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Johnston EA, Ekberg S, Jennings B, Jagasia N, van der Pols JC. Discussing diet, nutrition, and body weight after treatment for gynecological cancer: a conversation analytic study of outpatient consultations. J Cancer Surviv 2024; 18:1016-1031. [PMID: 36897546 PMCID: PMC11081991 DOI: 10.1007/s11764-023-01345-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 02/01/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE To generate direct observational evidence for understanding how diet, nutrition, and weight-related topics are discussed during follow-up after treatment for gynecological cancer, as recommended by survivorship care guidelines. METHODS Conversation analysis of 30 audio-recorded outpatient consultations, involving 4 gyne-oncologists, 30 women who had completed treatment for ovarian or endometrial cancer, and 11 family members/friends. RESULTS From 21 instances in 18 consultations, diet, nutrition, or weight-related talk continued beyond initiation if the issue raised was ostensibly relevant to the clinical activity being undertaken at the time. These instances led to care-related outcomes (i.e., general dietary recommendations, referral to support, behavior change counseling) only when the patient identified needing further support. Diet, nutrition, or weight-related talk was not continued by the clinician if it was not apparently related to the current clinical activity. CONCLUSIONS The continuation of diet, nutrition, or weight-related talk during outpatient consultations after treatment for gynecological cancer, and the subsequent delivery of care-related outcomes, depends on its immediate clinical relevance and the patient indicating needing further support. The contingent nature of these discussions means there can be missed opportunities for the provision of dietary information and support post-treatment. IMPLICATIONS FOR CANCER SURVIVORS If seeking information or support for diet, nutrition, or weight-related issues post-treatment, cancer survivors may need to be explicit regarding their need for this during outpatient follow-up. Additional avenues for dietary needs assessment and referral should be considered to optimize the consistent delivery of diet, nutrition, and weight-related information and support after treatment for gynecological cancer.
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Affiliation(s)
- Elizabeth A Johnston
- Cancer Council Queensland, Fortitude Valley, Brisbane, QLD, Australia.
- Faculty of Health, School of Exercise and Nutrition Sciences, Queensland University of Technology (QUT), Kelvin Grove, Brisbane, QLD, Australia.
- QIMR Berghofer Medical Research Institute, Population Health Program, Herston, QLD, Australia.
| | - Stuart Ekberg
- Faculty of Health, School of Psychology and Counselling, Queensland University of Technology (QUT), Kelvin Grove, Brisbane, QLD, Australia
| | - Bronwyn Jennings
- Department of Gynaecological Oncology, Mater Hospital Brisbane, South Brisbane, QLD, Australia
| | - Nisha Jagasia
- Department of Gynaecological Oncology, Mater Hospital Brisbane, South Brisbane, QLD, Australia
| | - Jolieke C van der Pols
- Faculty of Health, School of Exercise and Nutrition Sciences, Queensland University of Technology (QUT), Kelvin Grove, Brisbane, QLD, Australia
- QIMR Berghofer Medical Research Institute, Population Health Program, Herston, QLD, Australia
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Hajizadeh A, Heath L, Ahmad A, Kebbe M, Jebb SA, Aveyard P, Hughes G. Clinician resistance to broaching the topic of weight in primary care: Digging deeper into weight management using strong structuration theory. Soc Sci Med 2023; 329:115997. [PMID: 37327596 DOI: 10.1016/j.socscimed.2023.115997] [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: 12/30/2022] [Revised: 05/06/2023] [Accepted: 05/26/2023] [Indexed: 06/18/2023]
Abstract
Clinical trials have shown that providing advice and support for people with excess weight can lead to meaningful weight loss. Despite this evidence and guidelines endorsing this approach, provision in real-world clinical settings remains low. We used Strong Structuration Theory (SST) to understand why people are often not offered weight management advice in primary care in England. Data from policy, clinical practice and focus groups were analysed using SST to consider how the interplay between weight stigma and structures of professional responsibilities influenced clinicians to raise (or not) the issue of excess weight with patients. We found that general practitioners (GPs) often accounted for their actions by referring to obesity as a health problem, consistent with policy documents and clinical guidelines. However, they were also aware of weight stigma as a social process that can be internalised by their patients. GPs identified addressing obesity as a priority in their work, but described wanting to care for their patients by avoiding unnecessary suffering, which they were concerned could be caused by talking about weight. We observed tensions between knowledge of clinical guidelines and understanding of the lived experience of their patients. We interpreted that the practice of 'caring by not offering care' produced the outcome of an absence of weight management advice in consultations. There is a risk that this outcome reinforces the external structure of weight stigma as a delicate topic to be avoided, while at the same time denying patients the offer of support to manage their weight.
