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Jeffers L, Manner J, Jepson R, McAteer J. Healthcare professionals' perceptions and experiences of obesity and overweight and its management in primary care settings: a qualitative systematic review. Prim Health Care Res Dev 2024; 25:e5. [PMID: 38229563 PMCID: PMC11077507 DOI: 10.1017/s1463423623000683] [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: 04/21/2022] [Revised: 11/06/2023] [Accepted: 11/21/2023] [Indexed: 01/18/2024] Open
Abstract
AIM This qualitative systematic review aimed to synthesise existing qualitative research on HCPs' perceptions and experiences of obesity and its management in primary care settings. BACKGROUND Healthcare professionals (HCPs), particularly those in primary care, play a key role in policy implementation around weight management. Overweight and obese individuals are subject to weight stigma which has negative health consequences and reduces the likelihood of healthcare service usage. An understanding of HCPs' perceptions of obesity and weight management in primary care is necessary for the development and delivery of effective initiatives. METHODS A search strategy developed using the SPIDER framework was applied to Medline and CINAHL databases. Inclusion criteria were applied, and quality assessment was undertaken using the CASP framework. Fifteen papers meeting the inclusion criteria were analysed thematically. FINDINGS Four themes were identified: conflicting discourses surrounding obesity, medicalisation of obesity, organisational factors, and lack of patient knowledge and motivation. Conflicting discourses around obesity refers to the differing views of HCPs regarding what it means to have and treat obesity. Medicalisation of obesity considers whether obesity should be treated as a medical condition. Organisational factors were identified as knowledge, resources and time that affected HCPs' ability to provide care to overweight or obese. Finally, the review discovered that patients required their own knowledge and motivation to lose weight. This review has highlighted the need to provide safe, non-judgemental spaces for HCPs and patients to discuss weight and weight loss. This is essential to the therapeutic relationship and the provision of effective obesity management.
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Affiliation(s)
- Laura Jeffers
- Scottish Collaboration for Public Health Research and Policy, School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Jillian Manner
- Scottish Collaboration for Public Health Research and Policy, School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Ruth Jepson
- Scottish Collaboration for Public Health Research and Policy, School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - John McAteer
- Scottish Collaboration for Public Health Research and Policy, School of Health in Social Science, University of Edinburgh, Edinburgh, UK
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Prior SJ, Luccisano SP, Kilpatrick ML, Murfet GO. Assessment and Management of Obesity and Self-Maintenance (AMOS): An Evaluation of a Rural, Regional Multidisciplinary Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12894. [PMID: 36232191 PMCID: PMC9565125 DOI: 10.3390/ijerph191912894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 06/16/2023]
Abstract
Obesity is common in rural areas, and reduced specialist healthcare access impedes its management. A pilot nurse-practitioner-led Assessment and Management of Obesity and Self-Maintenance (AMOS) Clinic focused on individualised obesity care in people living with type 2 diabetes delivered in a rural setting. This study aimed to explore participant and staff experiences of the multidisciplinary obesity clinic to identify barriers and facilitators to self-care, health, and well-being. A two-stage, mixed-method design was used. Initially, three focus groups involving a sample of AMOS participants and semi-structured staff interviews helped identify key barriers/facilitators. These findings informed a survey delivered to all AMOS participants. Qualitative data were analysed using an inductive two-step thematic networks technique to identify themes. Quantitative data were summarised using descriptive statistics. A total of 54 AMOS participants and 4 staff participated in the study. Four themes were identified to describe AMOS participant experiences': 1. affordability; 2. multidisciplinary care; 3. person-centred care; and 4. motivation. Specialised, multidisciplinary and individualised obesity care available through one clinic facilitated self-care and improved health and well-being. Dedicated multidisciplinary obesity clinics are recommended in rural and remote areas.
