Obesity Management In Primary Care Research Articles

Prevalence and Correlates of Night Eating Syndrome, Insomnia, and Psychological Distress in Primary Care Patients with Obesity: A Cross-Sectional Study

Plain Language SummaryDespite the increasing interest in combating obesity, its prevalence is increasing worldwide. The success of available management modalities for obesity is often complicated by mental health, eating, and sleeping disorders. Night eating syndrome is a unique eating disorder characterized by excessive calorie intake at night that exceeds one-quarter of the total daily calorie consumption. We conducted a study on 425 individuals with obesity from five healthcare centers in Port Said, Egypt to evaluate the extent and associated factors of night eating syndrome, insomnia, and psychological distress among people with obesity. We found that around one in five individuals with obesity suffered from night eating syndrome or psychological distress, and one in six individuals with obesity had symptoms of insomnia. Notably, night eating syndrome, insomnia, and psychological distress were interrelated. Moreover, fatty liver occurred more frequently in patients with obesity who had night eating syndrome or insomnia highlighting the importance of maintaining circadian rhythms in metabolic disorders. Based on our findings, we recommend that family physicians should routinely assess dietary habits, sleeping disorders, and mental health conditions in people with obesity to enhance the success rate of obesity management in primary care.

“What’s the damage? Give it to me!”: Type 2 diabetes mellitus and obesity management in primary care with implications for biomedical science, clinical practice and population health

Type 2 diabetes mellitus (T2DM) is a condition that defines medicine in the 21st century. Multifactorial individual and environmental causes have given rise to a non-communicable disease that challenges traditional prevention and treatment paradigms. In this report, the author explores the case of one patient with T2DM he met during his general practice placement in South Auckland. He argued that in the face of such interwoven challenges, an understanding spanning from the pathophysiology to the pathological environment—and an ability to bridge these understandings in the clinical context—is essential in supporting patients with this complex condition.

Impact of a Community-Based Weight Management Program in a North Carolina Health Care System.

Current strategies for obesity management in primary care leave many patients inadequately treated or unable to access treatment entirely. We aimed to evaluate a comprehensive, primary care clinic-based weight management program's clinical effectiveness in a community practice setting. Methods: This was an18-month pre/postintervention study. We collected demographic and anthropometric data on patients enrolled in a primary care-based weight management program.The primary outcomes were percent weight loss postintervention and the proportion of patients who achieved a clinically significant total body weight loss (TBWL) of 5% or greater. Results: Our program served 550 patients over 1,952 visits from March 2019 through October 2020.A total of 209 patients had adequate program exposure, defined as four or more completed visits. Among these, all received targeted lifestyle counseling and 78% received antiobesitymedication.Patients who attended at least four visits had an average TBWL of 5.7% compared to an average gain of 1.5% total body weight for those with only one visit. Fifty-three percent of patients (n=111)achieved greater than 5% TBWL, and 20%(n=43)achieved greater than 10% TBWL. We demonstrated that a community-based weight management program delivered by obesity medicine-trained primary care providers effectively produces clinically significant weight loss. Future work will include wider implementation of this model to increase patient access to evidence-based obesity treatments in their communities.

Intensive behavioral Therapy for weight loss in patients with, or At-Risk of, type 2 Diabetes: Results from the PaTH to health diabetes study

Intensive behavioral therapy (IBT) is an important component of obesity treatment and can reduce the risk of type 2 diabetes (T2DM).Objective was to compare the effectiveness of IBT to usual care in achieving weight loss in two study cohorts within PaTH Network: T2DM and At-Risk of T2DM.The TD2M cohort was defined as age 18 years and older with an indication of T2DM in the EHR based on a validated algorithm and at least 2 outpatient primary care visits. The At-Risk of T2DM cohort was defined by a BMI ≥ 25 kg/m2. The primary outcome was weight change within 1-year of index date. Mixed-effects models assessed the effectiveness of IBT by comparing the changes between study groups.Between 2009 and 2020, a total of 567,908 patients were identified in the T2DM cohort and2,054,256 patients in the At-Risk of T2DM cohort. Both IBT patients and matched non-IBT patients in the T2DM cohort had decreased mean weight (primary outcome) (−1.56 lbs, 95 %CI: −1.88, −1.24 vs −1.70 lbs, 95 %CI: −1.95, −1.44) in 1-year after index date. In the At-Risk of T2DM cohort, both IBT and non-IBT patients experienced weight gain and resultant increased BMI. Patients with more than one IBT visit gained less weight than those with only one visit (1.22 lbs, 95 %CI: 0.82, 1.62 vs 6.72 lbs, 95 %CI: 6.48, 6.97; p < 0.001).IBT was unlikely to result in clinically significant weight loss. Barriers to utilizing IBT require further research to ensure broader adoption of obesity management in primary care.