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Affiliation(s)
- Anisa Hajizadeh
- Nuffield Department of Primary Care, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG, United Kingdom.
| | - Laura Heath
- Nuffield Department of Primary Care, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG, United Kingdom.
| | - Aryati Ahmad
- School of Nutrition and Dietetics, Universiti Sultan Zainal Abidin, Kampung Gong Badak, 21300, Terengganu, Malaysia.
| | - Maryam Kebbe
- Pennington Biomedical Research Centre, Louisiana State University, 6400 Perkins Rd, Baton Rouge, LA, 70808, United States.
| | - Susan Anne Jebb
- Nuffield Department of Primary Care, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG, United Kingdom.
| | - Paul Aveyard
- Nuffield Department of Primary Care, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG, United Kingdom.
| | - Gemma Hughes
- Nuffield Department of Primary Care, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG, United Kingdom.
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Tremblett M, Webb H, Ziebland S, Stokoe E, Aveyard P, Albury C. Talking delicately: Providing opportunistic weight loss advice to people living with obesity. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:None. [PMID: 36531292 PMCID: PMC9748302 DOI: 10.1016/j.ssmqr.2022.100162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 08/24/2022] [Accepted: 08/24/2022] [Indexed: 01/26/2023]
Abstract
Obesity is a major worldwide public health problem. Clinicians are asked to communicate public health messages, including encouraging and supporting weight loss, during consultations with patients living with obesity. However, research shows that talking about weight with patients rarely happens and both parties find it difficult to initiate. Current guidelines on how to have such conversations do not include evidence-based examples of what to say, when to say it and how to avoid causing offence (a key concern for clinicians). To address this gap, we examined 237 audio recorded consultations between clinicians and patients living with obesity in the UK in which weight was discussed opportunistically. Conversation analysis revealed that framing advice as depersonalised generic information was one strategy clinicians used when initiating discussions. This contrasted to clinicians who made advice clearly relevant and personalised to the patient by first appraising their weight. However not all personalised forms of advice worked equally well. Clinicians who spoke delicately when personalising the discussion avoided the types of patient resistance that we found when clinicians were less delicate. More delicate approaches included forecasting upcoming discussion of weight along with delicacy markers in talk (e.g. strategic use of hesitation). Our findings suggest that clinicians should not avoid talking about a patient's weight, but should speak delicately to help maintain good relationships with patients. The findings also demonstrate the need to examine communication practices to develop better and specific guidance for clinicians. Data are in British English.
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Affiliation(s)
- Madeleine Tremblett
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Helena Webb
- School of Computer Science, University of Nottingham, UK
| | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Elizabeth Stokoe
- Discourse and Rhetoric Group, Loughborough University, Loughborough, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Charlotte Albury
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
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Finlay KA, Madhani A, Anil K, Peacock SM. Patient-to-Patient Interactions During the Pain Management Programme: The Role of Humor and Venting in Building a Socially Supportive Community. FRONTIERS IN PAIN RESEARCH 2022; 3:875720. [PMID: 35571144 PMCID: PMC9091594 DOI: 10.3389/fpain.2022.875720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/21/2022] [Indexed: 11/20/2022] Open
Abstract
Objectives Social support is most positively perceived when there is an optimal match between a patient's need for communication and the purpose of their interaction. Maladaptive communication patterns may inhibit social bonding or mutual support, negatively impacting clinical outcomes. This study aimed to identify how people with chronic pain naturalistically converse together about their pain in the context of a Pain Management Programme (PMP). Methods Seven participants (4 females; 3 males) with ongoing chronic pain who were attending a PMP in a regional hospital in the United Kingdom were audio/video recorded during breaks in their PMP. Interactions were transcribed using Jeffersonian Transcription and analyzed using Conversation Analysis. Results Two conversational mechanisms were identified: (1) Conversational humor; and (2) A venting cycle. Participants used their pain-related experiences construct a motive for a joke, then proceeded to deliver the joke, which initiated a joke return from observers. The sequence was completed by a collaborative punchline. In the venting cycle, an initial complaint was escalated by the sharing of comparable experiences, after which the vent was concluded through a joke punchline, acting as a pivot to move the conversation forwards, terminating the venting. Conclusions Humorous interpersonal interactions about chronic pain provided a forum for social support-building within the PMP. Humor was affiliative and built social collaboration, helping individuals to together make sense of their pain in a prosocial atmosphere, approaching pain-related experiences with levity. Patient-to-patient interactions within the PMP were strongly prosocial and inclusive, potentially facilitating enhanced PMP clinical outcomes through collaboration.
