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Sudat SEK, Huang Q, Szwerinski N, Romanelli RJ, Azar KMJ. Changes in Healthcare Utilization After Lifestyle Intervention for Weight Loss. Am J Prev Med 2024; 66:619-626. [PMID: 37907133 PMCID: PMC10957326 DOI: 10.1016/j.amepre.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/27/2023] [Accepted: 10/27/2023] [Indexed: 11/02/2023]
Abstract
INTRODUCTION This study evaluates the real-world impact of a lifestyle change program (LCP) on healthcare utilization in a large health system. METHODS Using electronic health record data from a large health system in northern California, U.S., LCP participant and propensity-score-matched nonparticipant outcomes were compared in the second year post-participation: (1) overall healthcare utilization and (2) utilization and medications related to cardiometabolic conditions and obesity. Adult LCP participants between 2010 and 2017 were identified and matched 1:1 with replacement to comparable nonparticipants. Participants without electronic health record activity in the 12-36 months before baseline, or with conditions or procedures associated with substantial weight change, were excluded. Statistical analysis and modeling were performed in 2021-22. RESULTS Compared to matched nonparticipants, LCP participants in the 12-24 months post-baseline were more likely to have specialty-care visits (+4.7%, 95% CI +1.8%, +7.6%), electronic communications (8.6%, 95% CI +5.6%, +11.7%), and urgent-care visits (+6.5%, 95% CI +3.0%, 10.0%). Participants also had more office visits for cardiometabolic conditions and obesity (+1.72 visits/patient, 95% CI +1.05, +2.39). CONCLUSIONS Compared with matched nonparticipants, LCP participation was associated with higher utilization of outpatient services post-participation. Additional research could assess whether this indicates an increase in preventive care that could lead to improved future outcomes.
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Affiliation(s)
- Sylvia E K Sudat
- Sutter Health, Center for Health Systems Research, Walnut Creek, California.
| | - Qiwen Huang
- Sutter Health, Center for Health Systems Research, Palo Alto, California
| | - Nina Szwerinski
- Sutter Health, Center for Health Systems Research, Palo Alto, California
| | | | - Kristen M J Azar
- Sutter Health, Center for Health Systems Research, Palo Alto, California; Sutter Health, Institute for Advancing Health Equity, Sacramento, California; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
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Vuppalanchi R, Bonkovsky HL, Ahmad J, Barnhart H, Durazo F, Fontana RJ, Gu J, Khan I, Kleiner DE, Koh C, Rockey DC, Phillips EJ, Li YJ, Serrano J, Stolz A, Tillmann HL, Seeff LB, Hoofnagle JH, Navarro VJ. Garcinia cambogia, Either Alone or in Combination With Green Tea, Causes Moderate to Severe Liver Injury. Clin Gastroenterol Hepatol 2022; 20:e1416-e1425. [PMID: 34400337 PMCID: PMC9004424 DOI: 10.1016/j.cgh.2021.08.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Garcinia cambogia, either alone or with green tea, is commonly promoted for weight loss. Sporadic cases of liver failure from G cambogia have been reported, but its role in liver injury is controversial. METHODS Among 1418 patients enrolled in the Drug-Induced Liver Injury Network (DILIN) from 2004 to 2018, we identified 22 cases (adjudicated with high confidence) of liver injury from G cambogia either alone (n = 5) or in combination with green tea (n = 16) or Ashwagandha (n = 1). Control groups consisted of 57 patients with liver injury from herbal and dietary supplements (HDS) containing green tea without G cambogia and 103 patients from other HDS. RESULTS Patients who took G cambogia were between 17 and 54 years, with liver injury arising 13-223 days (median = 51) after the start. One patient died, one required liver transplantation, and 91% were hospitalized. The liver injury was hepatocellular with jaundice. Although the peak values of aminotransferases were significantly higher (2001 ± 1386 U/L) in G cambogia group (P < .018), the median time for improvement in total bilirubin was significantly lower compared with the control groups (10 vs 17 and 13 days; P = .03). The presence of HLA-B∗35:01 allele was significantly higher in the G cambogia containing HDS (55%) compared with patients because of other HDS (19%) (P = .002) and those with acute liver injury from conventional drugs (12%) (P = 2.55 × 10-6). CONCLUSIONS The liver injury caused by G cambogia and green tea is clinically indistinguishable. The possible association with HLA-B∗35:01 allele suggests an immune-mediated mechanism of injury. CLINICAL TRIALS gov number: NCT00345930.
