Changing the narrative around obesity in the UK: a survey of people with obesity and healthcare professionals from the ACTION-IO study

Perceptions, Attitudes, Behaviours and Barriers in Obesity Care: Findings from the ACTION-Vietnam Study

Objective

The ACTION Asia Pacific (ACTION-APAC) study was designed to identify the perceptions, attitudes, behaviours and potential barriers to effective obesity management in people with obesity (PwO) and healthcare professionals (HCPs) in nine countries of Southeast Asia. This study represents the findings in Vietnam.

Methodology

This cross-sectional, non-interventional study gathered information from Vietnamese PwO (n = 1000) and HCPs (n = 200) via an anonymous online survey between April and May 2022.

Results

The majority of PwO (67%) and HCPs (80%) believed that obesity is a chronic disease that profoundly impacts a person's overall health (76% PwO, 81% HCPs). About 58% of PwO agreed that managing weight loss was solely their responsibility. Meanwhile, 76% of HCPs believed they should actively contribute to their patients' weight loss efforts. Most of the PwO (82.7%) had attempted weight loss with an average of four times. PwO and HCPs cited lack of exercise (63% vs. 86%) and lack of motivation (60% vs. 80%) as the principal barriers to weight loss. HCPs cited PwOs' lack of interest (52%) and motivation to lose weight (45%) as top reasons for not discussing weight.

Conclusion

The study emphasised raising awareness for obesity management among PwO and HCPs and suggested early weight management conversations with HCPs.

The Impact of Brexit on UK Food Standards and Food Security: Perspectives on the Repositioning of Neoliberal Food Policy

Brexit, the exiting of the United Kingdom (UK) from the European Union (EU), has impacted socio-political relationships, both internally, and externally with other countries and economic groups. This has been especially true regarding international trade, and legal and market standards for food and food security. This paper examines how the enacting of Brexit has framed and underlined contemporary perceptions of the UK neoliberal food system, the relative importance of food standards, and the impact of policy transition on food security. Using a positional approach, perspectives and narratives within the literature are critiqued and synthesized, including academic sources, parliamentary debates, economic reports, and media analysis. The politico-economic effects of Brexit have altered food-related relationships, recalibrating trade interactions and changing the public funding that UK farmers receive. Through realigning extractive economic models, the pre-Brexit UK food system has been reset, and new perspectives about neoliberalism have emerged. Government intervention has steered away from traditional neoliberal framings towards neo-developmentalism. A dichotomy thus exists between recognizing the intrinsic right to adequate and nutritious food and maintaining existing cultural dynamics of food supply, and the use of agri-food policy as a politico-economic tool to drive higher economic growth. The implications of this policy change are stark for UK agri-food actors within food system transition post-Brexit.

Telemedicine Booths for Screening Cardiovascular Risk Factors: Prospective Multicenter Study

Background

Cardiovascular risk factors such as hypertension often remain undetected and untreated. This was particularly problematic during the COVID-19 pandemic when there were fewer in-person medical consultations.

Objective

This study aimed to determine whether health screening using a telemedicine booth would have an impact on people's medical care during the COVID-19 pandemic.

Methods

Health screening was run using a telemedicine booth (the consult station) that was placed in three different vaccination centers in northern France between July 2021 and September 2021. Participants followed a series of instructions to obtain various measures, including their blood pressure, BMI, and heart rate. If any measures were found to be outside of the normal range, participants were advised to consult a doctor. After 3 months, the participants with abnormal readings were contacted by telephone and were asked a series of standardized questions. The primary outcome was the percentage of respondents who reported that they had consulted a doctor since the health check.

Results

Approximately 6000 people attended the 3 vaccination centers over the study period. Of these, around 2500 used the consult station. A total of 1333 participants (53.3%) were found to have abnormal readings, which mostly concerned their blood pressure, heart rate, or BMI. There were 638 participants who responded to the follow-up call, and 234 of these (37%) reported that they had consulted a doctor since the health check. However, 158 of the 638 respondents (24.8%) reported that they would have consulted a doctor even without the screening.

