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Dedov II, Shestakova MV, Melnichenko GA, Mazurina NV, Andreeva EN, Bondarenko IZ, Gusova ZR, Dzgoeva FK, Eliseev MS, Ershova EV, Zhuravleva MV, Zakharchuk TA, Isakov VA, Klepikova MV, Komshilova KA, Krysanova VS, Nedogoda SV, Novikova AM, Ostroumova OD, Pereverzev AP, Rozhivanov RV, Romantsova TI, Ruyatkina LA, Salasyuk AS, Sasunova AN, Smetanina SA, Starodubova AV, Suplotova LA, Tkacheva ON, Troshina EA, Khamoshina MV, Chechelnitskaya SM, Shestakova EA, Sheremet’eva EV. INTERDISCIPLINARY CLINICAL PRACTICE GUIDELINES "MANAGEMENT OF OBESITY AND ITS COMORBIDITIES". OBESITY AND METABOLISM 2021; 18:5-99. [DOI: 10.14341/omet12714] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | - M. S. Eliseev
- Research Institute of Rheumatogy named after V.A. Nasonova
| | | | | | | | - V. A. Isakov
- Federal Research Center of Nutrition, Biotechnology and Food Safety
| | - M. V. Klepikova
- Russian Medical Academy of Continuous Professional Education
| | | | | | | | - A. M. Novikova
- Research Institute of Rheumatogy named after V.A. Nasonova
| | - O. D. Ostroumova
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry
| | - A. P. Pereverzev
- Russian National Research Medical University named after N.I. Pirogov
| | | | | | | | | | - A. N. Sasunova
- Federal Research Center of Nutrition, Biotechnology and Food Safety
| | | | | | | | - O. N. Tkacheva
- Russian National Research Medical University named after N.I. Pirogov
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Durrer Schutz D, Busetto L, Dicker D, Farpour-Lambert N, Pryke R, Toplak H, Widmer D, Yumuk V, Schutz Y. European Practical and Patient-Centred Guidelines for Adult Obesity Management in Primary Care. Obes Facts 2019; 12:40-66. [PMID: 30673677 PMCID: PMC6465693 DOI: 10.1159/000496183] [Citation(s) in RCA: 192] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 12/12/2018] [Indexed: 12/19/2022] Open
Abstract
The first contact for patients with obesity for any medical treatment or other issues is generally with General Practitioners (GPs). Therefore, given the complexity of the disease, continuing GPs' education on obesity management is essential. This article aims to provide obesity management guidelines specifically tailored to GPs, favouring a practical patient-centred approach. The focus is on GP communication and motivational interviewing as well as on therapeutic patient education. The new guidelines highlight the importance of avoiding stigmatization, something frequently seen in different health care settings. In addition, managing the psychological aspects of the disease, such as improving self-esteem, body image and quality of life must not be neglected. Finally, the report considers that achieving maximum weight loss in the shortest possible time is not the key to successful treatment. It suggests that 5-10% weight loss is sufficient to obtain substantial health benefits from decreasing comorbidities. Reducing waist circumference should be considered even more important than weight loss per se, as it is linked to a decrease in visceral fat and associated cardiometabolic risks. Finally, preventing weight regain is the cornerstone of lifelong treatment, for any weight loss techniques used (behavioural or pharmaceutical treatments or bariatric surgery).
