Obesity Care Research Articles

Patient-Centered Care for Obesity: How Health Care Providers Can Treat Obesity While Actively Addressing Weight Stigma and Eating Disorder Risk

Patient-Centered Care for Obesity: How Health Care Providers Can Treat Obesity While Actively Addressing Weight Stigma and Eating Disorder Risk

Exploring the weight bias of professionals working in the field of obesity with a mobile IAT: a pilot study.

Background:Obesity is common in many industrialized nations and often accompanied by related health issues. Furthermore, individuals living with overweight or obesity are often confronted with stigmatization in their daily lives. These problems may be aggravated if the objectivity of health care professionals is compromised due to (unconscious) prejudices. If pharmaceutical companies, regulatory agencies, and health insurers are also susceptible to these biases, decisions related to the development, approval, and reimbursement of obesity-related therapies may be negatively impacted.Materials and Methods:The ‘Implicit Association Test’ (IAT) is a psychometric test allowing to measure these attitudes and could therefore assist to reveal unconscious preferences. A self-developed mobile version, in the form of a ResearchKit-based IAT app was employed in the presented study. The objective was to determine (potential) weight bias and its characteristics for professionals attending a national obesity-related conference in Germany (G1), compared to a control group (without stated interest in the topic, G2) – both using the mobile app – and a historical control (G3) based on data provided by Project Implicit acquired by a web app.Results:Explicit evaluations of G1 were neutral at a higher percentage compared with G2 and G3, while implicit preference toward lean individuals did not differ significantly between G2 and G3, and G1.Conclusion:The greater discrepancy between the (more neutral) explicit attitude and the unconscious preference pointing in the anti-obesity direction could indicate an underestimated bias for the professional participants in G1. Implicit preference is often ingrained from childhood on, and difficult to overcome. Thus, even for professionals, it may unconsciously influence decisions made in the care they provide. Professionals in any given health care sector directed at obesity care should thus be made aware of this inconsistency to enable them to consciously counteract this potential effect.

Evidence and consensus-based clinical practice guidelines for management of overweight and obesity in midlife women: An AIIMS-DST initiative.

Evidence and consensus-based clinical practice guidelines for management of overweight and obesity in midlife women: An AIIMS-DST initiative.

Health managers and professionals’ perception on the care of child and adolescent obesity in Brazil’s Unified Health System

Resumo O estudo teve como objetivo analisar a percepção de gestores e profissionais de saúde sobre o cuidado disponível para crianças e adolescentes com sobrepeso e obesidade no Sistema Único de Saúde em Sergipe, Brasil. Trata-se de estudo qualitativo e exploratório, com amostra composta por 46 atores e coleta de dados por meio de entrevistas semiestruturadas. O cuidado existente foi percebido como falho e fragmentado, independentemente do nível de atenção à saúde. As principais dificuldades abrangeram o processo de trabalho, a gestão e organização do cuidado, a adesão familiar e a insuficiência de recursos. Potencialidades relacionadas à gestão, equipes e profissionais, que poderiam contribuir para a implantação de uma linha de cuidado integral, foram também identificadas. Contudo, a organização do cuidado à obesidade infantil ainda requer uma conectividade dos papéis e tarefas dos diversos atores, por meio da pactuação e corresponsabilização entre os serviços, profissionais e a família.

OBESITY, HEALTH CARE EXPENDITURE AND EDUCATION IN BAMENDA MUNICIPALITY-CAMEROON: CONSIDERATIONS FOR CURRICULUM INNOVATION

Obesity is a major risk factor to many non-communicable diseases leading to increase health care expenditures and concerns for curriculum innovations in many countries. Thus, the objectives of this study are: to determine the factors influencing health care expenditure, to investigate the effects of obesity on health care expenditure, to examine the relationship between obesity and education and to discuss implications for curriculum innovation on the basis of the findings. The study was conducted in the Bamenda Municipality of Mezam Division in the North West Region of Cameroon. The survey research design was employed. With the use of questionnaire, primary data was collected from 753 obese and non-obese individuals aged 20 and above. The multiple regression and multinomial logit results revealed that, level of monthly expenditure and education had statistically significant effect on health care expenditure in the Bamenda Municipality. There was insignificant effect of obesity on health care expenditures. Gender and age influenced health care expenditure and majority of those who had attained higher levels of education were non obese as opposed to their obese counterparts. The study argued that, curriculum innovation focusing on reducing obesity and health care expenditure via educational attainment remains a long term process. Therefore, educational stakeholders should sensitize the community on the basic rules on weight watching and the Bamenda City Council should create weight loss rehabilitation centers. The adoption of personalized and integrated approaches to innovative curriculum planning and design should be of utmost importance to the government of Cameroon.