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Affiliation(s)
- Raj Vuppalanchi
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Jawad Ahmad
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Huiman Barnhart
- Duke Clinical Research Institute, Duke University, Durham, NC (Y-J. L., HB, JG)
| | - Francisco Durazo
- University of California Los Angeles Medical School, Los Angeles, CA
| | - Robert J. Fontana
- Department of Medicine, University of Michigan School of Medicine, Ann Arbor, MI
| | - Jiezhun Gu
- Duke Clinical Research Institute, Duke University, Durham, NC (Y-J. L., HB, JG)
| | - Ikhlas Khan
- National Center for Natural Products Research, University of Mississippi, University, Mississippi
| | - David E. Kleiner
- Liver Disease Research Branch, Division of Digestive Diseases and Nutrition (JHH, JS), and the Liver Diseases Branch (CK), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), and the Laboratory of Pathology (DEK), National Cancer Institute, National Institutes of Health (NIH), Bethesda, MD
| | - Christopher Koh
- Liver Disease Research Branch, Division of Digestive Diseases and Nutrition (JHH, JS), and the Liver Diseases Branch (CK), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), and the Laboratory of Pathology (DEK), National Cancer Institute, National Institutes of Health (NIH), Bethesda, MD
| | - Don C. Rockey
- Department of Medicine, Medical University of South Carolina, Charleston, SC
| | | | - Yi-Ju Li
- Duke Clinical Research Institute, Duke University, Durham, NC (Y-J. L., HB, JG)
| | - Jose Serrano
- Liver Disease Research Branch, Division of Digestive Diseases and Nutrition (JHH, JS), and the Liver Diseases Branch (CK), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), and the Laboratory of Pathology (DEK), National Cancer Institute, National Institutes of Health (NIH), Bethesda, MD
| | - Andrew Stolz
- Department of Medicine, University of Southern California School of Medicine, Los Angeles, CA
| | | | - Leonard B. Seeff
- Department of Medicine, Einstein Healthcare Network, Philadelphia, PA
| | - Jay H. Hoofnagle
- Liver Disease Research Branch, Division of Digestive Diseases and Nutrition (JHH, JS), and the Liver Diseases Branch (CK), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), and the Laboratory of Pathology (DEK), National Cancer Institute, National Institutes of Health (NIH), Bethesda, MD
| | - Victor J. Navarro
- Department of Medicine, Einstein Healthcare Network, Philadelphia, PA
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Fitch AK, Bays HE. Obesity definition, diagnosis, bias, standard operating procedures (SOPs), and telehealth: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022. OBESITY PILLARS (ONLINE) 2022; 1:100004. [PMID: 37990702 PMCID: PMC10661988 DOI: 10.1016/j.obpill.2021.100004] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 12/20/2021] [Indexed: 11/23/2023]
Abstract
Background The Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) regarding definition, diagnosis, bias, standard operating procedures (SOPs) and telehealth is intended to provide clinicians an overview of obesity medicine and provide basic organizational tools towards establishing, directing, managing, and maintaining an obesity medical practice. Methods This CPS is based upon published scientific citations, clinical perspectives of OMA authors, and peer review by Obesity Medicine Association leadership. Results OMA has defined obesity as: "A chronic, progressive, relapsing, and treatable multi-factorial, neurobehavioral disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic, biomechanical, and psychosocial health consequences." While body mass index may be sufficiently diagnostic for populations and many patients, accurate diagnosis of adiposity in an individual may require anthropometric assessments beyond body weight alone (e.g., waist circumference, percent body fat, and android/visceral fat). Obesity complications can be categorized as "sick fat disease" (adiposopathy) and/or "fat mass disease." Obesity complications predominantly of fat mass origins include sleep apnea and orthopedic conditions. Obesity complications due to adiposopathic endocrinopathies and/or immunopathies include cardiovascular disease, cancer, elevated blood sugar, elevated blood pressure, dyslipidemia, fatty liver, and alterations in sex hormones in both males (i.e., hypogonadism) and females (i.e., polycystic ovary syndrome). Obesity treatment begins with proactive steps to avoid weight bias, including patient-appropriate language, office equipment, and supplies. To help manage obesity and its complications, this CPS provides a practical template for an obesity medicine practice, creation of standard operating procedures, and incorporation of the OMA "ADAPT" method in telehealth (Assessment, Diagnosis, Advice, Prognosis, and Treatment). Conclusions The OMA CPS regarding "Obesity Definition, Diagnosis, Bias, Standard Operating Procedures (SOPs), and Telehealth" is one in a series of OMA CPSs designed to assist clinicians care for patients with the disease of obesity.
