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Kaak KB, Holliday CP, Mulekar MS, Trepman E, Holliday NP. Women's perceptions of body mass graphics and their preferences for weight counselling. Clin Obes 2024; 14:e12632. [PMID: 38114087 DOI: 10.1111/cob.12632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 11/08/2023] [Accepted: 11/24/2023] [Indexed: 12/21/2023]
Abstract
Health care providers may lack data-driven guidance about best practises for discussing weight. We assessed women's self-perception of body mass index (BMI) and preferences for weight counselling by provider characteristics and the initiating question. A voluntary, anonymous survey was completed by 756 women (age ≥ 19 year) at our tertiary care obstetrics and gynaecology clinics in autumn 2021. The respondents' height and weight were collected before respondents selected graphics from a validated Body Image Scale that they felt best represented their current body size and which graphs should prompt weight loss or gain recommendations. Respondents were asked their preferences about provider characteristics for discussion about weight and to identify which of six initiating questions from a provider was most and least preferred. Blank responses were allowed. In 708 responses, 366 women (52%) selected the most accurate graphic that corresponded to their BMI; the selected graphic represented a lower than actual BMI in 268 women (38%) and higher in 74 women (10%). In 648 responses, 374 women (58%) preferred a female provider, but provider body shape, ethnicity/race and age were not important to most women. The most preferred question to initiate a discussion about weight was "A lot of women have trouble achieving or maintaining a healthy weight; is that something we can discuss?" in 181 of 555 women (33%), and the least preferred question was "Do you feel like you are at an appropriate weight?" in 172 of 554 women (31%). Provider knowledge about patient preferences regarding questions may facilitate the discussion about weight.
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Affiliation(s)
- Katherine B Kaak
- Department of Obstetrics and Gynecology, University of South Alabama College of Medicine, Mobile, Alabama, USA
- Department of Obstetrics and Gynecology, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA
| | - Candice P Holliday
- Department of Obstetrics and Gynecology, University of South Alabama College of Medicine, Mobile, Alabama, USA
| | - Madhuri S Mulekar
- Department of Mathematics and Statistics, University of South Alabama College of Arts and Sciences, Mobile, Alabama, USA
| | - Elly Trepman
- University of South Alabama College of Medicine, Mobile, Alabama, USA
| | - Nicolette P Holliday
- Department of Obstetrics and Gynecology, University of South Alabama College of Medicine, Mobile, Alabama, USA
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Howes EM, Parker MK, Misyak SA, DiFeliceantonio AG, Davy BM, Brown LEC, Hedrick VE. The Impact of Weight Bias and Stigma on the 24 h Dietary Recall Process in Adults with Overweight and Obesity: A Pilot Study. Nutrients 2024; 16:191. [PMID: 38257084 PMCID: PMC10818297 DOI: 10.3390/nu16020191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/07/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
People with overweight and obesity tend to both underreport dietary energy intake and experience weight stigma. This exploratory pilot study aimed to determine the relationship between weight bias and weight stigma and energy intake reporting accuracy. Thirty-nine weight-stable adults with BMI ≥ 25 completed three 24 h dietary recalls; indirect calorimetry to measure resting metabolic rate; a survey measuring weight stigma, psychosocial constructs, and physical activity; and a semi-structured qualitative interview. Multiple linear regression was used to determine if weight bias internalization, weight bias toward others, and experiences of weight stigma were predictive of the accuracy of energy reporting. A thematic analysis was conducted for the qualitative interviews. Weight stigma was reported by 64.1% of the sample. Weight stigma constructs did not predict the accuracy of energy intake reporting. People with obesity underreported by a mean of 477 kcals (p = 0.02). People classified as overweight overreported by a mean of 144 kcals, but this was not significant (p = 0.18). Participants reported a desire to report accurate data despite concerns about reporting socially undesirable foods. Future research should quantify the impact of weight stigma on energy reporting in 24 h recalls using a larger, more diverse sample size and objective measures like doubly labeled water for validation.
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Affiliation(s)
- Erica M. Howes
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, USA; (M.K.P.); (S.A.M.); (A.G.D.); (B.M.D.); (V.E.H.)
| | - Molly K. Parker
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, USA; (M.K.P.); (S.A.M.); (A.G.D.); (B.M.D.); (V.E.H.)
| | - Sarah A. Misyak
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, USA; (M.K.P.); (S.A.M.); (A.G.D.); (B.M.D.); (V.E.H.)
| | - Alexandra G. DiFeliceantonio
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, USA; (M.K.P.); (S.A.M.); (A.G.D.); (B.M.D.); (V.E.H.)
- Fralin Biomedical Research Institute at VTC, Virginia Tech, Roanoke, VA 24016, USA
| | - Brenda M. Davy
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, USA; (M.K.P.); (S.A.M.); (A.G.D.); (B.M.D.); (V.E.H.)
| | | | - Valisa E. Hedrick
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, USA; (M.K.P.); (S.A.M.); (A.G.D.); (B.M.D.); (V.E.H.)
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Aker S, Şahin MK. Obesity Bias and Stigma, Attitudes, and Beliefs Among Intern Doctors: a Cross-sectional Study from Türkiye. Obes Surg 2024; 34:86-97. [PMID: 37968559 DOI: 10.1007/s11695-023-06919-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/18/2023] [Accepted: 10/18/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND The purpose of this study was to determine intern physicians' attitudes and beliefs toward obesity and individuals with obesity and the frequency at which they encounter discriminatory language in their work environments. METHODS This cross-sectional study was performed with intern physicians at the Ondokuz Mayıs University Medical Faculty in Samsun, Türkiye. A questionnaire was employed for data collection (Appendix). Two hundred eighteen (82.2%) interns took part in the study. The questionnaire consisted of 53 questions in five sections, and included the attitudes toward obese persons (ATOP) and beliefs about obese persons (BAOP) scales. RESULTS The interns most frequently cited genetic factors (98.1%) and endocrine disorder-metabolic disorders (98.1%) as non-behavioral causes of obesity, and overeating (96.2%) and physical immobility (96.2%) as behavioral causes. Lifestyle changes and exercise were most frequently recommended for treatment. The interns' attitudes toward individuals with obesity were very slightly negative, but close to neutral. Analysis showed that 46.8% of the interns reported hearing members of academic staff, intern physicians, or health workers make negative or derogatory comments or jokes about obese patients during their education, while 22.0% reported witnessing an obese patient being subjected to discriminatory treatment in the hospital environment. CONCLUSION Medical faculties must develop curricula aimed at comprehensively addressing obesity-related bias. Such a curriculum should allow students to reflect on their biases, be aimed at reducing the effect of those biases on patient communication, and involve strategies directed toward eliminating those effects from physicians' treatment decisions.
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Affiliation(s)
- Servet Aker
- Department of Medical Education, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey.
| | - Mustafa Kürşat Şahin
- Department of Family Medicine, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
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Robinson KM, Scherer AM, Nishimura TE, Laroche HH. Value of cognitive interviewing in the development of the weight stigma in healthcare inventory. PATIENT EDUCATION AND COUNSELING 2023; 113:107767. [PMID: 37104937 DOI: 10.1016/j.pec.2023.107767] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/16/2023] [Accepted: 04/19/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND Despite the detrimental effects of weight stigma in healthcare, there is no widely validated measure comprehensively examining such experiences. OBJECTIVE We aimed to develop and pilot test an inventory to measure patient experiences of weight stigma in healthcare, and to ensure our items were easily understood. PATIENT INVOLVEMENT During our iterative design process, patients assessed whether our inventory items were easy to understand and we included an open-ended comments question. METHODS We compiled items from pre-existing tools assessing experiences of weight stigma in healthcare, and developed our own novel items. We conducted field pre-testing with a convenience sample of 48 patients at a Midwest academic internal medicine clinic. We utilized an iterative design process whereby respondents provided feedback on our inventory, we analyzed the data and made revisions, and then repeated the cycle. RESULTS Respondents found some of the language in our items confusing; expressed reluctance to speculate on the motivations of healthcare providers; had difficulty with "double-barreled" questions; found some questions vague; and expressed the desire to have weight addressed in clinical encounters neither too much nor too infrequently. We altered items appropriately, and in subsequent rounds of data collection they were easier to understand. DISCUSSION Patients found many common weight stigma survey items and some of our novel items confusing. Our modified inventory reduces patient confusion and enhances data quality. PRACTICAL VALUE Our study demonstrates the value of cognitive interviewing. Furthermore, the WSHCI will be a useful tool for clinicians and research teams seeking to measure weight stigma in healthcare but first needs to be validated in a larger sample. FUNDING This study was supported by the Physician Scientist Training Program, Diabetes Center T32 (DK112751), and the Clinical and Translational Science Award grant funded from the National Institutes of Health (UL1TR002537).
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Affiliation(s)
- Kathleen M Robinson
- Department of Internal Medicine, Division of Endocrinology, University of Iowa, Iowa City, USA.
| | - Aaron M Scherer
- Department of Internal Medicine, Division of General Internal Medicine, University of Iowa, Iowa City, USA
| | - Taryn E Nishimura
- Department of Internal Medicine, Division of General Internal Medicine, University of Iowa, Iowa City, USA; Department of Psychiatry, University of Iowa, Iowa City, USA
| | - Helena H Laroche
- Center for Children's Healthy Lifestyle and Nutrition, Children's Mercy Hospital, Kansas City, USA; University of Missouri-Kansas City School of Medicine, Kansas City, USA
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McVay MA, Cooper KB, Donahue ML, Carrera Seoane M, Shah NR, Webb F, Perri M, Jake‐Schoffman DE. Engaging primary care patients with existing online tools for weight loss: A pilot trial. Obes Sci Pract 2022; 8:569-584. [PMID: 36238223 PMCID: PMC9535672 DOI: 10.1002/osp4.592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/29/2021] [Accepted: 01/18/2022] [Indexed: 11/11/2022] Open
Abstract
Objective Free online tools show potential for promoting weight loss at a low cost, but there is limited evidence about how to effectively engage patients with them. To address this, a low‐dose, flexible intervention was developed that aims to enhance weight‐related discussions with primary care providers (PCPs) and engage patients with an organic (i.e., not researcher‐created) weight loss‐focused social media community and online self‐monitoring tool. Feasibility and acceptability of the intervention was evaluated in a single‐arm, 12‐week pilot. Methods PCPs were recruited at two clinics, then PCP's patients with upcoming appointments were identified and recruited. Patients received an interactive online kickoff before their scheduled primary care appointment, then 8 follow‐up messages over 12 weeks via email or their electronic health record patient portal. Patients completed assessments at baseline, post‐appointment, and week 12. Primary care providers and patients completed semi‐structured interviews. Results All PCPs approached enrolled (n = 6); patient recruitment was on track to meet the study goal prior to COVID‐19 restrictions, and n = 27 patients enrolled. Patient satisfaction with the pre‐appointment kickoff was high. Twenty‐four patients reported discussing weight‐related topics at their primary care appointment and all were satisfied with the discussion. Twenty‐two patients completed 12‐week assessments. Of these, 15 reported engaging with the self‐monitoring tool and 9 with the social media community. Patient interviews revealed reasons for low social media community engagement, including perceived lack of fit. On average, patients with available data (n = 21) lost 2.4 ± 4.1% of baseline weight, and 28.6% of these patients lost ≥3% of baseline weight. Primary care providers reported high intervention satisfaction. Conclusions The intervention and trial design show potential, although additional strategies are needed to promote tool engagement.
