Weight Counseling Research Articles

Health‐Related Quality of Life and Weight Loss among Overweight and Obese U.S. Adults, 2001 to 2002

To examine the prevalence and association of health-related quality of life (HRQOL) with trying to lose weight and with weight loss practices (eating fewer calories, physical activity, and both) among overweight and obese U.S. adults >/= 20 years of age. This study used data from the 2001 to 2002 National Health and Nutrition Examination Survey, a continuous annual survey of the civilian non-institutionalized U.S. population. This analysis included those > or = 20 years of age with BMI > or = 25 (n = 2578) who responded to four standard HRQOL measures that assessed general health status and recent physical health, mental health, and activity limitation. Among obese men, but not women, there were significant increasing linear trends in the adjusted prevalence of trying to lose weight as physically unhealthy and activity limitation days increased. Regardless of BMI or HRQOL, reducing calories was a common weight loss practice (66% to 86%). Except for recent activity limitation, respondents with BMI > or = 35 did not generally differ by HRQOL level in the attainment of recommended physical activity either alone or in combination with reduced calories, whereas those in the BMI 25 to 34.9 groups often differed significantly by HRQOL level. Specifically, increased unhealthy or activity limitation days were associated with reduced prevalence of attained physical activity. Our findings indicate an association between trying to lose weight and a greater number of unhealthy days reported by obese men, suggesting that these men may be influenced by traditional clinical weight-loss counseling that is prompted by weight and comorbidity, whereas women had a high prevalence of trying to lose weight irrespective of weight and HRQOL. Assessment of HRQOL, especially measures that evaluate physical domains, could provide subjective information to assist with weight counseling.

Weight-related perceptions among patients and physicians

Prior studies suggest that patients and physicians have different perceptions and expectations surrounding weight; however, few studies have directly compared patients' and physicians' perspectives. (1) To measure the extent to which obese patients and their physicians have discrepant weight-related perceptions, and (2) to explore patient and physician characteristics that may influence patient-physician discrepancy in motivation to lose weight. Four hundred and fifty-six obese patients (302 females; mean age = 55.1 years; mean BMI = 37.9) and their 28 primary care physicians (22 males, mean age = 44.1 years) from nonmetropolitan practices completed an anonymous survey after an office visit. Weight-related perceptions included perceived weight status, health impact of weight, 1-year weight loss expectations, and motivation to lose weight. Correlates included patient and physician sex, age, and BMI; physicians' reported frequency, perceived patient preference, and confidence for weight counseling; and practice characteristics (e.g., years in practice). Physicians assigned patients to heavier descriptive weight categories and reported a worse health impact than patients perceived for themselves, whereas patients believed they could lose more weight and reported a higher motivation to lose weight than their physicians perceived for patients (P < .001). Physicians who believed patients preferred to discuss weight more often (P = .001) and who saw more patients per week (P = .04) were less likely to underestimate patient motivation. Patients reported more optimistic weight-related perceptions and expectations than their physicians. Further research is needed to determine how these patient-physician discrepancies may influence weight loss counseling in primary care.

Impact of Perinatal Weight Change on Long-Term Obesity and Obesity-Related Illnesses

Adults are becoming increasingly overweight and obese and consequently are at greater risk of such disorders as type 2 diabetes, hypertension, and cardiovascular disease. For many young adult women, pregnancy may be an event that introduces problems in controlling body weight. This study was an attempt to determine the influence, if any, of perinatal weight change on body weight and the development of obesity-related illnesses 15 years after pregnancy. The study population included 484 women who were followed up 4, 10, and 15 years after having a child. Follow up averaged 14.7 years, and the average age at this time was 43 years. During pregnancy, body weight was documented at the first prenatal visit (averaging 10 weeks gestation), at 20 weeks, and at term. The average body mass index (BMI) increased significantly between the first prenatal visit and 15-year follow up. Women who were obese initially were most at risk. At 15 years, 30% of women were obese (BMI 30 kg/m2 or higher), 27% were overweight (BMI more than 25 kg/m2), 39% had normal body weight, and 4% were underweight. Weight gain over 15 years of follow up averaged 1.4 pounds a year and 21 pounds overall. Women who were obese at baseline gained an average of 34 pounds in 15 years, averaging 2.3 pounds annually. The average yearly gain for overweight women was 1.7 pounds, and for normal-weight women, 1.2 pounds. On multivariable analysis, baseline BMI explained only 12.6% of variability in BMI. Final BMI values were highest in women who were obese when pregnant, gained more weight than recommended, retained their pregnant weight 6 months postpartum, did not exercise aerobically, or did not breast feed their infants or did so for only a short time. At follow up, 13% of women had developed diabetes or prediabetes, and 30% had developed coronary heart disease or preheart disease. Both disorders were predicted to a significant degree by baseline BMI and weight gain over 15 years. Smoking status at last follow up also significantly predicted heart disease. At 15 years, women with diabetes or prediabetes were 46 pounds heavier, and those with heart disease or preheart disease were on average 31 pounds heavier than at baseline compared with 17.5 pounds for those not affected. These findings suggest that it would be appropriate to review recommendations limiting weight gain during pregnancy. Healthcare providers should refer overweight and obese women to weight counseling not only during pregnancy, but afterward as well. There is reason to believe that, working together, providers and patients can effectively and safely control pregnancy-related weight gain, and that this may slow the increase in the rate of obesity as well as lowering the risk of obesity-related chronic illnesses.

