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Anees A, Saeed ZI, Kemper S, Haggerty T, Davisson L. Surveying the Knowledge and Practices of Primary Care Residents in Managing Adult Patients with Obesity. J Gen Intern Med 2024; 39:1698-1703. [PMID: 38671204 PMCID: PMC11255137 DOI: 10.1007/s11606-024-08777-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND The prevalence of obesity is increasing worldwide at an alarming rate, yet obesity remains under-addressed during clinic encounters. A lack of training in how to treat obesity is one crucial factor contributing to this deficiency. OBJECTIVE This study explored resident physicians' perceptions of their education on obesity and its relationship with confidence and practice behaviors when caring for patients with obesity. DESIGN A survey was distributed to residency directors to share with residents in their programs. Participation was voluntary and anonymous. Data was collected over a 3-month period. PARTICIPANTS Residents in Family Medicine and Internal Medicine programs in West Virginia and Indiana who saw adult patients in an ambulatory care setting. MAIN MEASURES The electronic survey queried the presence of a formal curriculum on Obesity Medicine (OM) and each resident's knowledge, confidence, practice behaviors, and attitudes pertaining to OM. KEY RESULTS The survey was distributed to 490 residents in 12 programs. Response rate was 22.9% (112 resident physicians). All respondents felt that medical training in obesity should be strengthened. Residents who reported having a formal curriculum on OM were more likely than those without a curriculum to rate their confidence as "high" when discussing weight (35.0% vs. 16.7%, p = 0.03) and when counseling patients about diet and nutrition (37.5% vs. 18.1%, p = 0.02). They also more frequently reported learning enough from faculty to manage obesity (65.0% vs. 29.2%, p < 0.001). Residents with an OM curriculum reported discussing obesity as a problem with patients (100.0% vs. 86.1%, p = 0.01), and completing motivational interviews (90.0% vs. 58.3%, p = < 0.001), more frequently than their peers without a curriculum. CONCLUSIONS Residents with a formal OM curriculum were more confident in addressing and discussing obesity with patients. Formal training in OM will strengthen resident training to better address and treat patients with obesity.
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Affiliation(s)
- Amna Anees
- Department of Internal Medicine, Charleston Area Medical Center and WVU School of Medicine-Charleston Division, Charleston, WV, USA.
| | - Zeb Ijaz Saeed
- Division of Endocrinology, Diabetes and Metabolism, Indiana University, Indianapolis, IN, USA
| | - Suzanne Kemper
- Charleston Area Medical Center Institute for Academic Medicine, Charleston, WV, USA
| | - Treah Haggerty
- Department of Family Medicine, West Virginia University School of Medicine and WVU Medicine's Medical Weight Management Program, Morgantown, WV, USA
| | - Laura Davisson
- Department of Internal Medicine, West Virginia University School of Medicine and WVU Medicine's Medical Weight Management Program, Morgantown, WV, USA
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Trofymenko S, Kutob R, Algotar A. A Multi-Modality Intervention Improves Obesity Bias among Medical Students. MEDICINES (BASEL, SWITZERLAND) 2024; 11:4. [PMID: 38392692 PMCID: PMC10890647 DOI: 10.3390/medicines11020004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/09/2024] [Accepted: 01/23/2024] [Indexed: 02/24/2024]
Abstract
Background: Obesity is linked to chronic diseases in adults and children. Its prevalence continues to grow in the United States, necessitating the need for healthcare provider training and presenting an opportunity for the education of future medical providers. Despite this need, effectively implementing obesity education into medical school curricula has been challenging. Anti-obesity bias amongst healthcare providers and trainees represents a significant obstacle to the care of patients with obesity. Obesity bias may affect up to 1/3 of medical students. Methods: This study describes the development and preliminary testing of a brief, 2.5 h multi-modality teaching intervention consisting of online, interactive, and independent learning modules for first-year medical students and a patient panel focused on obesity, obesity bias, and motivational interviewing. The participants took Crandall's anti-fat attitude (AFA) questionnaire before and after an online independent learning module on motivational interviewing and obesity bias. The AFA consists of three subscales ("dislike", "fear of fat", and "willpower"). Individual responses were measured using a nine-point Likert-type response format (0 = very strongly disagree; 9 = very strongly agree). An average composite score was calculated for each subscale. Results: Data were analyzed from 103 first-year medical students enrolled at a college of medicine in the southwestern United States in 2022. The AFA mean composite scores decreased significantly, indicating a decrease in explicit anti-obesity attitude bias after completing the online module. This decrease was present in all three domains of fear (4.63 vs. 3.72, p < 0.001), dislike (1.25 vs. 0.88, p < 0.001) and willpower (3.23 vs. 2.31, p < 0.001). Conclusions: Relatively brief educational interventions can positively impact students' anti-obesity attitudes.
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Affiliation(s)
- Stephanie Trofymenko
- Department of Biomedical Sciences, Noorda College of Osteopathic Medicine, 2162 S 180 East, Provo, UT 84606, USA
| | - Randa Kutob
- Department of Family & Community Medicine, College of Medicine, University of Arizona, 655N Alvernon Way, Suite 228, Tucson, AZ 85711, USA
| | - Amit Algotar
- Department of Family & Community Medicine, College of Medicine, University of Arizona, 655N Alvernon Way, Suite 228, Tucson, AZ 85711, USA
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Alnughaymishi AA, Sekhar C. Managing Adult Obese Patients at Primary Health Care Centers in Qassim Province, Saudi Arabia. Cureus 2024; 16:e51704. [PMID: 38313932 PMCID: PMC10838558 DOI: 10.7759/cureus.51704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2024] [Indexed: 02/06/2024] Open
Abstract
Background Overweight and obesity have become a global health problem. This study aims to reduce the same problem, primarily with all levels of physicians and the hidden responsibility of all other allied health care workers and communities, including families and individuals. Objective The objective of this study is to determine the knowledge, attitude, and practice among the physicians toward the management of adult obesity at primary health care centers (PHCCs) of Qassim Province, Saudi Arabia. Methods A cross-sectional study was conducted among the 140 physicians working at the PHCC of Qassim through a self-administered questionnaire. A simple random method was used for the PHCC selection, and all the physicians were included at the PHCC level. Data was collected, cleaned, and analyzed with IBM SPSS Statistics, version 21.0 (IBM Corp., Armonk, NY). Necessary statistical tests were applied. Results The mean age and standard deviation (SD) in the study population were 34.29 ± 9.42, and 55.7% were males. The mean knowledge score and SD of correct answers were 4.61 ± 1.31. About four or more questions were answered correctly out of six knowledge questions (80.7%, n = 113). Out of 13 questions, the mean ± SD of correct practice questions was 9.88 ± 2.02. The mean ± SD of attitude questions was 8.06 ± 1.13. About 33 (23.6%) of the study population received obesity training courses. Conclusions Based on the study results, good knowledge, practice, and attitude were observed among the PHCC physicians of Qassim. However, a smaller number of physicians received obesity training in the study.
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Affiliation(s)
| | - Chandra Sekhar
- Family Medicine, Family Medicine Academy, Qassim Health Cluster, Buraydah, SAU
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Rajeev ND, Samaan JS, Premkumar A, Yu E, Srinivasan N, Samakar K. Providers' Knowledge and Perceptions of Bariatric Surgery: a Systematic Review. Obes Surg 2023; 33:3571-3601. [PMID: 37740831 PMCID: PMC10603000 DOI: 10.1007/s11695-023-06827-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/21/2023] [Accepted: 09/15/2023] [Indexed: 09/25/2023]
Abstract
Bariatric surgery remains underutilized despite its proven efficacy in the management of obesity. Provider perceptions of bariatric surgery are important to consider when discussing utilization rates. PubMed, SCOPUS, and OVID databases were searched in April 2023, and 40 published studies discussing providers' knowledge and perceptions of bariatric surgery were included. There were generally positive perceptions of the efficacy of bariatric surgery, although overestimations of surgical risks and postoperative complications were common. Providers' previous training was associated with knowledge and perceptions of bariatric surgery and familiarity with perioperative management across studies. These perceptions were also associated with referral rates, suggesting that inadequate provider knowledge may contribute to bariatric surgery underutilization. We advocate for increased bariatric surgery-related education throughout all stages of medical training and across specialties.
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Affiliation(s)
- Nithya D Rajeev
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo St., Suite 514, Los Angeles, CA, 90033, USA
| | - Jamil S Samaan
- Department of Medicine, Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - Agnes Premkumar
- Department of General Surgery, Creighton University of Phoenix, 3100 N. Central Ave, Phoenix, AZ, 85012, USA
| | - Erin Yu
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo St., Suite 514, Los Angeles, CA, 90033, USA
| | - Nitin Srinivasan
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo St., Suite 514, Los Angeles, CA, 90033, USA
| | - Kamran Samakar
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo St., Suite 514, Los Angeles, CA, 90033, USA.
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Carrasco D, Thulesius H, Jakobsson U, Memarian E. Primary care physicians’ knowledge and attitudes about obesity, adherence to treatment guidelines and association with confidence to treat obesity: a Swedish survey study. BMC PRIMARY CARE 2022; 23:208. [PMID: 35971075 PMCID: PMC9378264 DOI: 10.1186/s12875-022-01811-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/15/2022] [Indexed: 12/03/2022]
Abstract
Background Obesity is a chronic disease with increasing prevalence. We aimed to explore primary care physicians’ knowledge and attitudes about obesity and how knowledge and attitudes are associated with confidence and adherence to obesity guidelines and barriers to obesity treatment. Methods A questionnaire survey was sent by e-mail to 1642 primary care physicians in four regions in Sweden. The survey focused on the physicians’ knowledge, attitudes towards obesity, confidence in obesity management, adherence to obesity guidelines and barriers to optimal care. We created different statistical indices for knowledge, attitudes and adherence. To analyse the correlation between these indices, we used linear regression analyses. Results Replies from 235 primary care physicians yielded a response rate of 14.3%. Most physicians answered correctly that obesity is a disease (91%), that obesity regulation sits in the hypothalamus (70%) and that obesity is due to disorders of appetite regulation (69%). However, 44% of the physicians thought that the most effective weight reduction method for severe obesity was lifestyle changes; 47% believed that obesity is due to lack of self-control, 14% mentioned lack of motivation and 22% stated laziness. Although 97% believed that physicians can help individuals with obesity and 56% suggested that obesity treatment should be prioritised, 87% of the physicians expressed that losing weight is the patients’ responsibility. There was a positive association between higher knowledge and better adherence to obesity guidelines (B = 0.07, CI 0.02–0.12, p-value = 0.005) and feeling confident to suggest medication (p < 0.001) or bariatric surgery (p = 0.002). While 99% of the physicians felt confident to discuss lifestyle changes, 67% and 81% were confident to suggest medication or bariatric surgery, respectively. Respondents perceived that the greatest barrier in obesity management was lack of time (69%) and resources (49%). Conclusion There was a positive association between Swedish primary care physicians’ knowledge and adherence to obesity guidelines and being more confident to suggest obesity treatment. Yet, many physicians had an ambivalent attitude towards obesity management. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01811-x.