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Affiliation(s)
- Megan A. McVay
- Department of Health Education & Behavior University of Florida Gainesville FL
| | - Kellie B Cooper
- Department of Health Education & Behavior University of Florida Gainesville FL
| | | | | | - Nipa R. Shah
- Department of Community Health and Family Medicine University of Florida College of Medicine Jacksonville FL
| | - Fern Webb
- Department of Surgery University of Florida Jacksonville FL
| | - Michael Perri
- College of Public Health and Health Professions University of Florida Gainesville
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General Practitioner's Knowledge about Bariatric Surgery Is Associated with Referral Practice to Bariatric Surgery Centers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910055. [PMID: 34639357 PMCID: PMC8508327 DOI: 10.3390/ijerph181910055] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 09/20/2021] [Accepted: 09/20/2021] [Indexed: 11/16/2022]
Abstract
(1) Background: Patients seeking treatment for obesity and related diseases often contact general practitioners (GPs) first. The aim of this study was to evaluate GPs’ knowledge about weight loss surgery (WLS) and potential stereotypes towards obese patients. (2) Methods: For this prospective cohort study, 204 GPs in the region of the bariatric surgery center at the University Hospital Aachen were included. The participants filled out a questionnaire comprising general treatment of obese patients, stigmatization towards obese patients (1–5 points) as well as knowledge regarding WLS (1–5 points). (3) Results: The mean age of the GPs was 54 years; 41% were female. Mean score for self-reported knowledge was 3.6 points out of 5. For stigma-related items, the mean score was 3.3 points out of 5. A total of 60% of the participants recognized bariatric surgery as being useful. Knowledge about bariatric surgery significantly correlated with the number of referrals to bariatric surgery centers (p < 0.001). No significant correlation was found between stigma and referral to surgery (p = 0.057). (4) Conclusions: The more GPs subjectively know about bariatric surgery, the more often they refer patients to bariatric surgery specialists—regardless of potentially present stereotypes. Therefore, GPs should be well informed about indications and opportunities of WLS.
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Papadopoulos S, de la Piedad Garcia X, Brennan L. Evaluation of the psychometric properties of self-reported weight stigma measures: A systematic literature review. Obes Rev 2021; 22:e13267. [PMID: 34105229 DOI: 10.1111/obr.13267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Conceptualisation and measurement of weight stigma varies across available studies assessing those affected. This paper aims to systematically review the psychometric properties of available self-reported measures of weight stigma. METHOD Studies exploring the development and/or validation of weight stigma measures were identified through systematically searching Medline, CINAHL, PsycINFO, Embase, Web of Science, and Scopus databases. The Consensus-based Standards of Health Measurement Instruments (COSMIN) checklist was used to assess the psychometric properties of measures. RESULTS Thirty-six articles, reporting 18 different weight stigma measures, were included. For most included measures, measure development and content validity have not been assessed/reported. Structural validity, internal consistency, and hypothesis testing were the most commonly assessed/reported psychometric properties. High-quality ratings were given only for these properties. Most measures were rated as "indeterminate" and received an overall quality rating of "Very Low" as results were based on limited evidence. CONCLUSIONS Psychometric properties for published weight stigma measures have rarely been assessed/reported. The observed poor methodological quality for measure development, and limited content validity evidence, negatively impact the quality of evidence for the measures. There is a need for studies assessing the psychometric properties of existing weight stigma measures using COSMIN guidelines, and for a well-designed weight stigma measure informed by both theory and research.
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Affiliation(s)
- Stephanie Papadopoulos
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia
| | | | - Leah Brennan
- School of Psychology and Public Health, La Trobe University, Albury-Wodonga, New South Wales, Australia
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Fong C, Mateu-Gelabert P, Ciervo C, Eckhardt B, Aponte-Melendez Y, Kapadia S, Marks K. Medical provider stigma experienced by people who use drugs (MPS-PWUD): Development and validation of a scale among people who currently inject drugs in New York City. Drug Alcohol Depend 2021; 221:108589. [PMID: 33621804 PMCID: PMC8029599 DOI: 10.1016/j.drugalcdep.2021.108589] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Stigmatizing attitudes towards people who use drugs (PWUD) impact their access and retention in health care. Current measures of PWUD stigma in medical settings are limited. Therefore, we developed and validated theMedical Provider Stigma Experienced by PWUD (MPS-PWUD) scale. METHODS As part of an ongoing clinical trial, we recruited HCV RNA positive people who inject drugs in New York City. Based on 164 participants, principal component analysis (PCA) was conducted on fifteen stigma items answered on a 5-point Likert scale. We evaluated internal consistency using Cronbach's alpha coefficient and assessed construct validity by comparing stigma levels with willingness to communicate health concerns with medical providers and likelihood to seek HCV treatment. RESULTS PCA identified a 9-item scale with two components of stigmatization that explained 60.8 % of the total variance and overall high internal consistency (alpha = 0.90). Theenacted stigma (alpha = 0.90) consisted of 6 scale items related to the medical providers' stigmatizing actions or perceptions. The internalized stigma component (alpha = 0.84) included 3 scale items related to PWUD's shame or drug use disclosure. As hypothesized, higher levels of either stigma were associated with less likelihood to openly communicate with medical providers (p < 0.005). Participants with a higher level of enacted stigma were less likely to seek HCV treatment (p = 0.011). CONCLUSIONS The validated MPS-PWUD scale could help healthcare providers, harm reduction services and researchers measure stigma experienced by PWUD in medical settings in efforts to minimize the impact of stigma on limiting access to and retention of care for PWUD.
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Affiliation(s)
- Chunki Fong
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health (ISPH) 55 West 125th Street, New York, NY 10027, USA.
| | - Pedro Mateu-Gelabert
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health (ISPH) 55 West 125th Street, New York, NY 10027, USA
| | - Courtney Ciervo
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health (ISPH) 55 West 125th Street, New York, NY 10027, USA
| | | | - Yesenia Aponte-Melendez
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health (ISPH) 55 West 125th Street, New York, NY 10027, USA
| | - Shashi Kapadia
- Weill Cornell Medicine, 1305 York Ave 4th Floor, New York, NY, 10021, USA
| | - Kristen Marks
- Weill Cornell Medicine, 1305 York Ave 4th Floor, New York, NY, 10021, USA
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Baer HJ, De La Cruz BA, Rozenblum R, Nolido NV, Orav EJ, Metzler K, Block JP, Halperin F, McManus KD, Aronne LJ, Minero G, Bates DW. Integrating an online weight management program with population health management in primary care: Design, methods, and baseline data from the PROPS randomized controlled trial (Partnerships for Reducing Overweight and Obesity with Patient-centered Strategies). Contemp Clin Trials 2020; 95:106026. [PMID: 32428586 DOI: 10.1016/j.cct.2020.106026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/24/2020] [Accepted: 05/09/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Scalable, low-cost weight management strategies are needed in primary care. We conducted a pragmatic, cluster-randomized controlled trial to examine the effectiveness of an online weight management program integrated with population health management support. METHODS We adapted an online weight management program and integrated it with population health management support in 15 primary care practices (24 clinics). We randomized the 24 clinics to usual care (UC), online program alone (OP), or combined intervention (CI). Eligible participants had to be ages 20 to 70 and have a recent primary care visit, body mass index (BMI) ≥ 27 and < 40 kg/m2, and a diagnosis of hypertension or type 2 diabetes. Participants attended routine visits and completed surveys over 18 months. The primary outcome is absolute weight change at 12 months (± 90 days) after enrollment, calculated from weights measured at primary care visits and recorded in the electronic health record. RESULTS We enrolled 840 participants between July 2016 and August 2017 (326 UC, 216 OP, and 298 CI.) At enrollment, participants' mean age was 59.3 years, their mean weight was 203.1 pounds, and their mean BMI was 32.5 kg/m2; 60% of participants were female, 76.8% were white, 96.4% had hypertension, and 24.4% had type 2 diabetes. CONCLUSION It is feasible to adapt an online weight management program and integrate it with population health management support in primary care. The results of this trial will provide valuable information about the effectiveness of these strategies in primary care settings. ClinicalTrials.govregistration number:NCT02656693.
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Affiliation(s)
- Heather J Baer
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America; Harvard T.H. Chan School of Public Health, Boston, MA, United States of America.
| | - Barbara A De La Cruz
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, United States of America
| | - Ronen Rozenblum
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Nyryan V Nolido
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, United States of America
| | - E John Orav
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America; Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Kristina Metzler
- Department of Nutrition, Brigham and Women's Hospital, Boston, MA, United States of America
| | - Jason P Block
- Harvard Medical School, Boston, MA, United States of America; Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Brigham and Women's Hospital, Boston, MA, United States of America
| | - Florencia Halperin
- Harvard Medical School, Boston, MA, United States of America; Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston, MA, United States of America
| | - Katherine D McManus
- Department of Nutrition, Brigham and Women's Hospital, Boston, MA, United States of America
| | - Louis J Aronne
- BMIQ Professionals Program, Intellihealth/BMIQ, United States of America; Division of Endocrinology, Diabetes, and Metabolism, Weill Cornell Medicine, New York, NY, United States of America
| | - Guadalupe Minero
- BMIQ Professionals Program, Intellihealth/BMIQ, United States of America
| | - David W Bates
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America; Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
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McHale CT, Laidlaw AH, Cecil JE. Primary care patient and practitioner views of weight and weight-related discussion: a mixed-methods study. BMJ Open 2020; 10:e034023. [PMID: 32156764 PMCID: PMC7064140 DOI: 10.1136/bmjopen-2019-034023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To understand the beliefs that primary care practitioners (PCPs) and patients with overweight and obesity have about obesity and primary care weight management in Scotland. SETTING Seven National Health Service (NHS) Scotland primary care centres. PARTICIPANTS A total of 305 patients and 14 PCPs (12 general practitioners; two practice nurses) participated. DESIGN AND METHODOLOGY A cross-sectional mixed-methods study. PCPs and patients completed questionnaires assessing beliefs about obesity and primary care weight communication and management. Semi-structured interviews were conducted with PCPs to elaborate on questionnaire topics. Quantitative and qualitative data were synthesised to address study objectives. RESULTS (1) Many patients with overweight and obesity did not accurately perceive their weight or risk of developing weight-related health issues; (2) PCPs and patients reported behavioural factors as the most important cause of obesity, and medical factors as the most important consequence; (3) PCPs perceive their role in weight management as awareness raising and signposting, not prevention or weight monitoring; (4) PCPs identify structural and patient-related factors as barriers to weight communication and management, but not PCP factors. CONCLUSIONS Incongruent and/or inaccurate beliefs held by PCPs and patient may present barriers to effective weight discussion and management in primary care. There is a need to review, standardise and clarify primary care weight management processes in Scotland. Acknowledging a shared responsibility for obesity as a disease may improve outcomes for patients with overweight and obesity.