Conclusions

We succeeded in screening large numbers of people for cardiovascular risk factors during the COVID-19 pandemic by using a telemedicine booth. Although relatively few follow-up call respondents reported that they went on to consult a physician, the screening would nevertheless have raised people's awareness of their cardiovascular risk factors.

'My first thoughts are…': a Framework Method analysis of UK general practice healthcare professionals' internal dialogue and clinical reasoning processes when seeing patients living with obesity in primary care

OBJECTIVES

To use vignettes to facilitate exploration of the internal dialogue and clinical reasoning processes of general practice healthcare professionals (GPHCPs) during interactions with patients living with obesity.

DESIGN

This study used an exploratory qualitative research design. Data were collected using semistructured interviews. Interviews were transcribed verbatim, and data analysed using Framework Method analysis. Five vignettes were presented to participants, showing a patient's photograph, name, age and body mass index. Participants were asked to describe their first impressions of each fictionalised patient.

SETTING

Interviews were conducted remotely via Skype between August and September 2019.

PARTICIPANTS

A convenience sample of UK GPHCPs was recruited via a targeted social media strategy, using virtual snowball sampling. 20 participants were interviewed (11 general practice nurses and 9 general practitioners).

RESULTS

Five themes were generated: visual assessment, assumed internal contributing factors, assumed external contributing factors, potential clinical contributing factors and potential clinical consequences. A pattern-recognition approach was identified, as GPHCPs' assumptions around patients' lifestyles, occupations and eating habits emerged as explanations for their weight, with a mixture of both objective and subjective comments.

CONCLUSIONS

While it is part of the diagnostic skill of a clinician to be able to form a clinical picture based on the information available, it is important to be aware of the potential for assumptions made within this process to contribute to unconscious bias/stereotyping. Healthcare professionals need to work to counteract the potential impact of internal bias on their consultations to provide fair and equitable care for people living with obesity, by exercising reflexivity within their clinical practice.

Care provided to women during and after a pregnancy complicated by hyperglycaemia: the impacts of a multi-component health systems intervention

Background

Aboriginal and Torres Strait Islander women experience a disproportionate burden of hyperglycaemia in pregnancy. A multi-component health systems intervention aiming to improve antenatal and postpartum care was implemented across Australia's Northern Territory (NT) and Far North Queensland (FNQ) between 2016 and 2019. Components included clinician education, improving recall systems, enhancing policies and guidelines, and embedding Diabetes in Pregnancy (DIP) Clinical Registers in systems of care. This program was evaluated to determine impacts on clinical practice and maternal health.

Methods

Data for women with hyperglycaemia in pregnancy from primary care clinical records and the DIP Clinical Registers were analysed to assess changes in: antenatal and postpartum diabetes testing; HbA1c/glucose levels; medication use; weight checks performed, weight and body mass index; and postpartum contraception, smoking and breastfeeding.

Findings

Clinical practice in the NT improved, including increased uptake of the recommended first trimester 75 g oral glucose tolerance test among women with hyperglycaemia risk factors (Aboriginal and Torres Strait Islander women 11.7% to 26.5%, p < 0.001; non-Indigenous women 6.2% to 19.3%, p < 0.001). In the NT, postpartum diabetes monitoring (56% to 68%, p = 0.039) and contraceptive use (41% to 60%, p = 0.001) increased among Aboriginal and Torres Strait Islander women. In FNQ, postpartum glucose monitoring increased among women with T2D (26% to 68% Aboriginal and Torres Strait Islander, p = 0.002; 50% to 100% non-Indigenous, p = 0.008), although there were no improvements in antenatal care indicators.

Interpretation

Aspects of care for women with hyperglycaemia in pregnancy improved in the NT and FNQ following a multi-component health systems intervention.

Funding

This study is funded by the Australian National Health and Medical Research Council (NHMRC) Global Alliance for Chronic Diseases Grant 1092968.