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Chhour I, Blackshaw L, Moran LJ, Boyle JA, Robinson T, Lim SS. Barriers and facilitators to the implementation of lifestyle management in polycystic ovary syndrome: Endocrinologists' and obstetricians and gynaecologists' perspectives. PATIENT EDUCATION AND COUNSELING 2022; 105:2292-2298. [PMID: 34980547 DOI: 10.1016/j.pec.2021.12.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 12/18/2021] [Accepted: 12/21/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To study the barriers and facilitators to lifestyle management in PCOS from the perspectives of endocrinologists and obstetricians and gynecologists (Ob/Gyns) to inform the translation and implementation of the international evidence-based guideline on lifestyle management in PCOS. METHODS 11 endocrinologists and ten Ob/Gyns participated in semi-structured interviews and transcripts were thematically analyzed on NVIVO software. RESULTS Both endocrinologists and Ob/Gyns supported lifestyle as key to PCOS management but faced systemic barriers of lack of access to allied health services and had limited capacity for in-depth lifestyle discussions. They suggested team-based approach to address these barriers. Endocrinologists reported lifestyle could be a less effective treatment option and most of their patients had challenges with past failed lifestyle attempts while Ob/Gyns perceived the desire to conceive among patients a facilitator. The importance of credible, individualised and PCOS-specific lifestyle advice was highlighted. CONCLUSION Endocrinologists and Ob/Gyns perceived lifestyle management as integral to PCOS management but experience barriers to lifestyle management related to specialist care. PRACTICE IMPLICATIONS Resources that provide credible, individualized and PCOS-specific lifestyle advice, team care approach and professional development on motivating patients for lifestyle modification may address these barriers.
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Affiliation(s)
- Irene Chhour
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Lucinda Blackshaw
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Tracy Robinson
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Siew S Lim
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
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Znyk M, Zajdel R, Kaleta D. Consulting Obese and Overweight Patients for Nutrition and Physical Activity in Primary Healthcare in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7694. [PMID: 35805379 PMCID: PMC9265845 DOI: 10.3390/ijerph19137694] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/16/2022] [Accepted: 06/21/2022] [Indexed: 11/16/2022]
Abstract
The aim of this study was to evaluate the dietary and physical activity counseling provided to adults by family doctors. Predictors of counseling in primary healthcare were identified. A cross-sectional study was conducted from January 2020 to December 2021 among 896 adult primary care patients in the city of Łódź [Lodz], Poland. Almost 36% of the respondents were advised to change their eating habits, and 39.6% were advised to increase their physical activity. In a multivariate logistic regression analysis, people in poor health with chronic diseases related to overweight and obesity and with two, three or more chronic diseases, respectively, received advice on eating habits from their GP twice and three times more often than people in good health with no chronic conditions (OR = 1.81; p < 0.05 and OR = 1.63; p < 0.05; OR = 3.03; p < 0.001). People in the age groups 30−39 years and 40−49 years (OR = 1.71; p < 0.05 and OR = 1.58; p < 0.05), widowed (OR = 2.94; p < 0.05), with two, three or more chronic diseases (OR = 1.92; p < 0.01 and OR = 3.89; p < 0.001), and subjectively assessing overweight and obesity (OR = 1.61; p < 0.01) had a better chance of receiving advice on physical activity. The study found a higher proportion of advice on diet and physical activity provided to overweight and obese patients by primary care physicians than in other studies; however, still not all receive the necessary counseling. GPs should advise all patients not to become overweight and obese, not only those already affected by the problem.
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Affiliation(s)
- Małgorzata Znyk
- Department of Hygiene and Epidemiology, Medical University of Lodz, Żeligowskiego 7/9, 90-752 Łódź, Poland;
| | - Radosław Zajdel
- Department of Computer Science in Economics, University of Lodz, POW 3/5, 90-255 Łódź, Poland;
| | - Dorota Kaleta
- Department of Hygiene and Epidemiology, Medical University of Lodz, Żeligowskiego 7/9, 90-752 Łódź, Poland;
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Griauzde DH, Othman A, Dallas C, Oshman L, Gabison J, Markel DS, Richardson CR, Kullgren JT, Piatt G, Heisler M, Kilbourne AM, Kraftson A. Developing weight navigation program to support personalized and effective obesity management in primary care settings: protocol for a quality improvement program with an embedded single-arm pilot study. Prim Health Care Res Dev 2022; 23:e14. [PMID: 35234116 PMCID: PMC8919179 DOI: 10.1017/s1463423621000906] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/03/2021] [Accepted: 11/29/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Primary care providers (PCPs) are expected to help patients with obesity to lose weight through behavior change counseling and patient-centered use of available weight management resources. Yet, many PCPs face knowledge gaps and clinical time constraints that hinder their ability to successfully support patients' weight loss. Fortunately, a small and growing number of physicians are now certified in obesity medicine through the American Board of Obesity Medicine (ABOM) and can provide personalized and effective obesity treatment to individual patients. Little is known, however, about how to extend the expertise of ABOM-certified physicians to support PCPs and their many patients with obesity. AIM To develop and pilot test an innovative care model - the Weight Navigation Program (WNP) - to integrate ABOM-certified physicians into primary care settings and to enhance the delivery of personalized, effective obesity care. METHODS Quality improvement program with an embedded, 12-month, single-arm pilot study. Patients with obesity and ≥1 weight-related co-morbidity may be referred to the WNP by PCPs. All patients seen within the WNP during the first 12 months of clinical operations will be compared to a matched cohort of patients from another primary care site. We will recruit a subset of WNP patients (n = 30) to participate in a remote weight monitoring pilot program, which will include surveys at 0, 6, and 12 months, qualitative interviews at 0 and 6 months, and use of an electronic health record (EHR)-based text messaging program for remote weight monitoring. DISCUSSION Obesity is a complex chronic condition that requires evidence-based, personalized, and longitudinal care. To deliver such care in general practice, the WNP leverages the expertise of ABOM-certified physicians, health system and community weight management resources, and EHR-based population health management tools. The WNP is an innovative model with the potential to be implemented, scaled, and sustained in diverse primary care settings.
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Affiliation(s)
- Dina H. Griauzde
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Medical School, Ann Arbor, MI, USA
- University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Amal Othman
- Department of Family Medicine, University of Michigan, Medical School, Ann Arbor, MI, USA
| | - Chris Dallas
- Department of Internal Medicine, University of Michigan, Medical School, Ann Arbor, MI, USA
| | - Lauren Oshman
- Department of Family Medicine, University of Michigan, Medical School, Ann Arbor, MI, USA
| | - Jonathan Gabison
- Department of Family Medicine, University of Michigan, Medical School, Ann Arbor, MI, USA
| | - Dorene S. Markel
- Department of Learning Health Sciences, University of Michigan, Medical School, Ann Arbor, MI, USA
| | - Caroline R. Richardson
- University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
- Department of Family Medicine, University of Michigan, Medical School, Ann Arbor, MI, USA
| | - Jeffrey T. Kullgren
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Medical School, Ann Arbor, MI, USA
- University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
- Department of Health Management and Policy, University of Michigan, School of Public Health, Ann Arbor, MI, USA
| | - Gretchen Piatt
- Department of Learning Health Sciences, University of Michigan, Medical School, Ann Arbor, MI, USA
- Department of Health Behavior and Health Education, University of Michigan, School of Public Health, Ann Arbor, MI, USA
| | - Michele Heisler
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Medical School, Ann Arbor, MI, USA
- University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Amy M. Kilbourne
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
- Department of Learning Health Sciences, University of Michigan, Medical School, Ann Arbor, MI, USA
| | - Andrew Kraftson
- Department of Internal Medicine, University of Michigan, Medical School, Ann Arbor, MI, USA
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Chianelli M, Busetto L, Attanasio R, Disoteo O, Borretta G, Persichetti A, Samperi I, Scoppola A, Paoletta A, Grimaldi F, Papini E, Nicolucci A. Obesity management: Attitudes and practice of Italian endocrinologists. Front Endocrinol (Lausanne) 2022; 13:1061511. [PMID: 36733804 PMCID: PMC9888662 DOI: 10.3389/fendo.2022.1061511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/23/2022] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Obesity is a global pandemic and is cause of serious concern in all regions of the world. It is important to raise the attention of health care professionals in order to provide early treatment of patients with obesity. Obesity management, however, varies greatly amongst endocrinologists with respect to attitudes to diagnosis and treatment. Aim of this study was to identify practices and needs of Italian endocrinologists with respect to people with obesity. METHODS In this study, all members of the Italian Association of Clinical Endocrinologists (AME) were invited to participate in a web-based survey concerning the management of obesity. RESULTS The response rate was 24.1% (542/2248). Nutritional and obesity problems were reported as major areas of interest by 29.4% of the participants. A large proportion of patients seeking an endocrine consultation for other reasons are affected by obesity, but one in five respondents addressed the issue in 25% or less of the cases, while one in three always dealt with the problem. Obesity was managed personally/within a dedicated team by 42.6% of participants, while the remainders referred the patient to a dietician/nutritionist or a 2nd level center for obesity therapy. Metformin was used in a median of 30% of the patients (Interquartile range: 10-50) and liraglutide in 10% of the cases (IQR 0-30), while orlistat (median 0%; IQR 0-10) and naltrexone/bupropion (median 0%; IQR 0-5) were seldom prescribed. Cost of therapy was considered as the major limitation to the use of anti-obesity drugs, affecting adherence to long-term treatment. According to 41.9% of respondents, psychological support should be offered to all patients with obesity. Finally, 56% of participants believe that the availability of new drugs will increase the number of patients candidate to drug therapy. DISCUSSION In conclusion, it is of primary importance to raise the awareness of endocrinologists towards the problem of obesity and increase their confidence in managing this pathological condition.
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Affiliation(s)
- Marco Chianelli
- Endocrinology Unit, Regina Apostolorum Hospital, Rome, Italy
- Endocrinology and Metabolism - Regina Apostolorum Hospital, Roma, Italy
- *Correspondence: Marco Chianelli,
| | - Luca Busetto
- Department of Medicine, University of Padova, Padova, Italy
| | - Roberto Attanasio
- Scientific Committee of the Italian Association of Clinical Endocrinologists, Milan, Italy
| | | | - Giorgio Borretta
- Department of Endocrinology, Diabetes and Metabolism, Santa Croce & Carle Hospital, Cuneo, Italy
| | - Agnese Persichetti
- Service of Pharmacovigilance, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Irene Samperi
- SSD of Diabetology, Azienda Sanitaria Locale, Novara, Italy
| | | | | | - Franco Grimaldi
- Endocrinology, Diseases of Metabolism and Clinical Nutrition Unit, University Hospital S.M. Misericordia, Udine, Italy
| | - Enrico Papini
- Endocrinology and Metabolism - Regina Apostolorum Hospital, Roma, Italy
| | - Antonio Nicolucci
- Center for Outcomes Research and Clinical Epidemiology - CORESEARCH, Pescara, Italy
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General Practitioner's Knowledge about Bariatric Surgery Is Associated with Referral Practice to Bariatric Surgery Centers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910055. [PMID: 34639357 PMCID: PMC8508327 DOI: 10.3390/ijerph181910055] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 09/20/2021] [Accepted: 09/20/2021] [Indexed: 11/16/2022]
Abstract
(1) Background: Patients seeking treatment for obesity and related diseases often contact general practitioners (GPs) first. The aim of this study was to evaluate GPs’ knowledge about weight loss surgery (WLS) and potential stereotypes towards obese patients. (2) Methods: For this prospective cohort study, 204 GPs in the region of the bariatric surgery center at the University Hospital Aachen were included. The participants filled out a questionnaire comprising general treatment of obese patients, stigmatization towards obese patients (1–5 points) as well as knowledge regarding WLS (1–5 points). (3) Results: The mean age of the GPs was 54 years; 41% were female. Mean score for self-reported knowledge was 3.6 points out of 5. For stigma-related items, the mean score was 3.3 points out of 5. A total of 60% of the participants recognized bariatric surgery as being useful. Knowledge about bariatric surgery significantly correlated with the number of referrals to bariatric surgery centers (p < 0.001). No significant correlation was found between stigma and referral to surgery (p = 0.057). (4) Conclusions: The more GPs subjectively know about bariatric surgery, the more often they refer patients to bariatric surgery specialists—regardless of potentially present stereotypes. Therefore, GPs should be well informed about indications and opportunities of WLS.