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Affiliation(s)
- Calum T McHale
- School of Medicine, University of St Andrews, St Andrews, Fife, UK
| | - Anita H Laidlaw
- School of Medicine, University of St Andrews, St Andrews, Fife, UK
| | - Joanne E Cecil
- School of Medicine, University of St Andrews, St Andrews, Fife, UK
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El-Beheiry M, Vergis A, Choi JU, Clouston K, Hardy K. A survey of primary care physician referral to bariatric surgery in Manitoba: access, perceptions and barriers. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:S3. [PMID: 32309407 PMCID: PMC7154330 DOI: 10.21037/atm.2020.01.69] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background There is an important disconnect between surgical programs and primary care physicians (PCP) in the delivery of bariatric care. The objective of this study is to assess PCP knowledge and perception of a provincial bariatric surgery program. Methods A 32-question, IRB approved, survey was developed by bariatric surgery experts and vetted by local PCPs. A single round of paper surveys was administered to 1,000 PCPs between July and September 2015. Continuous variables were assessed by t-test and categorical variables by Chi-square test. Results There were 131 survey responses (13.1%). Half (54.2%) of respondents did not feel equipped to counsel their patients on operative management strategies. PCPs counselled on average 11.6%±17.0% of their obese patients on bariatric surgery. Many respondents (58.3%) thought excess weight loss from gastric bypass was less than 40% and most believed there was less than 50% resolution of diabetes (62.4%), hypertension (72.3%), dyslipidemia (77.8%) and obstructive sleep apnea (60.6%). PCPs who referred patients to the bariatric program (71.8%) were more comfortable counselling their patients on bariatric surgery options (56.8% vs. 17.1%, P<0.001) and were more comfortable with post-operative care (67.4% vs. 38.2%, P=0.004). Additionally, these PCPs estimated higher rates of diabetes and hypertension resolution post-bariatric surgery. The predominant perceived barrier to accessing bariatric surgery was wait times (33.3%). Conclusions PCPs appear to underestimate the efficacy of bariatric surgery in the treatment of obesity and feel ill-equipped to counsel patients. Further education related to bariatric surgery may improve PCP comfort in counselling and long-term follow-up.
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Affiliation(s)
- Mostafa El-Beheiry
- Section of General Surgery, Department of Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Ashley Vergis
- Section of General Surgery, Department of Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Jung-Un Choi
- Section of General Surgery, Department of Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Kathleen Clouston
- Section of General Surgery, Department of Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Krista Hardy
- Section of General Surgery, Department of Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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12
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Hong YR, Pavela G, Lee AM, Williamson VG, Cardel MI. Satisfaction with Health Care Among Individuals with Overweight and Obesity: A Nationally Representative Cross-sectional Study. J Gen Intern Med 2019; 34:1397-1399. [PMID: 30887437 PMCID: PMC6667531 DOI: 10.1007/s11606-019-04939-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Young-Rock Hong
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, 100195, Gainesville, FL, 32610, USA.
| | - Gregory Pavela
- Department of Health Behavior, School of Public Health, University of Alabama, Birmingham, Birmingham, AL, 35294, USA
| | - Alexandra M Lee
- Department of Health Outcomes and Biomedical Informatics, College of Medicine University of Florida, Gainesville, FL, 32610, USA
| | - Victoria G Williamson
- Department of Psychology, College of Liberal Arts and Sciences, University of Florida, Gainesville, FL, 32611, USA
| | - Michelle I Cardel
- Department of Health Outcomes and Biomedical Informatics, College of Medicine University of Florida, Gainesville, FL, 32610, USA
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13
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Abstract
Aim: The purpose of this scoping review was to explore the evidence on how perceptions and/or experiences of weight bias in primary health care influence engagement with and utilization of health care services by individuals with obesity. Background: Prior studies have found discrepancies in the use of health care services by individuals living with obesity; a greater body mass index has been associated with decreased health care utilization, and weight bias has been identified as a major barrier to engagement with health services. Methods: PubMed was searched from January 2000 to July 2017. Four reviewers independently selected 21 studies examining perceptions of weight bias and its impact on engagement with primary health care services. Findings: A thematic analysis was conducted on the 21 studies that were included in this scoping review. The following 10 themes were identified: contemptuous, patronizing, and disrespectful treatment, lack of training, ambivalence, attribution of all health issues to excess weight, assumptions about weight gain, barriers to health care utilization, expectation of differential health care treatment, low trust and poor communication, avoidance or delay of health services, and ‘doctor shopping’. Overall, our scoping review reveals how perceptions and/or experiences of weight bias from primary care health professionals negatively influence patient engagement with primary health care services.
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Prod'homme L, Riglet C, Godart N, Huas C. [Climb on the scale! Weight in consultations and adult patient's experiences: Exploratory study in general practice]. SANTE PUBLIQUE 2019; Vol. 31:7-17. [PMID: 31210519 DOI: 10.3917/spub.191.0007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Overweight patients feel stigmatized and are reluctant to talk about weight. Physicians question the efficiency of weight management. This work explored how the weight topic was initiated in GP consultations and the experience of patients about this action, whatever their weight or reason for consultation. METHODS Mixed method study conducted in parallel with direct observation of GPs' consultations by trainees (with a standardized observation grid) and semi directive interview (with guide) after the consultation. Analyses were descriptive on quantitative data, and thematic on verbatim (double blind coding). RESULTS 187 consultations were observed and 81 patients interviewed. In consultation, GPs initiated the majority of the weight discussions, with three types of approach: discussion alone, discussion and/or weighing, and weighing alone. GP's demands of weighing were very directive and sometimes seemed to make patients feel uncomfortable. The discussion about weight without weighing seemed to enhance a reflection on a possible change of patient's behavior.The joint analysis questions the scale's role in consultation since the discussion approach to the weight debate led to more patient mobilization and, according to them, "the weight is seen". For the patient, the eye appeared as a tool to measure weight, especially since the doctor could see variations. CONCLUSION Comparing the results of the two exploratory studies, in order to better understand this little studied phenomenon, allowed for the emergence of hypotheses and questions the role of the scale in consultations.
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Abstract
PURPOSE OF REVIEW This review describes the results of randomized controlled trials that have evaluated the efficacy of behavioral interventions for obesity in primary care settings. RECENT FINDINGS Most studies have found that high-intensity behavioral counseling (providing 12 or more sessions per year, as defined by the US Preventative Services Task Force), when delivered in-person, by phone, or electronically, produced clinically meaningful weight loss (4 to 7 kg). Low- to moderate-intensity behavioral counseling and counseling that did not include behavioral strategies (e.g., motivational interviewing) produced modest losses of 1 to 2 kg. The addition of weight loss medication increased mean losses relative to behavioral treatment alone. Consistent with national guidelines, the largest weight losses were achieved with high-intensity counseling, either alone or in combination with obesity pharmacotherapy. Primary care providers can support their patients by inviting them to discuss their weight concerns and referring interested individuals to appropriate interventions.
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Affiliation(s)
- Jena Shaw Tronieri
- Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, 3535 Market Street, Suite 3025, Philadelphia, PA, 19104, USA.
| | - Thomas A Wadden
- Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, 3535 Market Street, Suite 3025, Philadelphia, PA, 19104, USA
| | - Ariana M Chao
- Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, 3535 Market Street, Suite 3025, Philadelphia, PA, 19104, USA
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Adam Gilden Tsai
- Kaiser Permanente, Metabolic-Surgical Weight Management, 2045 Franklin Street, 3rd Floor, Denver, CO, 80205, USA
- University of Colorado School of Medicine, Aurora, CO, USA
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16
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Eisenberg D, Noria S, Grover B, Goodpaster K, Rogers AM. ASMBS position statement on weight bias and stigma. Surg Obes Relat Dis 2019; 15:814-821. [DOI: 10.1016/j.soard.2019.04.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 04/27/2019] [Indexed: 12/14/2022]
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17
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Examining Patient Perspectives on Weight Management Support in the Primary Care Setting. J Prim Prev 2018; 39:387-399. [DOI: 10.1007/s10935-018-0516-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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18
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Persky S, Goldring MR, Cohen RW. Genomics-informed weight management in primary care: anticipated public interest. Per Med 2018; 15:271-278. [DOI: 10.2217/pme-2018-0011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Aim: An exploratory survey assessed the influence of current and potential future genomic applications for weight management on individuals’ desires to address weight management within primary care. Materials & methods: A convenience sample of 714 US adults aged 18–70 completed an online survey that presented three scenarios: no genomic information; current genomic capabilities; and potential future applications of genomics for weight management. Results: Participants had increased interest in weight management assistance through primary care when considering genomic applications in weight management, p (1,1.68) = 24.66, p < 0.001; this increase was more robust among individuals who felt their weight was important for their health, p (1,1.68) = 20.85, p < 0.001. Conclusion: Primary care systems may need to accommodate a rise in the volume of patients seeking weight management assistance as genomic approaches come to fruition.
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Affiliation(s)
- Susan Persky
- Social & Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Megan R Goldring
- Social & Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Rachel W Cohen
- Social & Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
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Goldring MR, Persky S. Preferences for physician weight status among women with overweight. Obes Sci Pract 2018; 4:250-258. [PMID: 29951215 PMCID: PMC6009989 DOI: 10.1002/osp4.162] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/19/2018] [Accepted: 01/27/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Women with overweight experience stigma in clinical interactions. Emerging evidence suggests that one near-term approach to offset the negative consequences of weight stigma could be to capitalize on benefits of patient-physician weight concordance. However, it is likely that patient attitudes towards physicians with overweight are complicated and multifaceted and may include stigmatization of providers with overweight. METHODS Two-hundred ninety-eight women with overweight completed an online questionnaire and indicated preference for a physician who is 'overweight', 'not overweight', or indicated no preference. Participants provided reasons for their choice and answered questions about their weight-related beliefs and experiences. RESULTS The majority of women indicated no weight preference (63%), and a portion (36%) of the sample explicitly preferred physicians who are not overweight. Reasons provided for these preferences were primarily based on stereotyped notions of physician aptitude based on weight. Compared with having no preference, those who preferred physicians who are not overweight had fewer previous negative weight-related physician interactions and had increased beliefs about the controllability of weight. CONCLUSIONS These findings elucidate patient attitudes towards physicians with overweight in a sample at increased risk for weight stigmatization. Findings underscore the need for stigma-reducing interventions so that clinical experiences for both women and physicians with overweight can be improved.
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Affiliation(s)
| | - S. Persky
- Social and Behavioral Research BranchNational Human Genome Research InstituteBethesdaMDUSA
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20
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Koball AM, Mueller PS, Craner J, Clark MM, Nanda S, Kebede EB, Grothe KB. Crucial conversations about weight management with healthcare providers: patients' perspectives and experiences. Eat Weight Disord 2018; 23:87-94. [PMID: 27473870 DOI: 10.1007/s40519-016-0304-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 07/12/2016] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To elicit patient experiences of weight management discussions with providers and provide recommendations for future weight-related discussions. METHODS 1000 patients who recently saw their provider for non-weight specific appointments were mailed measures of demographics, self-reported height and weight, activity level, adherence, perceptions of and recommendations for weight-related discussions, and internalized weight bias. This study was primarily descriptive and utilized a mixed method design including collection of quantitative and qualitative data. RESULTS 242 patients responded (24 % response rate); 32.4 % overweight (N = 72), 41.9 % obese (N = 93). 47 % of overweight and 71 % of obese patients recalled that their provider discussed weight; 92 % were motivated to follow recommendations and 89 % felt confident doing so. Most patients (75 %) would like their provider to be "very direct/straightforward" when discussing weight, and 52 % would be "not at all offended" if they were diagnosed as "overweight/obese." Most patients (63 %) reported being "extremely comfortable" discussing weight with providers. Patients with higher BMI had higher levels of internalized weight bias (p < .001) and wanted their provider to "discuss weight sensitively" (p < .05). CONCLUSION This study suggests that patients have important preferences that providers should be mindful of when discussing weight. While these discussions can be challenging, most patients report that they would be comfortable having these conversations directly and most would have enhanced motivation and confidence following these conversations. Communicating about weight is needed and desired by patients; doing so sensitively with those at higher weight is essential.
