Hospital-based Weight Research Articles

A review of patient outcomes and responses to weight management strategies used by complications from excess weight service, a new paediatric, hospital-based weight management service

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

THE EFFECT OF A FREE COMMUNITY PEDIATRIC HEALTH INITIATIVE ON BMI, FITNESS MEASURES, AND QUALITY OF LIFE: A PILOT STUDY

Background: Pediatric obesity affects approximately 18% of children in the United States. Childhood obesity contributes to several health-related issues, including diabetes, hypertension, decreased quality of life (QOL), and adult morbidity. Risk factors for developing childhood obesity include socioeconomic factors, sedentary lifestyle, diet, and genetics. Programs tailored toward educating children and parents on healthy lifestyle choices, exercise, and nutrition have been shown to improve health-related outcomes for this population. Objective: The purpose of this study was to retrospectively investigate the effects of an 8-week community pediatric health program on body mass index (BMI), fitness measures, and QOL in overweight children. Methods: Subjects aged 8-16 years were recruited from a hospital-based weight management clinic to participate in an 8-week weight loss program. Subjects attended weekly one-hour sessions of health and wellness education, exercise instruction, home program development, and practical goal-setting. Seven children participated in the program and completed all outcome measures. Outcome measures included Body Mass Index (BMI), functional strength (jumping jacks, wall sits, push-ups, and sit-ups), balance (single-limb stance, SLS), flexibility (straight leg raise, SLR), endurance (6-minute walk test, 6MWT), and QOL assessment (Pediatric Quality of Life Inventory, PQOL). Outcomes were assessed at baseline and week eight. Results: Although the BMI did not show clinically significant improvement, three functional strength measures (wall sit p=0.026; push-ups p=0.010; sit-ups p=0.003), endurance (6MWT, p=0.026), and flexibility (left SLR, p=0.011, right SLR, p= 0.046) showed statistically significant improvement at week eight. Jumping jacks and the PQOL showed improvement without reaching statistical significance (p>0.05). No improvement in SLS was noted (p>0.05). Conclusion: The findings indicate a community-based pediatric health and wellness program significantly improved overweight children's fitness. Further research is needed to determine the long-term effects of this program.

P348Motivation of overweight patients with atrial fibrillation to lose weight or to follow a weight loss management program: a cross-sectional study

Abstract Funding Acknowledgements none Background Overweight and obesity increase the risk of recurrence and progression of atrial fibrillation (AF). Studies evaluating weight reduction programs in AF patients have shown benefits in AF burden, symptoms and quality of life. Despite this proof, AF patients often lack the will to tackle overweight and they do not commonly participate in cardiac rehabilitation programs. Purpose The objective of this study was to assess the motivation of AF patients with overweight or obesity to lose weight and/or to follow weight reduction programs. Methods A multicenter descriptive cross-sectional study was performed at three Belgian hospitals. A self-developed questionnaire was presented to AF patients with a BMI >27kg/m2 who presented for an outpatient cardiology visit or were hospitalized at the cardiology ward. The questionnaire was validated for its content by an expert panel and it addressed the following topics: knowledge about the relation between weight and AF; patients’ history of weight reduction efforts and its success; current motivation to reduce weight; factors related to motivation; interest in following weight reduction programs. Results A total of 143 patients (mean age 65.7 ± 9.2 years; mean BMI 32.3 ± 4.7kg/m2; 68.5% males; 47.6% hospitalized; mean duration of AF history 5.7 ± 6.0 years) out of 560 screened AF patients completed the questionnaire (figure 1). Only 69.9% of patients was aware of the positive effect of weight reduction on the progression of AF. Prior attempts to reduce weight were made by 76.2% of the patients in which a minority participated in a hospital-based weight reduction program (9.2%) or a structured fitness program (10.1%). Of the study patients, 75.5% were currently motivated to reduce weight, mainly driven by health considerations (78.7%). Univariate analysis showed that a higher educational degree, higher income, living with a partner, and higher BMI were positively correlated with motivation to reduce weight (p < 0.05). Multivariate regression analysis showed that a higher BMI (OR = 1.20; CI = 1.05-1.38; p = 0.010), younger age (0.96 (0.91-1.01); p = 0.108), a college/university degree (5.03 (1.57-16.16); p = 0.007) and living with a partner (4.31 (1.55-11.95); p = 0.005) were associated with greater odds ratio of motivation for weight reduction. A completely home-based program (including tele-rehabilitation) was the preferred approach for 57.9% of the patients, and 57.3% would consider a weight reduction program only if reimbursement was available. Conclusions AF patients with overweight still need to be better informed about overweight as a risk factor for AF. AF patients with a lower degree of education, living alone and a lower BMI need more external motivation to lose weight. A tailored weight reduction program, mainly home based, is the preferred option for patients. This will require further development and validation of tele-coaching programs for this patient group. Abstract Figure 1: Enrollment procedure