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Pirotta S, Joham AE, Moran LJ, Skouteris H, Lim SS. Informing a PCOS Lifestyle Program: Mapping Behavior Change Techniques to Barriers and Enablers to Behavior Change Using the Theoretical Domains Framework. Semin Reprod Med 2021; 39:143-152. [PMID: 34433214 DOI: 10.1055/s-0041-1735456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This article aimed to identify the behavior change techniques (BCTs) based on facilitators and barriers to lifestyle management in women with polycystic ovary syndrome (PCOS) according to the behavior change wheel (BCW). This qualitative study design using inductive thematic analysis following semistructured interviews (n = 20) identified barriers and enablers to lifestyle management. These were then mapped to Capability, Opportunity, Motivation-Behavioral Model (COM-B) constructs and the corresponding Theoretical Domains Framework (TDF) domains. This study included women with PCOS residing in Australia. Main outcome measures include intervention functions, policy categories, and BCTs described in the BCW. Twenty-three BCTs were recognized to influence behavior change in women with PCOS. Factors were categorized into the subcomponents of the COM-B: psychological capability (e.g., lack of credible information), physical capability (e.g., managing multiple health conditions), physical opportunity (e.g., limited access to resources), social opportunity (e.g., adequate social support), reflective motivation (e.g., positive health expectancies following behavior change), and automatic motivation (e.g., emotional eating). Future research should use this work to guide PCOS lifestyle intervention development and then test intervention effectiveness through an experimental phase to provide empirical evidence for wider use and implementation of tailored, theory-informed PCOS lifestyle programs as part of evidence-based PCOS management.
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Affiliation(s)
- Stephanie Pirotta
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - A E Joham
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Department of Diabetes, Monash Health, Clayton, Victoria, Australia
| | - L J Moran
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - H Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Warwick Business School, Warwick University, Coventry, United Kingdom
| | - S S Lim
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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12
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Memarian E, Carrasco D, Thulesius H, Calling S. Primary care physicians' knowledge, attitudes and concerns about bariatric surgery and the association with referral patterns: a Swedish survey study. BMC Endocr Disord 2021; 21:62. [PMID: 33832469 PMCID: PMC8030650 DOI: 10.1186/s12902-021-00723-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/21/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Obesity prevalence is increasing globally. Bariatric surgery is an effective treatment for severe and complex obesity resulting in significant and sustained weight loss. In Sweden, most bariatric surgery patients are referred by primary care physicians. We aimed to explore barriers for physicians to refer patients with severe and complex obesity for bariatric surgery. METHODS A questionnaire survey was in 2019 emailed to 1100 primary care physicians in the Skåne and Kronoberg regions in south Sweden. The survey focused on referral patterns, knowledge and attitudes towards bariatric surgery and concerns about postoperative complications. We created different statistical indices for referral patterns, knowledge, attitudes and concerns about bariatric surgery. To analyze the correlation between these indices, we did Spearman's correlations and regression analyses. RESULTS Of 1100 email respondents, we received 157 (14%) completed surveys. Among 157 physician respondents, 73% answered that they had good knowledge about the referral criteria for bariatric surgery, whereas 55 and 60% answered correctly to two items on criteria for bariatric surgery. A majority of respondents (84%) stated that their patients initiated referral to bariatric surgery. Half of the respondents had concerns about postoperative medical and surgical complications, but another half had a positive attitude to bariatric surgery as a treatment for obesity comorbidities. Almost half of the respondents (44%) answered that they needed to learn more about bariatric surgery. We found significant positive correlations between high knowledge and referral patterns (r = 0.292, p < 0.001) and positive attitudes (r = 0.235, p < 0.001) respectively. We found significant reverse correlations between concerns and referral patterns (r = - 0.355, p < 0.001) and between positive attitudes and concerns (r = - 0.294, p < 0.001). In logistic regression high levels of concerns explained low willingness to refer for bariatric surgery (Odds Ratio 0.2, 95% confidence interval 0.1-0.7). CONCLUSION According to this Swedish survey among primary care physicians, high levels of concerns about bariatric surgery among physicians seemed to be a barrier to refer patients with severe and complex obesity for bariatric surgery. Since high knowledge about obesity and bariatric surgery correlated negatively to concerns and positively to favorable attitudes to bariatric surgery, more knowledge about obesity and bariatric surgery is warranted.
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Affiliation(s)
- Ensieh Memarian
- Department of Clinical Sciences in Malmö, Lund University, Internal Medicine Research Group, Jan Waldenströms gata 15, 5th floor, Skane University Hospital, S-20502, Malmö, Sweden.
| | - Daniel Carrasco
- Department of Clinical Sciences in Malmö, Lund University, Internal Medicine Research Group, Jan Waldenströms gata 15, 5th floor, Skane University Hospital, S-20502, Malmö, Sweden
| | - Hans Thulesius
- Center for Primary Health Care Research Region Skåne and Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden
- Linnaeus University, Kalmar, Sweden
| | - Susanna Calling
- Center for Primary Health Care Research Region Skåne and Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden
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Abstract
BACKGROUND Each year from 2011 to 2017, fewer than 1% of eligible Americans underwent bariatric surgery to treat obesity and obesity-related comorbidities. Recent studies have suggested that a lack of knowledge within the primary care specialty about the safety and efficacy of bariatric surgery greatly affects referral. This study aimed to analyze a large cohort of primary care physicians' (PCPs) clinical perceptions regarding bariatric surgery and to identify major barriers to referral that could inform the implementation of a future educational strategy to address underutilization of bariatric surgery. STUDY DESIGN A prospective anonymous electronic survey was sent to all primary care physicians at a multicenter community-based academic hospital system between March and June of 2018, with 150 respondents, a response rate of 28%. The survey was composed of eleven questions in total, the first eight utilizing a five-point Likert scale, with answers including strongly disagree, disagree, neutral, agree, and strongly agree. The final three questions utilized freeform answers of numbers or text where appropriate. RESULTS Between 83 and 88% of PCPs responded favorably, either agree or strongly agree, to questions regarding the utility of bariatric surgery as an efficacious and valuable tool for the treatment of obesity and related comorbidities. PCPs reported an average body mass index (BMI) of 40.4 ± 5.0 kg/m2 at which bariatric surgery is a patient's best option for weight loss and an average BMI of 38.0 ± 5.6 kg/m2 at which surgery is the best option for management of comorbidities. Eighty-six percent of PCPs agree that having a BMI over 40 kg/m2 is a greater risk to a patient's long-term health than undergoing bariatric surgery. However, only 46.6% of PCPs claimed any familiarity with the NIH eligibility criteria for bariatric surgery and only 59.5% responded affirmatively that they were comfortable participating in the long-term care of a postoperative bariatric patient. The two highest reported barriers to referral for bariatric surgery together account for 40% of PCPs responses: 21.5% of PCPs report concern regarding surgical complications and/or long-term side effects as the primary barrier for referral, and 18.5% report concern for ineffective weight loss after bariatric surgery as a primary barrier to referral. CONCLUSION Results of this study indicate that despite largely positive attitudes toward the use of bariatric surgery in a patient population with obesity, primary care physicians report significant barriers to confidently referring their own patients. Further, bariatric surgery is overlooked in a large group of patients with BMIs between 35 and 40 kg/m2. Educational strategies to address these barriers should target rates of specific surgical complications and weight loss outcomes.
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14
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Schwenke M, Luppa M, Pabst A, Welzel FD, Löbner M, Luck-Sikorski C, Kersting A, Blüher M, Riedel-Heller SG. Attitudes and treatment practice of general practitioners towards patients with obesity in primary care. BMC FAMILY PRACTICE 2020; 21:169. [PMID: 32807094 PMCID: PMC7433134 DOI: 10.1186/s12875-020-01239-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 08/02/2020] [Indexed: 11/29/2022]
Abstract
Background Obesity is one of the most common and relevant health problems in need of urgent action in Germany. General practitioners (GPs) are the initial contact and thus one of the most important starting points for the successful treatment of overweight and obesity. The aim of the study was to assess the treatment practice and attitudes towards patients with obesity in primary health care in Germany. Methods Analyses were based on baseline data of the INTERACT trial of 47 GPs in central Germany. Stigmatizing attitudes were identified using the Fat Phobia Scale (FPS). In addition, questionnaires including sociodemographic information, attribution of causes of obesity, referral behavior and clinical activities were completed. Statistical investigations include descriptive analysis, principal component analysis, inference statistics and linear regression models. Results GPs rated the quality of medical care for patients with obesity in Germany as below average. The FPS score revealed a value of 3.70, showing that GPs’ attitudes towards patients with obesity are stigmatizing. Younger GP age, male gender and a lower number of referrals to specialists were associated with higher levels of stigmatizing attitudes. Conclusion Weight-related stigmatization has an impact on medical treatment. Obesity management guides would help to increase knowledge and reduce weight-related stigmatization in primary care, thereby improving medical care for obese and overweight patients.
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Affiliation(s)
- Maria Schwenke
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany. .,Integrated Research and Treatment Centre (IFB) Adiposity Diseases, Leipzig University Medical Center, Leipzig, Germany.
| | - Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany
| | - Franziska D Welzel
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany
| | - Margrit Löbner
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany
| | - Claudia Luck-Sikorski
- Integrated Research and Treatment Centre (IFB) Adiposity Diseases, Leipzig University Medical Center, Leipzig, Germany.,SRH University of Applied Health Sciences, Gera, Germany
| | - Anette Kersting
- Clinic for Psychosomatic Medicine and Psychotherapy, University Hospital Leipzig, University of Leipzig, Leipzig, Germany
| | - Matthias Blüher
- Integrated Research and Treatment Centre (IFB) Adiposity Diseases, Leipzig University Medical Center, Leipzig, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany.,Institute of General Medicine, University of Leipzig, Leipzig, Germany
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15
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Croghan IT, Ebbert JO, Njeru JW, Rajjo TI, Lynch BA, DeJesus RS, Jensen MD, Fischer KM, Phelan S, Kaufman TK, Schroeder DR, Rutten LJF, Crane SJ, Tulledge-Scheitel SM. Identifying Opportunities for Advancing Weight Management in Primary Care. J Prim Care Community Health 2020; 10:2150132719870879. [PMID: 31496342 PMCID: PMC6734618 DOI: 10.1177/2150132719870879] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: Much has been written about the patients' perspective concerning weight management in health care. The purpose of this survey study was to assess perspectives of primary care providers (PCPs) and nurses toward patient weight management and identify possible areas of growth. Patients and Methods: We emailed a weight management-focused survey to 674 eligible participants (437 [64.8%] nurses and 237 [35.2%] PCPs) located in 5 outpatient primary care clinics. The survey focused on opportunities, practices, knowledge, confidence, attitudes, and beliefs. A total of 219 surveys were returned (137 [62.6%] from nurses and 82 [34.4%] from PCPs). Results: Among 219 responders, 85.8% were female and 93.6% were white non-Hispanic. In this study, PCPs and nurses believed obesity to be a major health problem. While PCPs felt more equipped than nurses to address weight management (P < .001) and reported receiving more training than nurses (50.0% vs 17.6%, respectively), both felt the need for more training on obesity (73.8% and 79.4%, respectively). Although, PCPs also spent more patient contact time providing weight management services versus nurses (P < .001), the opportunity/practices score was lower for PCPs than nurses (-0.35 ± 0.44 vs -0.17 ± 0.41, P < .001) with PCPs more likely to say they lacked the time to discuss weight and they worried it would cause a poor patient-PCP relationship. The knowledge/confidence score also differed significantly between the groups, with nurses feeling less equipped to deal with weight management issues than PCPs (-0.42 ± 0.43 vs -0.03 ± 0.55, P < .001). Neither group seemed very confident, with those in the PCP group only answering with an average score of neutral. Conclusion: By asking nurses and PCP general questions about experiences, attitudes, knowledge, and opinions concerning weight management in clinical care, this survey has identified areas for growth in obesity management. Both PCPs and nurses would benefit from additional educational training on weight management.