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Affiliation(s)
- Sarah J. Prior
- Tasmanian School of Medicine, University of Tasmania, Burnie, TAS 7320, Australia
| | - Sharon P. Luccisano
- Diabetes Centre, Tasmanian Health Service—North West, Burnie, TAS 7320, Australia
| | - Michelle L. Kilpatrick
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia
| | - Giuliana O. Murfet
- Diabetes Centre, Tasmanian Health Service—North West, Burnie, TAS 7320, Australia
- School of Public Health, University of Technology Sydney, Ultimo, NSW 2007, Australia
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Abstract
OBJECTIVE This study explores patients' acceptance of obesity as a chronic disease. DESIGN Cross-sectional, qualitative study using semistructured phone interviews. SETTING The study was conducted in specialty and primary care clinics from a single central tertiary hospital in Lebanon. Recruitment took place between February and March 2021. PARTICIPANTS AND METHODS 25 adult patients with overweight or obesity were interviewed and the interviews were analysed thematically. RESULTS Four themes emerged: (1) patients' knowledge and awareness of obesity are based on their own experience; (2) there is ambivalence or conditional acceptance of obesity as a chronic disease; and patients with overweight or obesity perceived (3) that the role of physicians in obesity management is related to complications and (4) that obesity management is as simple as eating less and exercising more. CONCLUSIONS The study shows the studied population's ambivalence in accepting obesity as a chronic disease. Individuals with overweight or obesity considered the role of the healthcare professional in obesity conditional on morbid obesity and the presence of medical complications of obesity. Findings of this study advocate for educational campaigns about the nature of obesity as a chronic disease and the role of healthcare professionals in obesity management.
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Affiliation(s)
- Natally AlArab
- Family Medicine, American University of Beirut, Beirut, Lebanon
| | - Jumana Antoun
- Family Medicine, American University of Beirut, Beirut, Lebanon
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Conz CA, Jesus MCPD, Kortchmar E, Braga VAS, Machado RET, Merighi MAB. Path taken by morbidly obese people in search of bariatric surgery in the public health system. Rev Lat Am Enfermagem 2020; 28:e3294. [PMID: 32696927 PMCID: PMC7365606 DOI: 10.1590/1518-8345.3579.3294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 03/12/2020] [Indexed: 11/21/2022] Open
Abstract
Objective: to understand the path taken in the public health system by people with
morbid obesity in the search for bariatric surgery. Method: qualitative research based on the social phenomenology of Alfred Schütz, with
17 hospitalized morbidly obese people, with a scheduled date for bariatric
surgery. The phenomenological interview with open questions was used and the
statements were analyzed in the light of the theoretical-methodological
framework and literature related to the theme. Results: the participants were able to schedule bariatric surgery by referring
friends, family and public people. The waiting list for the procedure
generated anguish and anxiety due to fear of surgery, weight gain, risk of
worsening health and physical limitations, but it helped prepare for its
performance. The experience lived in the search for bariatric surgery led
these people to want continuity of care in the Basic Health Unit, after the
surgery, by professionals trained to meet their needs. Conclusion: the aspects inscribed in the path of people in search of bariatric surgery
signal the need to strengthen the assistance-related flows of the public
health system and to invest in professional training to reduce the social
inequalities in access to bariatric surgery and increased quality of
services.
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Affiliation(s)
| | | | - Estela Kortchmar
- Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP, Brazil
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Conz CA, Jesus MCPD, Kortchmar E, Braga VAS, Oliveira DMD, Merighi MAB. The health care experience of individuals with morbid obesity assisted in public healthcare services. Rev Esc Enferm USP 2020; 54:e03559. [PMID: 32609181 DOI: 10.1590/s1980-220x2018049903559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 08/01/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To understand the health care experience of individuals with morbid obesity assisted in public healthcare services. METHOD This was a qualitative study based on Alfred Schütz's social phenomenology, carried out in the medical-surgical clinic of a public hospital in São Paulo, Brazil. Interviews with open questions were conducted between January and April 2017. RESULTS Seventeen individuals with morbid obesity participated in the study. The findings revealed care(lessness) experiences of obese individuals in the Brazilian Healthcare System in terms of structure/logistics and human resources. Study participants shared care expectations about health care management and staff, and further considered the Primary Health Care service as a scenario of power to have their obesity-related care needs met. CONCLUSION The findings need to be carefully (re)examined by the healthcare system's micro- and macro management, as well as by health teaching and research personnel, in order to integrate, follow up and qualify care actions towards the prevention and control of obesity in public healthcare services.
