The effectiveness of social-support-based weight-loss interventions-a systematic review and meta-analysis.

OBJECTIVE: This systematic review and meta-analysis examined the effectiveness of social-support-based weight-loss interventions in adult populations with excess weight or obesity. METHODS: We performed a systematic review of randomized controlled trials that reported on the effectiveness of weight-loss interventions which incorporated a social connectedness component. To this end, we conducted a rigorous database search of MEDLINE, Embase, PsycINFO, CINAHL, Cochrane, and PubMed for relevant articles. The quality of eligible trials was evaluated by the Cochrane Risk-of-Bias2 tool. Five meta-analyses on intervention effectiveness in terms of weight loss were executed at 2-4-month assessment, 6-month assessment, end of intervention, and 3- and 6-month follow-up. RESULTS: Twenty-four trials involving couples or peers targeting weight loss in 4 919 adults with BMI ≥ 25 met inclusion criteria. Meta-analyses detected no significant effect of social-support-based weight-loss interventions at either 2-4 month or 6-month assessment. There were, however, significant effects at end of intervention [95% CI 0.39, p = 0.04] and at 3-month [95% CI 0.63, p < 0.01] and 6-month [95% CI 0.34, p = 0.05] follow-up. CONCLUSIONS: There seem to be a significant effect at the end of intervention and 3- and 6-month follow-up. However, further high-quality studies are needed before drawing any clear conclusions. TRIAL REGISTRATION: PROSPERO 2020 CRD42020173696.

Five Vital Components in an Occupational Therapy-Based Municipal Weight Loss Program Obtained Through Research Circles.

Introduction: Currently 1.9 billion adults worldwide are estimated to be overweight or obese. Weight loss sustainability is difficult, and weight loss rehabilitation programs have been criticised for having an individualistic approach. It has been suggested that occupational therapists could be used as part of a transdisciplinary approach because of their holistic perspective. During the development of an occupational therapy- based weight loss program five components arose as essential from earlier interviews with health professionals and citizens with obesity: diet, physical activities, social relations, habits and balancing everyday life. Before developing the program, we needed a clearer picture of which strategies should support the five components. The aim of this study was to obtain a description of strategies related to the five components that could support weight loss to become part of everyday life of people with obesity. Methods: This study took a participatory design by using research circle (RC) methodology. Two RC groups were created, one with occupational therapists and one with citizens with obesity. Researchers participated in both RC groups. Data was obtained through democratic principles. The two RC groups met four times over a period of 4 months. Qualitative content analysis was conducted. Results: Five themes arose: (1) Diet-Find the line between either-or, (2) Physical activity-Break the comfort zone, (3) Social relations-Stand strong together, (4) Habits-Focus on possibilities instead of bad habits, and (5) Balancing everyday life-Handling life's bumps. Conclusion: The strategies for a weight loss program including the five components should include awareness of senses and activity patterns surrounding meals, taking one step at a time when focusing of physical activities and be conscious of values, include family and friends in the program to find common ground and self-confidence and use re-placement activities. We suggest that the component of balancing everyday life should be seen as an overall component as all strategies are related to finding meaning and variation in activities which is part of an ongoing weight loss process.

What a weight loss programme should contain if people with obesity were asked - a qualitative analysis within the DO:IT study.

BACKGROUND: Currently 1.9 billion adults worldwide are estimated to be overweight or obese. In Denmark the municipalities hold the responsibility to deliver weight loss programmes to overweight and obese citizens. There is a tendency to assume that weight loss programmes that show positive effects in specialized hospital settings are directly transferrable to municipal settings. However, municipality-based weight loss programmes have not produced clinically significant reductions in body weight. One reason for this may be that much research evidence regarding obesity programming neglects the perspectives of people with obesity. The first step in developing a weight loss programme designed for municipal settings is to understand what people with obesity want and need from a programme. The aim of this study was to examine what people with obesity find important in a weight loss programme for weight loss and weight maintenance. METHODS: We used a qualitative, explorative, descriptive design with individual interviews. We included men and women age 17 and older with a BMI ≥ 25 kg/m2. Participants were recruited from the wait lists of 13 municipality programmes and through Facebook posts. Data were analyzed using content analysis. RESULTS: Thirty-four participants with overweight or obesity were individually interviewed (ages between 19 and 74). Findings suggest that weight loss programmes should; a) support participants in structuring days; b) consider the use of replacement activities to reduce cognitive and emotional burden; c) aide individuals to increase self-efficacy and; d) include family and friends as well as health professionals and peers in the weight loss process. Diet and exercise, while important, should be balanced with other meaningful activities in everyday life. CONCLUSION: Participants in this study wished to balance weight loss related activities with overall everyday life as well as finding the believe in their ability to lose weight in social relations.