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16
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Fujioka K, Harris SR. Barriers and Solutions for Prescribing Obesity Pharmacotherapy. Endocrinol Metab Clin North Am 2020; 49:303-314. [PMID: 32418592 DOI: 10.1016/j.ecl.2020.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
There are many valid reasons why health care providers are reluctant to use pharmacotherapy for weight management: the negative track record of weight loss medications has led to numerous safety concerns, and there is lack of formal training in obesity medicine and a general discomfort with using these medications. New medications have improved safety profiles, and their mechanisms are based on recent discoveries of how humans regulate weight. This, combined with a change in American health coverage, has slowly increased the use weight loss medication. This article examines the barriers and changes that are increasing the use of anti-obesity medications.
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Affiliation(s)
- Ken Fujioka
- Division of Diabetes and Endocrinology, Scripps Clinic Medical Group, 12395 El Camino Real, Suite 317, San Diego, CA 92130, USA
| | - Samantha R Harris
- Division of Diabetes and Endocrinology, Scripps Clinic Medical Group, 12395 El Camino Real, Suite 317, San Diego, CA 92130, USA.
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17
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Luig T, Wicklum S, Heatherington M, Vu A, Cameron E, Klein D, Sharma AM, Campbell-Scherer DL. Improving obesity management training in family medicine: multi-methods evaluation of the 5AsT-MD pilot course. BMC MEDICAL EDUCATION 2020; 20:5. [PMID: 31910854 PMCID: PMC6947955 DOI: 10.1186/s12909-019-1908-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 12/13/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Quality, evidence-based obesity management training for family medicine residents is needed to better support patients. To address this gap, we developed a comprehensive course based on the 5As of Obesity Management™ (ASK, ASSESS, ADVISE, AGREE, ASSIST), a framework and suite of resources to improve residents' knowledge and confidence in obesity counselling. This study assessed the course's impact on residents' attitudes, beliefs, and confidence with obesity counselling. METHODS The course combines lectures with a bariatric empathy suit experience, standardized and in-clinic patient practice, and narrative reflections. Using a multi-methods design we measured changes in 42 residents' attitudes, beliefs, and self-confidence and thematically analyzed the narrative reflections to understand residents' experience with the course content and pedagogy. RESULTS Following the course, residents reported improved attitudes towards people living with obesity and improved confidence for obesity counselling. Pre/post improvement in BAOP scores (n = 32) were significant (p < .001)., ATOP scores did not change significantly. Residents showed improvement in assessing root causes of weight gain (p < .01), advising patients on treatment options (p < .05), agreeing with patients on health outcomes (p < .05), assisting patients in addressing their barriers (p < .05), counseling patients on weight gain during pregnancy, (p < .05), counseling patients on depression and anxiety (p < .01), counseling patients on iatrogenic causes of weight gain (p < .01), counseling patients who have children with obesity (p < .05), and referring patients to interdisciplinary providers for care (p < .05). Qualitative analysis of narrative reflections illustrates that experiential learning was crucial in increasing residents' ability to empathically engage with patients and to critically reflect on implications for their practice. CONCLUSION The 5AsT-MD course has the potential to increase residents' confidence and competency in obesity prevention and management. Findings reflect the utility of the 5As to improve residents' confidence and competency in obesity management counselling.
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Affiliation(s)
- Thea Luig
- Office of Lifelong Learning & Physician Learning Program, University of Alberta, Edmonton, Canada
| | - Sonja Wicklum
- Cummings School of Medicine, University of Calgary, Calgary, Canada
| | - Melanie Heatherington
- Office of Lifelong Learning & Physician Learning Program, University of Alberta, Edmonton, Canada
| | - Albert Vu
- Core Internal Medicine, University of Alberta, Edmonton, Canada
| | - Erin Cameron
- Department of Human Sciences, Northern Ontario School of Medicine, Sudbury, Canada
| | - Doug Klein
- Department of Family Medicine, University of Alberta, Edmonton, Canada
| | - Arya M. Sharma
- Department of Medicine, Division of Endocrinology, University of Alberta, Edmonton, Canada
- Alberta Diabetes Institute, University of Alberta, Edmonton, Canada
| | - Denise L. Campbell-Scherer
- Office of Lifelong Learning & Physician Learning Program, University of Alberta, Edmonton, Canada
- Department of Family Medicine, University of Alberta, Edmonton, Canada
- Alberta Diabetes Institute, University of Alberta, Edmonton, Canada
- 2-590 Edmonton Clinic Health Academy, Office of Lifelong Learning/Physician Learning Program, University of Alberta, Edmonton, AB T6G 1C9 Canada
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18
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Koliaki C, Tzeravini E, Papachristoforou E, Severi I, El Deik E, Karaolia M, Noutsou M, Thanopoulou A, Kountouri A, Balampanis K, Lambadiari V, Tentolouris N, Kokkinos A. Eligibility and Awareness Regarding Metabolic Surgery in Patients With Type 2 Diabetes Mellitus in the Real-World Clinical Setting; Estimate of Possible Diabetes Remission. Front Endocrinol (Lausanne) 2020; 11:383. [PMID: 32582036 PMCID: PMC7292012 DOI: 10.3389/fendo.2020.00383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/14/2020] [Indexed: 01/06/2023] Open
Abstract
Despite high-quality evidence highlighting metabolic surgery as an effective treatment option for type 2 diabetes mellitus (T2DM), the number of patients receiving bariatric surgery (BS) remains low. Since the introduction of the Diabetes Surgery Summit II (DSS-II) eligibility criteria, data on eligibility rates for BS in T2DM cohorts remain scarce. The aims of the present study were to examine in a real-world clinical setting: (i) what is the percentage of T2DM patients visiting diabetes outpatient clinics who meet the DSS-II eligibility criteria, (ii) how many of these have been informed about the option of BS, and (iii) what are the characteristics associated with eligibility and awareness of BS. Demographic, anthropometric, clinical and socioeconomic data were obtained for all patients with T2DM who were consecutively examined in the outpatient clinics of three large-volume university hospitals (n = 1167). A medical registry form was completed to screen for BS eligibility. Patients were considered eligible if the recommendation by DSS-II criteria was either to "consider" or "recommend" BS. Eligible patients were further inquired whether they had ever been informed about the option of BS by their physicians. The advanced DiaRem score (ADRS) was applied to eligible patients to assess their probability of achieving postoperative T2DM remission. A significant percentage of T2DM patients who are routinely assessed in outpatient clinics meet the DSS-II eligibility criteria (15.3%). Eligible patients are younger and more obese, have a shorter T2DM duration, worse glycaemic control and better renal function, compared to non-eligible ones. Among eligible patients, only 39.3% have been medically informed about the option of BS. Informed patients are younger and more severely obese than non-informed ones. A significant percentage of non-informed patients (35%) have an ADRS ≤10, indicating a considerable probability for T2DM remission after BS, and are thus deprived of this opportunity due to lack of appropriate medical counseling. Screening and awareness of BS remain an unmet need in current T2DM management. Future research should focus on intensifying screening for BS eligibility at every medical visit and promoting evidence-based clinical recommendations for patients expected to benefit the most.
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Affiliation(s)
- Chrysi Koliaki
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Evangelia Tzeravini
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Eleftheria Papachristoforou
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Ioanna Severi
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Elina El Deik
- Diabetes Center, Second Department of Internal Medicine, Medical School, Hippokratio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Melina Karaolia
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Marina Noutsou
- Diabetes Center, Second Department of Internal Medicine, Medical School, Hippokratio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Thanopoulou
- Diabetes Center, Second Department of Internal Medicine, Medical School, Hippokratio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Kountouri
- Second Department of Internal Medicine and Research Institute, Medical School, National and Kapodistrian University of Athens, Attikon General Hospital, Athens, Greece
| | - Konstantinos Balampanis
- Second Department of Internal Medicine and Research Institute, Medical School, National and Kapodistrian University of Athens, Attikon General Hospital, Athens, Greece
| | - Vaia Lambadiari
- Second Department of Internal Medicine and Research Institute, Medical School, National and Kapodistrian University of Athens, Attikon General Hospital, Athens, Greece
| | - Nicholas Tentolouris
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Alexander Kokkinos
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
- *Correspondence: Alexander Kokkinos
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Blackshaw LCD, Chhour I, Stepto NK, Lim SS. Barriers and Facilitators to the Implementation of Evidence-Based Lifestyle Management in Polycystic Ovary Syndrome: A Narrative Review. Med Sci (Basel) 2019; 7:medsci7070076. [PMID: 31252682 PMCID: PMC6681274 DOI: 10.3390/medsci7070076] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 01/22/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is a complex condition that involves metabolic, psychological and reproductive complications. Insulin resistance underlies much of the pathophysiology and symptomatology of the condition and contributes to long term complications including cardiovascular disease and diabetes. Women with PCOS are at increased risk of obesity which further compounds metabolic, reproductive and psychological risks. Lifestyle interventions including diet, exercise and behavioural management have been shown to improve PCOS presentations across the reproductive, metabolic and psychological spectrum and are recommended as first line treatment for any presentation of PCOS in women with excess weight by the International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2018. However, there is a paucity of research on the implementation lifestyle management in women with PCOS by healthcare providers. Limited existing evidence indicates lifestyle management is not consistently provided and not meeting the needs of the patients. In this review, barriers and facilitators to the implementation of evidence-based lifestyle management in reference to PCOS are discussed in the context of a federally-funded health system. This review highlights the need for targeted research on the knowledge and practice of PCOS healthcare providers to best inform implementation strategies for the translation of the PCOS guidelines on lifestyle management in PCOS.
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Affiliation(s)
- Lucinda C D Blackshaw
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria 3168, Australia.
| | - Irene Chhour
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria 3168, Australia.
| | - Nigel K Stepto
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria 3168, Australia.
- Institute for Health and Sport, Victoria University, Melbourne, Victoria 8001, Australia.
- Australian Institute for Musculoskeletal Science (AIMSS), Victoria University, St. Albans, Victoria 3021, Australia.
- Medicine- Western Health, Faculty of Medicine, Dentistry and Health Science, Melbourne University, Melbourne, Victoria 3000, Australia.
| | - Siew S Lim
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria 3168, Australia.