Recent trends in adult body mass index and prevalence of excess weight: Data from the Canadian Primary Care Sentinel Surveillance Network.

To explore recent body mass index (BMI) trends over time among Canadian adults seen in primary care to identify the best target groups for preventive interventions. Retrospective descriptive cohort design. Data for this study were derived from the Canadian Primary Care Sentinel Surveillance Network database. All patients aged 18 years and older who had BMI measurements available between 2011 and 2016 were identified. A closed cohort (N = 243 078 unique patients) with a start date of January 1, 2011, was defined. Patients were excluded if key variables were missing or if BMI measurements were 15 kg/m2 or less or 50 kg/m2 or greater. The dependent variable for this study was BMI (kg/m2). Measured BMI values recorded in electronic medical records were used. A linear mixed-effect estimate was fit to model changes in BMI over time with control of baseline age and sex. Patients in the Canadian Primary Care Sentinel Surveillance Network database experienced a modest increase in mean (95% CI) BMI by 2.1% from 28.5 (28.4 to 28.6) kg/m2 in 2011 to 29.1 (28.9 to 29.2) kg/m2 in 2016 (P < .0001). This increase is not a measured difference in BMI in the same individual but reflects the difference in the average BMI of the population in 2011 versus 2016. Male patients had BMI values that were on average 1.02 kg/m2 higher than those of female patients (P < .0001). Mean BMI values increased most rapidly in young adults (18 to 34 years) compared with older adults. The findings indicate that current obesity management in primary care is failing to moderate weight trajectories in different groups by age and sex. The results also suggest that younger age groups, in whom accelerated weight gain occurred, should be the target of prevention initiatives.

The daily Self-Weighing for Obesity Management in Primary Care Study: Rationale, design and methodology

BackgroundDaily self-weighing (DSW) may be an effective harm-reduction intervention to disrupt continued weight gain. Self-Weighing for Obesity Management in Primary Care (SWOP) is a 24-month randomized controlled trial in 400 adults with obesity (BMI: kg/m2 ≥ 30) receiving primary care through a clinical network affiliated with an academic medical center.ObjectiveTo test DSW as a potentially scalable way to deter age-related weight gain among primary care patients with obesity.MethodsRandomized-controlled trial with two conditions: DSW (instruction to weigh daily and provision of a web-enabled digital scale with graphical weight feedback) or Standard Care (receive a monetary gift card equivalent to value of the scale). Both groups receive standardized weight management educational material. SWOP will test the causal effect of assignment to DSW (Aim 1) and adherence to DSW (Aim 2) on weight (primary outcome) and adoption of weight management practices (secondary outcomes), as well as evaluate the cost-effectiveness of DSW compared to standard care (Aim 3). Findings may inform clinical guidelines for weight management by providing evidence that DSW attenuates continued age-related weight gain among adults with obesity. This trial is registered with ClinicalTrials.gov (NCT04044794).

Obesity management in primary care: systematic review exploring the influence of therapeutic alliance.