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Affiliation(s)
- Afton M Koball
- Department of Behavioral Health, Gundersen Health System, 1900 South Avenue, La Crosse, WI, 54601, USA.
| | - Paul S Mueller
- Department of General Internal Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Julia Craner
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Matthew M Clark
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Sanjeev Nanda
- Department of General Internal Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Esayas B Kebede
- Department of General Internal Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Karen B Grothe
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, 55905, USA
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Gonzales KL, Garcia GE, Jacob MM, Muller C, Nelson L, Manson SM. Patient-provider relationship and perceived provider weight bias among American Indians and Alaska Natives. Obes Sci Pract 2018; 4:76-84. [PMID: 29479467 PMCID: PMC5818742 DOI: 10.1002/osp4.135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 08/21/2017] [Accepted: 08/29/2017] [Indexed: 12/25/2022] Open
Abstract
Objective The objective of this study was to examine patient-provider relationships among American Indians and Alaska Native (AI/AN) patients by examining associations between patient activation, perceived provider weight bias and working alliance. Patient activation is generally defined as having the knowledge, skills and confidence to manage one's health. Methods Among a sample of 87 AI/AN adults presenting for general medical care at an urban clinic in the north-west region of the USA, ordinary least squares regression analysis was completed to examine associations. Results Better working alliance scores were associated with increased patient activation, while perceived provider weight bias was associated with reduced patient activation. In addition, those with class II obesity had decreased patient activation. Conclusion These findings point to the importance of a positive patient-provider relationship in AI/ANs. Optimal patient engagement and subsequent health outcomes warrant additional consideration of patients' perceptions of provider weight bias within the context of health promotion and interventions.
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Affiliation(s)
- K. L. Gonzales
- Oregon Health Sciences University‐Portland State University School of Public HealthPortland State UniversityPortlandORUSA
| | - G. E. Garcia
- Department of SociologyPortland State UniversityPortlandORUSA
| | - M. M. Jacob
- Department of Education Studies, College of EducationUniversity of OregonEugeneORUSA
| | - C. Muller
- Initiative for Research and Education to Advance Community HealthWashington State UniversitySeattleWAUSA
| | - L. Nelson
- Initiative for Research and Education to Advance Community HealthWashington State UniversitySeattleWAUSA
| | - S. M. Manson
- Centers for American Indian and Alaska Native HealthUniversity of Colorado DenverAuroraCOUSA
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22
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Walker RE, Kusch J, Fink JT, Nelson DA, Morris G, Skalla J, Cisler RA. Facilitating Factors and Barriers to Weight Management in Women: Physician Perspectives. J Patient Cent Res Rev 2018; 5:18-27. [PMID: 31413993 PMCID: PMC6664340 DOI: 10.17294/2330-0698.1495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE The complexity of addressing overweight and obesity in women has been an ongoing public health and health care challenge. While the mechanism for addressing overweight and obesity in women remains unclear, it has been speculated that disparities in overweight and obesity by race and gender contribute to the complexity. The purpose of the present study was to examine perceptions of primary care physicians when discussing weight management with their patients. METHODS We conducted focus group discussions exploring facilitators and barriers to discussing weight management and weight loss among women patients. Participants included 18 family medicine and internal medicine physicians who were recruited using a snowball sampling technique from two large urban institutions. Focus group discussions were transcribed verbatim. Responses were then codified and analyzed in frequency of occurrence using specialized computer software. RESULTS Nine themes emerged from group discussions. These recurring themes reflected three overarching critical points: 1) potential utility of the primary care setting to address weight management; 2) the importance of positive patient-provider communication in supporting weight loss efforts; and 3) acknowledgement of motivation as intrinsic or extrinsic, and its role in obesity treatment. CONCLUSIONS Physician perceptions of their own lack of education or training and their inability to influence patient behaviors play crucial roles in discussing weight management with patients.
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Affiliation(s)
- Renee E Walker
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI
- Center for Urban Population Health, Milwaukee, WI
| | - Jennifer Kusch
- Center for Urban Population Health, Milwaukee, WI
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI
- School of Health Sciences, Milwaukee Area Technical College, Milwaukee, WI
| | - Jennifer T Fink
- Center for Urban Population Health, Milwaukee, WI
- Department of Health Informatics & Administration, College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI
| | - David A Nelson
- Center for Urban Population Health, Milwaukee, WI
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - George Morris
- Center for Urban Population Health, Milwaukee, WI
- Columbia St. Mary's, Milwaukee, WI
| | - Jessica Skalla
- Center for Urban Population Health, Milwaukee, WI
- Department of Health Informatics & Administration, College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI
| | - Ron A Cisler
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI
- Center for Urban Population Health, Milwaukee, WI
- Department of Health Informatics & Administration, College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI
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23
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Flodgren G, Gonçalves‐Bradley DC, Summerbell CD. Interventions to change the behaviour of health professionals and the organisation of care to promote weight reduction in children and adults with overweight or obesity. Cochrane Database Syst Rev 2017; 11:CD000984. [PMID: 29190418 PMCID: PMC6486102 DOI: 10.1002/14651858.cd000984.pub3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The prevalence of overweight and obesity is increasing globally, an increase which has major implications for both population health and costs to health services. This is an update of a Cochrane Review. OBJECTIVES To assess the effects of strategies to change the behaviour of health professionals or the organisation of care compared to standard care, to promote weight reduction in children and adults with overweight or obesity. SEARCH METHODS We searched the following databases for primary studies up to September 2016: CENTRAL, MEDLINE, Embase, CINAHL, DARE and PsycINFO. We searched the reference lists of included studies and two trial registries. SELECTION CRITERIA We considered randomised trials that compared routine provision of care with interventions aimed either at changing the behaviour of healthcare professionals or the organisation of care to promote weight reduction in children and adults with overweight or obesity. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane when conducting this review. We report the results for the professional interventions and the organisational interventions in seven 'Summary of findings' tables. MAIN RESULTS We identified 12 studies for inclusion in this review, seven of which evaluated interventions targeting healthcare professional and five targeting the organisation of care. Eight studies recruited adults with overweight or obesity and four recruited children with obesity. Eight studies had an overall high risk of bias, and four had a low risk of bias. In total, 139 practices provided care to 89,754 people, with a median follow-up of 12 months. Professional interventions Educational interventions aimed at general practitioners (GPs), may slightly reduce the weight of participants (mean difference (MD) -1.24 kg, 95% confidence interval (CI) -2.84 to 0.37; 3 studies, N = 1017 adults; low-certainty evidence).Tailoring interventions to improve GPs' compliance with obesity guidelines probably leads to little or no difference in weight loss (MD 0.05 (kg), 95% CI -0.32 to 0.41; 1 study, N = 49,807 adults; moderate-certainty evidence).It is uncertain if providing doctors with reminders results in a greater weight reduction than standard care (men: MD -11.20 kg, 95% CI -20.66 kg to -1.74 kg, and women: MD -1.30 kg, 95% CI [-7.34, 4.74] kg; 1 study, N = 90 adults; very low-certainty evidence).Providing clinicians with a clinical decision support (CDS) tool to assist with obesity management at the point of care leads to little or no difference in the body mass index (BMI) z-score of children (MD -0.08, 95% CI -0.15 to -0.01 in 378 children; moderate-certainty evidence), CDS tools may lead to little or no difference in weight loss in adults: MD -0.095 kg (-0.21 lbs), P = 0.47; 1 study, N = 35,665; low-certainty evidence. Organisational interventions Adults with overweight or obesity may lose more weight if the care was provided by a dietitian (by -5.60 kg, 95% CI -4.83 kg to -6.37 kg) or by a doctor-dietitian team (by -6.70 kg, 95% CI -7.52 kg to -5.88 kg; 1 study, N = 270 adults; low-certainty evidence). Shared care leads to little or no difference in the BMI z-score of children with obesity (adjusted MD -0.05, 95% CI -0.14 to 0.03; 1 study, N = 105 children; low-certainty evidence).Organisational restructuring of the delivery of primary care (i.e. introducing the chronic care model) may result in a slightly lower increase in the BMI of children who received care at intervention clinics (BMI change: adjusted MD -0.21, 95% CI -0.50 to 0.07; 1 study, unadjusted MD -0.18, 95% CI -0.20 to -0.16; N=473 participants; moderate-certainty evidence).Mail and phone interventions probably lead to little or no difference in weight loss in adults (mean weight change (kg) using mail: -0.36, 95% CI -1.18 to 0.46; phone: -0.44, 95% CI -1.26 to 0.38; 1 study, N = 1801 adults; moderate-certainty evidence). Care delivered by a nurse at a primary care clinic may lead to little or no difference in the BMI z-score in children (MD -0.02, 95% CI -0.16 to 0.12; 1 study, N = 52 children; very low-certainty evidence).Two studies reported data on cost effectiveness: one study favoured mail and standard care over telephone consultations, and the other study achieved weight loss at a modest cost in both intervention groups (doctor and doctor-dietitian). One study of shared care reported similar adverse effects in both groups. AUTHORS' CONCLUSIONS We found little convincing evidence for a clinically-important effect on participants' weight or BMI of any of the evaluated interventions. While pooled results from three studies indicate that educational interventions targeting healthcare professionals may lead to a slight weight reduction in adults, the certainty of these results is low. Two trials evaluating CDS tools (unpooled results) for improved weight management suggest little or no effect on weight or BMI change in adults or children with overweight or obesity. Evidence for all the other interventions evaluated came mostly from single studies. The certainty of the included evidence varied from moderate to very low for the main outcomes (weight and BMI). All of the evaluated interventions would need further investigation to ascertain their strengths and limitations as effective strategies to change the behaviour of healthcare professionals or the organisation of care. As only two studies reported on cost, we know little about cost effectiveness across the evaluated interventions.
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Affiliation(s)
- Gerd Flodgren
- Norwegian Institute of Public HealthDivision for Health ServicesPilestredet Park 7OsloNorway0176
| | | | - Carolyn D Summerbell
- Queen's Campus, Durham UniversitySchool of Medicine, Pharmacy and Health, Wolfson Research InstituteUniversity BoulevardThornabyStockton‐on‐TeesUKTS17 6BH
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Jung FUCE, Luck-Sikorski C, König HH, Riedel-Heller SG. Stigma and Knowledge as Determinants of Recommendation and Referral Behavior of General Practitioners and Internists. Obes Surg 2017; 26:2393-401. [PMID: 26886930 DOI: 10.1007/s11695-016-2104-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Despite reported effectiveness, weight loss surgery (WLS) still remains one of the least preferred options for outpatient providers, especially in Germany. The aim of this study was to examine the effect of stigma and knowledge on recommendation of WLS and referral to a surgeon by general practitioners (GPs) and internists. METHOD The sample consists of 201 GPs and internists from Germany. The questionnaire included questions on the perceived effectiveness of WLS, the frequency of recommendations of WLS, and the frequency of referral to WLS. Stigma, as well as knowledge was also assessed in this context. Linear and logistic regression models were conducted. A mediation analysis was carried out within post hoc analysis. RESULTS Knowledge (b = 0.258, p < 0.001) and stigma towards surgery (b = -0.129, p = 0.013) were related to the frequency of recommendation of WLS. Additionally, respondents, who were more likely to express negative attitudes towards WLS, were less likely to recommend WLS and thus refer patients to WLS (b = -0.107, p < 0.05). Furthermore, respondents with more expertise on WLS were more likely to recommend and thus refer patients to WLS (b = 0.026, p < 0.05). CONCLUSION This study showed that stigma plays a role when it comes to defining treatment pathways for patients with obesity. The question remains how this might influence the patients and their decision regarding their treatment selection. Interventions are required to make treatment decisions by physicians or patients independent of social pressure due to stigma.
