Obesity Management Training Research Articles

Obesity management in primary care: Are we adequately preparing the next generation of Canadian family physicians?

BackgroundObesity is a chronic disease that affects a large proportion of the population. We examined the preparation of Canadian medical learners for obesity management through three cross-sectional studies exploring the: 1) knowledge of evidence-based obesity management among medical students; 2) perspectives of family medicine residents on the adequacy of obesity management training in their residency programs; and 3) intentions of family medicine residents regarding obesity management when they enter practice. MethodsAn online survey instrument was developed for each study. For Study 1, the survey was developed by HP, VE and JA; the questions mapped onto the ten domains outlined in the 2020 Canadian Clinical Practice Guidelines on the Management of Obesity in Adults. For Study 2, the survey was developed by HP and TMcC; the questions aligned with competencies in the management of other chronic diseases. For Study 3, the survey was developed by MR, HP and MV; the Capability, Opportunity, and Motivation (COM-B) model was used as a framework for the questions. All three surveys met the criterion for face validity and the survey for Study 3 met criteria for content and criterion validity. ResultsStudy 1 enrolled 26 first-year and 22 fourth-year students. Total correct scores were below 50 % for both groups, and patient-centeredness scores differed significantly between the groups. Study 2 enrolled 494 family medicine residents; less than 25 % thought there was sufficient time devoted to training in obesity management during residency and approximately 75 % experienced inconsistent messaging about obesity management from their preceptors. Study 3 enrolled 150 family medicine residents. Few participants believed that they had been well trained or had a clear plan for managing obesity, but most believed that obesity management will form part of their practice and that they will have the time and resources for obesity management. ConclusionCurrent medical education does not reflect the requisite knowledge for contemporary obesity management. Further, family medicine residents identified gaps in mentorship of contemporary principles of obesity management. These findings support the revision of the medical curriculum in Canada to better reflect the science of obesity and its management.

Diagnostic and therapeutic challenges for PCPs regarding heart failure with preserved ejection fraction and obesity: results of an online internet-based survey

BackgroundObesity (body mass index ≥ 30 kg/m2) is a major risk factor for heart failure with preserved ejection fraction (HFpEF) and affects most patients with HFpEF. Patients living with obesity may experience delays in HFpEF diagnosis and management. We aimed to understand the clinical journey of patients with obesity and HFpEF and the role of primary care providers (PCPs) in diagnosing and managing patients with both conditions.MethodsAn anonymous, US population-based online survey was conducted in September 2020 among 114 patients with self-reported HFpEF and obesity and 200 healthcare providers, 61 of whom were PCPs who treat patients with HFpEF and obesity.ResultsHalf of patients (51%) with HFpEF reported waiting an average of 11 months to discuss their symptoms with a PCP; 11% then received their diagnosis from a PCP. PCPs initiated treatment and oversaw the management of HFpEF only 35% of the time, and 44% of PCPs discussed obesity treatment medication options with their patients. Only 20% of PCPs indicated they had received formal obesity management training, and 79% of PCPs indicated they would be interested in obesity management training and support.ConclusionPCPs could play a valuable role in addressing obesity and referring patients with obesity and signs and symptoms of HFpEF to cardiologists. Increased awareness of HFpEF and its link to obesity may help PCPs more quickly identify and diagnose their patients with these conditions.Graphical

A Survey of Obesity Education and Training in United States Pharmacy Schools

ObjectiveTo assess how obesity is addressed in Doctor of Pharmacy (PharmD) schools and colleges, identify the extent to which core obesity competencies are covered in the curricula, and identify opportunities for expanding obesity management training. MethodsAn online survey was conducted with PharmD program leaders in the United States. Respondents answered questions regarding obesity education in their pharmacy school curricula. Data were analyzed in aggregate, using descriptive statistics. ResultsWe collected responses from 75 of 150 (50%) PharmD programs. One-third (32%) of respondents thought their graduating students were very prepared to discuss obesity pharmacotherapy (anti-obesity medication) options with patients. A total of 45% reported obesity pharmacological treatment was covered to a great extent. Few respondents (19%) were very familiar with anti-obesity medications; 21% thought their students were similarly familiar. No programs covered weight stigma and discrimination to a great extent. Most respondents (88%) believed obesity education was fairly/very important to include in PharmD curricula, and 96% thought it was similarly appropriate to include. But 72% indicated that expanding obesity education was not a priority/low priority. Lack of room in the curricula was cited as the greatest barrier, with 60% of PharmD programs reporting this to be a large barrier. ConclusionPharmacists, as medication experts, are key members of the care team. However, obesity management/pharmacotherapy is not emphasized in most pharmacy schools. Therefore, pharmacists are not well-prepared to provide counseling on medications for obesity. Leveraging guidance on core obesity competencies and available resources could help expand obesity education in pharmacy schools.

