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Pearce C, Rychetnik L, Wutzke S, Wilson A. Obesity prevention and the role of hospital and community-based health services: a scoping review. BMC Health Serv Res 2019; 19:453. [PMID: 31277640 PMCID: PMC6612151 DOI: 10.1186/s12913-019-4262-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 06/14/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Control of obesity is an important priority to reduce the burden of chronic disease. Clinical guidelines focus on the role of primary healthcare in obesity prevention. The purpose of this scoping review is to examine what the published literature indicates about the role of hospital and community based health services in adult obesity prevention in order to map the evidence and identify gaps in existing research. METHODS Databases were searched for articles published in English between 2006 and 2016 and screened against inclusion and exclusion criteria. Further papers were highlighted through a manual search of the reference lists. Included papers evaluated interventions aimed at preventing overweight and obesity in adults that were implemented within and/or by hospital and community health services; were an empirical description of obesity prevention within a health setting or reported health staff perceptions of obesity and obesity prevention. RESULTS The evidence supports screening for obesity of all healthcare patients, combined with referral to appropriate intervention services but indicates that health professionals do not typically adopt this practice. As well as practical issues such as time and resourcing, implementation is impacted by health professionals' views about the causes of obesity and doubts about the benefits of the health sector intervening once someone is already obese. As well as lacking confidence or knowledge about how to integrate prevention into clinical care, health professional judgements about who might benefit from prevention and negative views about effectiveness of prevention hinder the implementation of practice guidelines. This is compounded by an often prevailing view that preventing obesity is a matter of personal responsibility and choice. CONCLUSIONS This review highlights that whilst a population health approach is important to address the complexity of obesity, it is important that the remit of health services is extended beyond medical treatment to incorporate obesity prevention through screening and referral. Further research into the role of health services in obesity prevention should take a systems approach to examine how health service structures, policy and practice interrelationships, and service delivery boundaries, processes and perspectives impact on changing models of care.
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Affiliation(s)
- Claire Pearce
- The Australian Prevention Partnership Centre, Sydney, NSW Australia
- Menzies Centre for Health Policy, University of Sydney, Sydney, NSW Australia
- Canberra Health Services, Canberra, ACT Australia
| | - Lucie Rychetnik
- The Australian Prevention Partnership Centre, Sydney, NSW Australia
- Menzies Centre for Health Policy, University of Sydney, Sydney, NSW Australia
- School of Medicine, University of Notre Dame, Sydney, Australia
| | - Sonia Wutzke
- The Australian Prevention Partnership Centre, Sydney, NSW Australia
| | - Andrew Wilson
- The Australian Prevention Partnership Centre, Sydney, NSW Australia
- Menzies Centre for Health Policy, University of Sydney, Sydney, NSW Australia
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Grabovac I, Smith L, Stefanac S, Haider S, Cao C, Waldhoer T, Jackson SE, Yang L. Health Care Providers' Advice on Lifestyle Modification in the US Population: Results from the NHANES 2011-2016. Am J Med 2019; 132:489-497.e1. [PMID: 30521796 DOI: 10.1016/j.amjmed.2018.11.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 11/09/2018] [Accepted: 11/09/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Health care providers are encouraged to prescribe lifestyle modifications for preventing and managing obesity and associated chronic conditions. However, the pattern of lifestyle advice provision is unknown. We investigate the prevalence of advised lifestyle modification according to weight status and chronic conditions in a US nationally representative sample. METHODS Adults ages 20-64years (n = 11,467) from the National Health and Nutrition Examination Survey between 2011 and 2016 were analyzed, with weight status and chronic conditions (high blood pressure, high blood cholesterol, osteoarthritis, coronary heart disease, and type 2 diabetes mellitus). Lifestyle modification advice by health care providers included: increase physical activity/exercise, reduce dietary fat/calories, control/lose weight, and all of the above. RESULTS High blood pressure (32.7%) and cholesterol (29.3%) were highly prevalent compared with osteoarthritis (7.4%), type 2 diabetes (5.7%), and coronary heart disease (3.7%). Those with type 2 diabetes received considerably more frequent advice (56.5%; 95% confidence interval [CI], 52.4%-60.6%) than those with high blood pressure (31.4%; 95% CI, 29.3%-33.6%) and cholesterol (27.0%; 95% CI, 24.9%-29.3%). Prevalence of lifestyle advice exhibited substantial increases with graded body mass index and comorbidity (all P < .001). After adjusting for comorbid conditions, advice was more commonly reported among women, those overweight/obese, nonwhite, or insured. A remarkably low proportion of overweight (21.4; 95% CI, 18.7%-24.3%) and obese (44.2%; 95% CI, 41.0%-47.4%) adults free of chronic conditions reported receiving any lifestyle advice. CONCLUSIONS Prevalence of lifestyle modification advised by health care providers is generally low among US adults with chronic conditions, and worryingly low among those without chronic conditions, however overweight or obese. Prescribed lifestyle modification is a missing opportunity in implementing sustainable strategies to reduce chronic condition burden.