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Affiliation(s)
- Angela K. Fitch
- Massachusetts General Hospital Weight Center, Harvard Medical School, 50 Staniford Street Suite 430, Boston, MA, 02114, USA
| | - Harold E. Bays
- Louisville Metabolic and Atherosclerosis Research Center, University of Louisville School of Medicine, 3288 Illinois Avenue, Louisville, KY, 40213, USA
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JaKa MM, Dinh JM, Rivard RL, Herrmann SD, Spoonheim J, Pronk NP, Ziegenfuss JY. Pragmatic Evaluation of a Health System-Based Employee Weight Management Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5901. [PMID: 34072841 PMCID: PMC8199381 DOI: 10.3390/ijerph18115901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/20/2021] [Accepted: 05/25/2021] [Indexed: 11/30/2022]
Abstract
Objective: We aimed to evaluate the fidelity and estimate the effectiveness of a novel health system employee weight-management program. Methods: Employees participating in a weight loss program consisting of self-monitoring, health coaching and meal replacements optionally enrolled in the 12-month study. Longitudinal, single-arm analyses were conducted evaluating change over time via survey, claims and programmatic data. Token participation incentives were offered for survey completion. Results: In total, 140 participants enrolled (51.2 ± 9.8 years; BMI = 33.2 ± 6.5 kg/m2; 89.3% female). During 1 year, participants attended 18.0 ± 12.2 coaching appointments and self-reported significant improvements in weight (-8.2 ± 10.5% body weight), BMI (-3.9 ± 6.5 kg/m2), fruit/vegetable intake, home food preparation, added sugar, sugar sweetened beverages and life satisfaction (all p < 0.05). No significant changes were reported in physical activity, weight-related social support, self-efficacy or healthcare utilization (all p > 0.05). Conclusions: The findings from this evaluation establish implementation fidelity. Clinically significant self-reported weight loss, coupled with improvements in many weight-related behaviors, suggest the program is an effective weight management tool when offered as an employee well-being program.
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Affiliation(s)
- Meghan M. JaKa
- HealthPartners Institute, Bloomington, MN 55425, USA; (M.M.J.); (R.L.R.); (N.P.P.); (J.Y.Z.)
| | - Jennifer M. Dinh
- HealthPartners Institute, Bloomington, MN 55425, USA; (M.M.J.); (R.L.R.); (N.P.P.); (J.Y.Z.)
| | - Rachael L. Rivard
- HealthPartners Institute, Bloomington, MN 55425, USA; (M.M.J.); (R.L.R.); (N.P.P.); (J.Y.Z.)
| | - Stephen D. Herrmann
- Sanford Research, Sioux Falls, SD 57104, USA;
- Sanford Health, Sioux Falls, SD 57117, USA
| | | | - Nicolaas P. Pronk
- HealthPartners Institute, Bloomington, MN 55425, USA; (M.M.J.); (R.L.R.); (N.P.P.); (J.Y.Z.)
- HealthPartners, Bloomington, MN 55425, USA;
| | - Jeanette Y. Ziegenfuss
- HealthPartners Institute, Bloomington, MN 55425, USA; (M.M.J.); (R.L.R.); (N.P.P.); (J.Y.Z.)