Sociodemographic and early-life predictors of being overweight or obese in a middle-aged UK population- A retrospective cohort study of the 1958 National Child Development Survey participants

Obesity has become a global public health concern. However, its precise origins and causation are still hotly debated, especially the relative importance of individual-level genetics and behaviours, as opposed to obesogenic environmental factors. Our key objective is to quantify the impact of sociodemographic and early-life course predictors of being overweight or obese at 16, being overweight/obese/severely obese42 years of age, and on the incidence of a status of being overweight/obese/severely obese between 16 and 42 years of age, spanning the years before and after marked increases in obesity prevalence in the UK. We used data collected from participants and their mothers from the 1958 National Child Development Survey. The outcomes of interest were being overweight (defined as [Formula: see text] ) or obese (defined as BMI > 30 kg/m2) at 16 and 42 years of age and incident obesity between 16 and 42 years of age. We assessed the risk factors for obesity using logistic regression models. We observed a strong influence of maternal obesity for being Obese/Severe Obese compared to being overweight across the three models (ORs 4.328,2.901,3.293 for the models relating to age 16, the age range 16-42, and age 42 respectively). Additionally, we note that maternal smoking (ORs 1.6 to 1.8 for 10 + cigarettes per day compared to non-smokers) on all three outcomes were statistically significant. Females were prone to being overweight/obese at 16 years of age (OR 1.96 CI 1.61 to 2.39) but less prone to develop obesity between 16 and 42 years of age (OR 0.89 CI 0.78 to 1.007). Our results suggest that sociodemographic and early-life risk factors could be used to target obesity prevention programmes for children and adults. In particular, we note that the effect of maternal influences persists through to age 42 and that strikingly, those predictors were just as powerful (and prevalent) in the era before the current obesity pandemic began. This suggests that, as Geoffrey Rose pointed out, novel studies are needed of factors at the community/societal level that may have caused the current obesity pandemic, since individual-level risk factors appear not to have changed over the time period spanning the pandemic's onset and growth.

ACTION Malaysia-perception and barriers to obesity management among people with obesity and healthcare professionals in Malaysia

BACKGROUND

Timely weight loss conversations between healthcare professionals (HCPs) and people with obesity (PwO) can help in effective obesity management. The Awareness, Care, and Treatment in Obesity maNagement in the Asia Pacific region (ACTION APAC) studied the attitudes, perceptions, and behaviours toward obesity among PwO and HCPs in nine countries of South and Southeast Asia. The current study is a subgroup analysis based on the Malaysian population, known as ACTION Malaysia (ACTION-MY), and aims to explore the attitudes, perceptions, behaviours, and barriers to effective obesity management among both PwO and HCPs.

METHODOLOGY

An online survey in dual languages (Malay and English) was conducted between April 2022 and May 2022 among 1001 adult PwO and 200 HCPs (general practitioners, endocrinologists, obstetricians/gynaecologists, cardiologists, and other appropriate specialities).

RESULTS

The findings highlighted significant gaps in obesity awareness, with 57% of PwO misclassifying their weight status as normal or overweight. While 68% of PwO valued discussing weight management with HCPs, success rates remained low. On average, patients made three weight loss attempts in adulthood, with 63% regaining weight even after maintaining weight loss for six months or more. Key barriers included insufficient exercise, motivation deficits, and poor hunger control. Although 88% of HCPs recognised obesity as a chronic disease affecting overall health, patient disinterest, limited awareness of treatment options, and time constraints hindered effective intervention. Despite 70% of PwO trusting HCPs' medication recommendations, only 10% received weight loss prescriptions.

CONCLUSIONS

This study emphasises the need for enhanced communication between HCPs and PwO, along with comprehensive support that includes mental health services. Addressing the perception gap regarding weight management responsibility is crucial. The results suggest that culturally contextualised approaches to obesity management in Malaysia are essential. Our findings highlight the urgent need for developing treatment strategies and policies targeting identified barriers and establishing collaborative frameworks to enhance obesity management within Malaysia's healthcare system.