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.

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. 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. 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. 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.

The family system seeking to transform its eating behavior in the face of childhood obesity.

to understand families' behaviors and eating practices in the face of childhood obesity. a qualitative study, which used the Grounded Theory as a methodological framework and the Complexity Theory as a theoretical framework. Twenty-six informants participated in the study, who were part of two sample groups. Data were collected through intensive interviews, using a semi-structured script. "The family system seeking to change eating behavior patterns in the face of childhood obesity" emerged as a central concept, relating three conceptual categories: "Recognizing its behavior patterns and eating practices"; "Reorganizing in the face of childhood obesity"; "Responding to change". the family influences children's eating behavior and contributes to changes that occur in it, which highlights the relevance of the family approach in childhood obesity care, raising reflection on the current nursing practice together with families who experience the same problem.

The Burden of Obesity in Nigeria

Background and Aims: Over the years, obesity has become a global health concern. According to the World Health Organization, as at 2016, the world has experienced over four-fold increase in obesity within four decades. This public health crisis has taken its toll in Nigeria with a reported prevalence of 14% as at 2020. This review thus seeks to assess available evidence on the burden of obesity, associated co-morbidities, risk of non-communicable diseases, and available management strategies in Nigeria. Methods: This narrative review was conducted on research articles retrieved without date restriction. The databases assessed were PubMed, Web of Science, Science Direct, and Google Scholar databases, as well as reference lists of relevant articles. The search terms used were “obesity in Nigeria”, “burden of obesity” “obesity co-morbidities”, and “obesity care.” Results: Studies have indicated that sedentary lifestyle, poor nutritional choices as well as genetic alterations are some of the causes of obesity in Nigeria. With the increasing prevalence of obesity, its associated co-morbidities, the current economic situation of the country and low accessibility to affordable healthcare services, it is currently a burden to healthcare professionals and the country at large. Conclusions: There is a need for the Nigerian government to focus more on healthcare development to cater for the increasing population and mitigate obesity occurrence. Moreover, there is a need for national orientation and sensitization on predisposing factors to obesity.

Rare genetic causes of obesity: Diagnosis and management in clinical care

Rare genetic forms of obesity are linked to impaired energy balance (i.e., eating behaviour and energy expenditure) involving hypothalamic pathways. More than 60 genes coding for proteins located in the hypothalamic leptin/melanocortin pathway contribute to the development of these rare forms of obesity. The ambition of the French National Protocol for the Diagnosis and Care (PNDS) of Obesity of Rare Causes was to establish practical recommendations for assessment and management at all ages. This report is available on the website of the French Health Authority (HAS). In addition to severe obesity, patients often display obesity-related comorbidities and neuropsychological/psychiatric disorders. These complex conditions make clinical management particularly challenging. Early diagnosis is critical for the organization of coordinated specialized multidisciplinary care, with mandatory interaction between caregivers, social partners and families. Strategies to prevent aggravation of obesity consist in limiting access to food, establishing a reassuring daily eating environment, and the practice of sustained adapted supervised daily physical activity. The implementation of genetic diagnosis in clinical practice now enables a personalized medicine approach with access to new drug therapies, and improves the analysis of the risk/benefit ratio of bariatric surgery.

Individual-level barriers to bariatric surgery from patient and provider perspectives: A qualitative study

BackgroundLess than 1% adults in the United States who meet body mass index criteria undergo bariatric surgery. Our objective was to identify patient and provider perceptions of individual-level barriers to undergoing bariatric surgery. MethodsAdults with severe obesity and obesity care providers described their experiences with the bariatric surgery care process in semi-structured interviews. Using conventional content analysis, individual-level barriers were identified within Andersen's Behavioral Model of Health Services Use. ResultsOf the 73 individuals interviewed, 36 (49%) were female, and 15 (21%) were non-white. Six individual-level barriers were identified: fear of surgery, fear of lifestyle change, perception that weight had not reached its “tipping point,” concerns about dietary changes, lack of social support, and patient characteristics influencing referral. ConclusionsPatient and provider education should address patient fears of surgery and the belief that surgery is a “last resort.” Bariatric surgery programs should strengthen social support networks for patients.

