Mental illness as a predictor of patient attendance and anthropometric changes: observations from an Australian publicly funded obesity management service.

OBJECTIVE: Obesity is associated with co-morbid mental illness. The Canberra Obesity Management Service (OMS) supports adults with severe obesity who have the psychosocial capacity to engage. This study will determine whether mental illness is a predictor of OMS attendance and anthropometric changes. METHOD: A retrospective audit was performed from July 2016 to June 2017. Baseline characteristics, attendance and anthropometrics were stratified according to the presence of mental illness. Outcomes included weight stabilisation and clinically significant weight loss. Descriptive analyses were performed. RESULTS: Mental illness was present in 60/162 patients (37%). Attendance was similar for those with and without mental illness. Patients with mental illness had twice as many co-morbidities (p = .001). Depressive disorders were most common (n = 28, 47%). Anxiety, schizophrenia spectrum and other psychotic disorders, and trauma- and stressor-related disorders also featured. Weight stabilisation was achieved by 25 patients (66%) with mental illness and 25 (35%) without. Clinically significant weight loss was observed in 10 patients (26%) with and 26 (40%) without mental illness. CONCLUSION: The presence of mental illness did not impact OMS attendance or weight stabilisation. The higher rate of co-morbidities in those with mental illness highlights the challenges faced by this vulnerable population.

A predictive model for non-completion of an intensive specialist obesity service in a public hospital: a case-control study.

BACKGROUND: Despite the growing evidence base supporting intensive lifestyle and medical treatments for severe obesity, patient engagement in specialist obesity services is difficult to achieve and poorly understood. To address this knowledge gap, we aimed to develop a model for predicting non-completion of a specialist multidisciplinary service for clinically severe obesity, termed the Metabolic Rehabilitation Programme (MRP). METHOD: Using a case-control study design in a public hospital setting, we extracted data from medical records for all eligible patients with a body mass index (BMI) of ≥35 kg/m2 with either type 2 diabetes or fatty liver disease referred to the MRP from 2010 through 2015. Non-completion status (case definition) was coded for patients whom started but dropped-out of the MRP within 12 months. Using multivariable logistic regression, we tested the following baseline predictors hypothesised in previous research: age, gender, BMI, waist circumference, residential distance from the clinic, blood pressure, obstructive sleep apnoea (OSA), current continuous positive airway pressure (CPAP) therapy, current depression/anxiety, diabetes status, and medications. We used receiver operating characteristics and area under the curve to test the performance of models. RESULTS: Out of the 219 eligible patient records, 78 (35.6%) non-completion cases were identified. Significant differences between non-completers versus completers were: age (47.1 versus 54.5 years, p < 0.001); residential distance from the clinic (21.8 versus 17.1 km, p = 0.018); obstructive sleep apnoea (OSA) (42.9% versus 56.7%, p = 0.050) and CPAP therapy (11.7% versus 28.4%, p = 0.005). The probability of non-completion could be independently associated with age, residential distance, and either OSA or CPAP. There was no statistically significant difference in performance between the alternate models (69.5% versus 66.4%, p = 0.57). CONCLUSIONS: Non-completion of intensive specialist obesity management services is most common among younger patients, with fewer complex care needs, and those living further away from the clinic. Clinicians should be aware of these potential risk factors for dropping out early when managing outpatients with severe obesity, whereas policy makers might consider strategies for increasing access to specialist obesity management services.

Perceptions, Attitudes, and Barriers to Obesity Care in Mexico: Data From the ACTION-IO Study.

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.

Infancy and Childhood Obesity Grade Predicts Weight Loss in Adulthood: The ONTIME Study.

We examined the relationships between intergenerational obesity, weight and size at birth, and obesity from infancy to adolescence with weight loss in response to a dietary intervention. We studied 4264 participants (3369 women; mean age 41.5 ± 12.9 years) of the ONTIME study. Participants followed a weight-loss treatment based on a Mediterranean diet. Associations between grandparental and parental obesity grade, birth weight and size, and obesity grade in infancy, childhood and adolescence with total weight loss in response to treatment were assessed, using multivariate linear regression models. A lower weight loss (kg) in response to treatment was found among participants who were obese during infancy (beta coefficient -2.13 kg; 95% CI, -3.96, -0.30; p = 0.023). Furthermore, obesity during infancy and also during childhood was associated with a slower weekly rate of weight loss during treatment (p < 0.05). In conclusion, obesity in infancy and in childhood impairs the weight-loss response to dietary treatments in adulthood. Tackling obesity throughout early life may improve the effectiveness of weight-loss interventions in adulthood.

Impact of COVID-19 on Obesity Management Services in the United Kingdom (The COMS-UK study).

Coronavirus Disease-2019 (COVID-19) has had a severe impact on all aspects of global healthcare delivery. This study aimed to investigate the nationwide impact of the pandemic on obesity management services in the UK in a questionnaire-based survey conducted of professionals involved in the delivery. A total of 168 clinicians took the survey; the majority of which maintained their usual clinical roles and were not redeployed except physicians and nurse specialists. Nearly all (97.8%) elective bariatric surgery was cancelled, 67.3% of units cancelled all multidisciplinary meeting activity, and the majority reduced clinics (69.6%). Most respondents anticipated that the services would recommence within 1-3 months. This study found that the COVID-19 pandemic has had a severe impact on the services involved in the management of patients suffering from severe, complex obesity in the UK.