Completion of registration of risk factor variables during telephone vs on-site follow-up after myocardial infarction: a nationwide observational study in 101 199 patients from contemporary clinical practice in Sweden

OBJECTIVES

The objective of this study was to assess the completeness of registration of secondary preventive variables comparing on-site visits with telephone consultations during follow-up after myocardial infarction.

DESIGN

This was an observational study based on the Swedish quality registry SWEDEHEART.

SETTING AND OUTCOME MEASURES

We analysed the proportion of missing values for major secondary preventive target data registered at the 2-month and 1-year follow-up visits, during 2006-2022 (n=101 199). χ2 tests were used to compare differences in data registration comparing on-site visits with telephone consultations. Patient characteristics and time trends in the proportion of missing values were also analysed.

RESULTS

Baseline characteristics for patients with on-site visits and telephone consultations were similar. At the 2-month follow-up, the proportion of missing data registered at on-site visits compared with telephone consultations was systolic blood pressure 2.4% (n=1729) vs 28.0% (n=5462), low-density lipoprotein cholesterol 9.1% (n=6525) vs 32.6% (n=6360), weight 20.1% (n=14 343) vs 43.0% (n=8401) and haemoglobin A1c for patients with diabetes mellitus 39.4% (n=4594) vs 69.4% (n=2225), p for all <0.0001. The differences were similar at the 1-year follow-up. Self-reported measures such as smoking status, level of physical activity and current medication had a low proportion of missing data (≤2.1%) for both follow-up modalities.

CONCLUSION

Registration of secondary preventive variables was less complete at telephone consultations compared with on-site cardiac rehabilitation follow-up visits, which might indicate lower quality of care during telephone follow-up. Further analysis on the possible impact of lack of registration of secondary preventive variables on patient outcomes is warranted.

Assessing economic investment required to scale up bariatric surgery capacity in England: a health economic modelling analysis

OBJECTIVES

To quantify the economic investment required to increase bariatric surgery (BaS) capacity in National Health Service (NHS) England considering the growing obesity prevalence and low provision of BaS in England despite its high clinical effectiveness.

DESIGN

Data were included for the patients with obesity who were eligible for BaS. We used a decision-tree approach including four distinct steps of the patient pathway to capture all associated resource use. We estimated total costs according to the current capacity (current scenario) and three BaS scaling up strategies over a time horizon of 20 years (projected scenario): maximising NHS capacity (strategy 1), maximising NHS and private sector capacity (strategy 2) and adding infrastructure to NHS capacity to cover the entire prevalent and incident obesity populations (strategy 3).

SETTING

BaS centres based in NHS and private sector hospitals in England.

MAIN OUTCOME MEASURES

Number of BaS procedures (including revision surgery), cost (GBP) and resource utilisation over 20 years.

RESULTS

At current capacity, the number of BaS procedures and the total cost over 20 years were estimated to be 140 220 and £1.4 billion, respectively. For strategy 1, these values were projected to increase to 157 760 and £1.7 billion, respectively. For strategy 2, the values were projected to increase to 232 760 and £2.5 billion, respectively. Strategy 3 showed the highest increase to 564 784 and £6.4 billion, respectively, with an additional 4081 personnel and 49 facilities required over 20 years.

CONCLUSIONS

The expansion of BaS capacity in England beyond a small proportion of the eligible population will likely be challenging given the significant upfront economic investment and additional requirement of personnel and infrastructure.

Insights from the ACTION Teens Study: a survey of adolescents living with obesity, their caregivers and healthcare professionals in the UK

OBJECTIVES

The Awareness, Care and Treatment In Obesity maNagement (ACTION) Teens study explored attitudes, behaviours, perceptions and barriers regarding effective obesity care among adolescents living with obesity (ALwO), caregivers and healthcare professionals (HCPs).

DESIGN

Cross-sectional online survey study.

SETTING

Study across 10 countries; here, we report data from UK respondents.