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Affiliation(s)
- Franziska U C E Jung
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Ph.-Rosenthal-Str. 55, 04103, Leipzig, Germany. .,IFB Adiposity Diseases, Leipzig University Medical Center, Leipzig, Germany. .,Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD), Halle-Jena-Leipzig, Leipzig, Germany.
| | - Claudia Luck-Sikorski
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Ph.-Rosenthal-Str. 55, 04103, Leipzig, Germany.,IFB Adiposity Diseases, Leipzig University Medical Center, Leipzig, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Ph.-Rosenthal-Str. 55, 04103, Leipzig, Germany
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25
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Halbert CH, Jefferson M, Melvin CL, Rice L, Chukwuka KM. Provider Advice About Weight Loss in a Primary Care Sample of Obese and Overweight Patients. J Prim Care Community Health 2017. [PMID: 28643551 PMCID: PMC5932732 DOI: 10.1177/2150131917715336] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Objective: Primary care providers play an important role in obesity prevention and reduction by advising patients about weight loss strategies. This study examined receipt of provider advice to lose weight among primary care patients who were overweight and obese. Methods: Observational study conducted among primary care patients (n = 282) who completed a survey that measured receipt of provider advice about weight loss/management, chronic health conditions, perceived weight status, and perceptions about shared decision making about weight loss/management. Results: Fifty-nine percent of participants had been advised by their physician to lose weight. Participants who were obese were more likely than those who were overweight to report provider advice (odds ratio [OR] = 1.31, 95% CI = 1.25-4.34, P = .001). Similarly, participants who believed they were obese/overweight had a greater likelihood of reporting provider advice compared with those who did not believe they were obese/overweight (OR = 1.40, 95% CI = 2.43-6.37, P = .0001). Shared decision making about weight loss/management was associated with an increased likelihood of reporting provider advice (OR = 3.30, 95% CI = 2.62-4.12, P = .0001). Conclusions: Patient beliefs about their weight status and perceptions about shared decision-making are important to receiving provider advice about weight loss/management among primary care patients. Practice Implications: Continued efforts are needed to enhance provider advice about weight loss/management among obese/overweight patients.
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Affiliation(s)
| | | | - Cathy L Melvin
- 1 Medical University of South Carolina, Charleston, SC, USA
| | - LaShanta Rice
- 1 Medical University of South Carolina, Charleston, SC, USA
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26
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Washington Cole KO, Gudzune KA, Bleich SN, Cheskin LJ, Bennett WL, Cooper LA, Roter DL. Providing prenatal care to pregnant women with overweight or obesity: Differences in provider communication and ratings of the patient-provider relationship by patient body weight. PATIENT EDUCATION AND COUNSELING 2017; 100:1103-1110. [PMID: 28062155 PMCID: PMC5410191 DOI: 10.1016/j.pec.2016.12.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 12/23/2016] [Accepted: 12/26/2016] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To examine the association of women's body weight with provider communication during prenatal care. METHODS We coded audio recordings of prenatal visits between 22 providers and 117 of their patients using the Roter Interaction Analysis System. Multivariate, multilevel Poisson models were used to examine the relationship between patient pre-pregnancy body mass index and provider communication. RESULTS Compared to women with normal weight, providers asked fewer lifestyle questions (IRR 0.66, 95% CI 0.44-0.99, p=0.04) and gave less lifestyle information (IRR 0.51, 95% CI 0.32-0.82, p=0.01) to women with overweight and obesity, respectively. Providers used fewer approval (IRR 0.68, 95% CI 0.51-0.91, p=0.01) and concern statements (IRR 0.68, 95% CI 0.53-0.86, p=0.002) when caring for women with overweight and fewer self-disclosure statements caring for women with obesity (IRR 0.40, 95% CI 0.19-0.84 p=0.02). CONCLUSION Less lifestyle and rapport building communication for women with obesity may weaken patient-provider relationship during routine prenatal care. PRACTICE IMPLICATIONS Interventions to increase use of patient-centered communication - especially for women with overweight and obesity - may improve prenatal care quality.
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Affiliation(s)
- Katie O Washington Cole
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health; 624N. Broadway, Room 750; Baltimore, Maryland, 21205, USA.
| | - Kimberly A Gudzune
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sara N Bleich
- Department of Health Policy and Management; Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lawrence J Cheskin
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Wendy L Bennett
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lisa A Cooper
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Debra L Roter
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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O'Neil CE, Nicklas TA. State of the Art Reviews: Relationship Between Diet/ Physical Activity and Health. Am J Lifestyle Med 2016. [DOI: 10.1177/1559827607306433.] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Obesity and 4 of the leading causes of death—heart disease, cancer, stroke, and type 2 diabetes mellitus—are related to lifestyle. The combination of a healthy weight, prudent diet, and daily physical activity clearly plays a role in primary, secondary, and tertiary prevention of these and other chronic diseases. Because nearly 65% of the adult population is overweight or obese, weight loss and maintenance are central to this review article. Improved lipid profiles, blood pressure, insulin sensitivity, and euglycemia are associated with weight loss or a normal body weight; thus, maintaining a healthy weight is a universal recommendation for health. The methods for improving lifestyle described in the section on obesity include assessing nutritional status and stages of change of the client, setting realistic goals, eating a diet high in fruits and vegetables with low-fat sources of dairy and protein, and achieving appropriate physical activity levels. The importance of physicians discussing weight with clients and vice versa is stressed. The common features of lifestyle-related diseases make them amenable to similar lifestyle interventions.
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Affiliation(s)
- Carol E. O'Neil
- Department of Pediatrics, Children's Nutrition Research Center, Baylor
College of Medicine, Houston, Texas (TAN)
| | - Theresa A. Nicklas
- Department of Pediatrics, Children's Nutrition Research Center, 1100
Bates Avenue, Baylor College of Medicine, Houston, TX 77030-2600,
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Marek RJ, Tarescavage AM, Ben-Porath YS, Ashton K, Heinberg LJ, Rish JM. Associations between psychological test results and failure to proceed with bariatric surgery. Surg Obes Relat Dis 2016; 13:507-513. [PMID: 27771315 DOI: 10.1016/j.soard.2016.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 08/22/2016] [Accepted: 09/06/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND The reasons why some patients who begin the presurgical process for bariatric surgery fail to complete the procedure are understudied. Previous research implies that psychological factors play a role. OBJECTIVES To examine whether scores from baseline psychological testing incrementally predict failure to proceed with bariatric surgery beyond demographic information in patients' medical charts and data derived from a clinical interview. SETTING Cleveland Clinic Bariatric and Metabolic Institute. METHODS The sample (n = 1160) was mainly female (72.41%), middle aged (mean age = 46.07 yr, SD = 11.70) and of Caucasian descent (65.76%). Hierarchical logistic regressions were conducted to test the incremental validity of baseline Minnesota Multiphasic Personality Inventory-2 Restructured Form scores after controlling for information gathered from the psychological interview and medical charts. Relative risk ratios were calculated to reflect the clinical utility of the results. RESULTS In total, 27.16% of patients failed to proceed with bariatric surgery after 1 year or more after a recommendation for surgery from their psychological evaluations. Psychological test scores were substantially associated with failure to proceed with surgery and significantly accounted for up to 6% of additional variance after controlling for psychological interview variables and medical chart data. Elevated scores on Minnesota Multiphasic Personality Inventory-2 Restructured Form scales, such as anxiety and substance use, identify patients at up to 2.5 times greater risk for failing to proceed with bariatric surgery. CONCLUSIONS Objective psychological test data-notably, scale scores assessing for substance abuse, anxiety, and demoralization-add to information obtained from a clinical interview and medical records in identifying patients at risk for failing to proceed with bariatric surgery.
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Affiliation(s)
- Ryan J Marek
- Department of Psychological Sciences, Kent State University, Kent, Ohio.
| | | | | | - Kathleen Ashton
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
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Lydecker JA, Galbraith K, Ivezaj V, White MA, Barnes RD, Roberto CA, Grilo CM. Words will never hurt me? Preferred terms for describing obesity and binge eating. Int J Clin Pract 2016; 70:682-90. [PMID: 27354290 PMCID: PMC4965320 DOI: 10.1111/ijcp.12835] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 05/04/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This study evaluated individuals' language preferences for discussing obesity and binge eating. METHOD Participants (N = 817; 68.3% female) were an online community sample. They rated the desirability of terms related to obesity and binge eating, and also completed psychometrically established eating-disorder measures. In addition to examining participants' preferences, analyses explored whether preferences differed by socio-demographic variables, weight status and binge-eating status. RESULTS Preferred obesity-related terms were weight and BMI, although women rated undesirable obesity-related terms even lower than did men. Participants with obesity and binge eating rated weight, BMI, unhealthy BMI and large size as less desirable than participants with obesity but not binge eating. Binge-related terms were generally ranked neutrally; preferred descriptions were kept eating even though not physically hungry and loss of control. CONCLUSIONS Preferred terms were generally consistent across sex, weight status and binge-eating status. Using terms ranked more preferably and avoiding terms ranked more undesirably may enhance clinical interactions, particularly when discussing obesity with women and individuals reporting binge eating, as these groups had stronger aversion to some non-preferred terms. Findings that the selected binge-related descriptions were rated neutrally on average provide support for their use by clinicians.
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Affiliation(s)
- Janet A. Lydecker
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | | | - Valentina Ivezaj
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Marney A. White
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Rachel D. Barnes
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Christina A. Roberto
- Department of Medical Ethics & Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Carlos M. Grilo
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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Jansen S, Desbrow B, Ball L. Obesity management by general practitioners: the unavoidable necessity. Aust J Prim Health 2016; 21:366-8. [PMID: 26349423 DOI: 10.1071/py15018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 05/01/2015] [Indexed: 11/23/2022]
Abstract
Nearly 62% of primary care patients are overweight or obese, and obesity is now a National Health Priority Area. Weight management interventions in primary care currently generate little more than 1 kg of weight loss per patient over a 2-year period. Consequently, further strategies are required to improve the effectiveness of weight management in primary care. The National Health and Medical Research Council (NHMRC) have released updated guidelines for the management of overweight and obese patients in primary care. However, there is some disconnect between establishment of guidelines and their implementation in practice. Barriers to GPs using guidelines for the management of obesity include low self-efficacy, perceived insufficient time in consultations and the challenge of raising the topic of a patient's weight. Nonetheless, patients prefer to receive weight management support from GPs rather than other health professionals, suggesting that the demand on GPs to support patients in weight management will continue. GPs cannot afford to side-line obesity management, as obesity is likely to be the most prevalent modifiable risk factor associated with patients' long-term health. Without further strategies to support GPs in their management of patients' weight, obesity will continue to be an expensive and long-term public health issue.