Clinical utility of the Danish version of the Canadian Occupational Performance Measure.

BACKGROUND: The Canadian Occupational Performance Measure (COPM) is intended to help clients identify and evaluate their occupational performance issues. As it enhances client-centred practice (CCP), more frequent use of the COPM might fulfill the political agenda of patient involvement in Denmark. However, in a study translating the COPM into Danish, challenges were found highlighting the need to study its clinical utility. AIM: To examine the clinical utility of the Danish version of the COPM (COPM-DK) and help determine whether to recommend a more routinely use. METHODS: Data gathered during qualitative interviews with 16 occupational therapists (OTs) from various settings were subjected to a qualitative content analysis. RESULTS: The COPM-DK appeared to have clinical utility, especially regarding the meaning and relevance of the information obtained, and seemed to facilitate an occupational lens and CCP. The OTs' difficulties and concerns when using the COPM and their personal and environmental commitment to the COPM seemed associated with how they performed the COPM. Thus, training was recommended to facilitate a valid and reliable use. CONCLUSION: Given the benefits and the perceived utility of the COPM-DK, a more routinely use, to place OTs and CCP in the center of Danish healthcare system, is recommended.Key MessagesThe utility of the Danish version of the Canadian Occupational Performance Measure is supported, according to Danish occupational therapists in various rehabilitation settings and hospitals.Using the Canadian Occupational Performance Measure seems to enhance a client-centred practice with collaborative goals and helps to establish partnership, being of value to the interdisciplinary team, too.The utility and acceptability of the Canadian Occupational Performance Measure seemed to be linked to the occupational therapists' experience and understanding of the Canadian Occupational Performance Measure's content and form, thus an introduction course is recommended to avoid a use that affects the assessment's validity and reliability.

Obesity treatment: a role for occupational therapists?

BACKGROUND: Half of the Danish population is overweight or obese. Obesity can negatively impact health and daily life. The Danish National Board of Health´s guidelines for weight loss programmes to the Danish municipalities, recommends multidisciplinary teams, including occupational therapy, and interventions targeting diet, exercise, psychosocial coping, and everyday life. AIM: To describe the structure and content of obesity programmes offered by the 98 municipalities in Denmark, including details such as the health professionals, programme recipients, dose, structure, content, and the role of occupational therapists. METHOD: A quantitative content analysis was conducted on 234 published Danish municipal weight loss programmes. Programme descriptions were identified through internet searches using both sundhed.dk and Google.com. RESULTS: Various health professionals conducted the programmes, and five involved occupational therapists. Programmes targeted children, adolescent and adults. Dose, structure and content were heterogeneous. CONCLUSION: The majority of the programmes were neither evidence-based, nor did they follow recommendations from Danish National Board of Health. Few programmes addressed the role of habits or social participation. Occupational therapists appear to be under-utilized as providers of the programmes. SIGNIFICANCE: Occupational therapists have a role to play in weight loss programmes, because of their training in activity analysis and their consideration of people, environments, and occupations. These components are included in the recommendations about psychosocial aspects and everyday life from the Danish National Board of Health.

The motivation and opportunities for weight loss related to the everyday life of people with obesity: A qualitative analysis within the DO:IT study.

BACKGROUND: Unsuccessful weight loss or weight loss maintenance is due to different barriers and physical limitations related to participation in everyday life. It will, therefore, be relevant to investigate the field from an occupational therapy perspective, since occupational therapists are uniquely trained in focussing on people's resources, meaningfulness and participation in everyday life. AIM: The aim was to explore what motivates people to lose weight from an OT perspective and which opportunities people with obesity experience in their everyday lives to achieve and maintain lost weight. MATERIAL AND METHODS: A descriptive phenomenological study including 21 semi-structured individual interviews was conducted as part of the DO:IT study. RESULTS: The data analysis led to the identification of three main themes: The influence of external circumstances on the desire for weight loss; use of time in everyday life; and changes in habits, routines and structure. CONCLUSION: People who are overweight or obese are motivated to lose weight because of health issues and feeling more comfortable with their body. The opportunities for weight loss lie in creating habits, routines and structuring everyday life activities to facilitate a healthier lifestyle. SIGNIFICANCE: The findings indicate that an occupational therapist should be part of weight-loss interventions.