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Affiliation(s)
- Katherine A. Finlay
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
- *Correspondence: Katherine A. Finlay
| | - Adam Madhani
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
| | - Krithika Anil
- Peninsula Allied Health Centre, School of Health Professions, University of Plymouth, Plymouth, United Kingdom
| | - Sue M. Peacock
- Pain in the Mind, Independent Practice, The Saxon Clinic, Milton Keynes, United Kingdom
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Alfadda AA, Caterson ID, Coutinho W, Cuevas A, Dicker D, Halford JCG, Hughes CA, Iwabu M, Kang JH, Nawar R, Reynoso R, Rhee N, Rigas G, Salvador J, Vázquez-Velázquez V, Sbraccia P. The 3Ds - Discussion, diagnosis and direction: Elements for effective obesity care by healthcare professionals. Eur J Intern Med 2021; 91:17-25. [PMID: 33495083 DOI: 10.1016/j.ejim.2021.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/06/2021] [Accepted: 01/11/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The care of people with obesity is often suboptimal due to both physician and patient perceptions about obesity itself and clinical barriers. Using data from the ACTION-IO study, we aimed to identify factors that might improve the quality of obesity care through adoption of the 3D approach (Discussion, Diagnosis and Direction [follow-up]) by healthcare professionals (HCPs). METHODS An online survey was completed by HCPs in 11 countries. Exploratory beta regression analyses identified independent variables associated with each component of the 3D approach. RESULTS Data from 2,331 HCPs were included in the statistical models. HCPs were significantly more likely to initiate weight discussions and inform patients of obesity diagnoses, respectively, if (odds ratio [95% confidence interval]): they recorded an obesity diagnosis in their patient's medical notes (1.59, [1.43-1.76] and 2.16 [1.94-2.40], respectively); and they were comfortable discussing weight with their patients (1.53 [1.39-1.69] and 1.15 [1.04-1.27]). HCPs who reported feeling motivated to help their patients lose weight were also more likely to initiate discussions (1.36 [1.21-1.53]) and schedule follow-up appointments (1.21 [1.06-1.38]). By contrast, HCPs who lacked advanced formal training in obesity management were less likely to inform patients of obesity diagnoses (0.83 [0.74-0.92]) or schedule follow-up appointments (0.69 [0.62-0.78]). CONCLUSION Specific actions that could improve obesity care through the 3D approach include: encouraging HCPs to record an obesity diagnosis; providing tools to help HCPs feel more comfortable initiating weight discussions; and provision of training in obesity management. CLINICAL TRIAL REGISTRATION NCT03584191.
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Affiliation(s)
- Assim A Alfadda
- Obesity Research Center and the Department of Internal Medicine, College of Medicine, King Saud University, P.O. Box 2925 (98), Riyadh 11461, Saudi Arabia.
| | - Ian D Caterson
- Boden Collaboration, Charles Perkins Centre, D17, University of Sydney, NSW 2006, Sydney, Australia
| | - Walmir Coutinho
- Pontifícia Universidade Católica do Rio de Janeiro (PUC-Rio), Instituto Estadual de Diabetes e Endocrinologia (IEDE), Rio de Janeiro, RJ, Brazil
| | - Ada Cuevas
- Center for Advanced Metabolic Medicine and Nutrition (CAMMYN) Avda Las Condes 9460, office 501, Santiago, Chile
| | - Dror Dicker
- Department of Internal Medicine D, Hasharon Hospital-Rabin Medical Center, Petah-Tikva, Israel; Sackler School Of Medicine, Tel Aviv University Tel Aviv, Israel
| | - Jason C G Halford
- School of Psychology, University of Leeds, University Road, Woodhouse, Leeds LS2 9JZ, UK
| | - Carly A Hughes
- Weight Management Service, Fakenham Medical Practice, Meditrina House, Trinity Road, Fakenham, NR21 8SY, UK
| | - Masato Iwabu
- Department of Diabetes and Metabolic Diseases, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Jae-Heon Kang
- Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, South Korea
| | - Rita Nawar
- The Weight Care Clinic, Dubai Healthcare City, Building 64, Block A, 2nd Floor, 2004, P.O. Box: 505042, Dubai, United Arab Emirates
| | - Ricardo Reynoso
- Novo Nordisk Health Care AG, Thurgauerstrasse 36/38, 8050 Zürich, Switzerland
| | - Nicolai Rhee
- Novo Nordisk Health Care AG, Thurgauerstrasse 36/38, 8050 Zürich, Switzerland
| | - Georgia Rigas
- Department of Bariatric Surgery, St George Private Hospital, Suite 3, Level 5, 1 South St, Kogarah, Sydney, Australia
| | - Javier Salvador
- Department of Endocrinology & Nutrition, Clínica Universidad de Navarra, Pamplona, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Verónica Vázquez-Velázquez
- Clínica de Obesidad y Trastornos de la Conducta Alimentaria, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Tlalpan, Belisario Domínguez Sección XVI, 14080 Ciudad de México, Mexico
| | - Paolo Sbraccia
- University of Rome Tor Vergata, Department of Systems Medicine, Via Montpellier,1, I-00133 Rome, Rome, Italy
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6