Preferences for Weight Loss Treatment Amongst Treatment-Seeking Patients with Severe Obesity: A Discrete Choice Experiment.

Treatment options for weight loss vary considerably with regard to risks and benefits, but the relative importance of treatment characteristics in patient decision-making is largely unknown, particularly amongst patients with severe obesity. Developing such services requires insight into the preferences of recipients for service attributes. The objective of this study was to quantify, using a discrete choice experiment, the preferences of treatment-seeking patients with severe obesity within the Irish population regarding different attributes of various obesity treatments. Within a cohort of patients with severe obesity attending a hospital-based weight management programme, patients' attitudes to and perceptions of three distinct treatment modalities were compared to those regarding not having treatment. The treatments included a structured lifestyle modification programme, lifestyle modification alongside weight loss medication, and bariatric surgery. On average, patients with severe and complicated obesity who were attending a weight management programme were more enthusiastic about participating in a programme to help improve their diet and physical activity than they were about having surgery if the methods of treatment had equivalent results and costs. The findings provide insights into preferences that might assist the development of more appropriate treatments for severe obesity.

Patient and parent satisfaction with hospital-based paediatric weight management services and reasons for attrition: a mixed methods systematic review

Patient and parent satisfaction with hospital-based paediatric weight management services and reasons for attrition: a mixed methods systematic review

A Step Toward Workplace Obesity Prevention: Evaluation of Weight Management Program for Hospital-based Health Care Providers

Background: Obesity is a worldwide problem. Healthy workplace and lifestyle are crucial in preventing obesity. A workplace weight management program could create a culture of health and facilitate weight control among health care providers. The present study aims to describe and evaluate the health outcomes of the interaction of professional practice and organizational infrastructure. Method: The hospital-based weight management program was an eight-week pilot randomized controlled study for obese health care providers. The primary outcomes were body weight and body mass index. The secondary outcomes included serum fasting glucose, fasting cholesterol, triglyceride, high- and low-density lipoprotein, body fat percentage, body mass, and quality of life. The RE-AIM framework was used to examine the intervention’s reach, effectiveness, adoption, implementation and maintenance at individual and organizational levels. Results: The program successfully attained the target population. Health care providers demonstrated short-term weight loss and decreased serum fasting cholesterol level after completing the program. The excellent retention rate (95%) of the study suggested that the participants were well-engaged in self-weight management. The program was implemented with adequate resource and support from the health organization. The organization may consider continuing the program in view of its long-term benefits to health care providers. Conclusion: Supportive organizational structure and culture enhanced professional practice and improved the health outcomes of the hospital-based weight management program participants.

Evaluation Of A Hospital-based Weight Loss Program Involving Exercise, Nutritional, And Behavior Change Modification.

