Obesity Care Research Articles

Association between delay in diabetes development and mortality in people with obesity: Up to 33 years follow-up of the prospective Swedish Obese Subjects study.

Life expectancy is reduced in people with obesity and is further reduced in those with concomitant type 2 diabetes. The aim of the study was to assess whether a 2-year delay in diabetes development influences life expectancy in people with obesity. Participants from the Swedish Obese Subjects study without diabetes at baseline and known diabetes status at the 2-year follow-up were included: bariatric surgery (n = 1471) and usual obesity care (n = 1392). Median follow-up was 26.1 years (interquartile range: 22.7-28.7 years). The Swedish Cause of Death Register, case sheets and autopsy reports were assessed to determine the direct cause of death. Analyses were adjusted for preselected risk factors: inclusion year, sex, baseline age, body mass index (BMI) and smoking. Across both study arms, 146 participants were newly diagnosed with type 2 diabetes at the 2-year examination, whereas 2717 remained diabetes-free. Most participants diagnosed with diabetes (n = 140) were from the usual care control group. During the follow-up, there were 18.3 deaths per 1000 person-years (95% confidence interval [CI]:14.1-23.9) in the group with diagnosed diabetes at the 2-year follow-up and 10.9 deaths per 1000 person-years (95% CI:10.2-11.8) in the group that remained diabetes-free (adjusted hazard ratio [HRadj] 1.60, 95% CI: 1.19-2.15, p = 0.002). The adjusted median life expectancy in the diabetes group was 3.7 years (95% CI: 1.4-6.0, p = 0.002) shorter than in the diabetes-free group. Specifically, cardiovascular mortality was higher in the group with diabetes (adj sub-hazard ratio [sub-HR] 1.74 [95% CI: 1.09-2.77], p = 0.021). A 2-year delay in diabetes development may be linked to increased life expectancy, possibly due to a reduction in cardiovascular mortality. Future studies should confirm these findings.

Sex differences in perceived discrimination among patients with obesity.

The negative impacts of perceived discrimination on health have been documented, but how perceptions of discrimination vary by sex among people with obesity (PWO) is not well understood. This study assessed sex differences in perceived discrimination among PWO. This cross-sectional study analysed self-reported data from racially/ethnically diverse PWO attending an academic obesity program. The primary outcome was perceived discrimination, assessed by the Major Experiences of Discrimination (MED) and Everyday Discrimination Scale (EDS). Sex differences were evaluated by univariate and multivariable regression analysis adjusted for key descriptive variables. The final analytical sample included 60 PWO (62% female, 61% non-Hispanic white (NHW), 12% Hispanic, 39% non-Hispanic black (NHB), mean age 53 years, mean BMI 34 kg/m2). Women experienced everyday discrimination 59% less than men but this was not significant (OR 0.41; 95% CI 0.08-2.16; p = .29). Participant highest BMI was correlated with acute discrimination (total MED score) (r = 0.39; p = .0024) and chronic discrimination (total EDS score) (r = 0.28; p = .03). Most participants reported more chronic discrimination compared to acute discrimination (85% vs. 48%). Mean MED (β -0.18; 95% CI -0.93 to +0.56; p = .62) and EDS scores (β -0.25; 95% CI -3.37 to +2.87; p = .87) were not significantly different between women and men. Perceived discrimination was common and experienced equally between men and women with obesity. Incorporating discrimination experiences into obesity care models may be an important step to improving quality of care and outcomes.

GLP-1 Receptor Agonists and the Path to Sustainable Obesity Care

This Viewpoint discusses the optimal treatment duration of glucagon-like peptide-1 receptor agonists in people with obesity and the benefits of off-ramping, the tapering of these antiobesity medications following an initial treatment period.

Recorded diagnosis of overweight/obesity in primary care is linked to obesity care performance rates.