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Hughes CA, Ahern AL, Kasetty H, McGowan BM, Parretti HM, Vincent A, Halford JCG. Changing the narrative around obesity in the UK: a survey of people with obesity and healthcare professionals from the ACTION-IO study. BMJ Open 2021; 11:e045616. [PMID: 34193488 PMCID: PMC8246368 DOI: 10.1136/bmjopen-2020-045616] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To investigate the perceptions, attitudes, behaviours and potential barriers to effective obesity care in the UK using data collected from people with obesity (PwO) and healthcare professionals (HCPs) in the Awareness, Care, and Treatment In Obesity maNagement-International Observation (ACTION-IO) study. DESIGN UK's PwO (body mass index of ≥30 kg/m2 based on self-reported height and weight) and HCPs who manage patients with obesity completed an online survey. RESULTS In the UK, 1500 PwO and 306 HCPs completed the survey. Among the 47% of PwO who discussed weight with an HCP in the past 5 years, it took a mean of 9 years from the start of their struggles with weight until a discussion occurred. HCPs reported that PwO initiated 35% of weight-related discussions; PwO reported that they initiated 47% of discussions. Most PwO (85%) assumed full responsibility for their own weight loss. The presence of obesity-related comorbidities was cited by 76% of HCPs as a top criterion for initiating weight management conversations. The perception of lack of interest (72%) and motivation (61%) in losing weight was reported as top reasons by HCPs for not discussing weight with a patient. Sixty-five per cent of PwO liked their HCP bringing up weight during appointments. PwO reported complex and varied emotions following a weight loss conversation with an HCP, including supported (36%), hopeful (31%), motivated (23%) and embarrassed (17%). Follow-up appointments were scheduled for 19% of PwO after a weight discussion despite 62% wanting follow-up. CONCLUSIONS The current narrative around obesity requires a paradigm shift in the UK to address the delay between PwO struggling with their weight and discussing weight with their HCP. Perceptions of lack of patient interest and motivation in weight management must be challenged along with the blame culture of individual responsibility that is prevalent throughout society. While PwO may welcome weight-related conversations with an HCP, they evoke complex feelings, demonstrating the need for sensitivity and respect in these conversations. TRIAL REGISTRATION NUMBER NCT03584191.
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Affiliation(s)
- Carly A Hughes
- Fakenham Weight Management Service, Fakenham Medical Practice, Fakenham, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Amy L Ahern
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | | | - Barbara M McGowan
- Institute of Diabetes, Endocrinology and Obesity, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Ann Vincent
- Department of Medicine, University College London, London, UK
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Zelenytė V, Valius L, Domeikienė A, Gudaitytė R, Endzinas Ž, Šumskas L, Maleckas A. Body size perception, knowledge about obesity and factors associated with lifestyle change among patients, health care professionals and public health experts. BMC FAMILY PRACTICE 2021; 22:37. [PMID: 33588766 PMCID: PMC7885487 DOI: 10.1186/s12875-021-01383-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 02/04/2021] [Indexed: 11/21/2022]
Abstract
Background The attitudes towards obesity may have an important role on healthier behavior. The goal of the present study was to explore the attitudes towards obesity and to investigate how these attitudes were associated with lifestyle-changing behavior among the patients attending primary care centers, health care professionals and public health experts. Methods This cross-sectional survey study was performed in 10 primary care offices in different regions in Lithuania and in 2 public health institutions. Nine hundred thirty-four patients, 97 nurses, 65 physicians and 30 public health experts have filled the questionnaire about attitudes towards obesity and presented data about lifestyle-changing activities during last 12 months. The attitudes were compared between different respondent groups and factors associated with healthier behaviors were analyzed among overweight/obese individuals in our study population. Results Participants failed to visually recognize correct figure corresponding to male and female with obesity. Majority of respondents’ perceived obesity as a risk factor for heart diseases and diabetes but had less knowledge about other diseases associated with weight. About one third of respondents changed their lifestyle during last 12 months. Overweight individuals with age < 45 years (OR 1.64, 1.06–2.55; p = 0.025) were more likely and those who overestimated current weight (OR 0.44, 0.20–0.96; p = 0.036) less likely to change their lifestyle. Disappointment with their current weight (OR 2.57, 1.36–4.84; p = 0.003) was associated with healthier behavior among participants with obesity. Conclusion Participants had similar body size perception and knowledge about obesity. Younger age had significant association with lifestyle changing behavior among overweight individuals and disappointment with current weight among obese participants.