Health professionals' perceptions of weight loss programmes and recommendations for future implementation: a qualitative study.

OBJECTIVE: Obesity is an increasing public health challenge and most weight loss programmes are still inadequate to support sustainable weight loss. One reason for the continued lack of success might be the dominant biomedical, individualised approach to weight loss. Holistic approaches that focus on overall health and well-being in addition to weight loss are increasingly recommended. In Denmark, health professionals in the municipalities are responsible for developing and conducting weight loss programmes. The objective of this study was to explore what health professional's perceived as an ideal, holistic weight loss programme that could be feasibly implemented in the municipalities. DESIGN: A phenomenological-hermeneutical qualitative study was performed using semistructured interviews. SETTING: Thirty-two Danish municipalities were weight loss programmes are developed and conducted. PARTICIPANTS: Thirty-five health professionals with experience conducting weight loss programmes. RESULTS: Three themes emerged from the analysis: Support from the social network are important both during and after a weight loss, Changing the self-belief by positive discussions and doing activities, Maintaining changes through daily life. CONCLUSION: Future municipal weight loss programmes should emphasise overall health and well-being instead of weight loss and adopt a holistic approach including a focus on social relationships, meaningful activities and successes as part of a balanced daily life.

Why people engage in a weight loss intervention at their workplace - a stratified case study.

BACKGROUND: The prevalence of obesity has increased significantly worldwide within the last decade. As obesity is recognised as a contributing factor when developing various health threatening chronic diseases, prevention initiatives focusing on weight loss are becoming more important. Because of the time spent at the workplace, workplaces can be optimal arenas for weight loss programs and these programs have been effective to decrease body weight. Thus, reasons for engaging in weight loss interventions needs exploring, in order to engage more workplaces in weight loss interventions. Such information provides important knowledge that may help to inform decisions of municipalities, employers and other public health decision makers, when and if implementing weight loss interventions. The aim of this study was therefore to explore reasons for employee engagement in weight loss projects at the workplace and the incentives a municipality, a manager at a home-care centre, and a project manager have to launch such project. METHODS: A stratified case study was conducted. A representative from the municipality, the manager at a home-care centre, the project manager of the weight loss intervention and six health-care workers were interviewed at the end of a one-year weight loss intervention at the workplace. Data were analysed using Systematic Text Condensation. RESULTS: Analysis identified different views and considerations for engaging in a weight loss intervention at the workplace. For the representative of the municipality the possible economical gain of the project was in focus. The project manager and the manager of the home-care centre both reflected mainly on improvement of the healthcare workers health. For the project manager, achieving good scientific results was highlighted as well. However, the employees were influenced by several factors, such as their own health and weight loss, the pressure from the environment and their struggle for recognition. CONCLUSIONS: This study concluded that if targeting the increasing worldwide obesity problem through workplace initiated weight loss programs, the sales pitch to managements and employers have to be tailored in order to increase the participation and the motivation for the initiative. TRIAL REGISTRATION: ClinicalTrial.gov : NCT01015716 , registration data 14.12.2010 (Prospectively registered).

Scandinavian women's experiences with abortions on request: a systematic review.