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Minimally Invasive Sleeve Gastrectomy as a Surgical Treatment for Nonalcoholic Fatty Liver Disease in Liver Transplant Recipients. Transplant Proc 2019; 52:276-283. [PMID: 31889539 DOI: 10.1016/j.transproceed.2019.11.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/08/2019] [Accepted: 11/02/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Obesity is a major public health burden that affects the transplant community because of its key role in fatty liver disease and transplantation outcomes. OBJECTIVES To evaluate the role of sleeve gastrectomy in treating recurrent and de novo nonalcoholic fatty liver disease (NAFLD) in liver transplant recipients. SETTING A university hospital. METHODS We describe 2 obese liver transplant recipients with recurrent and de novo NAFLD who underwent minimally invasive metabolic and bariatric surgery. RESULTS The surgery was performed successfully, with much of the operative time consumed by enterolysis. There were no intraoperative or postoperative complications. At last follow-up appointment (16 months postoperatively), there was a mean reduction in weight (31.98 kg), body mass index (10.2 kg/m2), glycosylated hemoglobin (1.05%), alanine aminotransferase (38 IU/L), steatosis score (0.34), and fibrosis score (0.05). The mean decrease in 6-month postoperative hepatic fat quantification was 6%. CONCLUSIONS These cases show that metabolic and bariatric surgery in obese, posttransplant recipients with recurrent and de novo nonalcoholic steatohepatitis lead to improved steatosis and reduced obesity and obesity-associated comorbidities.
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Krishnaswami A, Sidney S, Sorel M, Smith W, Ashok R. Temporal Changes in Health Care Utilization among Participants of a Medically Supervised Weight Management Program. Perm J 2019; 23:18-134. [PMID: 30939281 DOI: 10.7812/tpp/18-134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
CONTEXT Obesity is associated with increased incidence of chronic diseases such as type 2 diabetes mellitus, systemic hypertension, and other risk factors for cardiovascular disease. Obesity is also associated with increased use of outpatient clinical services, a metric of health care utilization. However, little is known of temporal changes in health care utilization among obese participants of a medical weight management program. OBJECTIVE To assess changes in 3 health care utilization metrics (primary care physician office visits, ambulatory clinic office visits, and health care touches [encounters]) in weight management program participants across 21 Kaiser Permanente Northern California Medical Centers during a 5-year period. DESIGN Retrospective observational study of 10,693 participants, with a linear-mixed effects model to account for repeated-measures analysis. MAIN OUTCOME MEASURES Five-year temporal changes in the 3 health care metrics. RESULTS At baseline, the participants' average age (standard deviation) was 51.1 (12.4) years, and their mean body mass index (standard deviation) was 39.7 (7.2) kg/m2. At the end of 4 months, there was a decrease in primary care visits (p < 0.001), with an increase in ambulatory clinic visits and health care touches (p < 0.001), because of increased weight management visits. At the end of 5 years, there was a 25% to 35% decrease from baseline in all 3 health care utilization metrics (p < 0.0001). Although slightly attenuated, these findings were similar in a risk-adjusted model. CONCLUSION Our findings may be useful to other integrated health care delivery systems considering initiating a similar weight management program.
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Severin R, Sabbahi A, Mahmoud AM, Arena R, Phillips SA. Precision Medicine in Weight Loss and Healthy Living. Prog Cardiovasc Dis 2019; 62:15-20. [PMID: 30610881 PMCID: PMC6546173 DOI: 10.1016/j.pcad.2018.12.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 12/30/2018] [Indexed: 02/06/2023]
Abstract
Obesity affects 600 million people globally and over one third of the American population. Along with associated comorbidities, including cardiovascular disease, stroke, diabetes, and cancer; the direct and indirect costs of managing obesity are 21% of the total medical costs. These factors shed light on why developing effective and pragmatic strategies to reduce body weight in obese individuals is a major public health concern. An estimated 60-70% of obese Americans attempt to lose weight each year, with only a small minority able to achieve and maintain long term weight loss. To address this issue a precision medicine approach for weight loss has been considered, which places an emphasis on sustainability and real-world application to individualized therapy. In this article we review weight loss interventions in the context of precision medicine and discuss the role of genetic and epigenetic factors, pharmacological interventions, lifestyle interventions, and bariatric surgery on weight loss.
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Affiliation(s)
- Richard Severin
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Integrated Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, IL, United States of America; Doctor of Physical Therapy Program, Robbins College of Health and Human Sciences, Baylor University, Waco, TX, United States of America
| | - Ahmad Sabbahi
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Integrated Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, IL, United States of America; School of Physical Therapy, South College, Knoxville, TN, United States of America
| | - Abeer M Mahmoud
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Integrated Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, IL, United States of America
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Integrated Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, IL, United States of America
| | - Shane A Phillips
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Integrated Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, IL, United States of America.
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