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Affiliation(s)
- Virginija Zelenytė
- Department of Preventive Medicine, Medical Academy, Lithuanian University of Health Sciences, A. Mickevičiaus st. 9, LT-44307, Kaunas, Lithuania.
| | - Leonas Valius
- Department of Family Medicine, Medical Academy, Lithuanian University of Health Sciences, A. Mickevičiaus st. 9, LT-44307, Kaunas, Lithuania
| | - Auksė Domeikienė
- Department of Preventive Medicine, Medical Academy, Lithuanian University of Health Sciences, A. Mickevičiaus st. 9, LT-44307, Kaunas, Lithuania.,Department of Family Medicine, Medical Academy, Lithuanian University of Health Sciences, A. Mickevičiaus st. 9, LT-44307, Kaunas, Lithuania
| | - Rita Gudaitytė
- Department of Surgery, Medical Academy, Lithuanian University of Health Sciences, A. Mickevičiaus st. 9, LT-44307, Kaunas, Lithuania
| | - Žilvinas Endzinas
- Department of Surgery, Medical Academy, Lithuanian University of Health Sciences, A. Mickevičiaus st. 9, LT-44307, Kaunas, Lithuania
| | - Linas Šumskas
- Department of Preventive Medicine, Medical Academy, Lithuanian University of Health Sciences, A. Mickevičiaus st. 9, LT-44307, Kaunas, Lithuania.,Institute of Health Research, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Almantas Maleckas
- Department of Surgery, Medical Academy, Lithuanian University of Health Sciences, A. Mickevičiaus st. 9, LT-44307, Kaunas, Lithuania.,Department of Gastrosurgical Research and Education, Sahlgrenska Academy, University of Gothenburg, Bla Straket 5, SE-41345, Gothenburg, Sweden
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Bessell E, Markovic TP, Fuller NR. How to provide a structured clinical assessment of a patient with overweight or obesity. Diabetes Obes Metab 2021; 23 Suppl 1:36-49. [PMID: 33621413 DOI: 10.1111/dom.14230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/28/2020] [Accepted: 10/09/2020] [Indexed: 12/27/2022]
Abstract
With the increasing prevalence of overweight and obesity worldwide, there is a reciprocal increase in the global economic burden and ill-health from obesity-related chronic diseases. Primary healthcare services have a role to play in ensuring early detection of weight issues and in directing patients towards evidence-based care to slow this progression. Research shows that many people with obesity are motivated to lose weight and want their clinician to initiate a conversation about weight management and treatment options. However, this conversation rarely occurs and there is a significant delay in treatment, resulting in an increased burden on the individual, healthcare system and society. In this paper, the components and rationale for the clinical assessment of adult patients with overweight or obesity, including anthropometric measurements and pathology tests, are described. Recommendations to ascertain the potential factors influencing the development of obesity in the patient, such as lifestyle factors (diet and physical activity) and mental health, are also provided. The potential sequelae of obesity that may be present and the necessary assessments for diagnosis are also addressed. These assessments are vital to ensure the patient is referred to the appropriate allied health services and/or specialists.