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Affiliation(s)
- Igor Grabovac
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Austria
| | - Lee Smith
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Compass House, Cambridge, UK
| | - Sinisa Stefanac
- Institute of Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria; Ludwig Boltzmann Cluster Arthritis and Rehabilitation, Vienna, Austria.
| | - Sandra Haider
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Austria
| | - Chao Cao
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, StLouis, Mo
| | - Thomas Waldhoer
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Austria
| | - Sarah E Jackson
- Department of Behavioral Science and Health, University College London, UK
| | - Lin Yang
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Austria; Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Holy Cross Centre, Calgary, Alberta, Canada; Preventive Oncology & Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
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Tang JW, Allen N, de Chavez P, Goff DC, Kiefe CI, Lewis CE, Carnethon M. Health-care access and weight change among young adults: the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Public Health Nutr 2013; 16:1796-800. [PMID: 22894769 PMCID: PMC3574627 DOI: 10.1017/s1368980012003813] [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: 10/07/2011] [Revised: 06/03/2012] [Accepted: 07/12/2012] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Health-care access is associated with improved control of multiple chronic diseases, but the association between health-care access and weight change is unclear. The present study aims to test the association between health-care access and weight change. DESIGN The Coronary Artery Risk Development in Young Adults (CARDIA) Study is a multicentre population-based prospective study. Weight change was calculated at 3 and 13 years after CARDIA year 7 (1992-1993). Health-care access was defined as no barriers or one or more barriers to access (health insurance gap, no usual source of care, not seeking care due to expense). Intermediary variables evaluated included history of dieting and use of diet pills, meal replacements or weight-control programmes. SETTING Four cities in the USA. SUBJECTS Participants were aged 18-30 years at baseline (1985-1986). Analyses include 3922 black and white men and women with relevant data from CARDIA years 7, 10 and 20 (1992-1993, 1995-1996 and 2005-2006, respectively). RESULTS Mean weight change was +2.22 kg (+4.9 lb) by 3 years and +8.48 kg (+18.7 lb) by 13 years, with no differences by health-care access. Being on a weight-reducing diet was not consistently associated with health-care access across examinations. Use of diet pills, meal replacements or organized weight-control programmes was low, and did not vary by health-care access. CONCLUSIONS Weight gain was high irrespective of health-care access. Public health and clinical approaches are needed to address weight gain.
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Affiliation(s)
- Joyce W Tang
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
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McIlfatrick S, Keeney S, McKenna H, McCarley N, McElwee G. Investigating the role of the general practitioner in cancer prevention: a mixed methods study. BMC FAMILY PRACTICE 2013; 14:58. [PMID: 23651706 PMCID: PMC3653692 DOI: 10.1186/1471-2296-14-58] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 04/24/2013] [Indexed: 01/14/2023]
Abstract
BACKGROUND Despite evidence of the effectiveness of cancer preventive services and the increasing development of guidelines, actual rates of delivery of cancer prevention activities remain low. Due to their frequent front-line contact with the public, family physicians (GPs) have the potential to play an important role in the primary prevention of cancer. However, there is a lack of information about their actual role in cancer prevention. The aim of this study was to investigate the actual and potential roles of general practitioners (GP) in the prevention of cancer. METHODS A sequential exploratory mixed methods approach was used. The sample included all the General Practice (GP) practices in a region in the UK (n=345). Postal questionnaires were administered to GPs (n=1249); following 290 returns (response rate 23%), semi-structured interviews were undertaken with GPs (n=14). RESULTS The majority of the GP respondents (66.4%, n=184) considered that they routinely provided cancer prevention information. This was specifically focusing on smoking cessation as almost all GPs (96.8%, n=270) enquired about a patient's smoking status. Overall, 47.2% (n=128) of GP respondents indicated that they felt they did not have time to perform a cancer prevention role; however, 88.3% (n=242) still felt that they had the 'opportunity' to do so. Over half the sample (61.3%, n=168) indicated that imposed health priorities and targets militated against providing cancer prevention activities. Almost all the GP respondents (98.9%, n=273) agreed with empowering individuals to take responsibility for their health issues. The GPs identified the need for alternative models for cancer prevention beyond current face to face patient care, including other health and non-health professionals. Whilst lack of time was identified as a critical factor, the GPs indicated that significant efforts were made to encourage patients to take personal responsibility for lifestyle choices. CONCLUSIONS The GPs indicated a need for training around behavioural change and theories of motivation and action. This has implications for primary care and family physicians worldwide. While doctor-patient consultations and the physicians' credibility offer great potential for cancer prevention, time pressures and imposed government targets often mean that their actual cancer prevention role is reduced.