Satisfied or unaware? Racial differences in perceived weight status

BackgroundObesity is disproportionately prevalent among many racial/ethnic minority communities. The efficacy of weight control efforts in these groups may depend on individual's ability to accurately perceive their weight status. We examined whether racial/ethnic differences exist in weight status misperception among overweight adults.MethodsNationally-representative data from the National Health and Nutrition Examination Survey (NHANES) 1999–2002 were examined. Participants included overweight and obese adult men (n = 3115) and women (n = 3437). Weight status misperception was identified among respondents who self-reported being "about the right weight/underweight."ResultsBlacks (OR = 2.06, 95% CI: 1.71, 2.54) were twice as likely and Hispanics (OR = 1.70, 95%CI: 1.33, 2.17) were 70-percent more likely than Whites to misperceive their weight, in models adjusted for age, education, income, marital status, self-reported health, and self-reported medical diagnosis of overweight. Black overweight (OR = 2.03, 95% CI: 1.26, 3.26) and obese (OR = 3.56, 95% CI: 1.57, 8.11) women were considerably more likely to exhibit misperception compared to their White female counterparts. Odds of misperception were higher among overweight Black (OR = 2.20, 95%CI: 1.54, 3.15), Hispanic (OR = 1.89, 95% CI: 1.30, 2.75), and obese Black men (OR = 2.84, 95% CI: 1.54, 5.22), compared to White men.ConclusionWeight status misperceptions among the overweight are more common among Blacks, and Hispanic men. The persistence of racial/ethnic differences after adjustment for medical diagnosis of overweight may suggest some resistance to physician weight counseling. Identifying strategies to correct weight status misperceptions status may be necessary to ensure the efficacy of clinical and public health obesity interventions conducted among these groups.

Developing a service to monitor and improve physical health in people with serious mental illness

Developing effective models of identifying and managing physical health problems amongst mentally ill populations has become a more pressing issue in recent years as the prescription of Second Generation Antipsychotics (SGAs) has burgeoned. Some of the side effects commonly associated with SGAs such as weight gain and metabolic disorders have potentially devastating effects on health and well-being, increasing cardiovascular risk and the incidence of diabetes. The Well-Being Support Programme (WSP), a nurse-led service, was designed to provide a care delivery system whereby physical problems could be identified and appropriate treatment and monitoring initiated by prompt referral to suitable specialist services or general practitioners, forging strong links between primary and secondary care and ensuring that mentally ill patients with physical health problems were receiving holistic care packages. Other problems such as unhealthy lifestyles and obesity were managed by the Nurse Advisor running the programme. Interventions such as weight counselling and groups, and structured exercise programmes were beneficial in terms of encouraging healthier lifestyles, managing obesity and improving self-esteem. This paper describes the manner in which the service was set up and implemented, demonstrating an effective model for identifying and managing physical health problems in the mentally ill.