Effects of moderate-intensity continuous training and high-intensity intermittent training in obesity management

Effects of moderate-intensity continuous training and high-intensity intermittent training in obesity management

"We Feel Like We Are in It Alone": A Mixed-Methods Study of Pediatric Primary Care Barriers for Weight Management.

Background: Obesity is a chronic multifactorial disease affecting approximately one in five youth. Many pediatric clinical strategies focus on behavioral change/lifestyle modification efforts, but are limited by their intensity and muted by their inability to address the sociocultural contexts of obesity. The primary objective of the study was to explore primary care pediatric clinicians' current barriers/management practices of patients with obesity. Methods: A mixed-methods study was conducted by distributing an electronic survey to pediatric providers in Washington, DC, and its surrounding metropolitan area. Three focus groups were conducted with a subgroup of these primary care clinicians to further explore their responses. Results: Pediatric clinicians (n = 81) completed the survey out of 380 invitations sent, and 20 took part in 3 focus groups, ranging in size between 4 and 8 clinicians. Over 90% of clinicians felt comfortable advising patients. However, 52% lacked confidence in addressing obesity and over 80% indicated that time constraint is a barrier to care and emphasized the need for more training in obesity management. Six themes emerged regarding clinician barriers to addressing obesity, including (1) limited time, (2) clinician perceived familial resistance, (3) challenges with racial and ethnic concordance, (4) perceived environmental barriers, (5) limited knowledge of community resources, and (6) inadequate collaborative support. Conclusions: Clinicians have difficulty implementing obesity management strategies into their everyday practice due to a variety of barriers. This study emphasized the need for better implementation strategies, tools, and collaboration with community stakeholders for clinicians to engage weight management more effectively.

Translation and application of an obesity behavior change technique training in a Spanish nursing undergraduate setting.

The TEnT PEGS framework is a behavior change communication toolkit which has been shown to be useful in increasing health professional trainees' skills and knowledge about obesity-related behavior change techniques. There is no version of the behavioral change intervention toolkit in Spanish. Therefore, the objectives of this study were 1) to translate the TEnT PEGS framework into Spanish and apply it to a Spanish nursing student population; 2) To analyze whether training with the Spanish toolkit (DEPREMIO) had a positive impact on students' skills in encouraging obesi-ty-related behavioral change. First year nursing students (n=95) attended two face-to-face (2 hours per session) obesity management training sessions. A specifically designed pre-post test was carried out. Data were collected using an ad-hoc questionnaire of fourteen items, ten of them evaluated the student's knowledge and attitude about behavior change techniques, and four evaluated the student's perception of their skills in developing different strategies. Training significantly increased most students' knowledge and attitudes with a 0.05 level of significance and effect sizes were between 0.36 and 0.77. It also increased students' skills, although not to any significant extent. The DEPREMIO toolkit helped nursing students to acquire more knowledge, attitudes and skills in obesity management. It therefore seems that this adaptation is an acceptable and feasible training tool for the Spanish nursing student population.

The 3Ds – Discussion, diagnosis and direction: Elements for effective obesity care by healthcare professionals

BackgroundThe care of people with obesity is often suboptimal due to both physician and patient perceptions about obesity itself and clinical barriers. Using data from the ACTION-IO study, we aimed to identify factors that might improve the quality of obesity care through adoption of the 3D approach (Discussion, Diagnosis and Direction [follow-up]) by healthcare professionals (HCPs). MethodsAn online survey was completed by HCPs in 11 countries. Exploratory beta regression analyses identified independent variables associated with each component of the 3D approach. ResultsData from 2,331 HCPs were included in the statistical models. HCPs were significantly more likely to initiate weight discussions and inform patients of obesity diagnoses, respectively, if (odds ratio [95% confidence interval]): they recorded an obesity diagnosis in their patient's medical notes (1.59, [1.43–1.76] and 2.16 [1.94–2.40], respectively); and they were comfortable discussing weight with their patients (1.53 [1.39–1.69] and 1.15 [1.04–1.27]). HCPs who reported feeling motivated to help their patients lose weight were also more likely to initiate discussions (1.36 [1.21–1.53]) and schedule follow-up appointments (1.21 [1.06–1.38]). By contrast, HCPs who lacked advanced formal training in obesity management were less likely to inform patients of obesity diagnoses (0.83 [0.74–0.92]) or schedule follow-up appointments (0.69 [0.62–0.78]). ConclusionSpecific actions that could improve obesity care through the 3D approach include: encouraging HCPs to record an obesity diagnosis; providing tools to help HCPs feel more comfortable initiating weight discussions; and provision of training in obesity management. Clinical trial registrationNCT03584191.