To identify the influence of the therapeutic alliance on the effectiveness of obesity interventions delivered in primary care. Systematic review of randomized controlled trials of primary care interventions for adult patients living with obesity. Comprehensive search strategy using the terms 'obesity', 'primary care' and 'intervention' of seven databases from 1 January 1998 to March 2018. Primary outcome was difference in weight loss in interventions where a therapeutic alliance was present. From 10 636 studies, 11 (3955 patients) were eligible. Only one study had interventions that reported all aspects of therapeutic alliance, including bond, goals and tasks. Meta-analysis was not included due to high statistical heterogeneity and low numbers of trials; as per our protocol, we proceeded to narrative synthesis. Some interventions included the regular primary care practitioner in management; very few included collaborative goal setting and most used prescriptive protocols to direct care. We were surprised that so few trials reported the inclusion of elements of the therapeutic alliance when relational aspects of primary care are critical for effectiveness. Interventions could be developed to maximize therapeutic relationships and research reports should describe interventions comprehensively. CRD42018091338 in PROSPERO (International prospective register of systematic reviews).

The Joys and Challenges of Delivering Obesity Care: a Qualitative Study of US Primary Care Practices.

Obesity is of epidemic proportion in the USA but most people with obesity do not receive treatment. To explore the experience of providing obesity management among primary care clinicians and their team members involved with weight loss in primary care practices. The study's focus was on examining the use of the Medicare payment code for intensive behavioral therapy for obesity (IBT), but other obesity management services and payment mechanisms were also studied. We conducted 85 interviews of clinicians (physician, advanced practice clinicians, registered dietitian, or other) practicing in primary care practices. Interviews gathered information about treatment approach to obesity, barriers, and facilitators to providing obesity care including the handling of billing and reimbursement (especially use of the IBT code), personal beliefs about the appropriateness of primary care providing weight loss services, and recommendations for improving weight management in primary care practice. The analysis was conducted using a grounded theory hermeneutic editing approach and the constant comparative method. Seventy-five interviews were included in this analysis. We identified three primary themes: (1) clinicians and staff involved in obesity management in primary care believe that addressing obesity is an essential part of primary care services, (2) because providing obesity care can be challenging, many practices opt out of treatment, and (3) despite the challenges, many clinicians and others find treating obesity feasible, satisfying, and worthwhile. Treating obesity in primary care settings poses several challenges but can also be very satisfying and rewarding. To improve the ability of clinicians and practice members to treat obesity, important changes in payment, education, and work processes are necessary.

Adult obesity management in New Zealand general practice: a review.

INTRODUCTION Obesity is an important issue that leads to further health complications, increases the strain on the national health system and lowers quality of life. There is little available information on obesity management to guide best practice in general practice, despite 32% of New Zealand adults reported to be obese. AIM To review obesity management in New Zealand general practice. METHODS We searched six online databases for peer-reviewed research about adult obesity management. Inclusion criteria were original research, a New Zealand adult sample aged 25-64 years with a body mass index (BMI) >30 (or >25 BMI if participants had comorbidities) with weight loss (kg) as a measurable outcome. RESULTS Eleven articles were identified: nine studies reported statistically significant weight loss from baseline, and two studies reported no significant weight loss. Three studies used a Kaupapa Māori approach. Weight loss results ranged from 0.56 to 12.1 kg. Weight loss interventions varied in strategy and suitability for individual patients. DISCUSSION We found that there are effective weight loss interventions available for primary health-care professionals to refer to. Although most interventions did produce some weight loss, patients may need more comprehensive interventions that include a combination of diet, exercise and behaviour modifications in culturally appropriate ways. Future research should aim to identify and mitigate potential barriers to obesity management in primary care, as well as develop comprehensive, multileveled interventions that are effective for the local population.

Attitudes, behaviours and strategies towards obesity patients in primary care: A qualitative interview study with general practitioners in Germany