REVIEW QUESTION/OBJECTIVE: The objective of the review was to explore the experiences of Scandinavian women with abortions on request, that is, before, during and after the intervention. INTRODUCTION: In Scandinavia, the primary issues surrounding the abortion debate to date have been women's legal rights to an abortion, and, to a lesser extent, how women experience an abortion on request and how society could and should support them. This systematic review investigated Scandinavian women's experiences in relation to this intervention. INCLUSION CRITERIA: The current review included all studies that focused on adult women (aged 15 and over) living in Scandinavia (Denmark, Sweden and Norway) who have experienced an abortion on request (a medically or surgically induced abortion without a medical indication for the mother or child, described here as an "abortion on request"). The phenomena of interest were Scandinavian women's experiences in relation to an abortion on request, that is, before, during and after the intervention, and self-reported psychosocial or psychological health consequences following the abortion. This systematic review focused on Scandinavian hospital or clinical environments where authorized medical personnel performed abortions on request. This review considered studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research. METHODS: A three-step search strategy was used to identify published and unpublished studies from 1973 to June 2016. The comprehensive literature search identified nine studies that met the inclusion criteria. These nine studies were assessed by two independent reviewers using the standardized critical appraisal instruments from the Joanna Briggs Institute (JBI). Six of these studies were deemed to be of sufficient methodological quality for inclusion in this systematic review. Data were extracted from the six included studies using the standardized data extraction tool from JBI. A total of 24 qualitative research findings were pooled using JBI methodology. RESULTS: A total of six studies met the inclusion criteria, with a total of 80 participants. Twenty-four research findings were extracted and grouped into six categories that were synthesized into three synthesized findings: 1) Experiences in connection with the decision-making process; 2) Experiences in connection with the procedure; and 3) Experiences after abortion. The vast majority of participants were aged 15 to 24 years at the time of the abortion. Conclusions and recommendations for practice apply to Scandinavian women within this age group. CONCLUSIONS: This systematic review indicates that young Scandinavians consider it a woman's responsibility to obtain and use contraceptives and that young women seeking an abortion on request have little knowledge of their own bodies with respect to fertility and their menstrual cycles. Young Scandinavian women between the ages of 15 and 24 years seeking an abortion on request experience conflicted feelings. They feel both joy and shame about their pregnancies and, during the decision-making process, are torn between the possibility of motherhood and the reasonable and expected choice of abortion that is supported by their parents and friends. The majority of women experience worse-than-expected pain and discomfort in connection with the abortion procedure. The approach of healthcare staff to women's physical needs is described as good and professional, but there is little or no focus on the women's emotional and existential needs. After abortions on request, young women express ambivalence: relief that the pregnancy has been terminated, coupled with a feeling of loss. Some suffer from guilt and some express regret.

The influence of occupation on wellbeing, as experienced by the elderly: a systematic review.

OBJECTIVE: The objective of this review was to synthesize knowledge regarding which types of occupations the elderly perceive as important to and supporting their overall wellbeing. INTRODUCTION: Being active is an important part of managing the daily challenges of advanced old age. Occupational therapy and occupational science are based on the premise that a person's occupations are intertwined with their health and are thus needed for them to experience a meaningful life and improve their wellbeing. INCLUSION CRITERIA: This review, which included independently living elderly people aged 65 and over living in Europe, the USA, Canada and Australia, sought to uncover if the elderly see any specific types of occupations as enhancing their wellbeing. This review included qualitative studies with designs including, but not limited to, phenomenology, grounded theory, ethnography and action research. METHODS: A three-step search strategy using Joanna Briggs Institute methodology was utilized. Both published and unpublished studies were searched. The following databases were searched for studies up to 2017: CINAHL, Nursing and Allied Health Source, Web of Science, PubMed and OpenGrey. Using the JBI Critical Appraisal Checklist for Qualitative Research, two independent reviewers assessed whether each study had the methodological quality required to be included in the review. Any disagreements were resolved through discussion with a third reviewer. The standardized JBI data extraction tool for interpretive and critical research was used to extract data from the included studies. JBI tools were used to pool the qualitative research findings. The findings were then aggregated through a process of rating according to quality, and categorized according to similarity in meaning, which generated a set of statements for each category. These categories were then subjected to a meta-synthesis to produce a single comprehensive set of synthesized findings useful as a basis for evidence-based practice. RESULTS: All three of the included studies utilized qualitative interviews and followed a phenomenological approach. The studies included only participants aged 85 and over. Thirty-five findings were extracted and grouped into four categories, which were synthesized into two meta-syntheses: 1) The importance of "doing" alone - to feel good, I have to be the master of my own life; and 2) Old habits never die - a structured day is a good day. Based on the dependability and credibility of the three studies, the ranking was high (see Summary of Findings). CONCLUSIONS: The present review shows that two factors enhance elderly people's wellbeing: first, variation and independence in undertaking activities; second, having a choice between the occupations and a structure of activities that make up daily life. The two factors are influenced by a balance between having activities alone and with others. This review is not intended to identify specific occupations that enhance elderly people's wellbeing, but rather to indicate which types of occupations enhance the wellbeing of the elderly, and provide value and meaning to their daily lives.Both the dependability and the credibility of the studies have been rated as moderate.