Weight loss can reduce health risks associated with obesity. Team-approach interventions that involve exercise, diet, and behavioral modification have been shown to result in successful weight loss. PURPOSE: The purpose of this project was to evaluate the effectiveness of a hospital-based team-approach physician-referred program that enrolls community members without use of incentives. METHODS: Participants included obese (BMI≥30) members of the community (COM, N=48) compared to employees of the local hospital (EMP, N=88). COM were referred to the program by a Physician while EMP were provided with incentives to participate. All participants were evaluated both pre- and post- a 16-week intervention period which included regular supervised exercise sessions and monthly consults with a Registered Dietitian (RD) and a Behavioral Health Specialist (BHS). Background information collected included, sex, initial weight (kg), BMI (kg/m2), percent fat (%) using Bioelectrical Impedance, and readiness for change (RTC) evaluation (modified Brownell LEARN RTC Questionnaire). Attendance at all sessions (RD, BHS, exercise) were recorded. If final weight was obtained, then the program was considered completed. Independent samples t-tests (p<0.05) were used to determine differences in physical characteristics between groups as well as in total weight loss. Association between consultation attendance (RD and BHS) and completion was determined by Chi-square test for independence with a Bonferroni adjustment. RESULTS: No significant differences were detected between participant initial characteristics. There was no significant difference in weight loss between groups (EMP=-12.29±12.56lbs vs COM=-15.58±8.08lbs, p=0.20). However, overall program completion was lower in the COM compared to EMP (58% vs. 85%, respectively). In the COM program a Chi-square test revealed a significant association only between attending BHS consultations and program completion (Χ2(1,n=48), Χ2=6.291, p=0.01, phi= 0.41). CONCLUSION: A team-approach weight loss program may be an effective intervention if the participants successfully complete the program. However, additional research is warranted to determine if adhering to BHS consultation visits could improve completion rates when other incentives are not offered.

Effectiveness of A Hospital-Based Weight Maintenance Program in Sustaining Weight Loss: A Retrospective Study

Effectiveness of A Hospital-Based Weight Maintenance Program in Sustaining Weight Loss: A Retrospective Study

A hospital-based birth weight analysis using computerized perinatal data base for a Chinese population

Objectives. We aimed to construct birth weight-for-gestational age nomograms based on a computerized perinatal data base in a hospital-based Chinese population.Methods. Retrospectively collected 28,052 singleton deliveries at Women and Children's Medical Center, Guangzhou, China. Standard curves of birth weight from 27 to 43 week's gestation were computed. The nomograms included the 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles and standard deviations.Results. 79.9% pregnant women delivered between 38, 39, and 40 gestational week, and the mean birth weights are 3160, 3282, and 3388 g, respectively. Preterm birth is 5.7%. In general, male birth weights are greater than females at each gestational week. The hospital-based Chinese population birth weight is lower than that of North American and Scandinavian population.Conclusions. A different standard birth weight is needed for different population. A hospital-based birth weight curve by gestational week is established, which can be a useful tool to estimate intrauterine fetal growth to define SGA or LGA fetuses.

Outcome of a hospital based multidisciplinary weight loss program in obese Filipino children

BackgroundChildhood obesity is becoming a problem for Filipino children with an increasing national prevalence of pediatric overweight and obesity. A multidisciplinary approach combining behavioral therapy with diet and exercise is often advocated as having the greatest impact in pediatric weight management. ObjectiveTo determine the effects of a weight loss program, which is a staged 3-mo, multidisciplinary intervention consisting of combined dietary, exercise, and behavioral methods in obese children. Research methods and proceduresProspective study done in a hospital-based weight management center; duration of study: 15 mo (November 2005 to January 2008); participants: 44 obese children (aged 5–17 y; body mass index [BMI] 85th–99th percentile); outcome measures: change in weight, BMI, BMI z-score (SD score); secondary measures included changes in waist circumference, blood pressure, and body fat. Statistical tests: paired t tests, χ2 test, Wilcoxon ranked sum test, regression analysis, and ANOVA. ResultsAt the end of the program, the patients demonstrated a decrease in weight, BMI, BMI z-score, body fat, systolic blood pressure, and waist circumference. Mean weight loss is 4.2 kg (P < 0.01) with an average of 5.3% weight loss; BMI decreased by 1.5 units (P < 0.01), BMI z-score by 0.15 (P < 0.004), body fat by 14% (P < 0.01), systolic blood pressure by 7.25 mm Hg (P < 0.05), and waist circumference by 5.4 cm (P < 0.05). Decrease in weight, BMI, and body fat were significantly correlated with number of sessions attended. ConclusionThe use of a multidisciplinary 3-mo staged program resulted in an effective weight loss in obese Filipino children, which was directly related to the frequency of sessions attended.