Periodical BMI measurement during visits with primary care pediatricians (PCP) can be central to diagnosing, managing, and treating overweight/obesity. The aim was to evaluate among children and adolescents with similar BMI percentiles, whether recording a formal diagnosis by PCP, of overweight/obesity is associated with improved performance rates of obesity-related care. The electronic database of the largest health maintenance organization in Israel was searched for all patients aged 2-18 years with BMI recorded at a visit with the PCP during 2017-2023. Among children with BMI percentiles consistent with overweight/obesity, performance rates of obesity care were compared between those with a recorded diagnosis of "overweight"/"obesity" placed by the PCP, and those with similar BMI percentiles without these recorded diagnoses. Among children with versus without recorded diagnoses of overweight/ obesity, rates were higher of referrals for screening measurements for obesity-related comorbidities, for dietitian and endocrine counseling, of performing subsequent BMI measurements, and of prescribing anti-obesity medications (p < 0.001 for all). Obesity-related comorbidities were more prevalent among those with than without recorded diagnoses (P < 0.001). Beyond BMI measurement, a recorded diagnosis of overweight/obesity by a PCP is linked to higher rates of obesity care performance and interventions, which may improve clinical outcomes. BMI measurement during visits with primary care pediatricians (PCP) can be central to diagnosing, managing, and treating overweight/obesity. We evaluated among children and adolescents with similar BMI percentiles, whether recording a formal diagnosis by PCP, of overweight/obesity is associated with improved performance rates of obesity-related care. We found that among children with versus without recorded diagnoses of overweight/obesity, rates were higher of referrals for screening measurements for obesity-related comorbidities, for dietitian and endocrine counseling, and of prescribing anti-obesity medications. Therefore, PCP should increase rates of recording diagnoses of overweight/obesity, to promote screening for obesity-related comorbidities, and aim to treat obesity as a chronic disease.

The Role of Weight Bias and Stigma in Obesity Care

The Role of Weight Bias and Stigma in Obesity Care

Factors that influence general practitioners' obesity-related clinical practices and determinants of behavior to target to promote best practice in obesity care: A qualitative exploration.

General practitioners (GPs) have been identified as pivotal in the identification and initiation of treatment for obesity, yet effective obesity management remains challenging in general practice. Despite the growing prevalence of obesity and the central role of GPs, there is a dearth of research exploring their experiences and challenges in managing the disease. This study aimed to understand these challenges by exploring GPs' experiences and to identify factors influencing their obesity management practices to inform the development of targeted intervention strategies. In-depth interviews were conducted with 10 GPs. Data were analyzed using abductive thematic analysis underpinned by the theoretical domains framework (TDF). Findings were mapped to the behavior change wheel (BCW) and the behavior change taxonomy to identify potential future intervention strategies. Participants described multiple barriers to effective obesity management, including knowledge gaps, lack of training, patient factors, and systemic challenges. Key themes identified were the need for increased support, improved patient engagement, and system-level changes. This study offers valuable insights into the challenges GPs encounter when managing obesity in general practice. Application of the TDF and BCW frameworks identified complex interactions between knowledge, beliefs, and environmental factors influencing GP behavior. These findings highlight key areas for targeted interventions to enhance obesity care and drive best practice.

Imaging of Body Composition.

Body composition is now recognized to have a major impact on health and disease. Imaging enables its analysis in an objective and quantitative way through diverse techniques such as dual-energy X-ray absorptiometry, computed tomography, magnetic resonance imaging, and ultrasonography. This review article first surveys the methodological aspects underpinning the use of these modalities to assess body composition, highlighting their strengths and limitations as well as the set of parameters that they measure and their clinical relevance. It then provides an update on the main applications of body composition imaging in current practice, with a focus on sarcopenia, obesity, lipodystrophies, cancer, and critical care. We conclude by considering the emerging role of artificial intelligence in the analysis of body composition, enabling the extraction of numerous metrics with the potential to refine prognostication and management across a number of pathologies, paving the way toward personalized medicine.

Evaluating Obesity: The "Why" Behind the American Academy of Pediatrics' Obesity Treatment Clinical Practice Guideline.

The 2023 American Academy of Pediatrics' "Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents with Obesity (Obesity CPG)" is a comprehensive document that addresses the evaluation and treatment of pediatric obesity. Much attention has been focused on the use of medications and surgery to treat severe obesity, but the document also thoroughly reviews the evaluation of obesity and its comorbidities through key action statements and consensus recommendations. The majority of these evaluation guidelines are well within the scope of the general pediatrician and an understanding of and implementation of them can lead to improved obesity care in the primary care setting. The goal of this article is to guide the reader in the evaluation of obesity and its comorbidities in the primary care setting through a chronic disease model lens as a basis for all future care. [Pediatr Ann. 2024;53(10):e378-e385.].