Background Obesity poses severe challenges for the health care system. GPs are in an advantageous position to contribute to preventing obesity by diagnosing patients and initiating treatment. Sporadic studies have shown that attitudes towards obesity management in primary care can have a major influence on treating patients successfully. Objectives The study focuses on attitudes and behavioural patterns towards obesity patients, willingness to provide care, approaches and strategies, and the challenges experienced. Methods After developing the interview guides based on a literature review, 36 GPs in North Rhine-Westphalia and Saarland, Germany, were interviewed between November 2019 and March 2020. Using qualitative typing according to Kluge, different prototypes of GPs were formed. The dimensions of the interview guides were used for deriving the prototypes. Results GPs were categorised into four types depending on how they saw themselves and their role in treating patients. The first type (the resigned) was conspicuous through its negative attitude towards obesity management and a lack of willingness to provide care. The second type (the instructors) emphasised the value of active exercise, diet and health promotion, while the third type (the motivators) saw psychosocial support and motivation as a key element in helping patients. In contrast, type four (the educators) focussed primarily on early prevention through patient education. Conclusion Depending on which (proto-)type a patient visits, different focuses and strategies are pursued for obesity management and doctor–patient communication. This results in different perspectives and chances of success about therapeutic measures.

Obesity Management in Primary Care During and Beyond the COVID-19 Pandemic

With 6.1 million United States cases as of early September 2020, the coronavirus disease 2019 (COVID-19) pandemic is presenting unprecedented challenges to primary care. As a complex multifactorial chronic disease, obesity is a significant risk for severe COVID-19 complications associated with high morbidity and mortality. Sustainable lifestyle changes and weight loss can be effective to address obesity and its complications. With COVID-19 expected to persist for the foreseeable future, treatment and prevention of obesity is more imperative than ever. This report summarizes how obesity management and lifestyle counseling can be incorporated and applied in primary care during and beyond the COVID-19 pandemic.

Measuring What Matters: Beyond Quality Performance Measures in Caring for Adults with Obesity.

Obesity is a chronic disease that poses serious health and societal burdens. Although guidelines exist for obesity management in primary care, evaluating the success of obesity treatment programs is hampered by lack of established, robust quality measures. This study aimed to develop, and test for feasibility, measures for operational tracking, quality performance, and patient-centered care in the context of a national collaborative to develop a model for obesity management in the US primary care setting. The authors developed and evaluated 7 measures used to track the care of patients with overweight or obesity (n = 226,727 at baseline) receiving care within 10 health care organizations (HCOs). Measure categories included: (1) operational tracking (obesity/overweight prevalence and prevalence of obesity-related complications); (2) quality performance (obesity diagnosis, change in weight over time, anti-obesity medication prescriptions, and assessment of obesity-related complications); and (3) patient-centered care (patient-reported outcomes). Measures were tested for feasibility, variability across HCOs, ability to detect differences over time, and value to the HCOs. All measures were feasible to collect, provided value to the participating HCOs, and demonstrated variation and ability to detect differences over time (eg, rates of documented diagnosis of obesity classes 1, 2, and 3 increased from 29%, 46%, and 66%, respectively, at baseline to 35%, 53%, and 71% at study end). This study confirmed the feasibility and perceived value of 7 operational, performance, and patient-centered measures collected in primary care practices in 10 HCOs over an 18-month period.

Sharing the 'weight' of obesity management in primary care: integration of registered dietitian nutritionists to provide intensive behavioural therapy for obesity for Medicare patients.

Clinical provision of intensive behavioral therapy for obesity (IBTO) has been a reimbursable treatment for obesity since 2012. However, gaps remain in the literature regarding its impact on patient outcomes. The primary objective of this study was to examine the integration of registered dietitian nutritionist provided IBTO into a primary care setting and evaluate clinic outcomes for Medicare Part B beneficiaries. A secondary objective was to examine intensity of IBTO (quantity of IBTO visits) versus clinical outcomes and influence of socioeconomic factors. A case-control retrospective chart review was conducted at a rural, Academic Family Medicine Clinic in Eastern North Carolina for patients seen between 1 January 2016 and 1 January 2019. In order to be included in the treatment group, patients had to be female, white or black race, have Medicare insurance and a body mass index ≥ 30 kg/m2. Mixed model analysis showed statistically significant improvements in clinical outcomes from IBTO treatment. Weight decreased by nearly 3 pounds, while body mass index was half a point lower. A1C was 0.1 units lower for IBTO patients, and they took prescription medication and average of 6 days less than the control group. Minorities and older respondents experienced smaller, all else constant, and annual fixed effects suggest that differentials widen over time. Registered dietitian nutritionist (RDN) provision of IBTO has demonstrated benefit in improving clinical outcomes including weight, A1C, and reduced medication duration (use) as demonstrated by the IBTO treatment group versus control. IBTO intensity was not predictive of success, and its impact was reduced with older and African American patients. IBTO is beneficial and can be delivered within the primary care setting by a RDN.