Monitoring Progress in Arthritis Management—United States and 25 States, 2003

Arthritis is a chronic disease affecting an estimated 43 million (20.8%) U.S. adults and is the leading cause of disability in the United States. Arthritis results in activity and work limitations, decreased quality of life, and substantial burden to the U.S. health-care system. Promotion of arthritis self-management through weight counseling, physical activity counseling, and arthritis education can reduce pain, improve function and quality of life, and delay disability among persons with arthritis. To encourage arthritis self-management, three objectives were added to the national health objectives for 2010. To monitor progress toward achieving these objectives and assess that progress by selected characteristics, CDC analyzed data from the 2003 National Health Interview Survey (NHIS) and the state-based 2003 Behavioral Risk Factor Surveillance System (BRFSS) survey. This report summarizes the results of those analyses, which indicated no statistically significant progress toward reaching the targets for weight counseling, physical activity counseling, and arthritis education. To meet these targets by 2010, public health and health-care agencies should increase efforts to improve awareness of these three factors among both health-care providers and patients. Such interventions will enable persons with arthritis to better self-manage their disease.

Weight counseling patterns of U. S. Pediatricians.

To estimate the proportion and characteristics of U.S. pediatricians who reportedly counsel their patients about maintaining a healthy weight. Beginning in October 1998, information was collected from 813 primary care pediatricians randomly selected from a nationally representative sample. Pediatricians were asked how frequently they counseled about maintaining a healthy weight during the well-care visits of patients in three age groups. Multivariable logistic regression determined which physician characteristics were associated with counseling. Approximately fifty percent of pediatricians reportedly always counseled about maintaining a healthy weight. Those who always counseled were more likely to be women, to spend more time with patients during well-care visits, and to conduct more well-care visits per week from patients in one particular age group. Most pediatricians who responded that they always counseled about healthy weight reported that they counseled about physical activity and nutrition, but not about balancing caloric intake with expenditure. Although many pediatricians report counseling about healthy weight, the frequency of counseling might be further increased by increasing the amount of time the patient spends during office visits with the pediatrician or with other professional staff, such as nurses or dietitians.

Does Physician Weight Affect Perception of Health Advice?

Background. Obesity is considered a growing health threat in the United States. Although physicians have an important role in counseling their patients for obesity prevention and treatment, physicians themselves are often overweight. There are few data regarding how physician body weight might affect patient receptiveness to obesity counseling. Methods. A 43-item survey instrument was developed that consisted of three scales related to physician characteristics, health locus of control, and perceptions on receiving health advice from overweight physicians. The survey was administered to 226 patients in five physician offices. Two of the physicians were classified as obese using BMI calculations, and three were nonobese. The responses from the surveys were grouped into those from obese and nonobese physicians. Results. Significant differences were found for patient receptiveness to counseling for treatment of illness ( P = 0.038) and health advice ( P = 0.049), with the patients of nonobese physicians indicating greater confidence scores. The difference for weight and fitness counseling did not reach significance ( P = 0.075). Analysis revealed that patient BMI was not a significant covariate nor were items related to physician characteristics in general or health locus of control. Conclusions. Patients seeking care from nonobese physicians indicated greater confidence in general health counseling and treatment of illness than patients seeing obese physicians. It is not known if this can be translated into increased success in obesity prevention and treatment.

Physician weight counseling for adolescents.

Adolescent obesity prevalence is increasing, with minimal study of physician weight counseling with youth. This study examines adolescents' (n=110) perceptions of physicians' weight counseling. Overweight adolescents (> or =85th percentile for body mass index, BMI) report receiving counseling more than nonoverweight adolescents. Physicians more often have counseled obese (> or =95th BMI percentile) than overweight but not obese adolescents (85th-94th BMI percentile). Prior counseling and adolescents' ethnicity were related to greater perceived physician concern and adolescent receptivity to future counseling. Overweight adolescents report attempting weight loss strategies at rates similar to recommendations, but recommendations for specific weight control behaviors do not increase the likelihood of adolescent attempts. Clin Pediatr. 2002;41:575-585

Personal and professional nutrition-related practices of US female physicians

The extent to which female physicians personally and clinically adhere to dietary recommendations is unknown and has implications for patients. We aimed to identify US female physicians' personal and professional nutrition- and weight-related habits and to identify which, if any, of their personal habits predicted their clinical practices. Our sample included the 4501 respondents to the Women Physicians' Health Study, a large, cross-sectional, questionnaire-based study of the health behaviors and counseling practices of US female physicians. Forty-three percent of physicians performed nutrition counseling, and 50% performed weight counseling with patients at least yearly. Forty-six percent thought that discussing nutrition was highly relevant to their practices, 47% thought the same about discussing weight, and 21% stated that they had received extensive related training. Primary care physicians, obstetricians-gynecologists, pediatricians, vegetarians, and those with a personal history of obesity were more likely to provide nutrition and weight counseling to patients. Female physicians report regularly performing more nutrition and weight counseling than they do most other types of prevention-related counseling. Female physicians report relatively healthy diet-related habits, and these personal habits are related to their likelihood to counsel their patients about nutrition and weight. Nutrition and weight-related issues are important to female physicians in both their personal and professional lives, and these 2 spheres influence each other.