Obesity Management in Primary Health Care: Front-Line Providers’ Experiences and Views

As in the rest of the world, obesity in Oman has increased and according to World Health Organization (WHO) data, prevalence of obesity in 2008 and 2016 were 20.9% and 27% respectively. This study explores primary care physicians’ current strategies and management of obesity, attitude and perceptions towards obesity, educational needs, and their views on long-term follow up.
 Methods: A cross sectional study was conducted where practicing family medicine physicians from different governorates were invited to participate in an online questionnaire-based survey. Participant were invited via email and responses were kept anonymous. Responses were collected over three weeks in April 2019 and only responses that met inclusion criteria were analyzed with SPSS v22.
 Results: 77 complete responses met inclusion criteria and female were the majority (67.5%). Half of participants had less than 10 years of experience. Weight and BMI were recorded routinely by two-thirds of participants whereas waist- hip ratio was recorded by only 12%. Weight reduction medications were prescribed by 5.2% and 24% would refer an obese patient to Bariatric center. Main barrier to obesity management and referral was inadequate obesity specialist centers followed by short consultation times. The pathophysiology mechanism of obesity and related hormones was only known by 40.8%. Almost all participants agreed that formal obesity management training should be integrated as part of residency training.
 Conclusion: Despite the significant number of comorbidities related to obesity and its complications, weight, BMI and other anthropometric measures were not routinely performed. Nationally, the rate of referral to bariatric centers for evaluation is low. Boundaries and challenges do exist and need to be addressed. Obesity and weight management need to be integrated as part of Family Physicians Training Program.

Knowledge, Attitude and Practices about Obesity Management among Saudi Board of Family Medicine Residents in Makkah Al-Mukarramah: A Cross-sectional Study

Background: As obesity has become one of the most common health problems in Saudi Arabia, the Ministry of Health launched an initiative as a part of KSA national transformation program aims to decrease the incidence of obesity and chronic diseases, by applying prevention strategies and provide proper management. Objectives: to explore the knowledge, attitudes, and practices of the joint program of family medicine candidates in Makkah regarding obesity management. Materials and methods: A cross sectional study was carried out among a representative sample of resident physicians of the joint program of family medicine Ministry of Health, Makkah city during January 2020. A self-administered validated questionnaire was used for data collection. It consists of four main sections; sociodemographic data, knowledge related questions, attitude related statements and practice related statements. Results: The study included 116 family medicine residents. Females represent 58.6% of them. Majority of the participants (98.3%) aged between 25 and 34 years. Obesity was reported among 13.8%; 8.6% class I and 5.2% class II. More than half of the family medicine residents (51.7%) had attended course or workshop about obesity and its management. More than half (57.8%) of the participants had good level of knowledge regarding obesity and its management, with the highest rate was observed among postgraduate year 2 (73.5%) whereas the lowest level was reported among those of PGY 1 (28.6%), p=0.003. Also, more than half (54.3%) expressed positive attitude towards obesity management, and this was steadily increasing with the advancing in residency level (p=0.016) and years of experience (0.011). Adequate practice regarding obesity management was observed among 61.2% of them. Obese residents had higher rate of adequate practice regarding obesity management, p=0.008. The commonest barriers faced by the resident physicians when managing patients with obesity were lack of training in obesity management (47.4%), lack of knowledge (45.7%), lack of effective referral system (39.7%) and lack of time (38.8%). Conclusion: Good Knowledge, positive attitude and adequate practice of the family medicine residents, Makkah regarding obesity and its management are moderate with some defective elements.