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Lous J, Freund KS. Predictors of weight loss in young adults who are over-weight or obese and have psychosocial problems: a post hoc analysis. BMC FAMILY PRACTICE 2016; 17:43. [PMID: 27068690 PMCID: PMC4827173 DOI: 10.1186/s12875-016-0437-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 03/22/2016] [Indexed: 11/24/2022]
Abstract
Background The aim of this study is in a general practice trial setting to identify predictive factors for weight loss after 1 year among young adults who are over-weight or obese and who have several psychosocial problems. Methods Twenty-eight general practitioners recruited 495 patients aged 20–45 years with psychosocial problems for a randomized general preventive study to increase self-efficacy to achieve a self-prioritised goal for a better life by discussions of resources and barriers for reaching the goal. The present study is a post hoc analysis of possible predictors of weight loss among all 218 patients who have over-weight or obesity. A 23-pages questionnaire was completed before and 1 year after randomization. 111 patients had a one-hour preventive health consultation with their general practitioners focused on life coaching and a follow-up consultation within 3 months, and 107 patients had no preventive consultation. Results Twenty-two patients stated during the preventive consultation that weight loss was a prioritised goal. They had a mean weight loss of 4.7 kgs compared with 1.6 kgs in the group without this goal and 1.6 kgs in the group without preventive consultation. In a logistic regression model, predictors of weight loss or no weight loss were a) pre-interventional consideration of weight loss within 30 days, b) having weight loss as a prioritised goal for improved quality of life, c) being female, d) being in the oldest half of participants, and e) having many psychosocial problems. In a linear regression model, the predictors together explained about 11 % of the weight loss. Important predictors were: obesity (explained 4 %), pre-interventional consideration of weight loss within 30 days (3 %), and having a preventive health consultation with weight loss as a prioritised goal (2 %). Conclusions Pre-interventional consideration of weight loss within 30 days and having weight loss as a prioritised goal during the health consultation were two important predictors for weight loss. By structured interventions focussing on the patients’ priorities, self-chosen goals, their resources and barriers for reaching the goals, changes may be obtained; especially in participants with many problems who often do not accept participation in procedures on risks. ClinicalTrials gov Registration NCT 01231256, Aug. 22. 2010.
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Affiliation(s)
- Jørgen Lous
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløwvej 9A, DK-5000, Odense, Denmark.
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Gupta S, Wang Z. Treatment satisfaction with different weight loss methods among respondents with obesity. Clin Obes 2016; 6:161-70. [PMID: 27008069 DOI: 10.1111/cob.12140] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/21/2016] [Accepted: 01/26/2016] [Indexed: 01/18/2023]
Abstract
Satisfaction with weight loss (WL) methods has been correlated with the effectiveness, long-term compliance and commitment to weight management. This study explored treatment satisfaction associated with different WL methods among patients with obesity. Cross-sectional data were analysed from the 2012 US National Health and Wellness Survey. Respondents with obesity were categorized as having a WL procedure (e.g., gastric bypass and gastric banding) or using a prescription medication for WL (Sur/Rx), vs. using self-modification WL techniques (e.g., diet, exercise and WL supplements). Overall satisfaction with current WL methods was assessed among the obese and the overweight/obese with type 2 diabetes mellitus (T2DM). Of the 22 927 respondents with obesity, 58.4% took no current action to lose weight, 2.3% were identified as Sur/Rx and 39.3% were identified as self-modification. The Sur/Rx group reported being very/extremely satisfied more frequently than the self-modification group (39.3% vs. 20.2%, P < 0.001). Similarly, respondents with T2DM that were overweight/obese reported higher satisfaction in the Sur/Rx vs. the self-modification group (46.6% vs. 22.7%, P < 0.001). Satisfaction with WL methods was greater for the Sur/Rx vs. the self-modification group. Data suggest the importance of including bariatric surgery and pharmacotherapy as an integral part in comprehensive WL management.
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Affiliation(s)
- S Gupta
- Health Outcomes Practice, Kantar Health, Princeton, NJ, USA
| | - Z Wang
- Health Economics & Outcomes Research, Eisai, Inc., Woodcliff Lake, NJ, USA
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33
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Exploring healthcare experiences among online interactive weight loss forum users. COMPUTERS IN HUMAN BEHAVIOR 2016. [DOI: 10.1016/j.chb.2015.12.048] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Chambers EC, Wylie-Rosett J, Blank AE, Ouziel J, Hollingsworth N, Riley RW, Selwyn PA. Increasing Referrals to a YMCA-Based Diabetes Prevention Program: Effects of Electronic Referral System Modification and Provider Education in Federally Qualified Health Centers. Prev Chronic Dis 2015; 12:E189. [PMID: 26542141 PMCID: PMC4651145 DOI: 10.5888/pcd12.150294] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Introduction The Diabetes Prevention Program has been translated to community settings with varying success. Although primary care referrals are used for identifying and enrolling eligible patients in the Diabetes Prevention Program, little is known about the effects of strategies to facilitate and sustain eligible patient referrals using electronic health record systems. Methods To facilitate and sustain patient referrals, a modification to the electronic health record system was made and combined with provider education in 6 federally qualified health centers in the Bronx, New York. Referral data from April 2012 through November 2014 were analyzed using segmented regression analysis. Results Patient referrals increased significantly after the modification of the electronic health record system and implementation of the provider education intervention. Before the electronic system modification, 0 to 2 patients were referred per month. During the following year (September 2013 through August 2014), which included the provider education intervention, referrals increased to 1 to 9 per month and continued to increase to 5 to 11 per month from September through November 2014. Conclusions Modification of an electronic health record system coupled with a provider education intervention shows promise as a strategy to identify and refer eligible patients to community-based Diabetes Prevention Programs. Further refinement of the electronic system for facilitating referrals and follow-up of eligible patients should be explored.
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Affiliation(s)
- Earle C Chambers
- 1300 Morris Park Ave, Block 408, Bronx, NY 10461. Telephone: 718-430-3057.
| | - Judith Wylie-Rosett
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Arthur E Blank
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Judy Ouziel
- YMCA Diabetes Prevention Program, Activate America, New York, New York
| | - Nicole Hollingsworth
- Office Of Community and Population Health, Montefiore Medical Center, Bronx, New York
| | - Rachael W Riley
- Office Of Community and Population Health, Montefiore Medical Center, Bronx, New York
| | - Peter A Selwyn
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York
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Dutton GR, Phillips JM, Kukkamalla M, Cherrington AL, Safford MM. Pilot study evaluating the feasibility and initial outcomes of a primary care weight loss intervention with peer coaches. THE DIABETES EDUCATOR 2015; 41:361-8. [PMID: 25740817 PMCID: PMC4511264 DOI: 10.1177/0145721715575356] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE The purpose of this single-group pilot study was to evaluate the feasibility, acceptability, and initial outcomes of a novel approach to delivering weight loss treatment in primary care using peer coaches and targeting predominantly African American patients with diabetes or prediabetes. METHODS Participants (N = 33) were recruited from a family medicine practice for a 6-month lifestyle intervention. Eligible patients were obese adults (body mass index [BMI] ≥30 kg/m(2)) with ≥1 additional cardiometabolic risk factor(s), including (1) elevated hemoglobin A1C or diagnosed diabetes, (2) elevated blood pressure, (3) elevated triglycerides, and/or (4) low high-density lipoprotein. The intervention included a combination of 12 group-based office visits with health professionals plus 12 individual phone contacts with peer coaches. Outcomes included weight loss, program adherence, and program satisfaction. RESULTS Participants (mean age = 56 ± 10 years; BMI = 42.9 ± 11.0 kg/m(2)) were predominantly female (88%) and African American (85%). Treatment resulted in a significant mean weight loss of -4.5 ± 7.2 kg, and approximately 27% of participants lost ≥5% of their initial body weight. Participants completed approximately 50% of the group visits and 40% of the telephone calls with peer coaches. Participants rated both components of the intervention favorably. CONCLUSIONS Results of this pilot study indicated that a primary care weight management program including group-based visits and peer-delivered telephone contacts achieved significant weight loss among predominantly African American patients with weight-related comorbidities, including diabetes and prediabetes. Additional research is needed to examine the long-term outcomes of this novel approach and to identify program components supporting patients' success.
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Affiliation(s)
- Gareth R Dutton
- University of Alabama at Birmingham, Department of Medicine, Division of Preventive Medicine, Birmingham, AL (Dr Dutton, Ms Phillips, Ms Kukkamalla, Dr Cherrington, Dr Safford)
| | - Janice M Phillips
- University of Alabama at Birmingham, Department of Medicine, Division of Preventive Medicine, Birmingham, AL (Dr Dutton, Ms Phillips, Ms Kukkamalla, Dr Cherrington, Dr Safford)
| | - Meghana Kukkamalla
- University of Alabama at Birmingham, Department of Medicine, Division of Preventive Medicine, Birmingham, AL (Dr Dutton, Ms Phillips, Ms Kukkamalla, Dr Cherrington, Dr Safford)
| | - Andrea L Cherrington
- University of Alabama at Birmingham, Department of Medicine, Division of Preventive Medicine, Birmingham, AL (Dr Dutton, Ms Phillips, Ms Kukkamalla, Dr Cherrington, Dr Safford)
| | - Monika M Safford
- University of Alabama at Birmingham, Department of Medicine, Division of Preventive Medicine, Birmingham, AL (Dr Dutton, Ms Phillips, Ms Kukkamalla, Dr Cherrington, Dr Safford)
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Kass AE, Wang AZ, Kolko RP, Holland JC, Altman M, Trockel M, Taylor CB, Wilfley DE. Identification as overweight by medical professionals: relation to eating disorder diagnosis and risk. Eat Behav 2015; 17:62-8. [PMID: 25602172 PMCID: PMC4380786 DOI: 10.1016/j.eatbeh.2014.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 10/03/2014] [Accepted: 12/03/2014] [Indexed: 12/11/2022]
Abstract
PURPOSE Discussions about weight between medical professionals and young adults may increase risk of eating disorders (EDs). Clarifying the relation between screening for overweight and ED risk is needed. METHODS 548 college-age women were classified as at-risk (n=441) or with an ED (n=107), and were assessed for disordered eating attitudes, behaviors, and relevant history, including, "Has a doctor, nurse, or other medical professional ever told you that you were overweight?" Regression analyses were used to evaluate the relations between being identified as overweight and current disordered eating behaviors, attitudes, and ED diagnosis, without and with covariates (history of weight-related teasing, history of an ED, family history of being identified as overweight, and current body mass index). RESULTS 146 (26.6%) women reported being previously identified as overweight by a medical professional. There was no relation between being previously identified as overweight and having an ED. Those identified as overweight were more likely to have weight/shape concerns above a high-risk cutoff, but showed no difference in dietary restraint, binge eating, purging behaviors, or excessive exercise compared to those not identified. CONCLUSIONS Being previously identified as overweight by a medical professional was associated with increased weight/shape concerns but not with current disordered eating behaviors or ED status. Minimizing the potential negative effects of overweight screening on weight and shape concerns by providing patients with strategies to increase healthy lifestyle behaviors and long-term support for healthy weight loss goals may have a positive impact on reducing the public health problem of overweight and obesity.