Effect of Exercise on 24-Month Weight Loss Maintenance in Overweight Women

Debate remains regarding the amount of physical activity that will facilitate weight loss maintenance. Between December 1, 1999, and January 31, 2003, 201 overweight and obese women (body mass index [calculated as weight in kilograms divided by height in meters squared], 27 to 40; age range, 21-45 years) with no contraindications to weight loss or physical activity were recruited from a hospital-based weight loss research center. Participants were assigned to 1 of 4 behavioral weight loss intervention groups. They were randomly assigned to groups based on physical activity energy expenditure (1000 vs 2000 kcal/wk) and intensity (moderate vs vigorous). Participants also were told to reduce intake to 1200 to 1500 kcal/d. A combination of in-person conversations and telephone calls were conducted during the 24-month study period. Weight loss did not differ among the randomized groups at 6 months' (8%-10% of initial body weight) or 24 months' (5% of initial body weight) follow-up. Post-hoc analysis showed that individuals sustaining a loss of 10% or more of initial body weight at 24 months reported performing more physical activity (1835 kcal/wk or 275 min/wk) compared with those sustaining a weight loss of less than 10% of initial body weight (P < .001). The addition of 275 mins/wk of physical activity, in combination with a reduction in energy intake, is important in allowing overweight women to sustain a weight loss of more than 10%. Interventions to facilitate this level of physical activity are needed.

Provider and patient intervention to improve weight loss: A pilot study in a public hospital clinic

Objective To assess the efficacy of a literacy-appropriate weight loss intervention targeting providers and patients in improving physicians’ weight loss counseling and patients’ self-reported beliefs, and self-efficacy. Methods The study took place in a public hospital nephrology clinic. The intervention included two physician workshops and a small group patient education. Physician–patient communication was observed and coded. Structured interviews assessed patient recall of weight loss recommendations, weight-related beliefs, and self-efficacy. Results 64 patient visits were observed before and after the intervention. 75% of patients were African American, 96% lacked private insurance, 71% had low literacy skills; mean body mass index (BMI) of 35 kg/m 2. Physician counseling improved significantly post-intervention, particularly in assessing, supporting and advising patients about weight loss and exercise. Patients reported increases in recall of weight loss recommendations and were more likely to report greater confidence about losing weight (52% vs. 70%, p < 0.01). Conclusions This pilot study offers promising directions to address provider and patient barriers to weight loss education and counseling in a public hospital. Practice implications Hospital-based weight loss interventions need to target both physicians and patients.

Translating the diabetes prevention program into a hospital-based weight loss program.

Intensive lifestyle interventions have established efficacy, but translation to real-world settings has not been well demonstrated. Using the diffusion of innovations model, we describe the adoption of the Diabetes Prevention Program (DPP) Lifestyle Intervention into a hospital-based program and report feasibility, acceptability, and outcomes. Patients (N = 118; 72% female, mean age = 48.8, mean baseline body mass index = 43.3) were enrolled into 16 weeks of DPP. Weight loss (kg) was measured at baseline and after treatment. Mean weight loss after 16 weeks was 5.57 kg (SD = 4.6) or 4.6% of baseline weight, and 30% met the 7% weight loss goal. Outcomes are compared with those reported in the DPP trial. Most participants (90.4%) were satisfied with the service; however, only 56% were satisfied with their weight loss. The DPP was successfully translated into a real-world clinic with some protocol modifications. Weight loss was modest among heavier patients with more comorbidities than the original DPP sample. Diffusion of innovations theory provides a useful framework for adopting evidence-based programs in the clinical setting.