Improving obesity management training in family medicine: multi-methods evaluation of the 5AsT-MD pilot course

BackgroundQuality, evidence-based obesity management training for family medicine residents is needed to better support patients. To address this gap, we developed a comprehensive course based on the 5As of Obesity Management™ (ASK, ASSESS, ADVISE, AGREE, ASSIST), a framework and suite of resources to improve residents’ knowledge and confidence in obesity counselling. This study assessed the course’s impact on residents’ attitudes, beliefs, and confidence with obesity counselling.MethodsThe course combines lectures with a bariatric empathy suit experience, standardized and in-clinic patient practice, and narrative reflections. Using a multi-methods design we measured changes in 42 residents’ attitudes, beliefs, and self-confidence and thematically analyzed the narrative reflections to understand residents’ experience with the course content and pedagogy.ResultsFollowing the course, residents reported improved attitudes towards people living with obesity and improved confidence for obesity counselling. Pre/post improvement in BAOP scores (n = 32) were significant (p < .001)., ATOP scores did not change significantly. Residents showed improvement in assessing root causes of weight gain (p < .01), advising patients on treatment options (p < .05), agreeing with patients on health outcomes (p < .05), assisting patients in addressing their barriers (p < .05), counseling patients on weight gain during pregnancy, (p < .05), counseling patients on depression and anxiety (p < .01), counseling patients on iatrogenic causes of weight gain (p < .01), counseling patients who have children with obesity (p < .05), and referring patients to interdisciplinary providers for care (p < .05).Qualitative analysis of narrative reflections illustrates that experiential learning was crucial in increasing residents’ ability to empathically engage with patients and to critically reflect on implications for their practice.ConclusionThe 5AsT-MD course has the potential to increase residents’ confidence and competency in obesity prevention and management. Findings reflect the utility of the 5As to improve residents’ confidence and competency in obesity management counselling.

Higher Physician Body Mass Index is Associated with Increased Weight Bias in an Arab Country with High Prevalence of Obesity.

Background:Obesity is a worldwide problem. The Arab world, and particularly the Middle East, has witnessed a recent dramatic rise in obesity and obesity-related diseases. Yet, little is known about physician attitudes toward or management of obesity in this region of the world. The purpose of this study is to explore physician perceptions and attitudes toward obesity in the United Arab Emirates (UAE).Methods:A cross-sectional, self-administered anonymous survey of primary care physicians was performed between December 2015 and January 2017 at academic medical centers in the UAE.Results:A total of 573 of 698 physicians (82% response rate) completed the survey. Thirty-seven percent of respondents met body mass index (BMI) criteria for overweight and 12% for obesity. Physicians had sufficient knowledge but lacked training in obesity management. Physician subspecialty impacted knowledge with internal medicine physicians showing better obesity knowledge (Chi-square 392, df 210, P = 0.00). There was no significant relationship between knowledge and attitudes with physician age, gender, or nationality. Attitudinal responses toward obesity management were generally positive. However, there was an inverse correlation between physician BMI and positive attitudes toward obesity management (Chi-square 1551, df 323, P = 0.00).Conclusions:Although our study did not find significant weight bias, negative attitudes were directly correlated with physician BMI, a significant concern as half of physicians surveyed reported BMIs consistent with overweight and obesity.

Integrating childhood obesity resources into the patient-centered medical home: Provider perspectives in the United States.

Pediatric primary care providers play a critical role in managing obesity yet often lack the resources and support systems to provide effective care to children with obesity. The objective of this study was to identify system-level barriers to managing obesity and resources desired to better managing obesity from the perspective of pediatric primary care providers. A 64-item survey was electronically administered to 159 primary care providers from 26 practices within a large pediatric primary care network. Bivariate analyses were performed to compare survey responses based on provider and practice characteristics. Also factor analysis was conducted to determine key constructs that effect pediatric interventions for obesity. Survey response rate was 69% ( n = 109), with the majority of respondents being female (77%), physicians (67%), and without prior training in obesity management (74%). Time constraints during well visits (86%) and lack of ancillary staff (82%) were the most frequently reported barriers to obesity management. Information on community resources (99%), an on-site dietitian (96%), and patient educational materials (94%) were most frequently identified as potentially helpful for management of obesity in the primary care setting. Providers who desired more ancillary staff were significantly more likely to practice in clinics with a higher percentage of obese, Medicaid, and Hispanic patients. Integrating ancillary lifestyle expert support into primary care practices and connecting primary care practices to community organizations may be a successful strategy for assisting primary care providers with managing childhood obesity, especially among vulnerable populations.

The Effects of Extended Parallel Process Model on Obese Soldiers' Knowledge, Attitudes, and Practices about Obesity Management: A Randomized Controlled Clinical Trial.