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Affiliation(s)
- Dominique Durrer Schutz
- Service d'enseignement thérapeutique pour maladies chroniques, Département de médecine communautaire, Hôpitaux Universitaires de Genève, Genève/Eurobesitas COMs Center, Vevey, Switzerland
| | - Luca Busetto
- Department of Medicine, Padova University Hospital, Bariatric Unit, University of Padova, Padova, Italy
| | - Dror Dicker
- Internal Medicine D & Obesity Clinic, Hasharon Hospital, Rabin Medical Centre, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nathalie Farpour-Lambert
- Service d'enseignement thérapeutique pour maladies chroniques, Département de médecine communautaire, de premier recours et des urgencies, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Rachel Pryke
- GP Winyates Health Centre, Fellow National Institute for Health and Care Excellence, Winyates, United Kingdom
| | - Hermann Toplak
- Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Daniel Widmer
- Vice President of European Union of General Practitioners (UEMO), Lausanne, Switzerland
| | - Volkan Yumuk
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Yves Schutz
- Department of Integrative Physiology, Faculty of Medicine, University of Fribourg, Fribourg, Switzerland,
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Cameron LD, Durazo A, Ramírez AS, Corona R, Ultreras M, Piva S. Cultural and Linguistic Adaptation of a Healthy Diet Text Message Intervention for Hispanic Adults Living in the United States. JOURNAL OF HEALTH COMMUNICATION 2017; 22:262-273. [PMID: 28248628 PMCID: PMC5555404 DOI: 10.1080/10810730.2016.1276985] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Hispanics represent a critical target for culturally adapted diet interventions. In this formative research, we translated HealthyYouTXT, an mHealth program developed by the U.S. National Cancer Institute, into HealthyYouTXT en Español, a linguistically and culturally appropriate version for Spanish speakers in the United States. We report a three-stage, mixed-methods process through which we culturally adapted the text messages, evaluated their acceptability, and revised the program based on the findings. In Stage 1, we conducted initial translations and adaptations of the text libraries using an iterative, principle-guided process. In Stage 2, we used mixed methods including focus groups and surveys with 109 Hispanic adults to evaluate the acceptability and cultural appropriateness of the program. We used survey data to evaluate whether self-determination theory (SDT) factors (used to develop HealthyYouTXT) of autonomous motivation, controlled motivation, and amotivation and Hispanic cultural beliefs about familism, fatalism, and destiny predict program interest and its perceived efficacy. Mixed-methods analyses revealed substantial interest in HealthyYouTXT, with most participants desiring to use it and viewing it as highly efficacious. Both cultural beliefs (i.e., beliefs in destiny and, for men, high familism) and SDT motivations (i.e., autonomy) predicted HealthyYouTXT evaluations, suggesting utility in emphasizing them in messages. Higher destiny beliefs predicted lower interest, suggesting that they could impede program use. In Stage 3, we implemented the mixed-methods findings to finalize HealthyYouTXT en Español. The emergent linguistic principles and multistage, multimethods process can be applied in health communication adaptations.
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Affiliation(s)
- Linda D Cameron
- a School of Social Sciences, Humanities, and the Arts , University of California, Merced , Merced , California , USA
- b Psychological Sciences , University of California, Merced , Merced , California , USA
- c Health Sciences Research Institute , University of California, Merced , Merced , California , USA
| | - Arturo Durazo
- a School of Social Sciences, Humanities, and the Arts , University of California, Merced , Merced , California , USA
- b Psychological Sciences , University of California, Merced , Merced , California , USA
| | - A Susana Ramírez
- a School of Social Sciences, Humanities, and the Arts , University of California, Merced , Merced , California , USA
| | - Roberto Corona
- a School of Social Sciences, Humanities, and the Arts , University of California, Merced , Merced , California , USA
- b Psychological Sciences , University of California, Merced , Merced , California , USA
| | - Mayra Ultreras
- a School of Social Sciences, Humanities, and the Arts , University of California, Merced , Merced , California , USA
- b Psychological Sciences , University of California, Merced , Merced , California , USA
| | - Sonia Piva
- a School of Social Sciences, Humanities, and the Arts , University of California, Merced , Merced , California , USA
- b Psychological Sciences , University of California, Merced , Merced , California , USA
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Yumuk V, Tsigos C, Fried M, Schindler K, Busetto L, Micic D, Toplak H. European Guidelines for Obesity Management in Adults. Obes Facts 2015; 8:402-24. [PMID: 26641646 PMCID: PMC5644856 DOI: 10.1159/000442721] [Citation(s) in RCA: 703] [Impact Index Per Article: 78.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 11/24/2015] [Indexed: 02/06/2023] Open
Abstract
Obesity is a chronic metabolic disease characterised by an increase of body fat stores. It is a gateway to ill health, and it has become one of the leading causes of disability and death, affecting not only adults but also children and adolescents worldwide. In clinical practice, the body fatness is estimated by BMI, and the accumulation of intra-abdominal fat (marker for higher metabolic and cardiovascular disease risk) can be assessed by waist circumference. Complex interactions between biological, behavioural, social and environmental factors are involved in regulation of energy balance and fat stores. A comprehensive history, physical examination and laboratory assessment relevant to the patient's obesity should be obtained. Appropriate goals of weight management emphasise realistic weight loss to achieve a reduction in health risks and should include promotion of weight loss, maintenance and prevention of weight regain. Management of co-morbidities and improving quality of life of obese patients are also included in treatment aims. Balanced hypocaloric diets result in clinically meaningful weight loss regardless of which macronutrients they emphasise. Aerobic training is the optimal mode of exercise for reducing fat mass while a programme including resistance training is needed for increasing lean mass in middle-aged and overweight/obese individuals. Cognitive behavioural therapy directly addresses behaviours that require change for successful weight loss and weight loss maintenance. Pharmacotherapy can help patients to maintain compliance and ameliorate obesity-related health risks. Surgery is the most effective treatment for morbid obesity in terms of long-term weight loss. A comprehensive obesity management can only be accomplished by a multidisciplinary obesity management team. We conclude that physicians have a responsibility to recognise obesity as a disease and help obese patients with appropriate prevention and treatment. Treatment should be based on good clinical care, and evidence-based interventions; should focus on realistic goals and lifelong multidisciplinary management.