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Affiliation(s)
- Claudete Aparecida Conz
- Universidade de São Paulo, Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem, São Paulo, SP, Brazil
| | - Maria Cristina Pinto de Jesus
- Universidade Federal de Juiz de Fora, Faculdade de Enfermagem, Departamento de Enfermagem Básica, Juiz de Fora, MG, Brazil
| | - Estela Kortchmar
- Universidade de São Paulo, Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem, São Paulo, SP, Brazil
| | - Vanessa Augusta Souza Braga
- Universidade de São Paulo, Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem, São Paulo, SP, Brazil
| | | | - Miriam Aparecida Barbosa Merighi
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem Materno-Infantil e Psiquiátrica, São Paulo, SP, Brazil
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Rust C, Prior RM, Stec M. Implementation of a clinical practice guideline in a primary care setting for the prevention and management of obesity in adults. Nurs Forum 2020; 55:485-490. [PMID: 32243604 DOI: 10.1111/nuf.12453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/27/2020] [Accepted: 03/28/2020] [Indexed: 11/30/2022]
Abstract
Over two-thirds of American adults have obesity or overweight, increasing the risk of comorbidities, mortality, and healthcare costs. Despite this growing issue, screening and counseling for an unhealthy weight are not common in primary care and clinical practice guidelines (CPGs) for prevention and management of obesity are underutilized. Following the stepwise approach outlined in the Registered Nurses' Association of Ontario Toolkit: Implementation of Best Practice Guidelines, the Institute for Clinical Systems Improvement: Prevention and Management of Obesity for Adults were implemented in a primary care office in Lexington, KY. Education was implemented with providers and staff. An assessment of readiness for change was completed at check-in and customizable phrases were built into the electronic health record. After a 12-week implementation, providers were consistently assessing for comorbidities, setting goals, and managing weight in those with obesity using evidence-based strategies. Readiness for change was being documented in less than 40% of those patients. For those with overweight providers were assessing readiness for change in only 30% of patients and were setting goals in just over 40% of patients. After the implementation, care more closely followed the CPG but additional steps are necessary to improve the prevention and management of obesity in this population.
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Affiliation(s)
- Chelsea Rust
- Baptist Health Center for Medical Weight Loss, Lexington, Kentucky
| | - Richard M Prior
- College of Nursing, University of Cincinnati, Cincinnati, Ohio
| | - Melissa Stec
- College of Nursing, SUNY Downstate Health Sciences University, Brooklyn, New York
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Werder O, Holland K, Munro J. Communication's role in overcoming challenges for obesity prevention partnerships. Health Promot Int 2020; 35:205-216. [PMID: 30805614 DOI: 10.1093/heapro/daz005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
With obesity rates growing worldwide calls have increased to coordinate efforts in nationwide partnership models. Yet, the necessity for professional partnerships has brought into sharper focus a problem in jointly communicating obesity and its prevention. Following a social representation framework and using episodic interviewing of members from different professions directly or indirectly involved in obesity prevention, this report critically analysed concepts and communicative approaches held by those professional areas. Key findings included different perspectives about communication orientations, namely distribution of responsibility, control and communication goals. This suggests that the profession-specific world-views prevented respondents from communicating with members from other professions. We conclude that health communication experts bring unique skills to bring together professional teams to not only develop a common language and conceptual framework but also facilitate a sense of inclusion and personal accomplishment.
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Affiliation(s)
- Olaf Werder
- Department of Media and Communications, The University of Sydney, Sydney, NSW, Australia
| | - Kate Holland
- Faculty of Arts and Design, University of Canberra, Canberra, NSW, Australia
| | - Jay Munro
- Department of Media and Communications, The University of Sydney, Sydney, NSW, Australia
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Abstract
NPs are ideal candidates for implementing positive health changes for obese patients. Providers have medical expertise and can promote obesity reduction strategies to their patients. Increased awareness of the influence of health policy and clinical implications for obesity management are needed.
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Selby LM, Tobin BS, Conner BT, Gomez M, Busch G, Hauser J. A quantitative, retrospective inquiry of the impact of a provider-guided low-carbohydrate, high-fat diet on adults in a wellness clinic setting. Diabetes Metab Syndr 2019; 13:2314-2319. [PMID: 31235173 DOI: 10.1016/j.dsx.2019.05.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 05/24/2019] [Indexed: 11/18/2022]
Abstract
AIMS Despite the critical status of obesity as an epidemic chronic illness in the United States contributing toward diabetic and cardiovascular disease as well as early preventable death, treatment approaches in primary care remain in conflict; providers lack evidence-based guidelines toward impactful disease management, particularly from dietary approaches. This study aimed to evaluate the impact of initiation of a 5-10% low-carbohydrate, 75-85% high-fat diet on specific clinical indicators of obesity, a metabolic disease associated with increased morbidity and mortality, at baseline and six months in an adult population. MATERIALS AND METHODS Utilizing a retrospective electronic medical record data collection protocol, one hundred patients with obesity in a wellness clinic in the Southwestern United States between 2017 and 2018 prescribed a low-carbohydrate, high-fat diet were selected via simple random sampling. Measurements of body mass index, hemoglobin A1C, and lipid levels were extracted at baseline and six months after initiation. RESULTS Mean differences of each biomarker at baseline and six months were analyzed utilizing paired samples t-testing in SPSS and demonstrated statistically-significant improvement across each category. Body mass index decreased, hemoglobin A1C decreased, and each of three clinically-relevant lipid level measurements moved numerically toward normal-value ranges. CONCLUSION Data from this sample of 100 patients with obesity suggest body weight, diabetic, and cardiovascular status improvement from a low-carbohydrate, high-fat diet over six months, affording a prescriptive nutrition option for primary care providers to consider prior to or as a complement to pharmacologic management.