Association of childhood abuse with behavioral weight-loss outcomes: Examining the mediating effect of binge eating severity.

The study aims were to (1) document the relationship between a history of childhood abuse and weight change during behavioral obesity treatment and (2) estimate the indirect effect of childhood abuse on weight change through binge eating severity. Participants (n = 431) were enrolled in a behavioral weight-loss intervention. Childhood physical and emotional abuse history and current binge eating severity were self-reported. Percent weight loss at 6 months was calculated using measured weight. Adjusted mediation models examined whether there was an indirect effect of childhood physical and emotional abuse on 6-month percent weight loss that operated through binge eating severity. After covariate adjustment, childhood physical abuse, but not emotional abuse, predicted a lower percent weight loss (B = -1.78%; 95% CI: -3.10% to -0.47%). Although childhood physical and emotional abuse were positively related to baseline binge eating severity, binge eating severity did not mediate the associations between either childhood abuse type and percent weight loss. Individuals with a childhood physical abuse history had a lower percent weight loss than those without such histories during behavioral obesity treatment. This effect was not explained by binge eating severity. Individuals with a history of childhood abuse may benefit from trauma-informed obesity care.

THE EFFECT OF GROUP EDUCATION USING ONLINE MEDIA ON SELF CARE ON OBESITY STUDENTS AT THE FACULTY OF NURSING MUHAMMADIYAH UNIVERSITY JAKARTA 2021

Introduction: Obesity in young adults can cause various health problems, including in the long term it will cause complications of diseases such as hypertension, diabetes mellitus and death at a young age. Self care in obesity is a management consisting of diet processing, physical activity, modification of life attitude (behavior therapy) and medical therapy. Peer group education is a method that helps increase understanding and self-care for obese students. The purpose of this study was to determine the peer group education method to increase self-care of obese students.
 Method: The research design used was a quasi-experimental pre and post test, with a dependent t-test. Collecting data using the Diabetes Self Management Questionnaire (DMSQ). Sample of 30 respondents.
 Results: The results of this study obtained that there was an effect of peer group education on increasing the self-care value of obese students (p-value = 0.00).
 Conclusion: Suggestions from this study are self-care is one of the efforts that can be used to overcome the problem of obesity at a young age. Educational institutions can implement self-care through healthy exercise programs every morning or health education programs in health services.

New Horizons. A New Paradigm for Treating to Target with Second-Generation Obesity Medications.

In treating obesity as a chronic disease, the essential goal of weight loss therapy is not the quantity of weight loss as an end unto itself but rather the prevention and treatment of complications to enhance health and mitigate morbidity and mortality. This perspective on obesity care is consistent with the complications-centric American Association of Clinical Endocrinology (AACE) obesity guidelines and the diagnostic term of adiposity-based chronic disease (ABCD). Many complications require 10% to 20% weight loss to achieve therapeutic goals; however, existing obesity medications fail to produce ≥10% weight loss in the majority of patients. In June, 2021, semaglutide 2.4 mg/week was approved for chronic weight management. Phase 3 clinical trials demonstrated that this medication produced > 10% placebo-subtracted weight loss, more than half of patents lost ≥15%, and over one third lost ≥20% of baseline weight. This essentially doubles effectiveness over existing obesity medications, provides sufficient weight loss to ameliorate a broad range of complications, and qualifies as the first member of a second-generation class of obesity medications. The advent of second-generation medications fully enables a treat-to-target approach for management of ABCD as a chronic disease. Specifically, with this degree of efficacy, second-generation medications permit active management of body weight as a biomarker to targets associated with effective treatment and prevention of specific complications. ABCD can now be managed similar to other chronic diseases such as type 2 diabetes, hypertension, and atherosclerosis, which are treated to biomarker targets that can be modified based on the clinical status of individual patients [ie, hemoglobin A1c (HbA1c), blood pressure, and low-density lipoprotein cholesterol (LDL-c)] to prevent the respective complications of these diseases.

Lessons Learned for Obesity Prevention and Care from Five Integrated Programs.

Lessons Learned for Obesity Prevention and Care from Five Integrated Programs.