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Affiliation(s)
- Volkan Yumuk
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Constantine Tsigos
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Martin Fried
- Clinical Center for Minimally Invasive and Bariatric Surgery, ISCARE Lighthouse, Prague and 1st Medical Faculty, Charles University, Prague, Czech Republic
| | - Karin Schindler
- Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Luca Busetto
- Department of Medicine, Padova University Hospital – Bariatric Unit, University of Padova, Padova, Italy
| | - Dragan Micic
- Centre for Metabolic Disorders in Endocrinology, Institute of Endocrinology, Diabetes and Diseases of Metabolism, Clinical Center of Serbia, Belgrade, Serbia
| | - Hermann Toplak
- Department of Medicine, Institute for Diabetes and Metabolism, Medical University, Graz, Austria
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Abstract
Health care is continuously undergoing evolutionary changes. These changes have been very dramatic for the end users. Instead of simple physician office visits and lengthy hospital stays, we are now faced with short hospital stays, office visits to different specialty providers, and an array of choices around them. With the present highway of choices between illness and wellness, it is important for transitions between these two to be affordable, advantageous to patients, and uncomplicated. This article discusses the choices patients and health care providers must make as the number of care options increase along with the risks and benefits.
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Messina CR, Lane DS, Anderson JC. Body mass index and screening for colorectal cancer: gender and attitudinal factors. Cancer Epidemiol 2012; 36:400-8. [PMID: 22386859 PMCID: PMC4230010 DOI: 10.1016/j.canep.2012.02.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 02/03/2012] [Accepted: 02/06/2012] [Indexed: 01/13/2023]
Abstract
BACKGROUND Overweight/obese women and men are at increased risk for colorectal cancer (CRC) incidence and mortality. Research examining body mass index (BMI) and CRC screening has had mixed results. A clearer understanding of the extent to which high-BMI subgroups are screened for CRC is needed to inform planning for CRC screening promotions targeting BMI. METHODS Data were obtained from a random, population-based sample of women and men at average-risk for CRC (aged 50-75 years) during 2004 (n = 1098). Multiple logistic regression analyses were conducted to evaluate whether BMI category was significantly associated with the probability of reporting recent CRC screening and with the probability of agreeing with statements denoting attitudes/perceptions about CRC and screening. Attitudes/perceptions about CRC and screening were evaluated as potential mediators and moderators of the association between BMI category and CRC screening. RESULTS After controlling for characteristics associated with CRC screening, overweight and obese women were each 40% less likely to have CRC screening than women with normal-BMI (OR = 0.6, 95% CI:0.4-0.9 and OR = 0.6, 95% CI:0.3-0.9). BMI category was unrelated to screening among men. Obese women (but not men) were less aware than normal-BMI women that obesity increased risk for CRC (OR = 0.5, 95% CI:0.3-0.9) and less worried about CRC (OR = 0.5, 95% CI:0.3-0.8). However, findings suggest that attitudes/perceptions about CRC and screening did not mediate or moderate the association between BMI category and CRC screening. CONCLUSION Overweight/obese women are at increased risk for CRC because of their greater BMI and their propensity not to screen for CRC. Study findings suggest that potentially modifiable perceptions, e.g., lack of awareness of risk for CRC and less worry about CRC, in this subgroup may not explain the relationship between BMI category and reduced screening.