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Affiliation(s)
- Lisa M Selby
- School of Nursing, Simmons University, 300 The Fenway, Boston, MA, 02115, United States; MountainView Physician Services, 4351 East Lohman Avenue, Suite 202, Las Cruces, NM, 88011, United States.
| | - Brenda S Tobin
- School of Nursing, Simmons University, 300 The Fenway, Boston, MA, 02115, United States.
| | - Brian T Conner
- School of Nursing, Simmons University, 300 The Fenway, Boston, MA, 02115, United States.
| | - Melissa Gomez
- MountainView Physician Services, 4351 East Lohman Avenue, Suite 202, Las Cruces, NM, 88011, United States.
| | - Garrett Busch
- MountainView Physician Services, 4351 East Lohman Avenue, Suite 202, Las Cruces, NM, 88011, United States.
| | - Jimmie Hauser
- MountainView Physician Services, 4351 East Lohman Avenue, Suite 202, Las Cruces, NM, 88011, United States.
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Hyer S. Practice patterns of nurse practitioners related to weight management in primary care. J Am Assoc Nurse Pract 2019; 31:236-244. [PMID: 30681653 DOI: 10.1097/jxx.0000000000000122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Obesity prevalence rates for adults are at an all-time high. This systematic review of the literature aimed to examine the practice patterns of nurse practitioners (NPs) related to weight management in primary care and recommend future areas of research as it relates to the diagnosis and management of patients with obesity by NPs. DATA SOURCES The databases CINAHL PLUS with Full Text, Cochrane Central Register of Controlled Trials, ERIC, MEDLINE, PsycINFO, and SPORTDiscuss were searched. CONCLUSIONS The initial search resulted in 169 articles. Fifteen peer-reviewed articles from 13 studies were included in the analysis. Four themes emerged from the analysis: approach to practice; the practitioner's role within the interdisciplinary team; communication; and resources and tools. IMPLICATIONS FOR PRACTICE This review was conducted to better understand the challenges and facilitators to the management of patients with obesity in primary care. Future research between NPs and variables related to obesity are necessary to further identify areas for education, training, and policy development.
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Affiliation(s)
- Suzanne Hyer
- University of Central Florida, College of Nursing, Orlando, Florida
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Elvsaas IKØ, Giske L, Fure B, Juvet LK. Multicomponent Lifestyle Interventions for Treating Overweight and Obesity in Children and Adolescents: A Systematic Review and Meta-Analyses. J Obes 2017; 2017:5021902. [PMID: 29391949 PMCID: PMC5748119 DOI: 10.1155/2017/5021902] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 09/27/2017] [Accepted: 10/19/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Treatment of childhood obesity is important in preventing development of obesity-related diseases later in life. This systematic review evaluates the effect of multicomponent lifestyle interventions for children and adolescents from 2 to 18 years. METHODS AND RESULTS We performed systematic searches in nine databases. Thirty-nine studies met the criteria for meta-analyses. We found a significant difference in body mass index (BMI) after 6 months (MD -0.99 (95% CI -1.36 to -0.61)), 12 months (MD -0.67 (95% CI -1.01 to -0.32)), and 24 months (MD -0.96 (95% CI -1.63 to -0.29)) in favour of multicomponent lifestyle interventions compared to standard, minimal, and no treatment. We also found a significant difference in BMI Z scores after 6 months (MD -0.12 (95% CI -0.17 to -0.06)), 12 months (MD -0.16 (95% CI -0.21 to -0.11)), and 24 months (MD -0.16 (95% CI -0.21 to -0.10)) in favour of multicomponent lifestyle interventions. Subgroup analyses suggested an increased effect in specialist health care with a group treatment component included in the intervention. CONCLUSION Multicomponent lifestyle interventions have a moderate effect on change in BMI and BMI Z score after 6, 12, and 24 months compared with standard, minimal, and no treatment.
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Affiliation(s)
| | - L. Giske
- Norwegian Institute of Public Health, Oslo, Norway
| | - B. Fure
- Norwegian Institute of Public Health, Oslo, Norway
- The Arctic University of Norway, Tromsø, Norway
| | - L. K. Juvet
- Norwegian Institute of Public Health, Oslo, Norway
- University College of Southeast Norway, Notodden, Norway
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