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Affiliation(s)
- Erica Bessell
- Boden Collaboration, Charles Perkins Centre, Faculty of Medicine and Health University of Sydney, Sydney, New South Wales, Australia
| | - Tania P Markovic
- Boden Collaboration, Charles Perkins Centre, Faculty of Medicine and Health University of Sydney, Sydney, New South Wales, Australia
- Metabolism and Obesity Services, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Nicholas R Fuller
- Boden Collaboration, Charles Perkins Centre, Faculty of Medicine and Health University of Sydney, Sydney, New South Wales, Australia
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9
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Vázquez‐Velázquez V, Laviada‐Molina H, García‐García E, Sandoval‐Diez E, Mancillas‐Adame L. Perceptions, Attitudes, and Barriers to Obesity Care in Mexico: Data From the ACTION-IO Study. Obesity (Silver Spring) 2021; 29:317-326. [PMID: 33491317 PMCID: PMC7898320 DOI: 10.1002/oby.23077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/06/2020] [Accepted: 11/01/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The Awareness, Care, and Treatment in Obesity Management-International Observation (ACTION-IO) study (ClinicalTrials.gov identifier NCT03584191) aimed to identify perceptions, attitudes, behaviors, and barriers to effective obesity care in people with obesity (PwO) and health care professionals (HCPs). This study presents the results from Mexico. METHODS An online survey was conducted. In Mexico, eligible PwO were ≥18 years of age with BMI ≥30 kg/m2 based on self-reported height and weight. Eligible HCPs had direct patient care. RESULTS The survey was completed by 2,000 PwO and 400 HCPs in Mexico. Many PwO (71%) and HCPs (94%) categorized obesity as a chronic disease. Sixty-three percent of PwO felt motivated to lose weight, but many HCPs perceived that PwO were not interested in losing weight (76%) or motivated to lose weight (69%). Lack of financial means to support weight-loss efforts was a barrier for PwO (34%) to discussing weight with HCPs. Sixty-five percent of PwO had discussed weight with HCPs in the past 5 years. PwO (80%) and HCPs (89%) considered lack of exercise as the main barrier to weight loss. Few PwO (34%) had successfully lost ≥5% of their body mass over the past 3 years. CONCLUSIONS This ACTION-IO study in Mexico identified discrepancies in the perceptions of PwO and HCPs, highlighting opportunities for further education and patient-centered approaches.
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Affiliation(s)
- Verónica Vázquez‐Velázquez
- Obesity and Eating Disorder ClinicInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico CityMexico
| | | | - Eduardo García‐García
- Obesity and Eating Disorder ClinicInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico CityMexico
| | | | - Leonardo Mancillas‐Adame
- Endocrinology DivisionUniversity Hospital and Medical SchoolAutonomous University of Nuevo LeónSan Nicolás de los GarzaMexico
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10
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Mace S, Collins S, Speer S. Talking about breast symmetry in the breast cancer clinic: What can we learn from an examination of clinical interaction? Health Expect 2021; 24:209-221. [PMID: 33517586 PMCID: PMC8077149 DOI: 10.1111/hex.13144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/30/2020] [Accepted: 09/06/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Breast asymmetry is a common post-operative outcome for women with breast cancer. Quality of cosmetic result is viewed clinically as a critical endpoint of surgery. However, research suggests that aesthetic standards governing breast reconstruction can be unrealistic and may problematically enforce feminine appearance norms. The aim of reconstructive procedures is to help women live well with and beyond breast cancer. Therefore, understanding how patients and clinicians talk about surgical outcomes is important. However, we lack evidence about such discussions. OBJECTIVE To examine clinical communication about breast symmetry in real-time consultations in a breast cancer clinic. DESIGN Seventy-three consultations between 16 clinicians and 47 patients were video-recorded, transcribed and analysed using conversation analysis. RESULTS In most cases, patients do considerable interactional work to persuade clinicians of the validity of their concerns regarding breast asymmetry, and clinicians legitimize these concerns, aligning with patients. In a significant minority of cases, patients appear more accepting of their treatment outcome, but clinicians prioritize symmetry or treat symmetry with the presence of breast tissue as normative, generating misalignment between clinician and patient. CONCLUSION Current clinical communication guidelines and practices may inadvertently reinforce culturally normative assumptions regarding the desirability of full, symmetrical breasts that are not held by all women. Clinicians and medical educators may benefit from detailed engagement with recordings of clinical communication like those analysed here, to reflect on which communicative practices may work best to attend to a patient's individual stance on breast symmetry, and optimize doctor-patient alignment.