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20
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Roebroek YGM, Talib A, Muris JWM, van Dielen FMH, Bouvy ND, van Heurn LWE. Hurdles to Take for Adequate Treatment of Morbidly Obese Children and Adolescents: Attitudes of General Practitioners Towards Conservative and Surgical Treatment of Paediatric Morbid Obesity. World J Surg 2019; 43:1173-1181. [PMID: 30478687 DOI: 10.1007/s00268-018-4874-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Bariatric surgery is regarded as the most effective treatment of morbid obesity in adults. Referral patterns for bariatric surgery in adults differ among general practitioners (GPs), partially due to restricted knowledge of the available treatment options. Reluctance in referral might be present even stronger in the treatment of morbidly obese children. OBJECTIVES The aim of this study was to investigate the current practice of GPs regarding treatment of paediatric morbid obesity and their attitudes towards the emergent phenomenon of paediatric weight loss surgery. METHODS All GPs enlisted in the local registries of two medical centres were invited for a 15-question anonymous online survey. RESULTS Among 534 invited GPs, 184 (34.5%) completed the survey. Only 102 (55.4%) reported providing or referring morbidly obese children for combined lifestyle interventions. A majority (n = 175, 95.1%) estimated that conservative treatment is effective in a maximum of 50% of children. Although 123 (66.8%) expect that bariatric surgery may be effective in therapy-resistant morbid obesity, only 76 (41.3%) would consider referral for surgery. Important reasons for reluctance were uncertainty about long-term efficacy and safety. The opinion that surgery is only treatment of symptoms and therefore not appropriate was significantly more prevalent amongst GPs who would not refer (58.3% vs. 27.6%, p < 0.001). CONCLUSION There is a potential for undertreatment of morbidly obese adolescents, due to suboptimal knowledge regarding guidelines and bariatric surgery, as well as negative attitudes towards surgery. This should be addressed by improving communication between surgeons and GPs and providing educational resources on bariatric surgery.
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Affiliation(s)
- Yvonne G M Roebroek
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, NL-6229 HX, Maastricht, The Netherlands.
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
| | - Ali Talib
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, NL-6229 HX, Maastricht, The Netherlands
| | - Jean W M Muris
- Department of Family Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | | | - Nicole D Bouvy
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, NL-6229 HX, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - L W Ernest van Heurn
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Pediatric Surgery, Emma Children's Hospital, Academic Medical Center/VU University Medical Center, Amsterdam, The Netherlands
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21
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Aboueid S, Pouliot C, Nur T, Bourgeault I, Giroux I. Dietitians' perspectives on patient barriers and enablers to weight management: An application of the social-ecological model. Nutr Diet 2019; 76:353-362. [PMID: 30609185 DOI: 10.1111/1747-0080.12510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 10/27/2018] [Accepted: 11/19/2018] [Indexed: 11/30/2022]
Abstract
AIM Dietitians are nutrition experts who conduct nutrition assessments and provide support to patients seeking to manage their weight. The aim of the present study was to assess dietitians' perspectives on the barriers and enablers encountered by patients during their weight management journey. METHODS Fourteen individual semi-structured interviews were conducted over a 3-month period in 2017 with dietitians working in Ontario, Canada. All interviews were audio-recorded and transcribed verbatim. Two researchers coded the data independently using a directed content analysis approach. RESULTS Emerging themes were classified at societal, community, relationship, individual levels of the social-ecological model (SEM). Barriers included low socioeconomic status, 'go big or go home approach', lack of knowledge and cooking skills, lack of time, emotional eating, unsupportive home and work environments, discrimination and weight bias, lack of communication between health professionals, and low accessibility to healthy foods. Enablers included community programs, workplaces promoting healthy behaviours, and ongoing clinical support. Dietitians mentioned that patients encounter many barriers that may coexist and hinder weight management and/or maintenance of lost weight. CONCLUSIONS Communication between health team members and ongoing patient support in the clinical setting are required. A whole-of-government, whole-of-society approach is needed to target the various aforementioned barriers at various level of the SEM.
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Affiliation(s)
- Stephanie Aboueid
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Catherine Pouliot
- Department of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Teeyaa Nur
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Ivy Bourgeault
- Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
| | - Isabelle Giroux
- Department of Nutrition Sciences, University of Ottawa, Ottawa, Ontario, Canada
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Iwamoto S, Saxon D, Tsai A, Leister E, Speer R, Heyn H, Kealey E, Juarez-Colunga E, Gudzune K, Bleich S, Clark J, Bessesen D. Effects of Education and Experience on Primary Care Providers' Perspectives of Obesity Treatments during a Pragmatic Trial. Obesity (Silver Spring) 2018; 26:1532-1538. [PMID: 30257072 PMCID: PMC6168402 DOI: 10.1002/oby.22223] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 05/08/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine the impact of a 1-year pragmatic obesity trial on primary care providers' (PCPs) perspectives of treatment. METHODS PCPs from four intervention clinics (PCP-I) and five control clinics (PCP-C) completed pre- and postintervention surveys on weight-loss counseling, comfort discussing obesity treatments, and perceived effectiveness of interventions; questions were rated on 0 to 10 Likert scales. Only PCP-I received patient updates and education about obesity management. RESULTS Eighty PCPs completed preintervention surveys (pre: 71% female, 71% physicians); 82 PCPs completed postintervention surveys (post: 66% female, 70% physicians). PCPs were most comfortable discussing exercise before and after the trial (pre PCP-C: 8.22 [1.44], mean [standard deviation (SD)]; post PCP-C: 8.37 [1.24]; P = 0.8; pre/post PCP-I: 7.88 [1.51] vs. 7.80 [1.71]; P = 0.3). PCPs were initially least comfortable discussing phentermine/topiramate extended release (ER) but developed significantly more comfort after the trial, to a greater degree among PCP-I (pre/post PCP-C: 2.86 [2.66] vs. 3.73 [2.72], P < 0.001; pre/post PCP-I: 4.00 [2.57] vs. 6.17 [2.27], P < 0.001). After the trial, both PCPs rated exercise significantly less effective for weight loss, with a greater decrease in effectiveness rations among PCP-I (pre/post PCP-C: 7.73 [1.94] vs. 6.93 [2.35], P = 0.017; pre/post PCP-I: 6.27 [2.69] vs. 5.15 [2.31], P = 0.001). Both PCPs rated phentermine (pre/post PCP-C: 5.03 [2.05] vs. 5.50 [2.12], P = 0.002; pre/post PCP-I: 5.70 [1.64] vs. 6.83 [1.18], P = 0.001) and phentermine/topiramate ER (pre/post PCP-C: 3.91 [2.33] vs. 5.47 [2.54], P < 0.001; pre/post PCP-I: 5.58 [2.21] vs. 7.02 [1.47], P < 0.001) significantly more effective after the trial, though ratings were higher among PCP-I. CONCLUSIONS PCPs initially overvalued exercise and undervalued weight-loss medications. PCPs exposed to education and experience gave higher comfort and effectiveness ratings to weight-loss medications.
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Affiliation(s)
- Sean Iwamoto
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
- Department of Endocrinology, Veterans Affairs Eastern Colorado Health Care System, Denver, CO, USA
| | - David Saxon
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
- Denver/Seattle Center of Innovation for Veteran-Centered and Values Driven Care, Department of Endocrinology, Veterans Affairs Eastern Colorado Health Care System, Denver, CO, USA
| | - Adam Tsai
- Department of Internal Medicine and Metabolic-Surgical Weight Management, Kaiser Permanente Colorado, Denver, CO, USA
| | - Erin Leister
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA
- Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine, Aurora, CO, USA
| | - Rebecca Speer
- Department of Medicine, Section of Endocrinology, Denver Health Medical Center, Denver, CO, USA
| | - Hilde Heyn
- Department of Medicine, Section of Endocrinology, Denver Health Medical Center, Denver, CO, USA
| | - Elizabeth Kealey
- Anschutz Health and Wellness Center, University of Colorado at Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Elizabeth Juarez-Colunga
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA
- Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine, Aurora, CO, USA
| | - Kimberly Gudzune
- Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University, Baltimore, MD, USA
| | - Sara Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jeanne Clark
- Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University, Baltimore, MD, USA
| | - Daniel Bessesen
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
- Department of Medicine, Section of Endocrinology, Denver Health Medical Center, Denver, CO, USA
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Hite A, Victorson D, Elue R, Plunkett BA. An Exploration of Barriers Facing Physicians in Diagnosing and Treating Obesity. Am J Health Promot 2018; 33:217-224. [PMID: 29986601 DOI: 10.1177/0890117118784227] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To determine whether primary care physicians can accurately assess body mass index (BMI) by visual inspection and to assess barriers related to the diagnosis and management of obesity. DESIGN Prospective Survey Study. SETTING Hospitals and Clinics. SUBJECTS Primary care providers in the fields of Internal Medicine, Family Medicine and Obstetrics/Gynecology. MEASURES Measures investigated included providers visual assessment of BMI, BMI knowledge, diagnosis and management of obese patients, and perceived barriers to treatment. ANALYSIS Top and bottom quartiles and total scores were determined for responses regarding the reported management of obesity, reported comfort with care, and reported barriers to care and used as the cut point. Statistical analyses were utilized to examine relations and compare groups. RESULTS 206 (74%) of the 280 eligible providers completed the survey. The accuracy of visual assessment of BMI was 52%. Physicians were more likely to underestimate BMI than overestimate (36% ± 4% vs 12% ± 6%, respectively, P < .001). Although 91% of providers report routinely calculating BMI, only 61% routinely discuss BMI. Providers feel comfortable providing exercise (72%) and dietary counseling (61%). However, fewer are comfortable prescribing medical (16.4%) and surgical options (36%). CONCLUSION Visual assessment of BMI is not reliable. Primary care physicians in our study population do not consistently discuss obesity with their patients and many report insufficient knowledge with regard to treatment options. Further studies are needed to determine whether these results are valid for other physicians in various practice settings and to mid-level providers. In addition, research is needed that investigate how collaboration with providers outside the medical field could reduce the burden on physicians in treating patients with overweight or obesity.
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Affiliation(s)
- Ashley Hite
- 1 Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Pritzker School of Medicine, University of Chicago, Evanston, IL, USA
| | - David Victorson
- 2 Department of Medical Social Science, Northwestern University, Chicago, IL, USA
| | - Rita Elue
- 1 Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Pritzker School of Medicine, University of Chicago, Evanston, IL, USA
| | - Beth A Plunkett
- 1 Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Pritzker School of Medicine, University of Chicago, Evanston, IL, USA
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24
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Shentow-Bewsh R, Zuberi D. Reducing the prevalence of obesity in Canada: a call to action. SOCIAL WORK IN PUBLIC HEALTH 2018; 33:329-341. [PMID: 29897305 DOI: 10.1080/19371918.2018.1482252] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
With rates of obesity among adults and youth rising in Canada, it is clear that the current approaches currently used to reduce the prevalence of obesity, with an emphasis on individual weight management interventions focused on restrictive dieting, are not proving successful at a population level. Given that obesity is associated with poor physical and mental health outcomes, is placing a multi-billion-dollar economic burden on Canada and disproportionately affects disadvantaged groups, such as Aboriginal Canadians and women of low socioeconomic status, it is a health and social issue that must be addressed immediately by social workers and policy makers. This article discusses the benefits of implementing a multifaceted population-level intervention that is health centered, evidence based, antistigmatizing to obese individuals, and accessible to all Canadians. The proposed intervention includes increased education for primary care physicians, the development of walkable neighborhoods, taxation of junk food, financial incentives, clear nutrition labelling, public awareness campaigns, regulation of food advertising (especially targeted to children), and school-based health promotion initiatives. This article also discusses the unique role that social workers must play in leading the charge against the stigmatization of obese individuals, while also championing policies to effectively reduce the prevalence of obesity in Canada.