PARTICIPANTS

Overall, 416 ALwO (aged 12 to <18 years; body mass index ≥95th percentile for age and sex (WHO charts)), 498 caregivers and 250 HCPs in the UK completed the survey (August-December 2021).

PRIMARY AND SECONDARY OUTCOME MEASURES

Survey questions addressed key aspects of obesity management for ALwO.

RESULTS

Overall, 46% of ALwO perceived their weight as normal or below normal and 86% believed their health was at least good; 56% and 93% of caregivers responded similarly for their ALwO. Despite this, most ALwO (57%) had attempted to lose weight in the past year and 34% felt highly motivated to lose weight. YouTube and social media were most often used by ALwO for information about weight management (41% and 39%); few ALwO and caregivers sought information from a doctor (13% and 22%). Among ALwO who had discussed weight with an HCP (n=122), 49% trusted their weight-management advice. Only 10% of ALwO and 8% of caregivers were told by a doctor that they/their child had obesity. For HCPs, obesity-related comorbidities were the most common reason for initiating weight conversations with ALwO (73%), while short appointment times were the most common barrier (46%). Overall, 30% of ALwO and 11% of caregivers did not feel comfortable bringing up weight with an HCP.

CONCLUSIONS

Improved education and communication are needed among ALwO, caregivers and HCPs in the UK to help improve awareness of obesity, its aetiology and its impact on health, and to support HCPs to proactively initiate weight-related conversations and build trust with ALwO and caregivers.

TRIAL REGISTRATION NUMBER

NCT05013359.

Personal Experiences and Preferences for Weight-Management Services from Adults Living with Overweight and Obesity in the United Kingdom

Evidence-based approaches for weight management in the United Kingdom are lacking. This study examined preferences for behavioural weight-management programmes amongst adults aged eighteen and over in Northern Ireland who had experience living with overweight (i.e., body mass index (BMI) ≥ 25 kg/m2). It involved the design and implementation of an online survey assessing previous experience with weight management and preferences for future weight-management programmes. A total of 94.7% of participants had previously engaged with weight-management services but many struggled to maintain weight loss. Older adults were more likely to be motivated to reduce their weight whilst younger adults were more likely be motivated to change their appearance. A focus on both wellbeing and weight-related outcomes was evident. Participants preferred programmes to be low-cost, delivered by a range of professionals by blended delivery, consisting of short (≤1 h) weekly sessions. These preferences highlighted important considerations for the components of future services to improve engagement and effectiveness.

ACTION-FRANCE: Insights into Perceptions, Attitudes, and Barriers to Obesity Management in France

Background/Objectives: ACTION-FRANCE (Awareness, Care, and Treatment In Obesity maNagement in France) aims to identify the perceptions, attitudes, behaviors, and potential barriers to effective obesity management in France and guide collaborative actions. Methods: ACTION-FRANCE is a cross-sectional survey of people with obesity (PwO) and healthcare professionals (HCPs) in France. The PwO and HCP survey questionnaire periods ran from 27 September 2022 to 1 February 2023 and from 19 December 2022 to 31 March 2023, respectively. Results: The study, encompassing 1226 PwO and 166 HCPs, reveals a shared recognition of obesity as a chronic condition. However, despite being requested by most PwO, weight-related discussions are surprisingly infrequent, leading to delayed diagnosis and care. PwO and HCPs held different views as to why: HCPs often attributed it to PwO's lack of motivation or disinterest, whereas PwO avoided them because they felt weight management was their own responsibility and were uncomfortable discussing it. When weight was discussed, primarily with general practitioners (GPs), discussions mostly focused on physical activity and diet. However, results identified the strong psychosocial impact of obesity: 42% of respondents reported anxiety/depressive symptoms, and many more hesitated to engage in certain social activities because of their weight. Psychotherapy was only discussed by 55% of HCPs. Pharmaceutical options were also rarely discussed (19.5% of HCPs), though 56.1% of PwO reported they would want to. Conclusions: HCPs' and PwO's perceptions differed significantly and need to converge through enhanced communication. A holistic approach, integrating comprehensive training for GPs and recognizing psychological comorbidities, would help to bridge perceptual gaps effectively and foster more empathetic and effective patient care.