Background:There are standard guidelines for obesity management, although only few obese people can adhere to these guidelines. This study aimed to assess the effects of Extended Parallel Process Model (EPPM) on obese soldiers' knowledge, attitudes, and practices (KAPs) about obesity management.Materials and Methods:This randomized controlled clinical trial was conducted in Yazd, Iran (2016). Two military centers were chosen through simple random sampling. They were randomly assigned to the experimental or the control group. Then, individuals were randomly selected and either received or did not receive high-risk and efficacy information about obesity. The KAPs of soldiers were measured by researcher made questionnaires before, immediately after, and 1 month after training.Results:Independent t test showed significant differences in perceived severity susceptibility response efficacy self-efficacy knowledge and practices between two groups immediately after training (p < 0.001).Conclusions:It seems that obesity management training according to EPPM is effective to the improvement of soldiers' KAP during military services.

Current attitudes and practices of obesity counselling by health care providers

Relatively few patients receive obesity counselling consistent with the USPSTF guidelines, and many health care professionals (HCPs) are biased in their attitudes towards obesity management. A national sample of family physicians, internists, OB/GYN physicians, and nurse practitioners (NPs) completed a web-based survey of beliefs, practice, and knowledge regarding obesity management. A majority of HCPs believe that it is both the patient's and the provider's responsibility to ensure that the patient is counselled about obesity. Obesity (77%), obesity-related diseases (79%), or obesity-related risk factors (71%) prompt HCPs to offer obesity counselling; 59% of HCPs wait for the patient to broach the subject of their weight. Increased blood pressure (89%) and heart disease risks (90%) are the most common themes in counselling. Across all HCPs except NPs "exercise" is discussed more frequently than "physical activity" (85% vs 81%), "diet" more frequently than "eating habits" (77% vs 75%), and "obesity" more frequently than "unhealthy weight" (60% vs 45%). NPs are more likely to discuss physical activity, eating habits, and unhealthy weight instead. To improve counselling for obesity, HCPs reported needing more time (70%), training in obesity management (53%), improved reimbursement (53%), and better tools to help patients recognise obesity risks (50%). Obesity-related diseases, risk factors, or obesity alone predict obesity counselling amongst HCPs. Better training in weight management and tools to help patients recognise risks appear to be key elements in helping patients compare the risks of what they may consider invasive therapy against the risks of continued obesity.

Investigating the feasibility and acceptability of health psychology-informed obesity training for medical students

Health psychologists have succeeded in identifying theory-congruent behaviour change techniques (BCTs) to prevent and reduce lifestyle-related illnesses, such as cardiovascular disease, cancers and diabetes. Obesity management discussions between doctors and patients can be challenging and are often avoided. Despite a clear training need, it is unknown how best to tailor BCT research findings to inform obesity-management training for future healthcare professionals. The primary objective of this descriptive study was to gather information on the feasibility and acceptability of delivering and evaluating health psychology-informed obesity training to UK medical students. Medical students (n = 41) attended an obesity management session delivered by GP tutors. Sessions were audio-recorded to enable fidelity checks. Acceptability of training was explored qualitatively. Tutors consistently delivered training according to the intervention protocol; and students and tutors found the training highly acceptable. This psychology-informed training can be delivered successfully by GP tutors and further research is warranted to explore its efficacy.

Can our residents carry the weight of the obesity crisis? A mixed methods study

Obesity is a worldwide problem and has reached epidemic proportions in the Middle East. Although physicians are in a unique position to counsel and treat their obese patients, little is known about healthcare provider management of obesity in this region of the world. The purpose of this study is to assess resident physician diagnosis and management of obese patients, and barriers to obesity management in the United Arab Emirates. We conducted a retrospective medical records review of an internal medicine resident clinic in an academic medical centre in the UAE. A focus group was then held with a convenience sample of 20 Internal Medicine residents. Questions were aimed at understanding barriers to obesity diagnosis and management. Focus group discussions were analysed using qualitative thematic analysis. Of 155 patients seen in resident clinic in 2012 and 2013 (representing 766 patient encounters), 50 (32%) met the criteria for overweight, and 102 (66%) met the criteria for obesity. Despite the high prevalence, only 9% had documentation of BMI or obesity in their medical record. Six percent were offered diet or exercise advice, and 6% were referred to a dietician. Focus group results indicated residents had sufficient knowledge, but lacked training in obesity management and adequate time for counselling. Weight biases and feelings of incompetence may exist among our trainees. Obesity is under-recognised and under-treated by our residents. The findings confirm that a significant gap exists between optimal obesity management recommendations and the current practices of our trainees.