Healthcare professionals’ perspectives on the barriers and facilitators of integrated childhood obesity care

BackgroundBoth the causes and consequences of childhood obesity can be complex. To provide healthcare that is suitably tailored to the specific needs of children with obesity integrated care is required. The objective of this study was to explore the perceived barriers and facilitators of healthcare professionals (HCPs) in providing integrated care for children with obesity, to support them in tailoring the healthcare approach.MethodsIn this qualitative study, semi-structured in-depth interviews were conducted with 18 healthcare professionals with experience in childhood obesity care; pediatricians, youth healthcare nurses and a youth healthcare physician. A two-phased thematic content analysis was performed: an inductive analysis with open and selective coding and a deductive analysis with axial coding using the patient-centered care model by Stewart.ResultsOverall, the healthcare professionals defined the etiology of obesity as complex, and experienced the integrated care as complicated. The results fit into the four theme-structure of the patient-centered care model, with the integrated care system as an additional fifth theme. The main barriers were perceived within the sub-themes of illness and healthcare experiences, and sensitivity over talking about weight-related issues. The main facilitators were perceived within the sub-themes of conducting a biomedical, psychosocial and lifestyle assessment, tailoring the approach to families’ situation and investing in a family-professional relationship. Weight stigma appeared to be an underlying barrier for healthcare professionals that impacted, both explicitly and implicitly, upon all themes.ConclusionsHealthcare professionals providing integrated care for children with obesity, experience this type of care as complicated and comprising many barriers and facilitators regarding the four themes of the patient-centered care model and the fifth theme of the integrated care system. This paper demonstrates the patient-centered care model could prove helpful structuring a tailored approach within integrated care. This approach supports healthcare professionals in adopting a broad perspective towards individual and environmental factors and investing in the relationship, with respect to the sensitivity and complexity of childhood obesity.

Uric Acid Levels in Overweight and Obese Children, and Their Correlation With Metabolic Risk Factors.

Obesity is an ongoing medical condition that continues to rise on a global scale. Numerous metabolic disorders, such as type 2 diabetes mellitus, hyperlipidemia, and hyperuricemia, are closely associated with obesity. This particular study aims to investigate the occurrence of hyperuricemia and its association with other metabolic factors among children and adolescents aged 6 to 14 years who are overweight or obese residing in Riyadh, Saudi Arabia. In this research, a cross-sectional, descriptive, and analytical study was carried out on 339 children and adolescents. These participants were selected randomly from a list of patients who had sought medical care for overweight and obesity at the pediatric endocrinology, general pediatrics, and family medicine clinics in King Abdulaziz Medical City (KAMC), located in Riyadh, Saudi Arabia, in the period from January 2020 to January 2022. To gather the necessary data, the electronic medical records of the participating individuals were carefully reviewed, encompassing various relevant variables, including demographic characteristics, anthropometric measurements, serum uric acid levels, lipid profiles, and fasting blood sugar. Out of the total 339 participants, 48 (14.2%) were identified as overweight, while 291 (85.8%) were classified as obese. The study revealed that the overall prevalence of hyperuricemia among the participants was 54%. There was an increased risk of hyperuricemia associated with male gender and elevated levels of LDL and TG. The significant prevalence of hyperuricemia among children and adolescents who are overweight or obese is evident. In order to improve control and management of this condition, it is crucial to prioritize the promotion of a healthy lifestyle among these individuals.

Paradoxical bodies: negotiating biomedical fix, responsibility, and care in a weight-loss surgery clinic

AbstractThis ethnographic project explores how inherent discursive and social tensions are expressed and worked out within obesity care at a weight-loss surgical (WLS) clinic. First, complicated doctor and patient encounters occur because WLS follows a medical logic of intervention and is presented as a “biomagical” procedure that miraculously alters the body. Surgeons, however, explain that the surgery’s success depends on patients’ long and hard work. Second, the clinic’s interdisciplinary approach adds more complexity. While expanding the scope of treatment, it blurs the division of labor among professionals and the distinction between body and mind. It also diffuses the responsibility for patients’ lifestyles and recovery among professionals. Third, alongside notions about patients’ autonomy and free choice, their wishes and bodies are constantly channeled, problematized, and negotiated with various family and peer support. While crucial for the surgery’s success, such interconnectedness raises questions about how decision making and social pressures affect the patients’ journey. Thus, WLS is refracted among webs of multiple actors and contradictory perspectives. This complexity invites a reflection on how such tensions and paradoxes destabilize medical power in modifying the body, challenge personal responsibility assumptions, and impact the quality of care.