A qualitative exploration of the experiences of pregnant women living with obesity and accessing antenatal care

Women are advised to optimise weight before pregnancy. However, many are either already living with overweight or obesity prior to becoming pregnant, increasing the risks for adverse outcomes. Health care professionals (HCP) are responsible for advising women of risks throughout and following pregnancy. However, midwives often find broaching the conversation around maternal obesity difficult. This study explored the experiences of pregnant women living with obesity in accessing antenatal care. Seventeen women completed a semi-structured interview. Transcripts were analysed thematically. Four themes were developed: 1) antenatal care is inconsistent, 2) additional support is needed, 3) women feel judged about their weight, and 4) weight cycling is highly prevalent. Findings suggest that pregnant women living with obesity often experience weight bias from HCPs, feel judged because of their weight and are left feeling confused and overlooked. Women reported inconsistencies in advice and care offered and acknowledged a lack of continuity of care throughout pregnancy. We call for an urgent need for further multidisciplinary training to address the concerns, experiences and needs of pregnant women living with obesity.

A Qualitative Exploration of Patient and Staff Experiences of the Receipt and Delivery of Specialist Weight Management Services in the UK

BACKGROUND

Addressing the increasing prevalence of obesity is a global public health priority. Severe obesity (body mass index > 40) reduces life expectancy, due to its association with people developing complications (e.g. diabetes, cancer, cardiovascular disease), and greatly impairs quality of life. The National Health Service (NHS) in the UK provides specialist weight management services (SWMS) for people with severe obesity, but key uncertainties remain around patient access to and engagement with weight management services, as well as pathways beyond the service.

METHODS

In this multiple methods study, using online forum data and semi-structured interviews, stakeholders' experiences of delivering and receiving SWMS were explored. Using the web search engine Google with keywords and web address (URL) identifiers, relevant public online platforms were sourced with snowball sampling and search strings used to identify threads related to people's experiences of accessing SWMS (n = 57). Interviews were conducted with 24 participants (nine patients, 15 staff), and data from all sources were analysed thematically using the framework approach.

RESULTS

Six themes related to access to and engagement with SWMS emerged during data analysis: (1) making the first move, (2) uncertainty and confusion, (3) resource issues, (4) respect and understanding, (5) mode of delivery, and (6) desire for ongoing support.

CONCLUSION

There is a mixed and varied picture of SWMS provision across the UK. The service offered is based on local clinical decision making and available resources, resulting in a range of patient experiences and perspectives. Whilst service capacity issues and patient anxiety were seen as barriers to accessing care, peer support and positive clinical and group interactions (connectedness between individuals) were considered to increase engagement.

Access to publicly funded weight management services in England using routine data from primary and secondary care (2007-2020): An observational cohort study

BACKGROUND

Adults living with overweight/obesity are eligible for publicly funded weight management (WM) programmes according to national guidance. People with the most severe and complex obesity are eligible for bariatric surgery. Primary care plays a key role in identifying overweight/obesity and referring to WM interventions. This study aimed to (1) describe the primary care population in England who (a) are referred for WM interventions and (b) undergo bariatric surgery and (2) determine the patient and GP practice characteristics associated with both.