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Affiliation(s)
- Sonja McIlfatrick
- Institute of Nursing and Health Research, University of Ulster, Newtownabbey, N. Ireland, UK.
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Allen PJ, Batra P, Geiger BM, Wommack T, Gilhooly C, Pothos EN. Rationale and consequences of reclassifying obesity as an addictive disorder: neurobiology, food environment and social policy perspectives. Physiol Behav 2012; 107:126-37. [PMID: 22583861 DOI: 10.1016/j.physbeh.2012.05.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 04/02/2012] [Accepted: 05/06/2012] [Indexed: 01/13/2023]
Abstract
The rapid increase in the prevalence of obesity is a priority for investigators from across numerous disciplines, including biology, nutritional science, and public health and policy. In this paper, we systematically examine the premise that common dietary obesity is an addictive disorder, based on the criteria for addiction described in the Diagnostic and Statistical Manual (DSM) of Mental Disorders of the American Psychiatric Association, version IV, and consider the consequences of such a reclassification of obesity for public policy. Specifically, we discuss evidence from both human and animal studies investigating the effects of various types and amounts of food and the food environment in obese individuals. Neurobiological studies have shown that the hedonic brain pathways activated by palatable food overlap considerably with those activated by drugs of abuse and suffer significant deficits after chronic exposure to high-energy diets. Furthermore, food as a stimulus can induce the sensitization, compulsion and relapse patterns observed in individuals who are addicted to illicit drugs. The current food environment encourages these addictive-like behaviors where increased exposure through advertisements, proximity and increased portion sizes are routine. Taking lessons from the tobacco experience, it is clear that reclassifying common dietary obesity as an addictive disorder would necessitate policy changes (e.g., regulatory efforts, economic strategies, and educational approaches). These policies could be instrumental in addressing the obesity epidemic, by encouraging the food industry and the political leadership to collaborate with the scientific and medical community in establishing new and more effective therapeutic approaches.
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Affiliation(s)
- Patricia J Allen
- Department of Psychology, Tufts University, Medford, MA 02155, USA
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Nguyen HT, Markides KS, Winkleby MA. Physician advice on exercise and diet in a U.S. sample of obese Mexican-American adults. Am J Health Promot 2011; 25:402-9. [PMID: 21721967 DOI: 10.4278/ajhp.090918-quan-305] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE To document the prevalence of obese Mexican-Americans never advised by health professionals regarding exercise and diet, and to determine risk factors for no advice. METHODS Data came from 1787 obese Mexican-American adults (body mass index ≥30; age ≥18 years) in the Medical Expenditure Panel Survey. The survey included self-reported receipt of health care provider advice on exercise and diet as well as sociodemographic, health-related, and provider-related factors. Multivariable logistic regression models were performed separately for advice regarding exercise and advice regarding diet. RESULTS Overall, 45% of respondents reported that they had never received advice from a doctor or health care professional to exercise more, and 52% reported that they have received advice to eat fewer higher-fat/high-cholesterol foods. Men, nonmarried respondents, lower-educated respondents, those who preferred to speak Spanish at home, and those without comorbid chronic conditions were less likely to receive advice. DISCUSSION Results suggest that obese Mexican-Americans are insufficiently advised by health care providers regarding exercise and diet. Given the seriousness of obesity-related health risks and the increasing prevalence of overweight status and obesity among Mexican-Americans, it is vital that providers are involved in finding ways to effectively educate and/or treat overweight patients.
