine whether weight management advice from health care professionals modifies the effect of underassessment of weight.

METHODS

Data (n=979) from the 2006 and 2008 National Health and Nutrition Examination Survey were analyzed. Multivariate logistic regression was used to identify factors associated with underassessment of weight, weight management behaviors, and receipt of weight management advice from health care professionals.

RESULTS

Underassessment of weight was common (26%). Men, overweight persons, Blacks and Hispanics were more likely to underassess their weight. Those who underassessed their weight were 53% less likely to report weight management behaviors, odds ratio 0.47 (95% CI=0.31-0.73). Weight management advice increased weight management behaviors among individuals who underassessed their weight, 3.49 (95% CI=1.70-7.18).

CONCLUSIONS

Underassessment of weight can negatively affect weight management behaviors of overweight and obese individuals with diabetes. Weight management advice from health care professionals is important, and can modify the effect of underassessment of weight on weight management behaviors in this high risk group.

Use of the internet in the treatment of obesity and prevention of type 2 diabetes in primary care

Cardiovascular prevention, including emphasising healthy diet and physical activity patterns for weight loss and diabetes prevention, is an important focus of primary care medicine, yet provision of intensive lifestyle counselling in the primary care setting remains uncommon. Online approaches for providing lifestyle counselling are emerging as a new avenue for bringing support to outpatient patient populations. Features of successful programmes include the use of a structured behavioural programme, electronic counselling support and feedback, and uncomplicated user interfaces. Online tools may be used independently or to complement in-person approaches. Limited data also suggest that the internet can be used to support the maintenance of weight loss. In addition, the internet may help overcome various clinical barriers to lifestyle support, including significant time limitations, a need to prioritise acute care and maintain clinical workflow, and the high cost of counselling. Furthermore, the continuity of the primary care patient-provider(s) relationship provides an established source of long-term support which has been difficult to create in other community settings. As the field of online lifestyle counselling matures, nutrition and physical activity experts will face new challenges in providing asynchronous counselling without the assistance of traditional non-verbal communication cues. However, the potential for reaching a wider population in a convenient and accessible manner also creates unique opportunities for providing lifestyle support.

Accuracy, determinants, and consequences of body weight self-perception in type 2 diabetes: the Fremantle Diabetes Study

OBJECTIVE

To assess the accuracy, determinants, and consequences of body weight self-perception in type 2 diabetes.

METHODS

We studied 1272 community-based patients and a 518-patient overweight/obese subset who returned for ≥4 annual reviews. Multiple logistic regression was used to identify baseline predictors of correct weight self-perception and to determine whether correct weight self-perception predicted future weight loss. Overweight and obesity were defined as body mass indices of 25.0-29.9 and ≥30.0 kg/m(2), respectively.

RESULTS

Of the patients who were overweight (40.0%) or obese (41.8%) at baseline, 52.8% and 83.7%, respectively, correctly self-identified their weight category. Overweight/obese participants who self-identified correctly were more likely to have been informed they were overweight (P<.001), predominantly by their general practitioner (80.1%). Overweight participants had less self-awareness if they were not abdominally obese, did not speak English fluently, were male, or had a low income. Obese participants were more likely to consider themselves overweight if they had better diabetes knowledge and higher educational attainment. Correct weight self-perception did not influence subsequent weight loss.

CONCLUSIONS

Health care professionals can facilitate body weight self-awareness in type 2 diabetes. Education programmes should recognise the impact of gender and socio-demographic variables on accurate weight self-perception.