METHODS AND FINDINGS

An observational cohort study was undertaken using routinely collected primary care data in England from the Clinical Practice Research Datalink linked with Hospital Episode Statistics. During the study period (January 2007 to June 2020), 1,811,587 adults met the inclusion criteria of a recording of overweight/obesity in primary care, of which 54.62% were female and 20.10% aged 45 to 54. Only 56,783 (3.13%) were referred to WM, and 3,701 (1.09% of those with severe and complex obesity) underwent bariatric surgery. Multivariable Poisson regression examined the associations of demographic, clinical, and regional characteristics on the likelihood of WM referral and bariatric surgery. Higher body mass index (BMI) and practice region had the strongest associations with both outcomes. People with BMI ≥40 kg/m2 were more than 6 times as likely to be referred for WM (10.05% of individuals) than BMI 25.0 to 29.9 kg/m2 (1.34%) (rate ratio (RR) 6.19, 95% confidence interval (CI) [5.99,6.40], p < 0.001). They were more than 5 times as likely to undergo bariatric surgery (3.98%) than BMI 35.0 to 40.0 kg/m2 with a comorbidity (0.53%) (RR 5.52, 95% CI [5.07,6.02], p < 0.001). Patients from practices in the West Midlands were the most likely to have a WM referral (5.40%) (RR 2.17, 95% CI [2.10,2.24], p < 0.001, compared with the North West, 2.89%), and practices from the East of England least likely (1.04%) (RR 0.43, 95% CI [0.41,0.46], p < 0.001, compared with North West). Patients from practices in London were the most likely to undergo bariatric surgery (2.15%), and practices in the North West the least likely (0.68%) (RR 3.29, 95% CI [2.88,3.76], p < 0.001, London compared with North West). Longer duration since diagnosis with severe and complex obesity (e.g., 1.67% of individuals diagnosed in 2007 versus 0.34% in 2015, RR 0.20, 95% CI [0.12,0.32], p < 0.001), and increasing comorbidities (e.g., 2.26% of individuals with 6+ comorbidities versus 1.39% with none (RR 8.79, 95% CI [7.16,10.79], p < 0.001) were also strongly associated with bariatric surgery. The main limitation is the reliance on overweight/obesity being recorded within primary care records to identify the study population.

CONCLUSIONS

Between 2007 and 2020, a very small percentage of the primary care population eligible for WM referral or bariatric surgery according to national guidance received either. Higher BMI and GP practice region had the strongest associations with both. Regional inequalities may reflect differences in commissioning and provision of WM services across the country. Multi-stakeholder qualitative research is ongoing to understand the barriers to accessing WM services and potential solutions. Together with population-wide prevention strategies, improved access to WM interventions is needed to reduce obesity levels.

The perceptions of healthcare practitioners on obesity management in Peninsular Malaysia: a cross-sectional survey

BACKGROUND

Practitioners' perceptions of patients with obesity and obesity management shape their engagement in obesity care delivery. This study aims to describe practitioners' perceptions, experiences and needs in managing patients with obesity, determine the extent of weight stigma among health practitioners, and identify the factors associated with negative judgment towards patients with obesity.

METHODS

A cross-sectional online survey was conducted from May to August 2022 with health practitioners commonly involved in obesity management in Peninsular Malaysia, including doctors in primary care, internal medicine and bariatric surgery, and allied health practitioners. The survey explored practitioners' perceptions, barriers and needs in managing obesity, and evaluated weight stigma using the Universal Measures of Bias - Fat (UMB Fat) questionnaire. Multiple linear regression analysis was used to identify demographic and clinical-related factors associated with higher negative judgment towards patients with obesity.

RESULTS

A total of 209 participants completed the survey (completion rate of 55.4%). The majority (n = 196, 94.3%) agreed that obesity is a chronic disease, perceived a responsibility to provide care (n = 176, 84.2%) and were motivated to help patients to lose weight (n = 160, 76.6%). However, only 22% (n = 46) thought their patients were motivated to lose weight. The most frequently reported barriers to obesity discussions were short consultation time, patients' lack of motivation, and having other, more important, concerns to discuss. Practitioners needed support with access to multi-disciplinary care, advanced obesity training, financing, comprehensive obesity management guidelines and access to obesity medications. The mean (SD) of the UMB Fat summary score was 2.99 (0.87), with the mean (SD) domain scores ranging between 2.21 and 4.36 (1.06 to 1.45). No demographic and clinical-related factors were significantly associated with negative judgment from the multiple linear regression analyses.

CONCLUSION

Practitioners in this study considered obesity a chronic disease. While they had the motivation and capacity to engage in obesity management, physical and social opportunities were the reasons for not discussing obesity with their patients. Practitioners needed more support to enhance their capability and opportunity to engage with obesity management. Weight stigma in healthcare settings in Malaysia should be addressed, given the possibility of hindering weight discussions with patients.