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Affiliation(s)
| | - Daniyal Zuberi
- a Factor-Inwentash Faculty of Social Work, Toronto, Canada
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25
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Falvo AM, Hite Philp F, Eid GM. Primary care provider management of patients with obesity at an integrated health network: A survey of practices, views, and knowledge. Surg Obes Relat Dis 2018; 14:1149-1154. [PMID: 29929858 DOI: 10.1016/j.soard.2018.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 04/28/2018] [Accepted: 05/02/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Obesity is a serious health problem that affects a wide range of patients and disease processes. OBJECTIVE The purpose of this study is to evaluate perceptions, knowledge, and practice habits of primary care providers (PCPs) regarding the care of patients with obesity, including barriers to effective care and their experience with bariatric surgery in our integrated health network. SETTING Integrated health network. METHODS A 16-question survey was distributed electronically to 160 PCPs at our integrated health network. Results were analyzed to identify attitudes, knowledge, practice habits, and bariatric surgery referral patterns while treating patients with obesity. RESULTS Among 160 PCPs, 45 (28.1%) responded. Specialty, sex, patient population, insurance accepted, and practice years of PCPs were reported. Most PCPs reported "always" calculating patient body mass index (88.9%) with only 13.3% "always" discussing the body mass index results. Respondents most frequently prescribed diet and exercise to patients with obesity and rarely prescribed medications, with bariatric surgery referrals falling between the two. PCPs viewed management of obesity as the responsibility of the patient (97.6%) and the PCP (100%). Ninety-three percent felt obesity is a common diagnosis in their practice, but no one correctly identified the prevalence of obesity in our region. Respondents demonstrated adequate knowledge regarding medical consequences of obesity. A majority was able to identify the correct eligibility criteria for bariatric surgery, as well specific medical problems that can improve or be eliminated postoperatively. While 61.9% of respondents were aware of free weight loss and bariatric informational sessions offered, 28.6% reported that they were unfamiliar with existing bariatric surgeons. One respondent was not aware of any bariatric surgery performed. Some PCPs reported prior negative experiences with post-bariatric surgery patients, and thus were hesitant to refer additional patients. CONCLUSIONS PCPs report discussing an obesity diagnosis with patients but are not always using body mass index in that discussion. They most often prescribe lifestyle modification as treatment for patients, which they believe to be most effective to treat obesity. However, they report only one third of their patients are motivated to lose weight. Additionally, they demonstrate appropriate knowledge of indications and benefits of bariatric surgery. A majority of the PCPs is aware of weight loss informational sessions and bariatric services provided within our integrated health network, but almost one third were unable to identify a surgeon, a possible target for improved relationships. Barriers to care include patient motivation and insurance coverage.
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Affiliation(s)
| | | | - George M Eid
- Allegheny Health Network, Pittsburgh, Pennsylvania
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Zacharoulis D, Bakalis V, Zachari E, Sioka E, Tsimpida D, Magouliotis D, Tasiopoulou V, Chatedaki C, Tzovaras G. Current knowledge and perception of bariatric surgery among Greek doctors living in Thessaly. Asian J Endosc Surg 2018; 11:138-145. [PMID: 29105338 DOI: 10.1111/ases.12436] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 08/29/2017] [Accepted: 09/03/2017] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The purpose of this study was to assess doctors' knowledge, current conceptions, and clinical practice regarding obesity and bariatric surgery. METHODS A self-administered survey was administered to 500 doctors with varying medical specialties in public and private practice. RESULTS The response rate was 60%. Most participants (77.3%) were in private practice. Although almost half of the participants could define morbid obesity and obesity-related comorbidities, only 8.7% felt educated about bariatric surgery. Participants had little knowledge of various types of bariatric procedures. A minority of doctors (24.7%) knew of the existence of a bariatric center in their area. Only 21.3% of doctors had referred a patient to a bariatric center. Reasons for non-referral included lack of interest in bariatric surgery (37.3%), patient refusal (35.3%), increased operative fees (17.3%), lack of confidence in bariatric surgery (6.3%), and lack of access to a nearby bariatric center (3.7%). The majority of doctors were interested in learning more about bariatric surgery and related guidelines, but they remained reluctant to conduct patients' postoperative follow-ups. CONCLUSION The penetration of bariatric surgery in the medical community remains limited, despite its proven effectiveness in facilitating sustained weight loss and resolving several obesity-related comorbidities. A great effort should be made to inform health-care providers about the evolution of bariatric procedures, the potential benefits they offer, and the existence of certified bariatric centers. This will allow doctors to provide optimum health care to patients who could benefit from bariatric surgery.
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Affiliation(s)
- Dimitris Zacharoulis
- Department of Surgery, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Vissarion Bakalis
- Department of Surgery, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Eleni Zachari
- Department of Surgery, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Eleni Sioka
- Department of Surgery, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Dialecthi Tsimpida
- Department of Surgery, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Dimitrios Magouliotis
- Department of Surgery, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Vasiliki Tasiopoulou
- Department of Surgery, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Christina Chatedaki
- Department of Surgery, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - George Tzovaras
- Department of Surgery, University Hospital of Larissa, University of Thessaly, Larissa, Greece
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27
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Simon R, Lahiri SW. PROVIDER PRACTICE HABITS AND BARRIERS TO CARE IN OBESITY MANAGEMENT IN A LARGE MULTICENTER HEALTH SYSTEM. Endocr Pract 2018; 24:321-328. [PMID: 29561192 DOI: 10.4158/ep-2017-0221] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To identify provider recommendations and barriers in obesity management in a multicenter academic health system with extensive weight-loss management resources. METHODS A 26-question online survey was sent to attending physicians, trainees, and advanced practice providers in primary care specialties (internal medicine, family medicine, women's health) and endocrinology. RESULTS The survey response rate was 26% (111/430). Of respondents, 50% were internal medicine, 24% family medicine, 16% women's health, and 9% endocrinology. The majority were attending physicians (54%) and residents (40%). About 50% of respondents advised weight loss for a body mass index (BMI) >30 kg/m2 in >50% of clinic visits. Limited time (82%) was the most common reason for not discussing weight loss, followed by the perception that discussion would not change patient behavior, insufficient knowledge, and discomfort broaching the subject. Common barriers to prescribing anti-obesity medications included limited experience (57%) and concern for adverse reactions (26%). Only 44% offered bariatric surgery to >50% of their patients who met criteria. Primary reasons for not referring included concerns of high surgical risk from comorbidities (57%) and potential adverse events (32%). Endocrinology had the highest referral to surgery. Attending physicians and fellows were more likely than residents to advise weight loss at lower BMI, offer medications, and refer to bariatric surgery. CONCLUSION Our study reveals reluctance and lack of primary care confidence in managing obesity with pharmacotherapy and bariatric surgery, especially in the earlier stages of obesity. Barriers to care include lack of clinic time, limited experience, and concerns about treatment risks. ABBREVIATIONS BMI = body mass index; HbA1c = hemoglobin A1c; IRB = Institutional Review Board.
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28
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Imbus JR, Voils CI, Funk LM. Bariatric surgery barriers: a review using Andersen's Model of Health Services Use. Surg Obes Relat Dis 2017; 14:404-412. [PMID: 29249585 DOI: 10.1016/j.soard.2017.11.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 11/06/2017] [Indexed: 12/20/2022]
Abstract
Severe obesity affects nearly 20 million adults in the United States and is associated with significant morbidity and mortality. Bariatric surgery is the most effective treatment for weight loss and resolution of obesity-related co-morbidities. Of adults with severe obesity,<1% undergo bariatric surgery annually. Both contextual (health system, clinicians, and community) and individual factors contribute to the underutilization of bariatric surgery. In this review, we summarize potential barriers to undergoing bariatric surgery within the framework of Andersen's Behavioral Model of Health Services Use.
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Affiliation(s)
- Joseph R Imbus
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, Wisconsin
| | - Corrine I Voils
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, Wisconsin; William S. Middleton Veterans Memorial Hospital, Madison, Wisconsin
| | - Luke M Funk
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, Wisconsin; William S. Middleton Veterans Memorial Hospital, Madison, Wisconsin.
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29
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Metcalf M, Rossie K, Stokes K, Tanner B. The Perceptions of Medical School Students and Faculty Toward Obesity Medicine Education: Survey and Needs Analysis. JMIR MEDICAL EDUCATION 2017; 3:e22. [PMID: 29122740 PMCID: PMC5701085 DOI: 10.2196/mededu.7361] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 08/23/2017] [Accepted: 09/10/2017] [Indexed: 05/09/2023]
Abstract
BACKGROUND Recent trends in obesity show that over two-thirds of US adults are considered at least overweight (body mass index, BMI≥25 kg/m2) and of those, about one-third are categorized as obese (BMI≥30 kg/m2). Physicians can address the health impacts of obesity; yet research has suggested that physicians-in-training frequently fail to recognize obesity, are not properly educated regarding treatment options, and spend relatively little clinic time treating obesity. Medical school is a unique opportunity to address this area of need so that the doctors of tomorrow are prepared to treat obesity appropriately. OBJECTIVES The objective of this study was to determine perceptions of where clinical training for medical students on the topic of obesity and its treatment should improve and expand so that we could address the needs identified in a computerized clinical simulation. METHODS We conducted a literature review, as well as a needs analysis with medical school students (N=17) and faculty (N=12). Literature review provided an overview of the current state of the field. Students provided input on their current needs, learning preferences, and opinions. Faculty provided feedback on current training and their perceptions of future needs. RESULTS Most students were familiar with obesity medicine from various courses where obesity medicine was a subtopic, most frequently in Biochemistry or Nutrition, Endocrinology, and Wellness courses. Student knowledge about basic skills, such as measuring waist circumference, varied widely. About half of the students did not feel knowledgeable about recommending weight loss treatments. Most students did not feel prepared to provide interventions for patients in various categories of overweight/obesity, patients with psychosocial issues, obesity-related comorbidities, or failed weight loss attempts. However, most students did feel that it was their role as health professionals to provide these interventions. Faculty rated the following topics as most important to supplement the curriculum: patient-centered treatment of weight, bringing up the topic of weight, discussing weight and well-being, discussing the relationship between weight and comorbidities, and physician role with overweight or obese patients. CONCLUSIONS A review of the literature as well as surveyed medical students and faculty identified a need for supplementation of the current obesity medicine curriculum in medical schools. Specific needed topics and skills were identified.
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Affiliation(s)
- Mary Metcalf
- Clinical Tools, Inc., Chapel Hill, NC, United States
| | - Karen Rossie
- Clinical Tools, Inc., Chapel Hill, NC, United States
| | - Katie Stokes
- Clinical Tools, Inc., Chapel Hill, NC, United States
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Hainer V, Tsigos C, Toplak H, Micic D. Comment on the Paper by Uerlich et al: Obesity Management in Europe: Current Status and Objectives for the Future. Obes Facts 2016;9:273-283. Obes Facts 2016; 9:392-396. [PMID: 27898413 PMCID: PMC5644818 DOI: 10.1159/000452249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 09/30/2016] [Indexed: 11/19/2022] Open
Affiliation(s)
- Vojtech Hainer
- Obesity Management Center, Institute of Endocrinology, Prague, Czech Republic
| | - Constantine Tsigos
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Hermann Toplak
- Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Dragan Micic
- Medical Faculty, University of Belgrade, Belgrade, Serbia
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Abstract
Obesity is commonly encountered in veterinary patients. Although there are various published dietary approaches to achieving weight loss, successful long-term prevention of weight regain has proven elusive. Adding environmental and behavioral treatment strategies to a weight loss plan may help the veterinary team, the pet, and the pet owner maximize the effectiveness of the program. Because the owner directly affects the environment and behavior of the pet undergoing a weight loss plan, treatment strategies with an emphasis on owner involvement is the focus of this review. Veterinary use of the 5 A's behavioral counseling approach with the pet owner is discussed.
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Affiliation(s)
- Maryanne Murphy
- Department of Clinical Nutrition, Red Bank Veterinary Hospital, 197 Hance Avenue, Tinton Falls, NJ 07724, USA.