Eating patterns, physical activity, and attempts to change weight among adolescents

To determine eating patterns and demographic and dietary factors associated with adolescents' attempts to change weight. Data from students participating in the Massachusetts Youth Risk Behavior Survey (YRBS) were analyzed. Race, age, school grade, academic achievement, gender, body image, eating patterns, level of exercise, participation in team sports, cigarette use, diet pill use, and vomiting were examined. The weighted sample included 3055 students: 49% female and 78% white. Mean age was 16 years (+/- 1.2 years). Associations were measured using Spearman's r, Chi-square, Mantel-Haenszel test for trend, and logistic regression analyses. A total of 61.5% of females and 21.5% of males reported trying to lose weight; 6.8% of females and 36.3% of males were trying to gain weight. There was a strong correlation (r = 0.62, p < 0.0001) between attempting to gain weight and self-perception of underweight for both genders. Females reported having changed their intake of several foods if attempting to change weight; males changed their intake of dessert foods. Hard exercise, stretching, and toning were associated with trying to lose weight among females and with trying to gain weight among males. High-calorie food consumption and exercise were associated with attempts at weight change. Unhealthy eating to change weight highlights the need for effective nutrition and weight counseling among adolescents.

Recognition and management of obesity in a family practice setting.

Research on the diagnosis and management of obesity in primary care is limited. Our study goals were to describe the rate of obesity in a primary care setting, to identify factors associated with clinically recognized obesity, and to ascertain the level of diet and exercise counseling for obesity. Medical records from a private group practice were used for a historical cohort study of 276 patients (aged 40 years and older) who were provided care for a maximum 4.5-year follow-up period. Forty-six percent of the study patients (95 percent confidence interval = 0.43, 0.49) received an obesity diagnosis according to medical record notations. The diagnosis of obesity, in turn, was predicted by body mass index (BMI) quartile (P < 0.001) and a positive family history of cardiovascular disease (P < 0.01). Those patients with a diagnosis of obesity had a higher mean level of subsequent weight and diet counseling (P = 0.0001) but the same level (P = 0.11) of exercise counseling as nonobese patients. Weight and diet counseling was also predicted by diabetes (P = 0.0001) and hypercholesterolemia (P = 0.0003). The clinical recognition of obesity was not determined by BMI alone. Although weight and diet counseling was initiated for those individuals described as obese, there was a relatively low level of exercise counseling among these patients. Additional research could provide ways of reducing both physician and patient barriers to exercise counseling.

Weight changes in a couples program: Negative association of marital adjustment

This study investigated the difference in weight changes of subjects who rated their marriages as more adjusted vs subjects who rated their marriages as less adjusted. Twenty-six moderately obese subjects were assigned to one of two groups based on their initial scores on the Locke-Wallace Marital Adjustment Scale (MAS). The 10 subjects in the “moderately unhappy” group (MAS ⩽ 99) lost significantly more weight than the 16 subjects in the “relatively happy” group (MAS ⩾ 100) at the end of the one-year treatment program (29.9 lb vs 20.4 lb) and at 3-month follow-up (27.7 lb vs 17.8 lb). Significantly more subjects in the unhappy group also reached ideal weight than subjects in the happy group (50% vs 7.7%). Subjects' initial MAS scores were significantly and negatively correlated with weight changes at post-treatment and follow-up: partners' MAS scores at the end of treatment were also significantly and negatively correlated to subjects' weight losses at post-treatment. None of the couples was initially maritally distressed but one couple met this criterion (MAS ⩽ 85) by the end of treatment and follow-up. It was concluded that marital counseling is not a pre-requisite for weight counseling, couples' marital adjustment does not improve as the subject loses weight and a moderate level of marital dissatisfaction does not seem to be an insurmountable barrier to successful weight loss and may be an advantage for some individuals.