Knowledge, attitudes and practices of medical staff towards obesity management in patients with spinal cord injuries: an International survey of four western European countries.

To (1) examine the opinions of medical staff working in spinal cord injury (SCI) centres (SCICs); (2) evaluate their knowledge, attitudes and practices towards obesity prevention and management; (3) report the number of beds and dietitians available at each SCIC. A 37-item questionnaire was sent to 23 SCICs in the UK, the Netherlands, Belgium and the Republic of Ireland between September 2012 and January 2013. Eighteen SCICs returned the questionnaires for analysis. All respondents stated that they had an interest in obesity treatment but only 2.3% of the respondents received training in obesity management. Sixty-one percent of staff did not consider body mass index (BMI) to be appropriate for use in SCI patients and subsequently less than half of the respondents use BMI routinely. The majority of respondents reported that they are confident in dealing with overweight (74.5%) and obese (66.1%) SCI adults, less than half (44.1%) are confident in treating overweight and obese SCI children. Respondents also indicated the need for nationally adopted guidelines and a lack of physical activity provision. There were 17.5 whole-time equivalent (WTE) dietitians recorded in 22 SCICs, equivalent to 47.8 beds per WTE dietitians (range 10-420). Non-UK SCIC dietitians are significantly better resourced than in UK SCICs (beds per WTE dietitian: 36 vs 124, P=0.035). Medical staff expressed the need to participate in obesity prevention and management. Appropriate training should be considered for all medical staff and the development of specific weight management guidelines and dietetic provision should be considered.

Outcomes of neurofeedback training in childhood obesity management: a pilot study.

This pilot study sought to evaluate the neurofeedback training outcomes in childhood obesity management. The study involved 34 overweight and obese children, age 6-18 years (12 patients in the intervention group, 22 in the control group). Complete assessment of children was done before the intervention and 3 and 6 months after the intervention; eating behavior and quality-of-life questionnaires were assessed at study start and 6 months after. All children received classic lifestyle recommendations for weight management, while the intervention group also had 20 neurofeedback sessions (infra-low-frequency training). The neurofeedback intervention was associated with less weight loss compared with classic weight management. The mean change in body-mass index standard deviation score at 3 months was -0.29 for the intervention group and -0.36 for the control group (p=0.337); after 6 months, the changes were -0.30 and -0.56, respectively (p=0.035). Quality of life improved similarly for both groups. Subjective outcomes reported by patients in the intervention were less snacking, improved satiety, enhanced attention capacity, ameliorated hyperactivity, and better sleep patterns. Larger studies, with training methods involving both the left and right cortices, should further clarify the role of neurofeedback training in obesity management.

Obesity management in gynecologic cancer survivors: provider practices and attitudes

Obesity is associated with the development and risk of death from several women's cancers. The study objective was to describe and compare oncologic providers' attitudes and practices as they relate to obesity counseling and management in cancer survivors. Society of Gynecologic Oncology members (n = 924) were surveyed with the use of a web-based, electronic questionnaire. χ(2) and Fisher exact tests were used to analyze responses. Of the 240 respondents (30%), 92.9% were practicing gynecologic oncologists or fellows, and 5.1% were allied health professionals. Median age was 42 years; 50.8% of the respondents were female. Of the respondents, 42.7% reported that they themselves were overweight/obese and that ≥50% of their survivor patients were overweight/obese. Additionaly, 82% of the respondents believed that discussing weight would not harm the doctor-patient relationship. Most of the respondents (95%) agreed that addressing lifestyle modifications with survivors is important. Respondents believed that gynecologic oncologists (85.1%) and primary care providers (84.5%) were responsible for addressing obesity. More providers who were ≤42 years old reported undergoing obesity management training (P < .001) and were more likely to believe that survivors would benefit from obesity education than providers who were >42 years old (P = .017). After initial counseling, 81.5% of the respondents referred survivors to other providers for obesity interventions. Oncology provider respondents believe that addressing obesity with cancer survivors is important. Providers believed themselves to be responsible for initial counseling but believed that obesity interventions should be directed by other specialists. Further research is needed to identify barriers to care for obese cancer survivors and to improve physician engagement with obesity counseling in the "teachable moment" that is provided by a new cancer diagnosis.

How training affects Australian paediatricians’ management of obesity

ObjectiveSecondary care could be the optimal sector for managing child and adolescent obesity, given low primary care uptake and limited tertiary services. We aimed to determine Australian paediatricians’ self-reported competence...