Association of Bariatric Surgery With Cancer Incidence in Patients With Obesity and Diabetes: Long-term Results From the Swedish Obese Subjects Study

Obesity and type 2 diabetes are associated with serious adverse health effects, including cancer. Although bariatric surgery has been shown to reduce cancer risk in patients with obesity, the effect of bariatric surgery on cancer risk in patients with obesity and diabetes is less studied. We therefore examined the long-term incidence of cancer after bariatric surgery and usual care in patients with obesity and diabetes in the matched prospective Swedish Obese Subjects (SOS) study. The SOS study examines long-term outcomes following bariatric surgery or usual care. The current analysis includes 701 patients with obesity and type 2 diabetes at baseline, 393 of whom underwent bariatric surgery and 308 who received conventional obesity treatment. Information on cancer events was obtained from the Swedish National Cancer Register. Median follow-up time was 21.3 years (interquartile range 17.6-24.8 years, maximum 30.7 years). During follow-up, the incidence rate for first-time cancer was 9.1 per 1,000 person-years (95% CI 7.2-11.5) in patients with obesity and diabetes treated with bariatric surgery and 14.1 per 1,000 person-years (95% CI 11.2-17.7) in patients treated with usual obesity care (adjusted hazard ratio 0.63 [95% CI 0.44-0.89], P = 0.008). Moreover, surgery was associated with reduced cancer incidence in women (0.58 [0.38-0.90], P = 0.016), although the sex-treatment interaction was nonsignificant (P = 0.630). In addition, diabetes remission at the 10-year follow-up was associated with reduced cancer incidence (0.40 [0.22-0.74], P = 0.003). These results suggest that bariatric surgery prevents cancer in patients with obesity and diabetes and that durable diabetes remission is associated with reduced cancer risk.

Incorporating Obesity and Weight Bias Training Improved Attitudes of Hospital Staff Towards People With Obesity in Alberta

Over 90% of people with type 2 diabetes have obesity or are overweight. People who live with obesity often report experiencing weight bias and stigma when accessing health care. The Diabetes, Obesity and Nutrition Strategic Clinical NetworkTM has worked to improve inpatient glycemic control in people with diabetes throughout the province and we now aim to improve the care and experience of people living with obesity in hospital. Our first step was to pilot an initiative that developed standards and guidelines for improving obesity care with hospital staff. The objective of this study was to assess the effect of the implementation of educational resources on weight bias among hospital staff.

Age moderates the relationships between obesity, glucose variability, and intensive care unit mortality: a retrospective cohort study

BackgroundAlthough the associations between obesity, glucose variability (GV), and Intensive Care Unit (ICU) mortality have been studied extensively, whether age moderates these associations is not well understood.Materials and methodsThe medical records of 1062 patients, who were admitted into ICU at Sir Run Run Shaw Hospital (Zhejiang, China), were studied. Logistic regression was used to test the associations between obesity, GV, and ICU mortality. Furthermore, the moderation effect of age was tested.ResultsAfter controlling for covariates, the underweight group had the highest odds of death (OR 2.38, 95% CI 1.43–3.95, p < 0.001) in comparison with the control group (overweight). However, normal weight (OR 1.29, 95% CI 0.88–1.89, p = 0.185) and obese (OR 1.08, 95% CI 0.61–1.90, p = 0.790) groups had similar odds of death, compared to the overweight group. Age significantly moderated the association between obesity and mortality, where being overweight was more advantageous than being normal weight in older adults (B = 0.03, SE = 0.01, OR 1.03, 95% CI 1.001–1.06, p = 0.045). Meanwhile, higher GV predicted greater mortality in adjusted models (OR 1.23, 95% CI 1.06–1.42, p = 0.005). We also found an interaction between age and GV (B = − 0.01, SE = 0.01, OR 0.99, 95% CI 0.98–0.999, p = 0.025), which suggested that the association between GV and mortality becomes weaker with increasing age.ConclusionsWith increasing age, the association between BMI and mortality becomes stronger and the association between glucose variability and mortality becomes weaker. Future studies should investigate the underlying mechanisms of such phenomenon and the causal relationship between obesity, GV, and ICU mortality.

Significance of sugar intake in young adults: a review.