Curbing the Obesity Epidemic: Should GLP-1 Receptor Agonists Be the Standard of Care for Obesity?

This article summarizes the medical management of obesity with an emphasis on incretin-based therapeutics that target the neuro-hormonal basis of obesity. Medications that mimic the effect of incretins, a group of peptide hormones released in response to nutrient intake that regulate appetite, result in potent and durable weight loss. Glucagon-like peptide 1 (GLP-1) agonists and glucose-dependent insulinotropic polypeptide (GIP) agonists such as semaglutide and tirzepatide are approved by the United States Food and Drug Administration (FDA) for the management of obesity. The SELECT trial demonstrated that semaglutide led to a reduction in major adverse cardiovascular events in patients without diabetes who were either overweight and had preexisting cardiovascular disease or obese. The treatment of obesity is critical to prevent the progression of cardiovascular-kidney-metabolic syndrome. Incretin-based therapies offer remarkable weight loss and reduce major cardiovascular adverse events.

251 - Access to allied health and specialist obesity services are barriers to obesity care in rural and regional populations in Australia

251 - Access to allied health and specialist obesity services are barriers to obesity care in rural and regional populations in Australia

New Tools Take Whole-Person Approach to Obesity Care.

New Tools Take Whole-Person Approach to Obesity Care.

Work-restricting musculoskeletal pain after bariatric surgery or usual obesity care in the Swedish Obese Subjects study.

The objective of this study was to study the recovery from, and incidence of, work-restricting musculoskeletal pain after bariatric surgery compared with usual obesity care. Pain in different body regions was monitored using questionnaires in the nonrandomized, prospective, controlled Swedish Obese Subjects (SOS) study, which included 2007 participants treated with bariatric surgery and a matched control group of 2040 participants receiving usual obesity care at primary health care centers. Self-reported pain in the neck and shoulders, back, hips, knees, and ankles was captured from questionnaires administered at baseline and after 1, 2, 3, 4, 6, 8, 10, 15, and 20 years. Compared with matched controls, bariatric surgery was associated with better recovery from baseline work-restricting knee and ankle pain in both the short (1-4 years) and long term (up to 20 years), as well as from back and hip pain in the short term. In participants without pain at baseline, bariatric surgery was associated with a lower incidence of developing new pain in the knee and ankle in the short and long term. Bariatric surgery was associated with better recovery from pain, primarily in weight-bearing joints, as well as with prevention of pain development in the knee and ankle compared with matched controls receiving usual obesity care.

Bone Quality Indices Correlate with Growth Hormone Secretory Capacity in Women Affected by Weight Excess: A Cross-Sectional Study.

Background/Objectives: Obesity can be associated with impaired growth hormone (GH) secretion, with possible negative repercussions on bone health. We aimed to investigate the relationships between GH secretory capacity, evaluated with GHRH + arginine stimulation test, and bone parameters, assessed with a dual-energy X-ray absorptiometer, in a population of adult female patients affected by overweight and obesity. Methods: We assessed 276 women affected by overweight or obesity referred to the High-Specialization Center for the Care of Obesity, Umberto I Polyclinic, between 2014 and 2019 with signs or symptoms of growth hormone deficiency (GHD). Results: A total of 97 patients were diagnosed with GHD, and 179 patients with normal GH secretion were considered our control group. GHD patients showed a significantly reduced trabecular bone score (TBS) (p = 0.01). Bone quality parameters corrected for body mass index (BMI) had a positive and significant linear correlation with stimulated GH secretory capacity. Conclusions: In conclusion, bone quality, evaluated by TBS and hip structural analysis, correlates with GH-stimulated secretory capacity. GHD may act as an additive factor in the alteration of bone microarchitecture in patients affected by obesity, who are already at a higher risk of fractures.

Nurses' Role in Obesity Management in Adults in Primary Healthcare Settings Worldwide: A Scoping Review.