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Affiliation(s)
- Stephanie Mace
- Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Sarah Collins
- Division of Medical Education, School of Medical Sciences, The University of Manchester, Manchester, UK
| | - Susan Speer
- Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, Manchester, UK
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Dicker D, Kornboim B, Bachrach R, Shehadeh N, Potesman-Yona S, Segal-Lieberman G. ACTION-IO as a platform to understand differences in perceptions, attitudes, and behaviors of people with obesity and physicians across countries - the Israeli experience. Isr J Health Policy Res 2020; 9:56. [PMID: 33087177 PMCID: PMC7579877 DOI: 10.1186/s13584-020-00404-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 09/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obesity is a highly prevalent, complex, and chronic relapsing disease with a considerable unmet medical need. We aimed to identify perceptions, attitudes, behaviors, and barriers to effective obesity treatment among people with obesity (PwO) and physicians in Israel. METHODS The ACTION-IO study was an online survey conducted in 11 countries, including Israel. Findings from the Israeli cohort are reported here. Israeli respondents were PwO (body mass index of ≥30 kg/m2 based on self-reported height and weight) and physicians primarily in direct patient care. RESULTS In total, 750 PwO and 169 physicians completed the survey in Israel. Although most PwO (70%) and physicians (95%) perceived obesity as a chronic disease, the majority of PwO assumed full responsibility for their own weight loss (88%) compared with only 19% of physicians who placed the responsibility for weight loss on their patients with obesity. Many PwO (62%) and physicians (73%) agreed that a complete change in lifestyle would be required for PwO to lose weight and felt that treatment of obesity should be a team effort between different healthcare professionals (HCPs; 80 and 90%, respectively). Dietitians were considered by 82% of physicians to be the most effective professionals in helping PwO achieve their weight loss goals. Many PwO (69%) liked that their HCP initiated weight management discussions and 68% of those who had not previously discussed their weight would like their HCP to initiate the conversation. However, among PwO who had discussed their weight with an HCP, 59% considered the discussions to be a little helpful or not at all helpful. The beliefs that patients have little interest in or motivation for losing weight were identified by physicians as the main reasons (71 and 70%, respectively) for not initiating weight management discussions. CONCLUSIONS In line with the ACTION-IO international study, our Israeli dataset reveals a need to improve awareness, primarily among physicians, on the physiologic basis and clinical management of obesity, including how to approach weight and weight management discussions during patient consultations. TRIAL REGISTRATION Registered at ClinicalTrials.gov , NCT03584191 . Data first posted on ClinicalTrials.gov : 12 July 2018 - 'Retrospectively registered'.
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Affiliation(s)
- Dror Dicker
- Department of Internal Medicine D & obesity clinic, Hasharon Hospital, Rabin Medical Center, Petah Tikva, Sackler School of Medicine, Tel Aviv University, Keren Kayemet St. 7, 49100, Petah Tikva, Israel.
| | - Batya Kornboim
- Department of Family Medicine, Clalit Health Services, Haifa, Israel
| | - Rakefet Bachrach
- Department of Family Medicine, Clalit Health Services, Nethania, Israel
| | - Naim Shehadeh
- Endocrinology, Diabetes and Metabolism Institute, Rambam Medical Center, Haifa, Israel
| | | | - Gabriella Segal-Lieberman
- Center for Weight Management, Institute of Endocrinology, Sheba Medical Center, Ramat-Gan, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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12
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Caterson ID, Alfadda AA, Auerbach P, Coutinho W, Cuevas A, Dicker D, Hughes C, Iwabu M, Kang J, Nawar R, Reynoso R, Rhee N, Rigas G, Salvador J, Sbraccia P, Vázquez‐Velázquez V, Halford JC. Gaps to bridge: Misalignment between perception, reality and actions in obesity. Diabetes Obes Metab 2019; 21:1914-1924. [PMID: 31032548 PMCID: PMC6767048 DOI: 10.1111/dom.13752] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/03/2019] [Accepted: 04/16/2019] [Indexed: 12/14/2022]
Abstract
AIMS Despite increased recognition as a chronic disease, obesity remains greatly underdiagnosed and undertreated. We aimed to identify international perceptions, attitudes, behaviours and barriers to effective obesity care in people with obesity (PwO) and healthcare professionals (HCPs). MATERIALS AND METHODS An online survey was conducted in 11 countries. Participants were adults with obesity and HCPs who were primarily concerned with direct patient care. RESULTS A total of 14 502 PwO and 2785 HCPs completed the survey. Most PwO (68%) and HCPs (88%) agreed that obesity is a disease. However, 81% of PwO assumed complete responsibility for their own weight loss and only 44% of HCPs agreed that genetics were a barrier. There was a median of three (mean, six) years between the time PwO began struggling with excess weight or obesity and when they first discussed their weight with an HCP. Many PwO were concerned about the impact of excess weight on health (46%) and were motivated to lose weight (48%). Most PwO (68%) would like their HCP to initiate a conversation about weight and only 3% were offended by such a conversation. Among HCPs, belief that patients have little interest in or motivation for weight management may constitute a barrier for weight management conversations. When discussed, HCPs typically recommended lifestyle changes; however, more referrals and follow-up appointments are required. CONCLUSIONS Our international dataset reveals a need to increase understanding of obesity and improve education concerning its physiological basis and clinical management. Realization that PwO are motivated to lose weight offers an opportunity for HCPs to initiate earlier weight management conversations.