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32
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Tork S, Meister KM, Uebele AL, Hussain LR, Kelley SR, Kerlakian GM, Tymitz KM. Factors Influencing Primary Care Physicians’ Referral for Bariatric Surgery. JSLS 2016; 19. [PMID: 26390524 PMCID: PMC4539491 DOI: 10.4293/jsls.2015.00046] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background and Objectives: Bariatric surgery has been shown to be an effective weight loss treatment for the morbidly obese, but some primary care physicians remain hesitant about postoperative treatment and management of patients who have undergone the surgery and recommend it to their obese patients infrequently. The purpose of this study was to evaluate perceptions of primary care physicians of the role of bariatric surgery in the management of obese patients and to identify possible barriers to treatment. Methods: A survey of PCPs within our institution was conducted to determine attitudes, knowledge, and practices regarding the treatment of morbidly obese patients, with a specific focus on identifying factors that influence referral patterns for bariatric surgery. Results: Among 161 eligible PCPs, 57 (35.4%) responded. Most respondents (59%) reported that at least 1 in 4 of their patients had a BMI ≥35 kg/m2. Although 39% thought that diet and exercise were an effective means of sustained weight loss, only 12% were satisfied with prescribing nonsurgical interventions. Sixty-three percent agreed that bariatric surgery is generally effective in the long term. All respondents were aware of the commonly established benefits, including improvement of diabetes, hypertension, and hyperlipidemia. In addition, 65% were familiar with the indications for bariatric surgery, and 70% felt comfortable discussing it with patients as a treatment option. Fewer than half of the respondents felt confident in providing postoperative management. Cost was a perceived limitation, with 53% reporting that most of their patients could not afford bariatric surgery. Conclusions: The general attitude of PCPs toward bariatric surgery is supportive. Physicians are largely aware of the indications and benefits; however, far fewer are comfortable in management of patients after surgery. A lack of supplemental information and concerns regarding the cost of surgery can impede treatment and referrals.
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Haggerty T, Xiang J, Dino G, Doyle G, King DE. Patient Attitudes toward Weight Related Discussions in Rural Appalachian Primary Care Clinics. ACTA ACUST UNITED AC 2016; 2016. [PMID: 32483392 DOI: 10.21885/wvmj.2016.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Purpose West Virginia (WV) consistently has one of the highest rates of obesity, nationally, yet previous studies suggest that conversations about weight with providers are infrequent. This study's aim was to determine frequency and type of weight-related discussions occurring in WV primary care clinics and whether discussions differed according to weight status. Methods A cross-sectional survey was completed by patients in rural primary care practices. Participants answered questions related to demographics, obesity related illnesses, experience receiving a physician mediated discussion, and attitude and beliefs related to weight. Results Among the total of 490 surveys collected, a little more than half of the participants (56.9%) have discussed weight with their physician; a majority of participants (89.5%) thought a physician should tell risks associated with an unhealthy weight; 78.3% participants felt weight loss is important to them; 86.1% participants believed weight affects their health. Participants with obesity were more likely than participants who are overweight to discuss weight with their physician (71.8 vs.44.0%, p<0.0001), and believed that their physicians helped them lose weight previously (29.4% vs 9.9%, p<0.0001) and can help them lose weight in the future (92.9% vs. 71.1, p<0.0001). Conclusion Physicians are often having weight related discussions with patients with obesity however this discussion happens less with overweight patients. Practitioners may want to be more attentive to addressing weight related issues in overweight patients.
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Affiliation(s)
- Treah Haggerty
- Department of Family Medicine, School of Medicine, West Virginia University, Morgantown, West Virginia
| | - Jun Xiang
- Department of Family Medicine, School of Medicine, West Virginia University, Morgantown, West Virginia
| | - Geri Dino
- Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, West Virginia
| | - Greg Doyle
- Department of Family Medicine, School of Medicine, West Virginia University, Morgantown, West Virginia
| | - Dana E King
- Department of Family Medicine, School of Medicine, West Virginia University, Morgantown, West Virginia
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Leiter LA, Astrup A, Andrews RC, Cuevas A, Horn DB, Kunešová M, Wittert G, Finer N. Identification of educational needs in the management of overweight and obesity: results of an international survey of attitudes and practice. Clin Obes 2015; 5:245-55. [PMID: 26238414 DOI: 10.1111/cob.12109] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/11/2015] [Accepted: 06/25/2015] [Indexed: 02/05/2023]
Abstract
Despite the availability of a growing range of interventions to assist control of body weight for people with excess weight or obesity, only a small proportion of people achieve their weight loss goals and are able to maintain body weight reductions in the long term. Negative attitudes and beliefs are often found among physicians and others involved in treating obesity and may adversely impact the effectiveness of management. In this international study, healthcare professionals were invited to complete an online survey of their attitudes and practice in the management of excess body weight. A total of 335 clinicians completed the survey of whom approximately half were based in Europe. A key finding from the survey is that, while participants are generally confident in their ability to manage overweight and obesity effectively, they also report that most of their patients are not successful in achieving their weight loss goals. At the same time, participants tended to overestimate the effectiveness of current medical management in maintaining reductions in body weight. Educational initiatives addressing the real-life effectiveness of different weight control interventions may help to close the gap between clinicians' perceptions and reality in the management of excess body weight.
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Affiliation(s)
- L A Leiter
- Division of Endocrinology and Metabolism, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - A Astrup
- Department of Nutrition, Exercise and Sports, and Global Energy Balance Network, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - R C Andrews
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | - A Cuevas
- Department of Clinical Nutrition, Las Condes Clinic, Santiago, Chile
| | - D B Horn
- Department of Surgery, Center for Obesity Medicine and Metabolic Performance, University of Texas Health Science Center, Houston, TX, USA
| | - M Kunešová
- Institute of Endocrinology, Obesity Management Centre, Charles University, Prague, Czech Republic
| | - G Wittert
- Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - N Finer
- UCLH Centre for Weight Loss, Metabolic and Endocrine Surgery, University College London Hospitals, London, UK
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Kim KK, Yeong LL, Caterson ID, Harris MF. Analysis of factors influencing general practitioners' decision to refer obese patients in Australia: a qualitative study. BMC FAMILY PRACTICE 2015; 16:45. [PMID: 25887524 PMCID: PMC4396120 DOI: 10.1186/s12875-015-0262-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/30/2015] [Indexed: 01/19/2023]
Abstract
Background Referral for both lifestyle and surgical interventions are recommended as part of the clinical management of obesity in general practice. However, current practice falls short of this. This qualitative study aimed to describe the factors influencing general practitioners’ (GPs) referral intentions for their obese patients. Methods Semi-structured qualitative interviews were conducted with 24 GPs from four geographically different areas in New South Wales, Australia about the management of their obese patients. A qualitative analysis was applied using inductive thematic analysis. Results The predominant factors influencing GPs’ referral were their own attitudes and experience, and their patient’s motivation. Lifestyle intervention Referrals were usually initiated by GPs and influenced by their patients and the local health system. Referrals to conduct bariatric surgery were frequently initiated by the patient and influenced by GPs’ limited previous experience, patients’ expectations and ability to pay, as well as professional and legal issues. There was no strong link between referral and the remoteness of areas or the availability of surgical referral services. Conclusion There were differences between GPs reported referral behaviour for lifestyle and surgical interventions. GPs’ attitudes to referral were often formed by their limited case experience rather than by a review of more systematic evidence, especially for surgical interventions. These patterns may be improved by educating and better communicating with GPs about the outcomes for their patients when they are referred. Electronic supplementary material The online version of this article (doi:10.1186/s12875-015-0262-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kyoung Kon Kim
- Department of Family Medicine, Gachon University Gil Medical Centre, 774beon-gil 21, Namdongdae-ro, Namdong-gu, Incheon, Korea.
| | - Lin-Lee Yeong
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Ian D Caterson
- Boden Institute, University of Sydney, Sydney, Australia.
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW 2052, Australia.
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Wong MS, Gudzune KA, Bleich SN. Provider communication quality: influence of patients' weight and race. PATIENT EDUCATION AND COUNSELING 2015; 98:492-8. [PMID: 25617907 PMCID: PMC4379992 DOI: 10.1016/j.pec.2014.12.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 10/25/2014] [Accepted: 12/21/2014] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To examine the relationship between patient weight and provider communication quality and determine whether patient race/ethnicity modifies this association. METHODS We conducted a cross-sectional analysis with 2009-2010 medical expenditures panel survey-household component (N=25,971). Our dependent variables were patient report of providers explaining well, listening, showing respect, and spending time. Our independent variables were patient weight status and patient weight-race/ethnicity groups. Using survey weights, we performed multivariate logistic regression to examine the adjusted association between patient weight and patient-provider communication measures, and whether patient race/ethnicity modifies this relationship. RESULTS Compared to healthy weight whites, obese blacks were less likely to report that their providers explained things well (OR 0.78; p=0.02) or spent enough time with them (OR 0.81; p=0.04), and overweight blacks were also less likely to report that providers spent enough time with them (OR 0.78; p=0.02). Healthy weight Hispanics were also less likely to report adequate provider explanations (OR 0.74; p=0.04). CONCLUSION Our study provides preliminary evidence that overweight/obese black and healthy weight Hispanic patients experience disparities in provider communication quality. PRACTICE IMPLICATION Curricula on weight bias and cultural competency might improve communication between providers and their overweight/obese black and healthy weight Hispanic patients.
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Affiliation(s)
- Michelle S Wong
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, USA.
| | - Kimberly A Gudzune
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Sara N Bleich
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, USA
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Cooke NK, Nietfeld JL, Goodell LS. The development and validation of the childhood obesity prevention self-efficacy (COP-SE) survey. Child Obes 2015; 11:114-21. [PMID: 25585108 DOI: 10.1089/chi.2014.0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Physicians can play an important role in preventing and treating childhood obesity. There are currently no validated measures of medical students' self-efficacy in these skills; therefore, we sought to develop a valid and reliable computerized survey to measure medical students' self-efficacy in skills needed to prevent and treat childhood obesity. METHODS We developed the Childhood Obesity Prevention Self-Efficacy (COP-SE) survey with input from two expert panels and cognitive interviews with medical students. We administered the 43-item COP-SE computerized survey to a nation-wide sample of medical students. RESULTS The final sample consisted of 444 medical students from 53 medical schools. Exploratory factor analysis revealed a two-factor structure with a correlation of 0.637 between factors and high reliability within factors. The correlation between the COP-SE and a measure of general self-efficacy was moderate (0.648), and reliability within factors was high (Factor 1=0.946; Factor 2=0.927). CONCLUSIONS The 18-item COP-SE is a valid and reliable measure of childhood obesity prevention self-efficacy. Factor 1 assesses self-efficacy in nutrition counseling, and Factor 2 measures self-efficacy to assess readiness to change and initiate nutrition lifestyle changes. The correlation between the COP-SE and a measure of general self-efficacy indicates that the COP-SE is a distinct, valid assessment of domain-specific self-efficacy. The high reliability of items within factors indicates the items measure the same constructs. Therefore, medical schools can use this valid and reliable instrument as a formative or summative assessment of students' self-efficacy in childhood obesity prevention and treatment.