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Affiliation(s)
- Catherine R. Messina
- Department of Preventive Medicine, HSC L3, Rm 086, Stony Brook University, Stony Brook NY 11794-8036
| | - Dorothy S. Lane
- Department of Preventive Medicine, HSC L3, Rm 086, Stony Brook University, Stony Brook NY 11794-8036
| | - Joseph C. Anderson
- Department of Gastroenterology, University of Connecticut, 263 Farmington Avenue Farmington, CT 06030 and VA Outcomes Group, VA Medical Center, 215 Main Street, Gastroenterology (111E), White River Junction, Vermont 05009
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Lehnert T, Sonntag D, Konnopka A, Riedel-Heller S, König HH. The long-term cost-effectiveness of obesity prevention interventions: systematic literature review. Obes Rev 2012; 13:537-53. [PMID: 22251231 DOI: 10.1111/j.1467-789x.2011.00980.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Obesity prevention provides a major opportunity to improve population health. As health improvements usually require additional and scarce resources, novel health technologies (interventions) should be economically evaluated. In the prevention of obesity, health benefits may slowly accumulate over time and it can take many years before an intervention has reached full effectiveness. Decision-analytic simulation models (DAMs), which combine evidence from diverse sources, can be utilized to evaluate the long-term cost-effectiveness of such interventions. This literature review summarizes long-term economic findings (defined as ≥ 40 years) for 41 obesity prevention interventions, which had been evaluated in 18 cost-utility analyses, using nine different DAMs. Interventions were grouped according to their method of delivery, setting and risk factors targeted into behavioural (n=21), community (n=12) and environmental interventions (n=8). The majority of interventions offered good value for money, while seven were cost-saving. Ten interventions were not cost-effective (defined as >50,000 US dollar), however. Interventions that modified a target population's environment, i.e. fiscal and regulatory measures, reported the most favourable cost-effectiveness. Economic findings were accompanied by a large uncertainty though, which complicates judgments about the comparative cost-effectiveness of interventions.
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Affiliation(s)
- T Lehnert
- Department for Medical Sociology and Health Economics, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Abstract
BACKGROUND Pregnancy is the only physiologic condition in which we encounter chronically elevated intra-abdominal pressure (IAP), while pathologically several pathologies, such as ascites and morbid obesity, are affected by this phenomenon. This paper introduces and validates a new model that is able to create and maintain chronically increased IAP, facilitating the study of phenomena related to chronically elevated IAP, i.e., obesity. METHODS An experimental device was implanted in 15 rabbits, which consisted of an intra-abdominal balloon (IAB), an external control valve, and a connecting tube. A Foley catheter was inserted in their urinary bladders. IAPs were measured simultaneously transvesically and via the device. During the acute phase, IAB was gradually inflated to 16 cmH(2)O, and IAPs were consecutively measured. During the chronic phase, residual IAPs were measured in a weekly rate for 8 weeks. Statistical significances, mean bias, and precisions were calculated. RESULTS During the acute phase, the saline in the IAB efficiently increases IAP to 16 cmH(2)O. IAPs measured both through the urinary bladder and the device correlate well with small bias and high precision. Our model maintains sufficiently chronically increased IAP for at least 8 weeks. No mortality was observed. CONCLUSIONS A rabbit model establishing and maintaining chronically increased IAP was successfully created and proved to be simple, effective, and repeatable. This model established chronically increased IAP permitting this way the study of its effect on organs and systems.
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Tsigos C, Hainer V, Basdevant A, Finer N, Fried M, Mathus-Vliegen E, Micic D, Maislos M, Roman G, Schutz Y, Toplak H, Zahorska-Markiewicz B. Management of obesity in adults: European clinical practice guidelines. Obes Facts 2008; 1:106-16. [PMID: 20054170 PMCID: PMC6452117 DOI: 10.1159/000126822] [Citation(s) in RCA: 225] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The development of consensus guidelines for obesity is complex. It involves recommending both treatment interventions and interventions related to screening and prevention. With so many publications and claims, and with the awareness that success for the individual is short-lived, many find it difficult to know what action is appropriate in the management of obesity. Furthermore, the significant variation in existing service provision both within countries as well as across the regions of Europe makes a standardised approach, even if evidence-based, difficult to implement. In formulating these guidelines, we have attempted to use an evidence-based approach while allowing flexibility for the practicing clinician in domains where evidence is currently lacking and ensuring that in treatment there is recognition of clinical judgment and of regional diversity as well as the necessity of an agreed approach by the individual and family. We conclude that i) physicians have a responsibility to recognise obesity as a disease and help obese patients with appropriate prevention and treatment, ii) treatment should be based on good clinical care and evidence-based interventions and iii) obesity treatment should focus on realistic goals and lifelong management.
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Affiliation(s)
- Constantine Tsigos
- Metabolism and Diabetes Unit, Evgenidion Hospital, Athens University Medical School, Athens, Greece.
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