Centre for Healthy Weights: Shapedown BC: preliminary psychological outcomes of obese youth presenting for hospital-based weight management treatment

Centre for Healthy Weights: Shapedown BC: preliminary psychological outcomes of obese youth presenting for hospital-based weight management treatment

Anorexia Nervosa

Anorexia Nervosa

Association of Major Depression and Binge Eating Disorder with Weight Loss in a Clinical Setting

Obesity has been linked to both major depressive disorder (MDD) and binge eating disorder (BED) in clinical and epidemiological studies. The present study compared weight loss among patients with and without MDD and BED who participated in a hospital-based weight loss program modeled after the Diabetes Prevention Program. Of 131 obese patients who enrolled in treatment, 17% were diagnosed with MDD only, 13% were diagnosed with BED only, 17% were diagnosed with both MDD and BED, and 53% lacked either diagnosis in a pretreatment clinical interview. After treatment, patients with MDD only attained 63% of the weight loss that non-depressed patients attained. Patients with BED only attained 55% of the weight loss that non-binge eaters attained. The effect of MDD on weight loss was not accounted for by the presence of BED or vice versa. Only 27% of patients with both MDD and BED achieved clinically significant weight loss compared with 67% of patients who had neither disorder. Results were not significantly altered when gender, age, and diabetes status were adjusted. Both MDD and BED were prevalent among this obese clinical population, and each disorder was independently associated with worse outcomes. Research is needed to investigate how to increase the efficacy of behavioral weight loss programs for individuals with MDD and/or BED.

Which factors are associated with a successful outcome in a weight management programme for obese children?

To identify factors important in determining whether an obese child achieves significant reductions in Body Mass Index Standard Deviation Score (BMI SDS) within a UK, hospital-based paediatric obesity service aimed at lifestyle modification. Observational Study. 137 obese children (63 boys) who have attended our childhood obesity service within the last three and a half years at The Royal Hospital for Children, Bristol, UK. BMI SDS with a target reduction of - 0.5 or greater. 70% of children achieved reductions in BMI SDS with 18% achieving the target reduction. In those attending the clinic for a year or more the levels improved to 83% and 28% respectively. Age was found to be the most important predictor with younger children achieving larger reductions in BMI SDS. More boys than girls were likely to achieve target reductions in BMI SDS and those without a parental history of obesity were more likely to achieve greater reductions in BMI SDS. Socio-economic status did not appear to impact upon the child's level of success. In families of obese children, motivated to seek help by attending a hospital-based weight control clinic, improvements in BMI are possible by a simple approach of education and continued support. Improvement is greatest in younger children with maximal benefit being seen in boys without a parental history of obesity. We believe this emphasizes the importance of identifying significant obesity in primary school aged children, who seem most likely to benefit from simple lifestyle modification, while many older children may require additional intervention programmes to improve BMI.

Bone health status in relation to body adiposity in obese children and youth enrolled in a hospital-based weight management program

Understanding of the pathogenesis of bone fragility in men requires knowledge of its structural basis. There is no evidence that gender differences in fracture rates are explained by gender differences in bone mineral content (BMC) or areal bone mineral density (BMD). This is an untested assumption. The BMD measurement integrates the modeling and remodeling that occurs on the periosteal and endosteal surfaces of bone during growth and aging. The size, shape, and architecture of the bone so formed determine its breaking strength. None of these three-dimensional structural components is “seen” by the dual photons of the densitometer.Men and women attain a similar peak vertebral height during growth. Vertebral width is greater in men, conferring higher BMC and areal BMD, but trabecular number and thickness (trabecular volumetric BMD) is no greater in men than women. Blacks have shorter vertebra than whites, and vertebral width is similar. Trabecular thickness is greater in blacks than whites. Thus, at peak, gender differences in vertebral strength are likely to be size, not BMD, dependent. Racial differences in vertebral strength are likely to be BMD, not size, dependent.Greater periosteal expansion during growth in males than females, and blacks than whites, establishes the gender and racial differences in peak bone size. Men have wider long bones than women. Blacks have wider long bones than whites. The proximity of the endocortical surface to the periosteal surface determines peak cortical width, which is similar in men, women, blacks, and whites. It is the greater distance of the cortical mineral mass from the neutral axis of a long bone in males than in females, in blacks than in whites, and in men with, than men without, fractures, that partly accounts for the greater bone strength in the first mentioned in each group. Thus, at peak, racial and gender differences in long bone strength are likely to be size, not BMD dependent.Trabecular bone loss is similar in men and women. Loss of connectivity is greater in women. Endocortical resorption is greater in women than men, but men lose less cortical width because subperiosteal apposition during aging is greater in men than in women offsetting endocortical resorption. Men with spine fractures have smaller vertebrae because vertebral width is less. Men with hip fractures have smaller femoral neck width. In both types of fractures, there is less bone in the smaller bone-reduced volumetric BMD. The relative contributions of reduced accrual during growth, excessive bone loss during aging, or both to the deficit in volumetric BMD are undefined. No antifracture efficacy trials have been done in men.Reasonable approaches to treatment include the use of testosterone in hypogonadal men, and vitamin D if vitamin D deficiency is present. Calcium supplements may slow endocortical bone loss. Bisphosphonates may increase BMD.