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Affiliation(s)
- Andrea E Kass
- Department of Psychology, Washington University in St. Louis, 660 South Euclid Avenue, Campus Box 8134, St. Louis, MO 63110, USA.
| | - Annie Z Wang
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8134, St. Louis, MO 63110, USA
| | - Rachel P Kolko
- Department of Psychology, Washington University in St. Louis, 660 South Euclid Avenue, Campus Box 8134, St. Louis, MO 63110, USA
| | - Jodi C Holland
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8134, St. Louis, MO 63110, USA
| | - Myra Altman
- Department of Psychology, Washington University in St. Louis, 660 South Euclid Avenue, Campus Box 8134, St. Louis, MO 63110, USA
| | - Mickey Trockel
- Department of Psychiatry, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA
| | - C Barr Taylor
- Department of Psychiatry, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA
| | - Denise E Wilfley
- Department of Psychology, Washington University in St. Louis, 660 South Euclid Avenue, Campus Box 8134, St. Louis, MO 63110, USA; Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8134, St. Louis, MO 63110, USA
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Teixeira FV, Pais-Ribeiro JL, Maia A. A qualitative study of GPs' views towards obesity: are they fighting or giving up? Public Health 2015; 129:218-25. [PMID: 25698498 DOI: 10.1016/j.puhe.2015.01.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 12/12/2014] [Accepted: 01/07/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Several studies indicate that general practitioners (GPs) are not taking the issue of obesity as seriously as they should. Therefore, the aim of this study was to understand GPs' views about obesity and obese people and how these professionals perceive their role in the treatment of this disease. STUDY DESIGN Qualitative study using semi-structured interviews. METHODS Sixteen semi-structured interviews were conducted with Portuguese GPs. Data were analyzed according to thematic analysis procedures. RESULTS GPs are negative about their own role in obesity treatment. Although they believe it is part of their job to advise obese patients on the health risks of obesity, the majority of doctors think they are not making any difference in getting their patients to make long term lifestyle changes. GPs hold negative attitudes towards these patients blaming them for being unmotivated and non-compliant and are also pessimistic about their ability to lose weight. Doctors are facing a dilemma in their practices: they want to play an active role but, due to a set of negative beliefs and perceived barriers, they are playing a relatively passive role, feeling defeated and unmotivated, which is reflected in a decrease of efforts and a willing to give up on most of the cases. CONCLUSIONS This issue should be taken in to account during physicians' education since doctors should be aware of how their own beliefs and attitudes influence their behaviour and practices, compromising, therefore, the adherence to and the success in obesity treatment. They seem to need more precise guidelines and better tools for screening and management of obesity, more referral options, and improved coordination with other specialities.
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Affiliation(s)
- F V Teixeira
- Faculty of Psychology and Science Education, University of Porto, Portugal.
| | - J L Pais-Ribeiro
- Faculty of Psychology and Science Education, University of Porto, Portugal.
| | - A Maia
- School of Psychology, University of Minho, Portugal.
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Miedema B, Reading SA, Hamilton RA, Morrison KS, Thompson AE. Can certified health professionals treat obesity in a community-based programme? A quasi-experimental study. BMJ Open 2015; 5:e006650. [PMID: 25652801 PMCID: PMC4322212 DOI: 10.1136/bmjopen-2014-006650] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To test the effectiveness of a non-pharmaceutical programme for obese participants in a rural Eastern Canadian Province using certified health professionals. DESIGN A prospective quasi-experimental design with repeated premeasure and postmeasure. PARTICIPANTS 146 participants with obesity (body mass index >30 kg/m(2)) from rural and urban communities in an Eastern Canadian Province were divided into four groups. INTERVENTION A 6-month intensive active community-based lifestyle intervention (InI) delivered by Certified Exercise Physiologists, Certified Personal Trainers and Registered Dietitians, followed by 6 months of self-management. A second intervention (InII) was nested in InI and consisted of group-mediated cognitive-behavioral intervention (GMCBI) delivered by an exercise psychologist to two of the four InI groups. OUTCOMES (1) Improving health outcomes among the participants' preactive and postactive 6-month intervention and self-management period, (2) Documenting the impact of InII (GMCBI) and location of the intervention (urban vs rural). RESULTS The 6-month active InI significantly improved cardiovascular health for participants who completed the intervention. InII (GMCBI) significantly lowered the attrition rate among the participants. The self-management period was challenging for the participants and they did not make further gains; however, most were able to maintain the gains achieved during the active intervention. The location of the intervention, urban or rural, had little impact on outcomes. CONCLUSIONS A community-based programme utilising healthcare professionals other than physicians to treat obese patients was effective based on premeasure and postmeasure. During the self-management phase, the participants were able to maintain the gains. Psychological support is essential to participant retention.
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Affiliation(s)
- Baukje Miedema
- Dalhousie University Family Medicine Teaching Unit, Dr. Everett Chalmers Regional Hospital, Fredericton, Canada
| | - Stacey A Reading
- Department of Sport & Exercise Science, University of Auckland, Auckland, New Zealand
| | - Ryan A Hamilton
- Psychology Department, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Katherine S Morrison
- Dalhousie University Family Medicine Teaching Unit, Dr. Everett Chalmers Regional Hospital, Fredericton, Canada
| | - Ashley E Thompson
- Dalhousie University Family Medicine Teaching Unit, Dr. Everett Chalmers Regional Hospital, Fredericton, Canada
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Patient and physician characteristics associated with the provision of weight loss counseling in primary care. Obes Res Clin Pract 2015; 8:e123-30. [PMID: 24743007 DOI: 10.1016/j.orcp.2012.12.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 12/04/2012] [Accepted: 12/15/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND A variety of physician and patient characteristics may influence whether weight loss counseling occurs in primary care encounters. OBJECTIVES This study utilized a cross-sectional survey of primary care patients, which examined patient characteristics, physician characteristics, and characteristics of the physicianâ??patient relationship associated with weight loss counseling and recommendations provided by physicians. PARTICIPANTS (N = 143, mean age = 46.8 years, mean BMI = 36.9 kg/m(2), 65% Caucasian) were overweight and obese primary care patients participating in a managed care weight loss program. MEASURES PARTICIPANTS completed self-report surveys in the clinic prior to the initial weight loss session. Surveys included items assessing demographic/background characteristics, weight, height, and a health care questionnaire evaluating whether their physician had recommended weight loss, the frequency of their physiciansâ?? weight loss counseling, and whether their physician had referred them for obesity treatment. RESULTS Patient BMI and physician sex were most consistently associated with physiciansâ?? weight loss counseling practices. Patients seen by female physicians were more likely to be told that they should lose weight, received more frequent obesity counseling, and were more likely to have been referred for obesity treatment by their physician. Length and frequency of physicianâ??patient contacts were unrelated to the likelihood of counseling. CONCLUSIONS These findings add to previous evidence suggesting possible differences in the weight loss counseling practices of male and female physicians, although further research is needed to understand this potential difference between physicians.
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Jackson SE, Beeken RJ, Wardle J. Perceived weight discrimination and changes in weight, waist circumference, and weight status. Obesity (Silver Spring) 2014; 22:2485-8. [PMID: 25212272 PMCID: PMC4236245 DOI: 10.1002/oby.20891] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 08/20/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine associations between perceived weight discrimination and changes in weight, waist circumference, and weight status. METHODS Data were from 2944 men and women aged ≥50 years participating in the English Longitudinal Study of Ageing. Experiences of weight discrimination were reported in 2010-2011 and weight and waist circumference were objectively measured in 2008-2009 and 2012-2013. ANCOVAs were used to test associations between perceived weight discrimination and changes in weight and waist circumference. Logistic regression was used to test associations with changes in weight status. All analyses adjusted for baseline BMI, age, sex, and wealth. RESULTS Perceived weight discrimination was associated with relative increases in weight (+1.66 kg, P < 0.001) and waist circumference (+1.12 cm, P = 0.046). There was also a significant association with odds of becoming obese over the follow-up period (OR = 6.67, 95% CI 1.85-24.04) but odds of remaining obese did not differ according to experiences of weight discrimination (OR = 1.09, 95% CI 0.46-2.59). CONCLUSIONS Our results indicate that rather than encouraging people to lose weight, weight discrimination promotes weight gain and the onset of obesity. Implementing effective interventions to combat weight stigma and discrimination at the population level could reduce the burden of obesity.
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Affiliation(s)
- Sarah E Jackson
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College LondonLondon, UK
- Correspondence: Sarah E. Jackson ()
| | - Rebecca J Beeken
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College LondonLondon, UK
| | - Jane Wardle
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College LondonLondon, UK
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Gudzune KA, Bennett WL, Cooper LA, Clark JM, Bleich SN. Prior doctor shopping resulting from differential treatment correlates with differences in current patient-provider relationships. Obesity (Silver Spring) 2014; 22:1952-5. [PMID: 24942593 PMCID: PMC4149586 DOI: 10.1002/oby.20808] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 05/27/2014] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To determine the prevalence of doctor shopping resulting from differential treatment and to examine associations between this shopping and current primary care relationships. METHODS In 2012, a national internet-based survey of 600 adults receiving primary care in the past year with a BMI ≥ 25 kg/m(2) was conducted. Our independent variable was "switching doctors because I felt treated differently because of my weight." Logistic regression models to examine the association of prior doctor shopping with characteristics of current primary care relationships: duration, trust in primary care provider (PCP), and perceived PCP weight-related judgment, adjusted for patient factors were used. RESULTS Overall, 13% of adults with overweight/obesity reported previously doctor shopping resulting from differential treatment. Prior shoppers were more likely to report shorter durations of their current relationships [73% vs. 52%; p = 0.01] or perceive that their current PCP judged them because of their weight [74% vs. 11%; p < 0.01] than nonshoppers. No significant differences in reporting high trust in current PCPs were found. CONCLUSIONS A subset of patients with overweight/obesity doctor shop resulting from perceived differential treatment. These prior negative experiences have no association with trust in current relationships, but our results suggest that patients may remain sensitive to provider weight bias.
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Affiliation(s)
- Kimberly A Gudzune
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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Wimalawansa SJ. Stigma of obesity: A major barrier to overcome. J Clin Transl Endocrinol 2014; 1:73-76. [PMID: 29159086 PMCID: PMC5685031 DOI: 10.1016/j.jcte.2014.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 06/06/2014] [Accepted: 06/11/2014] [Indexed: 11/09/2022] Open
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Castelnuovo G, Manzoni GM, Pietrabissa G, Corti S, Giusti EM, Molinari E, Simpson S. Obesity and outpatient rehabilitation using mobile technologies: the potential mHealth approach. Front Psychol 2014; 5:559. [PMID: 24959157 PMCID: PMC4051130 DOI: 10.3389/fpsyg.2014.00559] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 05/20/2014] [Indexed: 11/22/2022] Open
Abstract
Obesity is currently an important public health problem of epidemic proportions (globesity). Inpatient rehabilitation interventions that aim at improving weight-loss, reducing obesity-related complications and changing dysfunctional behaviors, should ideally be carried out in a multidisciplinary context with a clinical team composed of psychologists, dieticians, psychiatrists, endocrinologists, nutritionists, physiotherapists, etc. Long-term outpatient multidisciplinary treatments are likely to constitute an essential aspect of rehabilitation. Internet-based technologies can improve long-term obesity rehabilitation within a collaborative approach by enhancing the steps specified by psychological and medical treatment protocols. These outcomes may be augmented further by the mHealth approach, through creating new treatment delivery methods to increase compliance and engagement. mHealth (m-health, mobile health) can be defined as the practice of medicine and public health, supported by mobile communication devices for health services and information. mHealth applications which can be implemented in weight loss protocols and obesity rehabilitation are discussed, taking into account future research directions in this promising area.