Daily Self-Weighing for Obesity Management in Primary Care

Daily Self-Weighing for Obesity Management in Primary Care

Management of overweight and obesity in primary care-A systematic overview of international evidence-based guidelines.

SummaryOverweight and obesity are increasing worldwide. In general practice, different approaches exist to treat people with weight problems. To provide the foundation for the development of a structured clinical pathway for overweight and obesity management in primary care, we performed a systematic overview of international evidence‐based guidelines. We searched in PubMed and major guideline databases for all guidelines published in World Health Organization (WHO) “Stratum A” nations that dealt with adults with overweight or obesity. Nineteen guidelines including 711 relevant recommendations were identified. Most of them concluded that a multidisciplinary team should treat overweight and obesity as a chronic disease. Body mass index (BMI) should be used as a routine measure for diagnosis, and weight‐related complications should be taken into account. A multifactorial, comprehensive lifestyle programme that includes reduced calorie intake, increased physical activity, and measures to support behavioural change for at least 6 to 12 months is recommended. After weight reduction, long‐term measures for weight maintenance are necessary. Bariatric surgery can be offered to people with a BMI greater than or equal to 35 kg/m2 when all non‐surgical interventions have failed. In conclusion, there was considerable agreement in international, evidence‐based guidelines on how multidisciplinary management of overweight and obesity in primary care should be performed.

October and Obesity Care Week

Two important health care conditions are given special recognition each year during the month of October: National Breast Cancer Awareness Month and National Obesity Care Week. While my thoughts go out to all who are impacted by breast cancer, I want to focus this month’s Letter on obesity and Obesity Care Week, October 7 – 13. According to the CDC, approximately 40% of adults in the U.S. are obese. Heart disease, stroke, type 2 diabetes and certain types of cancer are related to obesity. These diseases are major causes of preventable deaths and each day impact the lives of the patients we see. The treatment for obesity is complicated since multiple factors contribute to the disease. However, NPs are well positioned to help patients who are obese lose weight and manage chronic disease. To address the obesity issue and prepare NPs to provide a patient-centered approach to obesity and weight management, AANP is offering a free, in-depth, seven module CE activity through May 2019 in the AANP CE Center. Completion of all seven modules in the bundle will earn the learner an Introductory Certificate of Obesity Management in Primary Care and provide seven contact hours of CE, including one contact hour that may be used toward pharmacology credit. AANP also offers a Specialty Practice Group (SPG) related to the care of patients who are obese. As members of the SPG, NPs are provided an opportunity to network with other NPs who care for patients with weight issues. Please take advantage of these excellent opportunities to help fight obesity and assist patients with the prevention of this chronic disease that impacts longevity and the quality of life.

Five A\u2019s counseling in weight management of obese patients in primary care: a cluster-randomized controlled trial (INTERACT)

BackgroundObesity is one of the most prevalent health problems in western societies. However, it seems not effectively managed in the healthcare system at present. Originating from smoking cessation a tool called the 5As for obesity management has been drafted and adapted by the Canadian Obesity Network (CON) to improve weight counseling and provider-patient-interaction. This paper describes the rationale and design of the INTERACT study. The objective of the INTERACT study is to evaluate the effectiveness and intervention costs of a 5As eLearning program for obesity management aimed specifically at general practitioners (GPs).MethodsThe INTERACT study is a cluster randomized controlled trial aimed at implementing and evaluating an online-tutorial for obesity management based on the 5As approach in cooperating primary health care practices. Effectiveness of the 5As intervention will be evaluated by assessing patients and doctors perspectives on obesity management in primary care before and after the training. GPs in the intervention group will get access to the 5As obesity management online-tutorial while GPs in the control group will be assigned to a waiting list. Outcome measures for patients and GPs will be compared between the intervention group (treatment as usual + training of the GP) and the control group (treatment as usual). Hierarchical regression models will be used to analyze effects over time pre- and post-intervention.DiscussionThe 5As present physicians with a simple mnemonic for patient counseling in the primary care context. While the use of the 5As in weight counseling seems to be associated with improved doctor-patient interaction and motivation to lose weight, intervention studies assessing the effectiveness of a short 5A eLearning tutorial for physicians on secondary outcomes, such as weight development, are lacking.Trial registrationThe study has been registered at the German Clinical Trials Register (DRKS00009241; date of registration: 03.02.2016).