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Affiliation(s)
- Ha T Nguyen
- Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1084, USA.
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Tang JW, Kushner RF, Thompson J, Baker DW. Physician counseling of young adults with rapid weight gain: a retrospective cohort study. BMC FAMILY PRACTICE 2010; 11:31. [PMID: 20433703 PMCID: PMC2874787 DOI: 10.1186/1471-2296-11-31] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Accepted: 04/30/2010] [Indexed: 11/10/2022]
Abstract
BACKGROUND The incidence of weight gain is highest during young adulthood. Our study aims to describe weight gain patterns among young adults and to evaluate physician recognition of and counseling for rapid weight gain. METHODS This retrospective cohort study included patients ages 18-35 at an academic internal medicine clinic between 2004-2008. We conducted chart reviews to determine weight change over time, whether weight gain greater than 3 lbs/year was documented, whether counseling was provided, and whether patients became overweight. We categorized weight gain documentation by location on the problem list, encounter diagnosis, or note text. We categorized counseling as weight-specific or general diet and exercise counseling. We used Chi-square tests to evaluate the relationship between weight change over time and the following variables: gender, diagnosis of weight gain, and counseling for weight gain. Fisher's Exact test was used to test for an association between diagnosis and counseling category. RESULTS The study included 365 patients. Weight gain was greater than 3 lbs/year for 24% (90/365) of patients, of whom 56 (15%) gained 3-5.9 lbs/year, and 34 (9%) gained more than 6 lbs/year. Among patients gaining more than 3 lbs/year, physicians documented weight gain as a problem in only 10% (9/90). Of the 9 patients for whom weight gain was documented, physicians provided weight-specific counseling in three, and general diet and exercise counseling in four. Of the 81 individuals with no documented diagnosis of weight gain, 63% had no documented counseling, but 34% received general diet and exercise counseling. Among patients with over 180 days of follow-up, 8% (10/126) became overweight. CONCLUSIONS Physicians infrequently recognize or counsel for weight gain among young adult patients. Improving identification of patients with rapid weight gain can provide an opportunity for tailored weight-related counseling.
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Affiliation(s)
- Joyce W Tang
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA.
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Anjomshoaa I, Cooper ME, Vieira AR. Caries is Associated with Asthma and Epilepsy. Eur J Dent 2009; 3:297-303. [PMID: 19826602 PMCID: PMC2761161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES There is evidence of association between systemic diseases and oral conditions, although it is not clear if these are direct or mediated by underlying factors such as health behaviors. The aim of this work was to evaluate whether self-reported systemic diseases were associated with caries experience. METHODS Medical history data and caries experience (DMFT and DMFS; Decayed, Missing due to caries, Filled Teeth/Surface) were obtained from the University of Pittsburgh School of Dental Medicine Dental Registry and DNA Repository. Information on 318 subjects (175 females and 143 males) was evaluated. Regression analysis was used to test for association between caries experience and disease status. RESULTS The stronger associations were found between caries experience and asthma and epilepsy. With respect to asthma, DMFT above 15 (R(2) = 0.04) and DMFS above 50 (R(2) = 0.02) were associated. After controlling for gender differences in asthma, the associations remained strong (R(2) = 0.05 for both DMFT and DMFS). For epilepsy, DMFT above 15 (R(2) = 0.18) and DMFS above 50 (R(2) = 0.14) were associated. CONCLUSIONS Asthma and epilepsy are associated with higher caries experience.
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Affiliation(s)
- Ida Anjomshoaa
- Department of Oral Biology, School of Dental Medicine, University of Pittsburgh, PA, USA
| | - Margaret E. Cooper
- Department of Oral Biology, Center for Craniofacial and Dental Genetics, School of Dental Medicine, University of Pittsburgh, PA, USA
| | - Alexandre R. Vieira
- Department of Oral Biology, School of Dental Medicine, University of Pittsburgh, PA, USA,Corresponding author: Alexandre R. Vieira, 614 Salk Hall, Department of Oral Biology, School of Dental Medicine, University of Pittsburgh, 3501 Terrace Street, Pittsburgh, 15261, PA, USA., Phone: (412) 383-8972, Fax: (412) 624-3080, E-mail:
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Affiliation(s)
- Dariush Mozaffarian
- Division of Cardiovascular Medicine and Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. dmozaff
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