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Affiliation(s)
- Gianluca Castelnuovo
- Department of Psychology, Catholic University of MilanMilan, Italy
- Istituto Auxologico Italiano Istituto di Ricovero e Cura a Carattere Scientifico, Psychology Research LaboratoryOspedale San Giuseppe, Verbania, Italy
| | - Gian Mauro Manzoni
- Istituto Auxologico Italiano Istituto di Ricovero e Cura a Carattere Scientifico, Psychology Research LaboratoryOspedale San Giuseppe, Verbania, Italy
- Faculty of Psychology, eCampus UniversityComo, Italy
| | - Giada Pietrabissa
- Department of Psychology, Catholic University of MilanMilan, Italy
- Istituto Auxologico Italiano Istituto di Ricovero e Cura a Carattere Scientifico, Psychology Research LaboratoryOspedale San Giuseppe, Verbania, Italy
| | - Stefania Corti
- Istituto Auxologico Italiano Istituto di Ricovero e Cura a Carattere Scientifico, Psychology Research LaboratoryOspedale San Giuseppe, Verbania, Italy
- Department of Psychology, University of BergamoBergamo, Italy
| | | | - Enrico Molinari
- Department of Psychology, Catholic University of MilanMilan, Italy
- Istituto Auxologico Italiano Istituto di Ricovero e Cura a Carattere Scientifico, Psychology Research LaboratoryOspedale San Giuseppe, Verbania, Italy
| | - Susan Simpson
- School of Psychology, Social Work and Social Policy, University of South AustraliaAdelaide, SA, Australia
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Kirk SFL, Price SL, Penney TL, Rehman L, Lyons RF, Piccinini-Vallis H, Vallis TM, Curran J, Aston M. Blame, Shame, and Lack of Support: A Multilevel Study on Obesity Management. QUALITATIVE HEALTH RESEARCH 2014; 24:790-800. [PMID: 24728109 DOI: 10.1177/1049732314529667] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In this research, we examined the experiences of individuals living with obesity, the perceptions of health care providers, and the role of social, institutional, and political structures in the management of obesity. We used feminist poststructuralism as the guiding methodology because it questions everyday practices that many of us take for granted. We identified three key themes across the three participant groups: blame as a devastating relation of power, tensions in obesity management and prevention, and the prevailing medical management discourse. Our findings add to a growing body of literature that challenges a number of widely held assumptions about obesity within a health care system that is currently unsupportive of individuals living with obesity. Our identification of these three themes is an important finding in obesity management given the diversity of perspectives across the three groups and the tensions arising among them.
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Affiliation(s)
| | | | | | | | - Renee F Lyons
- Bridgepoint Collaboratory in Research and Innovation, Toronto, Ontario, Canada
| | | | | | | | - Megan Aston
- Dalhousie University, Halifax, Nova Scotia, Canada
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Obese older adults report high satisfaction and positive experiences with care. BMC Health Serv Res 2014; 14:220. [PMID: 24885429 PMCID: PMC4052349 DOI: 10.1186/1472-6963-14-220] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 05/13/2014] [Indexed: 11/10/2022] Open
Abstract
Background Obese, older adults often have multiple chronic conditions resulting in multiple health care encounters. However, their satisfaction and experiences with care are not well understood. The objective of this study was to examine the independent impact of obesity on patient satisfaction and experiences with care in adults 65 years of age and older with Medigap insurance. Methods Surveys were mailed to 53,286 randomly chosen adults with an AARP® Medicare Supplement Insurance Plan insured by UnitedHealthcare Insurance Company (for New York residents, UnitedHealthcare Insurance Company of New York) in 10 states. Following adjustment for non-response bias, multivariate regression modeling was used to adjust for demographic, socioeconomic and health status differences to estimate the independent impact of weight on satisfaction and experiences with care. Outcome variables included four global and four composite measures of satisfaction and experiences with care. Results 21.4% of the respondents were obese. Relative to normal weight, obesity was significantly associated with higher patient satisfaction and better experiences with care in seven of the eight ratings measured. Conclusions Obese individuals were more satisfied and had better experiences with care. Obese individuals had more office visits and discussions about nutrition, exercise and medical checks. This may have led to increased attentiveness to care, explaining the increase in satisfaction and better experiences with care. Given the high level of satisfaction and experiences with care in older, obese adults, opportunities exist for clinicians to address weight concerns in this population.
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Hansson LM, Rasmussen F. Association between perceived health care stigmatization and BMI change. Obes Facts 2014; 7:211-20. [PMID: 24903462 PMCID: PMC5644841 DOI: 10.1159/000363557] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 02/05/2014] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND/AIMS This study examined the association between experiences of health care stigmatization and BMI changes in men and women with normal weight and obesity in Sweden. METHODS The participants were drawn from a population-based survey in Sweden (1996-2006), and data on their perceived health care stigmatization were measured in 2008. They were categorized in individuals with normal weight (n = 1,064), moderate obesity (n = 1,273), and severe obesity (n = 291). The main outcome measure was change in BMI. RESULTS Individuals with severe obesity experiencing any health care stigmatization showed a BMI increase by 1.5 kg/m2 more than individuals with severe obesity with no such experience. For individuals with moderate obesity, insulting treatment by a physician and avoidance of health care were associated with a relative BMI increase of 0.40 and 0.75 kg/m2, respectively, compared with their counterparts who did not experience stigmatization in these areas. No difference in experience of any form of health care stigmatizing associated BMI change was observed for men and women with normal weight. CONCLUSION In this large, population-based study, perceived health care stigmatization was associated with an increased relative BMI in individuals with severe obesity. For moderate obesity, the evidence of an association was inconclusive.
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Affiliation(s)
- Lena M. Hansson
- *Lena M Hansson, Department of Public Health Sciences, Karolinska Institutet, Widerströmska huset, SE-171 77 Stockholm (Sweden),
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Nurses' self-efficacy and practices relating to weight management of adult patients: a path analysis. Int J Behav Nutr Phys Act 2013; 10:131. [PMID: 24304903 PMCID: PMC4235199 DOI: 10.1186/1479-5868-10-131] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 11/28/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health professionals play a key role in the prevention and treatment of excess weight and obesity, but many have expressed a lack of confidence in their ability to manage obese patients with their delivery of weight-management care remaining limited. The specific mechanism underlying inadequate practices in professional weight management remains unclear. The primary purpose of this study was to examine a self-efficacy theory-based model in understanding Registered Nurses' (RNs) professional performance relating to weight management. METHODS A self-report questionnaire was developed based upon the hypothesized model and administered to a convenience sample of 588 RNs. Data were collected regarding socio-demographic variables, psychosocial variables (attitudes towards obese people, professional role identity, teamwork beliefs, perceived skills, perceived barriers and self-efficacy) and professional weight management practices. Structural equation modeling was conducted to identify correlations between the above variables and to test the goodness of fit of the proposed model. RESULTS The survey response rate was 71.4% (n = 420). The respondents reported a moderate level of weight management practices. Self-efficacy directly and positively predicted the weight management practices of the RNs (β = 0.36, p < 0.01), and fully or partially mediated the relationships between perceived skills, perceived barriers, professional role identity and teamwork beliefs and weight management practices. The final model constructed in this study demonstrated a good fit to the data [χ2 (14) =13.90, p = 0.46; GFI = 0.99; AGFI = 0.98; NNFI = 1.00; CFI = 1.00; RMSEA = 0.00; AIC = 57.90], accounting for 38.4% and 43.2% of the variance in weight management practices and self-efficacy, respectively. CONCLUSIONS Self-efficacy theory appears to be useful in understanding the weight management practices of RNs. Interventions targeting the enhancement of self-efficacy may be effective in promoting RNs' professional performance in managing overweight and obese patients.
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Abstract
This paper provides an overview of a new section of Current Obesity Reports, called Health Services and programs. This new section seeks to better understand the problems within health systems around obesity management and prevention and to discuss the latest research on solutions. There are few health system issues that are quite as controversial as obesity and there remain several key problems inherent within existing obesity management and prevention approaches that necessitate the adoption of new paradigms and practices. Beginning with articles on addressing weight bias and stigma in health professional training, promoting new models of weight management provision, reviewing the role of regulation and generating an understanding of obesity through a complex systems lens, this new section will encourage readers to better address the challenging problems in obesity management and in doing so, overcome the 'paradigm paralysis' that has characterized the last few decades of obesity research and practice.
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Affiliation(s)
- Sara F. L. Kirk
- School of Health and Human Performance, Dalhousie University, Halifax, NS B3H 4R2 Canada
- MRC Human Nutrition Research, Cambridge, UK
| | - Tarra L. Penney
- School of Health and Human Performance, Dalhousie University, Halifax, NS B3H 4R2 Canada
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Obese women's perceptions and experiences of healthcare and primary care providers: a phenomenological study. Nurs Res 2013; 62:252-9. [PMID: 23817283 DOI: 10.1097/nnr.0b013e318299a6ba] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Nearly two thirds of the adult population in the United States is overweight or obese. Adults who are overweight or obese require the same high-quality healthcare from their providers as any other adult. Unfortunately, stigma is a reality experienced by individuals who are overweight or obese, and healthcare professionals' views have sometimes been reported to be biased against individuals who are overweight or obese. However, there are gaps and inconsistencies in the literature regarding the types of experiences and perceptions of obese women receiving healthcare and whether stigma is present. OBJECTIVE The aim of this study was to describe the experiences and perceptions of obese women with regard to stigma in healthcare and from their healthcare provider. METHODS A phenomenological research approach using the Colaizzi method was utilized to examine and describe the lived experience of overweight and obese women with healthcare. Semistructured interviews were conducted with a diverse, purposive sample of 26 English-speaking women with a body mass index of over 30 kg/m. Participants were asked to describe their perceptions and experiences with regard to healthcare and their relationship with their healthcare providers. RESULTS Four themes emerged from the analysis of the data: (a) perceptions of health and healthcare, (b) respect me as a person, (c) establishing a healthcare connection, and (d) assertiveness is necessary. Although stigma was not named by women in this study, all acknowledged some negative treatment by healthcare providers. DISCUSSION Discussion relating to the current professional literature is presented. Implications for nursing education and research are discussed.
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Gudzune KA, Bleich SN, Richards TM, Weiner JP, Hodges K, Clark JM. Doctor shopping by overweight and obese patients is associated with increased healthcare utilization. Obesity (Silver Spring) 2013; 21:1328-34. [PMID: 23671015 PMCID: PMC3742565 DOI: 10.1002/oby.20189] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 11/07/2012] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Negative interactions with healthcare providers may lead patients to switch physicians or "doctor shop." We hypothesized that overweight and obese patients would be more likely to doctor shop, and as a result, have increased rates of emergency department (ED) visits and hospitalizations as compared to normal weight nonshoppers. DESIGN AND METHODS We combined claims data from a health plan in one state with information from beneficiaries' health risk assessments. The primary outcome was "doctor shopping," which we defined as having outpatient claims with ≥5 different primary care physicians (PCPs) during a 24-month period. The independent variable was standard NIH categories of weight by BMI. We performed multivariate logistic regression to evaluate the association between weight categories and doctor shopping. We conducted multivariate zero-inflated negative binominal regression to evaluate the association between weight-doctor shopping categories with counts of ED visits and hospitalizations. RESULTS Of the 20,726 beneficiaries, the mean BMI was 26.3 kg m(-2) (SD 5.1), mean age was 44.4 years (SD 11.1) and 53% were female. As compared to normal weight beneficiaries, overweight beneficiaries had 23% greater adjusted odds of doctor shopping (OR 1.23, 95%CI 1.04-1.46) and obese beneficiaries had 52% greater adjusted odds of doctor shopping (OR 1.52, 95%CI 1.26-1.82). As compared to normal weight non-shoppers, overweight and obese shoppers had higher rates of ED visits (IRR 1.85, 95%CI 1.37-2.45; IRR 1.83, 95%CI 1.34-2.50, respectively), which persisted during within weight group comparisons (Overweight IRR 1.50, 95%CI 1.10-2.03; Obese IRR 1.54, 95%CI 1.12-2.11). CONCLUSION Frequently changing PCPs may impair continuity and result in increased healthcare utilization.
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Affiliation(s)
- Kimberly A Gudzune
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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