Foodborne diseases non-communicable diseases (NCDs) are the main reason of death, accounting for 38 million (68%) of the 56 million premature deaths worldwide in 2012. Lower-middle and middle-income countries accounted for nearly three-quarters of all NCD fatalities (28 million), as well as the bulk of illness and premature death (82%). An excessive consumption of added sugar is source of worry for its link to unhealthy nutrition quality, overweight, and the risk of NCDs among adolescents. A further source of worry is the link among free sugar consumption and tooth cavities in young adults. Dental infections are the most common NCDs worldwide in young adults, and despite significant advances in management and cure in recent decades, issues remain, resulting in pain, anxiety, functional limitations (which include failing school grades and attendance in children), and social severe disability due to missing teeth. The purpose of this report is to give suggestions on how to consume added sugar in order to mitigate the possibility of NCDs in children and young adults, with an emphasis on the care and mitigation of obesity and metabolic syndrome and tooth decay among young adults. The Keywords like adolescent, Health, Dental Caries, Obesity, Sugar Intake, Recommendation have been used to evaluate the standard of evidence discovered via current systematic reviews of the scientific literature relating to significance of sugar intake consumption and its effect in young adults. The relevant data from prospective studies was judged to be of good quality, but data from nationwide population-based studies was judged to be of extremely low quality. Free sweeteners should be used in moderation during one's life, according to the World Health Organization (strong recommendation 1). WHO advises limiting natural sugar consumption to very little about 10% of total calorie intake among both grownups and children 2 (strong recommendation). There is a significant association of prevalence of tooth decay, obesity due to sugar consumption at an alarming rate hence regulators as well as curriculum developers can utilize the recommendation reviewed by us to compare current free sugar intake levels in their nations to a benchmark. They may also be used to design ways to reduce free sugar consumption through a wide variety of social health initiatives, if required.

Factor Structure, Validity, and Reliability of the STarT Back Screening Tool in Italian Obese and Non-obese Patients With Low Back Pain.

Background: The STarT Back Screening Tool (SBST) is a self-report questionnaire developed for prognostic purposes which evaluates risk factors for disability outcomes in patients with chronic low back pain. Previous studies found that its use enables to provide a cost-effective stratified care. However, its dimensionality has been assessed only using exploratory approaches, and reports on its psychometric properties are conflicting.Objective: The objective of this study was to assess the factorial structure and the psychometric properties of the Italian version of the STarT Back Screening Tool (SBST).Materials and Methods: Patients with medical diagnosis of low back pain were enrolled from a rehabilitation unit of a tertiary care hospital specialized in obesity care (Sample 1) and from a clinical internship center of an osteopathic training institute (Sample 2). At baseline and after 7 days patients were asked to fill a battery of self-report questionnaires. The factorial structure, internal consistency, test-retest reliability, and construct validity of the SBST were assessed.Results: One hundred forty-six patients were enrolled (62 from Sample 1 and 84 from Sample 2). The confirmatory factor analysis showed that the fit of the original two-correlated factors model was adequate (CFI = 0.98, TLI = 0.99, RMSEA = 0.03). Cronbach's α of the total scale (α = 0.64) and of the subscales (physical subscale α = 0.55; psychological subscale α = 0.61) was below the cutoffs, partly because of the low correlation of item 2 with the other items. Test-retest reliability was adequate (ICC = 0.84). The SBST had moderate correlations with comparisons questionnaires, except for the Roland-Morris Disability Questionnaire, which had a high correlation (r = 0.65).Discussion: The SBST has adequate psychometric properties and can be used to assess prognostic factors for disability in low back pain patients.

Preferences on how to measure and discuss health related quality of life within integrated care for children with obesity

BackgroundChildhood obesity can affect physical as well as psychosocial wellbeing. Therefore, childhood obesity care aims to improve all dimensions of health related quality of life (HRQoL). HRQoL can be measured with the generic questionnaire PedsQL4.0 and the weight-specific IWQOL-Kids. In the Netherlands, HRQoL assessment is conducted by the coordinating professional (CP). The aim of this qualitative study was to examine how and when to implement the measurement and discussion of HRQoL using the PedsQL4.0 and IWQOL-Kids within the integrated care for children with obesity in the Netherlands. Semi-structured interviews were conducted with fourteen CPs, in which the following was discussed: a) familiarity and attributions with regard to the assessment of HRQoL; b) wishes and needs with regard to the usage of the questionnaires; c) its practical incorporation.ResultsInterviews revealed that most CPs gained insight into the HRQoL by talking with families. One CP used the PedsQL4.0, the remaining CPs were unfamiliar with the two questionnaires. Even though some barriers, for instance a lack of time, might hinder the implementation of the PedsQL4.0 and IWQOL-Kids, all participants think the usage of either one or both questionnaires would have additional value to the support and care for children with obesity. There was no consensus about the questionnaire of preference.ConclusionsWhen the right preconditions are met, HRQoL questionnaires have the potential to support CPs in improving the care for children with obesity, tailored to each individual child.