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Affiliation(s)
- Natalie K Cooke
- 1 Department of Food, Bioprocessing, and Nutrition Sciences, North Carolina State University , Raleigh, NC
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Glauser TA, Roepke N, Stevenin B, Dubois AM, Ahn SM. Physician knowledge about and perceptions of obesity management. Obes Res Clin Pract 2015; 9:573-83. [PMID: 25791741 DOI: 10.1016/j.orcp.2015.02.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 02/24/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Approximately 35% of US adults are obese. The purpose of this study was to assess the knowledge and practice patterns of primary care physicians (PCPs), endocrinologists (ENDOs), cardiologists (CARDs) and bariatricians (BARIs) regarding obesity. METHODS A case vignette survey was distributed to 1625 US-based PCPs, ENDOs, CARDs, and BARIs via email and fax in February 2013. Results were analysed with PASW Statistics 18. RESULTS Respondents included 100 PCPs, 100 ENDOs, 70 CARDs, and 30 BARIs. The majority agreed obesity is a disease as defined by the AMA, however, half of PCPs, ENDOs, and CARDs also agreed obesity results from a lack of self-control. Familiarity with select obesity guidelines was low. Nearly all respondents used body mass index for obesity screening. No consensus as to when to initiate weight-loss medication was observed. Many physicians expected a larger weight loss with pharmacotherapy than is realistic (∼ 30%) or were unsure (∼ 22%). A majority of PCPs, ENDOs and CARDs expected less excess weight loss with gastric bypass surgery than is realistic, BARIs had a more reasonable expectation. CONCLUSIONS Overall, respondents demonstrated knowledge gaps for obesity guidelines and pathophysiology and generally lacked understanding of obesity medication efficacy, safety and MOA.
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Affiliation(s)
- Terry Ann Glauser
- CE Outcomes, LLC, 107 Frankfurt Circle, Birmingham, AL 35211, United States.
| | - Nancy Roepke
- CE Outcomes, LLC, 107 Frankfurt Circle, Birmingham, AL 35211, United States
| | - Boris Stevenin
- Novo Nordisk, 800 Scudders Mill Road, Plainsboro, NJ 08536, United States
| | - Anne Marie Dubois
- Novo Nordisk, 800 Scudders Mill Road, Plainsboro, NJ 08536, United States
| | - Soo Mi Ahn
- Novo Nordisk, 800 Scudders Mill Road, Plainsboro, NJ 08536, United States
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Aronne L, Shanahan W, Fain R, Glicklich A, Soliman W, Li Y, Smith S. Safety and Efficacy of Lorcaserin: A Combined Analysis of the BLOOM and BLOSSOM Trials. Postgrad Med 2015; 126:7-18. [DOI: 10.3810/pgm.2014.10.2817] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Herman BK, Safikhani S, Hengerer D, Atkins N, Kim A, Cassidy D, Babcock T, Agus S, Lenderking WR. The patient experience with DSM-5-defined binge eating disorder: characteristics, barriers to treatment, and implications for primary care physicians. Postgrad Med 2014; 126:52-63. [PMID: 25295650 DOI: 10.3810/pgm.2014.09.2800] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Binge eating disorder (BED) is now a formal diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). However, post-DSM-5 patient profiles and viewpoints on BED diagnosis and treatment remain unclear. This study used a focus group methodology to examine demographic and clinical characteristics, as well as perceptions of diagnosis and treatment from patients with BED symptoms who were either formally diagnosed with BED or undiagnosed. METHODS Binge eating disorder-diagnosed individuals (n = 11) or those meeting the DSM-5 BED diagnostic criteria but were undiagnosed (n = 14) participated in 6 semistructured focus groups conducted by trained staff at 3 geographic locations in the United States. Patients completed a series of demographic and clinical measures and then engaged in a moderated discussion focused on identifying factors associated with their experiences with BED. RESULTS Sixty percent of the patients were female, 48% were white and 40% were black, and 76% were employed. The diagnosed group had a slightly higher socioeconomic status; undiagnosed patients had a higher average body mass index. In the overall sample, comorbid anxiety (40%) and depression (40%) were the most common psychiatric comorbidities. Even in the diagnosed group, only half of the patients (54.5%) became aware of BED through their health care provider (HCP; n = 6). Patients perceived that HCPs were focused more on physical ailments, were judgmental about weight, and were unable to distinguish BED from obesity. They also expressed a desire for safe, nonjudgmental interactions with HCPs. CONCLUSIONS Education and income may be factors affecting access to care and BED diagnosis. Both patient groups reported considerable psychopathology and medical comorbidities. Moreover, the patient groups perceived HCPs as both having inadequate understanding of BED and providing insensitive and ineffective communication regarding eating behaviors. The study findings in diagnosed and undiagnosed patient groups underscore the need for greater BED disease state awareness and patient sensitivity among HCPs.
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Pouchard L, Jésus P, Fayemendy P, Desport J. P136: Évaluation par les patients de la prise en charge (PEC) de leur obésité en médecine générale et suggestions d’amélioration. NUTR CLIN METAB 2014. [DOI: 10.1016/s0985-0562(14)70778-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Acosta A, Azzalin A, Emmons CJ, Shuster JJ, Jay M, Lo MC. Improving residents' clinical approach to obesity: impact of a multidisciplinary didactic curriculum. Postgrad Med J 2014; 90:630-7. [PMID: 25214540 DOI: 10.1136/postgradmedj-2014-132821] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND/OBJECTIVES Obesity has been declared a 21st century pandemic by WHO. Yet surveys reveal physicians-in-training are uncomfortable managing obesity. One major barrier is the lack of residency education on obesity management. This study incorporates an obesity-specific didactic curriculum into an internal medicine (IM) residency programme and assesses its impact on residents' knowledge, attitudes, practice behaviours, and clinical outcomes in patients with obesity. METHODS The intervention consisted of four, 1 h, obesity-specific lectures in the University of Florida Resident Noon Conference. Lectures were taught by multidisciplinary experts and offered to 75 IM residents every 2 weeks from 5 November 2010 to 17 December 2010. Impact on IM residents' knowledge and attitudes was assessed by a pre- and post-intervention Obesity Awareness Questionnaire (OAQ). IM residents' clinical performance was assessed by chart reviews of 238 patients with body mass index >25 kg/m(2) in residents' clinics 4 months pre- and 6 months post-intervention for three clinical outcomes and seven practice behaviours on obesity management. Pre- and post-intervention outcomes were compared via paired t tests (quantitative data) or McNemar's test (binary data). RESULTS Mean lecture attendance was 25/75 residents (33%) per lecture. Survey response was 67/75 residents (89%) pre-OAQ and 63/75 residents (84%) post-OAQ. While most attitudes remained unchanged, IM residents gained significant confidence in exercise counselling, safety of bariatric surgery, and patients' weight loss potential; they were more likely to address obesity in the plan and referrals to bariatric surgery. Clinical outcomes and IM residents' knowledge demonstrated no improvement. CONCLUSIONS Our brief lecture-based curriculum has the potential to improve IM residents' attitudes and practice behaviours towards obesity. The lack of improvement in clinical outcomes and resident knowledge prompts the need for multimodal, longitudinal curricula with experiential application of obesity medicine.
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Affiliation(s)
- Andres Acosta
- Division of Internal Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Alice Azzalin
- Division of Internal Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Claudia J Emmons
- Division of Internal Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Jonathan J Shuster
- Department of Health Outcomes and Policy, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Melanie Jay
- Departments of Medicine and Population Health, New York Harbor Veteran Affairs Administration, New York University School of Medicine, New York, New York, USA
| | - Margaret C Lo
- Division of Internal Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
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Rurik I, Torzsa P, Ilyés I, Szigethy E, Halmy E, Iski G, Kolozsvári LR, Mester L, Móczár C, Rinfel J, Nagy L, Kalabay L. Primary care obesity management in Hungary: evaluation of the knowledge, practice and attitudes of family physicians. BMC FAMILY PRACTICE 2013; 14:156. [PMID: 24138355 PMCID: PMC3853764 DOI: 10.1186/1471-2296-14-156] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 10/15/2013] [Indexed: 12/02/2022]
Abstract
Background Obesity, a threatening pandemic, has an important public health implication. Before proper medication is available, primary care providers will have a distinguished role in prevention and management. Their performance may be influenced by many factors but their personal motivation is still an under-researched area. Methods The knowledge, attitudes and practice were reviewed in this questionnaire study involving a representative sample of 10% of all Hungarian family physicians. In different settings, 521 practitioners (448 GPs and 73 residents/vocational trainees) were questioned using a validated questionnaire. Results The knowledge about multimorbidity, a main consequence of obesity was balanced. Only 51% of the GPs were aware of the diagnostic threshold for obesity; awareness being higher in cities (60%) and the highest among residents (90%). They also considered obesity an illness rather than an aesthetic issue. There were wider differences regarding attitudes and practice, influenced by the the doctors’ age, gender, known BMI, previous qualification, less by working location. GPs with qualification in family medicine alone considered obesity management as higher professional satisfaction, compared to physicians who had previously other board qualification (77% vs 68%). They measured their patients’ waist circumference and waist/hip ratio (72% vs 62%) more frequently, provided the obese with dietary advice more often, while this service was less frequent among capital-based doctors who accepted the self-reported body weight dates by patients more commonly. Similar reduced activity and weight-measurement in outdoor clothing were more typical among older doctors. Diagnosis based on BMI alone was the highest in cities (85%). Consultations were significantly shorter in practices with a higher number of enrolled patients and were longer by female providers who consulted longer with patients about the suspected causes of developing obesity (65% vs 44%) and offered dietary records for patients significantly more frequently (65% vs 52%). Most of the younger doctors agreed that obesity management was a primary care issue. Doctors in the normal BMI range were unanimous that they should be a model for their patients (94% vs 81%). Conclusion More education of primary care physicians, available practical guidelines and higher community involvement are needed to improve the obesity management in Hungary.
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Affiliation(s)
- Imre Rurik
- Department of Family and Occupational Medicine, Faculty of Public Health, Medical and Health Science Center, University of Debrecen, Nagyerdei krt, 98, 4032, Debrecen, Hungary.
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Merrell J, Ashton K, Windover A, Heinberg L. Psychological risk may influence drop-out prior to bariatric surgery. Surg Obes Relat Dis 2012; 8:463-9. [PMID: 22465088 DOI: 10.1016/j.soard.2012.01.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Revised: 01/30/2012] [Accepted: 01/30/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Factors necessitating a delay before psychological clearance for bariatric surgery have been previously identified; however, research has not examined why patients who begin the preoperative evaluation fail to complete surgery or drop-out of bariatric programs. This study sought to explore the potential psychosocial reasons for a failure to reach bariatric surgery. The setting was an academic medical center. METHODS Data were analyzed from 129 patients psychologically evaluated for bariatric surgery who had failed to reach surgery after 15 months. Medical records were reviewed for demographics, body mass index, and psychiatric variables. RESULTS The most common reasons for not reaching surgery included withdrawal from the program, outstanding program requirements, self-canceled surgery, moving out of the area, insurance denial, switching to non-surgical weight management, or death. Patients with outstanding program requirements were psychosocially different from patients who had not achieved surgery for other reasons. They were significantly more likely to be involved in outpatient behavioral health treatment (chi-square = 12.90, P < .05), to be taking psychotropic medications (chi-square = 15.17, P < .05), and to have met the criteria for current or past alcohol abuse/dependence (chi-square = 23.70, P < .01), and there was a trend for previous inpatient hospitalizations (chi-square = 11.59, P < .07). CONCLUSION Patients who failed to complete outstanding program requirements often had significant psychiatric and/or substance abuse/dependence issues that required additional treatment. It is possible that these patients drop-out of the program due to unwillingness to complete psychiatric treatment recommendations. Continued screening of high-risk patients and the education of patients on the importance of managing these risks is indicated. However, patients may choose to leave programs once education has been provided or treatment mandated.
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Affiliation(s)
- Julie Merrell
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
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