A Systematic Review of Interprofessional Collaboration for Obesity Management in Primary Care, A Focus on Dietetic Referrals

Background: An interpr ofessional approach is recommended in the managementof obesity.Objectives: To elucidate: 1) dietetic referral practices of primary care providers to prevent and manage obesity, and 2) the factors that enable or disable the use of dietetic referrals.Methods: Inclusion criteria: 1) written in English 2) primary care settings, 3) weight-management approaches, 4) referrals to Dietitians, 5) adult patients, 6) published from 2000 and 2017, and 7) meets standard quality criteria.Findings: Factors hindering the use of dietetic referrals included lack of accessibility to dietetic services and associated cost to patients. Working in proximity and relationship building were considered enabling factors for providing dietetic referrals.Conclusions: Multidisciplinary primary care settings facilitate dietetic referrals through relationship building, accessibility to dietitians, and cost-free dietetic services.

Current Weight Management Approaches Used by Primary Care Providers in Six Multidisciplinary Healthcare Settings in Ontario.

Obesity management in primary care has been suboptimal due to lack of access to allied health professionals, time, and resources. To understand the weight management approaches used by primary care providers working in team-based settings and how they assess the most suitable approach for a patient. A total of 20 primary care providers (13 nurse practitioners and 7 family physicians) working in 6 multidisciplinary clinics in Ontario were interviewed. All interviews were recorded, transcribed verbatim, and coded using NVivo qualitative software. Conventional content analysis was used to inductively elucidate codes, which were then clustered into categories. A referral to on-site programming was the most frequent weight management approach used. The pharmacological approach was underutilized due to adverse side effects and cost to patients. Primary care providers assessed the most suitable weight management approach based on patients': preference, level of motivation, income status and access to resources, body mass index and comorbidities, and previous weight loss attempts. Primary care providers perceived that referring to health professionals and educational resources were the approaches preferred by patients. The team-based nature of these clinics allowed for referrals to various on-site professionals and/or programs. Some barriers to pursuing weight management avenues with patients were patient dependent.

Effect of an obesity best practice alert on physician documentation and referral practices.

The Centers for Medicare & Medicaid Services Electronic Health Record Meaningful Use Incentive Program requires physicians to document body mass index (BMI) and a follow-up treatment plan for adult patients with BMI≥25. To examine the effect of a best practice alert on physician documentation of obesity-related care and referrals to weight management treatment, in a cluster-randomized design, 14 primary care clinics at an academic medical center were randomized to best practice alert intervention (n=7) or comparator (n=7). The alert was triggered when both height and weight were entered and BMI was ≥30. Both intervention and comparator clinics could document meaningful use by selecting a nutrition education handout within the alert. Intervention clinics could also select a referral option from the list of clinic and community-based weight management programs embedded in the alert. Main outcomes were proportion of eligible patients with (1) obesity-related documentation and (2) referral. There were 26,471 total primary care encounters with 12,981 unique adult patients with BMI≥30 during the 6-month study period. Documentation doubled (17 to 33%) with implementation of the alert. However, intervention clinics were not significantly more likely to refer patients to weight management than comparator clinics (2.8 vs. 1.3%, p=0.07). Although the alert was associated with increased physician meaningful use compliance, it was not an effective strategy for improving patient access to weight management services. Further research is needed to understand system-level characteristics that influence obesity management in primary care.