Perspectives of healthcare professionals on facilitators, barriers and needs in children with obesity and their parents in achieving a healthier lifestyle

Objective

To explore the perspectives of healthcare professionals (HCPs) within an integrated care approach on the facilitators, barriers and needs in children with obesity and their parents in achieving a healthier lifestyle.

Methods

Semi-structured interviews were conducted with eighteen HCPs working within a Dutch integrated care approach. The interviews were analyzed by performing a thematic content analysis.

Results

Main facilitators identified by HCPs were support from parents and the social network. Main barriers were first and foremost family's lack of motivation, which was singled out as a precondition for starting the behavior change process. Other barriers were child's socio-emotional problems, parental personal problems, lack of parenting skills, parental lack of knowledge and skills regarding a healthier lifestyle, parental lack of problem awareness and HCP's negative attitude. To overcome these barriers, main needs that HCPs suggested were a tailored approach in healthcare and a supportive HCP.

Conclusion

The HCPs identified the breadth and complexity of underlying factors of childhood obesity, of which the family's motivation was pointed out as a critical factor to address.

Innovation

Understanding the patient's perspective is important for HCPs to provide the tailored care needed to address the complexity of childhood obesity.

Recruiting and Engaging Women of Reproductive Age with Obesity: Insights from A Mixed-Methods Study within A Trial

Engaging women with obesity in health-related studies during preconception is challenging. Limited data exists relating to their participation. The aim of this study is to explore the experiences and opinions of women participating in a weight-related, preconception trial. This is an explanatory sequential (quan-QUAL) mixed-methods Study Within A Trial, embedded in the GetGutsy randomized controlled trial (ISRCTN11295995). Screened participants completed an online survey of eight questions (single or multiple choice and Likert scale) on recruitment, motivations and opinions on study activities. Participants with abdominal obesity (waist circumference ≥ 80 cm) were invited to a subsequent semi-structured, online focus group (n = 2, 9 participants) that was transcribed and analyzed using inductive thematic analysis, with a pragmatic epistemological approach. The survey (n = 102) showed the main research participation motivations were supporting health research (n = 38, 37.3%) and wanting health screening (n = 30, 29.4%). Most participants were recruited via email (n = 35, 34.7%) or social media (n = 15, 14.7%). In the FGs, participants valued flexibility, convenience and. research methods that aligned with their lifestyles. Participants had an expanded view of health that considered emotional well-being and balance alongside more traditional medical assessments. Clinical trialists should consider well-being, addressing the interconnectedness of health and incorporate a variety of research activities to engage women of reproductive age with obesity.

Motivation and Limiting Factors for Adherence to Weight Loss Interventions among Patients with Obesity in Primary Care

The cornerstones of obesity management are diet, physical activity and behavioral change. However, there is considerable scientific evidence that lifestyle interventions to treat obesity are rarely implemented in primary care. The aim of this study is to analyze motivation to lose weight among patients with obesity, the resources implemented by primary care centers to promote behavioral change and the limiting factors reported by the patients themselves when attempting to lose weight. A total of 209 patients diagnosed with obesity were interviewed. The variables were obtained from both electronic clinical records (sex, age, BMI, diagnosis of metabolic syndrome and records of activities prescribed to promote behavioral change) and a self-administered personal questionnaire. A total of 67.5% of the respondents reported not having sufficient motivation to adhere to a weight loss program. Records of behavioral change activities were identified in only 3% of the clinical records reviewed. The barriers to adherence to diet and exercise plans most frequently mentioned by patients were not having a prescribed diet (27.8%), joint pain (17.7%), getting tired or bored of dieting (14.8%) and laziness (11.5%). Both the high percentage of patients reporting insufficient motivation to lose weight and the barriers to weight loss identified suggest that patients feel the need to improve their motivation, which should be promoted through primary care.