Vascular dysfunction in obstructive sleep apnea and type 2 diabetes mellitus

Despite the high prevalence of obstructive sleep apnea (OSA) in type 2 diabetes mellitus (DM), the attributable vascular risk from each condition is unknown. We hypothesize that OSA may have a similar effect on vascular function as type 2 diabetes does. Healthy normal-weight subjects, healthy obese subjects, subjects with type 2 diabetes, and obese subjects with OSA were enrolled. Vascular function was assessed with brachial artery ultrasound for flow-mediated dilatation (FMD) and in skin microcirculation by laser Doppler flowmetry. One hundred fifty-three subjects were studied: healthy normal-weight controls (NCs) (n = 14), healthy obese controls (OCs) (n = 33), subjects with DM (n = 68), and obese subjects with OSA (n = 38). The DM group did not undergo sleep study and thus may have had subclinical OSA. The OSA and type 2 diabetes groups had impaired FMD as compared to both the normal-weight and OC groups (5.8 ± 3.8%, 5.4 ± 1.6% vs. 9.1 ± 2.5%, 8.3 ± 5.1%, respectively, P < 0.001, post hoc Fischer test). When referenced to the NC group, a multiple linear regression model adjusting for covariates found that baseline brachial artery diameter (β = -3.75, P < 0.001), OSA (β = -2.45, P = 0.02) and type 2 diabetes status (β = -2.31, P = 0.02), negatively predicted % FMD. OSA status did not seem to affect nitroglycerin-induced vasodilation (endothelium-independent) of the brachial artery or vascular function in the skin microcirculation. OSA impairs endothelial function in the brachial artery to a similar degree as type 2 diabetes does. OSA, however, does not appear to affect brachial endothelium-independent vasodilation or skin microcirculatory function. Treatment of OSA in patients with concomitant type 2 diabetes, therefore, may be a potential therapeutic option to improve macro-, but not microvascular outcomes.

Patient perspectives on the role of weight management in type 2 diabetes

AIMS

To examine issues of weight misperception, perceived importance of weight management, and patient reports of their HCP's weight-related recommendations among patients with type 2 diabetes.

METHODS

575 overweight adults with type 2 diabetes completed a survey that assessed perceptions about weight management and discussions with HCP's about weight issues.

RESULTS

Among patients with BMI>30, weight misperception was rare (<10%) and perceived importance of weight loss common (>85%). Among overweight patients with BMI<30, weight misperception was more common (47%) and importance of weight loss was endorsed less frequently (68%). Most patients reported that HCP's had advised weight loss (72%) and discussed weight issues at most visits (59%). However, recommendations from HCP's were rarely specific. Few were informed by HCP's that certain diabetes medications might make weight management difficult. Weight misperception was less common, importance of weight loss was more common and weight management efforts were more frequent when HCPs discussed these issues directly.

CONCLUSIONS

Most overweight patients with type 2 diabetes recognize the importance of weight management. Patient reports indicate that HCP's are actively engaged in promoting weight loss and that their recommendations, when specific, are associated with patients' more frequent weight management efforts.

Value versus user fees: perspectives of patients before and after using a web-based portal for management of diabetes

The objective of this work was to rate the potential or actual usefulness of 15 features of a Web-based portal for diabetes management and assess whether patients would be willing to pay user fees for portal access. We used a combination of qualitative methods (focus group discussions) and quantitative methods (survey responses) to examine patients' perspectives. We enrolled 21 patients before the diabetes-specific portal was released ("preportal" group) and 18 patients after it was released ("portal-users" group). The two groups were similar except that 67% of preportal patients and 100% of portal users were Internet users. Overall, portal features that were rated most favorably were the online calculator to estimate blood glucose control (characterized as "very useful" by 74% of patients), appointment reminder systems (74%), e-mail access to health team (74%), personal tracking logs (69%), and online scheduling (69%). More patients from the preportal group than the portal-users group favored personal logs (86% versus 50%; p = 0.015) and opportunities to form interest groups (62% versus 28%; p = 0.034). Of the 30 patients who assigned a dollar amount for 1 month of portal access, 20 assigned zero dollars. Discussions about payment focused on equity and access. Because fees are expected to discourage portal usage, many patients believed that the potential benefits associated with self-management would not be realized. Others felt that the health system would benefit financially from a portal and should therefore absorb the costs. Even if portals are valued, patients may be resistant to paying for them. This opposition stems from concerns about fairness and from the recognition that health systems may experience cost savings if patients manage their diabetes successfully.