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Affiliation(s)
- Ian D. Caterson
- Boden InstituteCharles Perkins Centre, University of SydneySydneyAustralia
| | - Assim A Alfadda
- Obesity Research Center and Department of MedicineCollege of Medicine, King Saud UniversityRiyadhSaudi Arabia
| | | | - Walmir Coutinho
- Catholic University of Rio de Janeiro, State Institute of Diabetes and EndocrinologyRio de JaneiroBrazil
| | - Ada Cuevas
- Departamento de NutriciónClínica Las CondesSantiagoChile
| | - Dror Dicker
- Internal Medicine D, Hasharon Hospital Rabin Medical CenterPetah TikvaIsrael
- Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Carly Hughes
- Fakenham Weight Management ServiceFakenham Medical PracticeNorfolkUK
- University of East AngliaNorfolkUK
| | - Masato Iwabu
- Department of Diabetes and Metabolic DiseasesThe University of TokyoTokyoJapan
| | - Jae‐Heon Kang
- Department of Family Medicine, Kangbuk Samsung HospitalSungkyunkwan University School of MedicineSeoulSouth Korea
| | - Rita Nawar
- The Weight Care Clinic, Dubai Healthcare CityDubaiUnited Arab Emirates
| | | | | | - Georgia Rigas
- St George and Sutherland Clinical School, Faculty of MedicineUniversity of New South WalesSydneyAustralia
| | - Javier Salvador
- Department of Endocrinology and NutritionClínica Universidad de NavarraPamplonaSpain
- CIBER Fisiopatología de la Obesidad y NutriciónInstituto de Salud Carlos IIIMajadahondaSpain
| | - Paolo Sbraccia
- Department of Systems MedicineUniversity of Rome Tor VergataRomeItaly
| | - Verónica Vázquez‐Velázquez
- Clínica de Obesidad y Trastornos de la Conducta Alimentaria, Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránCiudad de MéxicoMexico
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13
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Lim S, Liang X, Hill B, Teede H, Moran LJ, O'Reilly S. A systematic review and meta-analysis of intervention characteristics in postpartum weight management using the TIDieR framework: A summary of evidence to inform implementation. Obes Rev 2019; 20:1045-1056. [PMID: 30942550 DOI: 10.1111/obr.12846] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 02/06/2019] [Accepted: 02/09/2019] [Indexed: 01/01/2023]
Abstract
Postpartum weight retention is a significant contributor to obesity in reproductive-aged women, but the key implementation characteristics of postpartum weight management interventions have not been systematically identified to inform policy and practice. This study aimed to evaluate the intervention characteristics associated with weight loss in postpartum women using the Template for Intervention Description and Replication (TIDieR) framework. We searched MEDLINE, CINAHL, EMBASE, PSYCINFO, and EBM databases to identify lifestyle intervention RCTs in postpartum women (within 2 years after birth) published up to January 2018. From 4512 studies, 33 studies were included in the systematic review and meta-analysis (n = 4960 women). Health professional-delivered interventions had significantly greater weight loss than those delivered by nonhealth professionals (mean difference, 95% confidence interval: (-3.22 kg [-4.83, -1.61] vs -0.99 kg [-1.53, -0.45], P = 0.01 for subgroup differences)). Diet and physical activity combined had significantly greater weight loss compared with physical activity-only interventions (-3.15 kg [-4.34, -1.96] vs -0.78 kg [-1.73, 0.16], P = 0.009 for subgroup differences). The extent of weight loss was not influenced by intervention intensity (duration, number of sessions) and setting (individual or group).
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Affiliation(s)
- Siew Lim
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Vic, Australia.,School of Agriculture and Food Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Xinyu Liang
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Vic, Australia.,School of Agriculture and Food Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Briony Hill
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Vic, Australia.,School of Agriculture and Food Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Helena Teede
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Vic, Australia.,School of Agriculture and Food Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Vic, Australia.,School of Agriculture and Food Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Sharleen O'Reilly
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Vic, Australia.,School of Agriculture and Food Science, University College Dublin, Belfield, Dublin 4, Ireland
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