Obesity is a chronic, prevalent, and complex health condition that adversely impairs physical and mental health. The World Health Organization calls for integrating obesity care into existing chronic disease management programs within primary healthcare services. This scoping review aimed to examine registered nurses' roles in the primary healthcare management of individuals with obesity. A scoping review was conducted using the Johanna Briggs Institute methodology framework. Thematic analysis was used to identify and categorize nurses' roles in primary healthcare obesity management of adults. Of 1142 documents included in this review, 15 papers met the inclusion criteria. Thematic analysis yielded the following six themes representing nurses' major roles: patient-centred care, patient assessments, therapeutic interventions, care management, patient education, and professional development. This review identified that the literature on nurses' roles primarily described their focus on lifestyle interventions (mainly nutrition and physical activity), anthropometric measurements, health planning, goal setting, supportive care, monitoring progress, and arranging follow-up. The Discussion highlights the importance of determining RN knowledge gaps and biases. More research is required to determine the need for additional RN pre-and or post-education related to obesity as a complex chronic disease.

An Interdisciplinary Intervention Based on Prescription of Physical Activity, Diet, and Positive Mental Health to Promote Healthy Lifestyle in Patients with Obesity: A Randomized Control Trial.

This study used a multimodal approach to address the issue of obesity among individuals with a Body Mass Index (BMI) between 30 and 40 residing in a rural region of north-east Spain. A pretest-posttest model was employed in a clinical trial design, comparing an intervention group with a control group. The intervention, which lasted for a period of nine months, was based on three main strategies: the prescription of physical activity, the promotion of healthy nutritional habits, and the management of emotional wellbeing through Positive Mental Health (PMH). A variety of assessment tools were employed, including the CLASS-AF scale and a stress test for physical activity levels; advanced anthropometry and blood analysis for metabolic and body composition variables; a Mediterranean diet adherence questionnaire for nutritional habits; and a PMH multifactorial questionnaire for the assessment of emotional management. The results revealed significant improvements in the level of physical activity and adherence to the Mediterranean diet in favor of the intervention group, where 89.4% (n = 17) of the participants went from being not very active/sedentary to being active. Also, adherence to the Mediterranean diet improved with a mean increase of 2.2 points on the scale [mean: 10.5 (CI 95%: 9.90, 11.09)]. In addition, significant reductions in body fat [mean: -2.50 kg (CI 95%: -3.56, -1.44)] and free fat mass [mean: -3.38% (IC 95%: -4.34, -2.41), along with decreased cholesterol levels (196 vs. 182 mg/dL), were observed, suggesting a decrease in cardiovascular and metabolic risk. In conclusion, this multimodal intervention was effective at improving the lifestyle of people with obesity and reducing their cardiovascular and metabolic risk. The combination of interventions focused on physical activity, diet, Positive Mental Health, and metabolic changes and were perceived as a comprehensive and complementary strategy in obesity care. These findings highlight the importance of approaching this condition from multiple perspectives to ensure optimal health outcomes.

How Can We Improve Obesity Care in 2024 and Beyond?

How Can We Improve Obesity Care in 2024 and Beyond?

Awareness is not enough: Developing competencies in behaviour change counselling for obesity management

BackgroundThis study describes the development and evaluation of a competency based training program in behaviour change counselling for obesity management. This was a real world study attempting to obtain evidence on the learning experience; specifically, achievement of level of competency as well as personal experiences of the integration of skills learned into practice. MethodsThis was a training effectiveness study involving a total of 28 evaluable licenced healthcare providers providing obesity care services. The design for this study is pre-experimental; specifically a one-group post-test only quasi-experimental design.Based on previous work developing a competency-based model of behaviour change counselling (developing change-based relationships, assessing and promoting readiness to change, implementing behaviour modification when ready, and addressing psychosocial determinants of behaviour) we report on training outcomes; specifically, the level of competency achieved in the various skill components of the intervention model. The model of training was based on corrective feedback, the development of peer-based learning and the creation of a mindmap to guide adaptation of interventions to the unique characteristics of individuals with obesity. Quantitative data on competency of components skills and qualitative information on the experience of training were used to evaluate the program. ResultsObjective assessment of skill competency post training demonstrated moderate to high skill in all aspects of behaviour change counselling. Learners reported frequent use of skills in clinical practice, particularly change-based relationships and readiness assessment/intervention. Qualitative interviews confirmed the value to learners in creating a safe place for corrective feedback, the development of the mindmap concept and the opportunity to teach back learned skills to peers. ConclusionProvision of competency-based behaviour change counselling in obesity management is critical to support the reformulation of obesity as a chronic disease and to be an important adjunct to medical/surgical interventions. In this paper, we have demonstrated the value of an intensive training program for obesity providers.