The effects of orlistat in patients with diabetes: improvement in glycaemic control and weight loss

ABSTRACTObjective: In addition to direct weight reduction, there may be other benefits of obesity treatment including improved insulin sensitivity. The purpose of this study was to characterise concomitant diabetes drug use and the related costs in patients with diabetes treated with orlistat (Xenical) in the first 6 months of treatment.* Xenical is a trade name of Roche Pharmaceuticals, Basle, SwitzerlandMethods: One hundred overweight patients with diabetes and a body mass index (BMI) ≥ 28 kg/m2 were enrolled in a structured UK hospital-based weight management clinic and treated with orlistat plus behavioural interventions. Among other measures, weight, glucose control (HbA1c) and drug treatments were recorded. Subjects were followed-up for a maximum of 24 months at intervals of 1–3 months, with a maximum treatment period of 24 months.Results: The majority of subjects (91%) had type 2 diabetes. They had a mean age of 55 years and 55% were women. For patients followed up at 6 months, their mean BMI at baseline was 39.5 kg/m2 with a mean HbA1c of 7.6%. The mean weight loss at 6 months was 7.1 kg ( p < 0.001). Despite a significant average absolute HbA1c reduction of 0.62% ( p < 0.001), the most notable gains were made by those with the highest baseline HbA1c values (a mean relative reduction of 20% for those above the 75th percentile). There were 50 patients treated with insulin at baseline and 47 at 6 months. Of those treated with insulin, the mean dose was 130 units at baseline and 90 units at 6 months ( p < 0.001). Twenty patients (44.4%) initially treated with oral hypoglycaemic agents alone reduced their dose after 6 months (not significant). Despite marked improvement in insulin sensitivity (baseline mean, 1.24 units/kg; 6 month mean, 0.90 units/kg [p < 0.001]) there was no correlation with BMI change. The average cost of diabetes treatment at baseline was £1.16 per day and £0.83 at 6 months ( p < 0.001). Age was the only independent predictor for insulin dose reduction.Conclusions: Orlistat appears to reduce the need for concomitant diabetes medication irrespective of weight loss, a reduction that is likely to represent a large cost offset for orlistat treatment.

Response of Taiwanese obese binge eaters to a hospital-based weight reduction program

Objective To investigate the characteristics and prevalence of binge eating among overweight Taiwanese and to determine the effect of binge eating on outcome of weight loss treatment. Methods One hundred and eighty-nine participants in a 12-week traditional weight-reduction program were classified on the basis of the Bulimic Investigation Test, Edinburgh (BITE) scores into binge eaters (≥20), subthreshold binge eaters (10–19), and nonbinge eaters (0–9). Results This study found a 15.9% prevalence of binge eating. The binge-eating groups (binge eaters and subthreshold binge eaters) were younger, had an earlier onset of obesity, and more psychological distress than nonbinge eaters. Differences in obesity treatment weight loss among binge eaters, subthreshold binge eaters, or nonbingers by last observation carried forward (LOCF) method were not significant. At the end of treatment, the subthreshold binge eaters had the greatest weight loss. Although their binge eating and mood significantly improved, binge eaters and subthreshold binge eaters still had significant pathology in eating behaviors at completion of the program. Conclusion Alternative treatment strategies focusing on disordered eating behaviors are needed to supplement standard dietary management of overweight treatment-seeking binge eaters.