Difference in Insulin Resistance Assessment between European Union and Non-European Union Obesity Treatment Centers (ESPE Obesity Working Group Insulin Resistance Project).

INTRODUCTION: The obesity epidemic has become one of the most important public health issues of modern times. Impaired insulin sensitivity seems to be the cornerstone of multiple obesity related comorbidities. However, there is no accepted definition of impaired insulin sensitivity. OBJECTIVE: We hypothesize that assessment of insulin resistance differs between centers. METHODS: The ESPE Obesity Working Group (ESPE ObWG) Scientific Committee developed a questionnaire with a focus on the routine practices of assessment of hyperinsulinemia and insulin resistance, which was distributed through Google Docs platform to the clinicians and researchers from the current ESPE ObWG database (n = 73). Sixty-one complete responses (84% response rate) from clinicians and researchers were analyzed: 32 from European Union (EU) centers (representatives of 14 countries) and 29 from Non-EU centers (representatives from 10 countries). Standard statistics were used for the data analysis. RESULTS: The majority of respondents considered insulin resistance (IR) as a clinical tool (85.2%) rather than a research instrument. For the purpose of IR assessment EU specialists prefer analysis of the oral glucose tolerance test (OGTT) results, whereas non-EU ones mainly use Homeostatic Model Assessment of Insulin Resistance (HOMA-IR; p = 0.032). There was no exact cutoff for the HOMA-IR in either EU or non-EU centers. A variety of OGTT time points and substances measured per local protocol were reported. Clinicians normally analyzed blood glucose (88.52% of centers) and insulin (67.21%, mainly in EU centers, p = 0.0051). Furthermore, most participants (70.5%) considered OGTT insulin levels as a more sensitive parameter of IR than glucose. Meanwhile, approximately two-thirds (63.9%) of the centers did not use any cutoffs for the insulin response to the glucose load. CONCLUSIONS: Since there is no standard for the IR evaluation and uniform accepted indication of performing, an OGTT the assessment of insulin sensitivity varies between EU and non-EU centers. A widely accepted standardized protocol is needed to allow comparison between centers.

ACTION-IO as a platform to understand differences in perceptions, attitudes, and behaviors of people with obesity and physicians across countries - the Israeli experience.

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'.

Primary care patient and practitioner views of weight and weight-related discussion: a mixed-methods study.

OBJECTIVE: To understand the beliefs that primary care practitioners (PCPs) and patients with overweight and obesity have about obesity and primary care weight management in Scotland. SETTING: Seven National Health Service (NHS) Scotland primary care centres. PARTICIPANTS: A total of 305 patients and 14 PCPs (12 general practitioners; two practice nurses) participated. DESIGN AND METHODOLOGY: A cross-sectional mixed-methods study. PCPs and patients completed questionnaires assessing beliefs about obesity and primary care weight communication and management. Semi-structured interviews were conducted with PCPs to elaborate on questionnaire topics. Quantitative and qualitative data were synthesised to address study objectives. RESULTS: (1) Many patients with overweight and obesity did not accurately perceive their weight or risk of developing weight-related health issues; (2) PCPs and patients reported behavioural factors as the most important cause of obesity, and medical factors as the most important consequence; (3) PCPs perceive their role in weight management as awareness raising and signposting, not prevention or weight monitoring; (4) PCPs identify structural and patient-related factors as barriers to weight communication and management, but not PCP factors. CONCLUSIONS: Incongruent and/or inaccurate beliefs held by PCPs and patient may present barriers to effective weight discussion and management in primary care. There is a need to review, standardise and clarify primary care weight management processes in Scotland. Acknowledging a shared responsibility for obesity as a disease may improve outcomes for patients with overweight and obesity.

Determining patient attendance, access to interventions and clinical outcomes in a publicly funded obesity programme: Results from the Canberra Obesity Management Service.

Multi-disciplinary specialist services have a crucial role in the management of patients with obesity. As demand for these services increases, so too does the need to monitor individual service performance and compare outcomes across multiple sites. This paper reports on results from the publicly funded Canberra Obesity Management Service. A descriptive observational study was conducted on new patients who attended an initial medical review from July 2016 to June 2017. Baseline characteristics, comorbidities, attendance, service utilization and outcomes were collated until June 2018. Of the 162 patients identified, 64% continued to attend beyond initial medical review. Dietetics was the most commonly accessed allied health service, followed by exercise physiology and psychology. Very low-energy diet was the most commonly trialled intensive intervention, followed by pharmacotherapy and bariatric surgery. Mean baseline weight for those who continued beyond initial medical review was 142.0 kg (SD 26.6 kg), with a mean weight change of -6.2 kg (SD 10.2 kg) and a mean change in percentage body weight of -5% (SD 7%). Clinically significant weight loss was achieved in 36% of these patients, with a further 47% achieving weight stabilization. Mean Depression, Anxiety and Stress Scale scores reduced from 8-6-8 to 7-5-5, and mean Epworth Sleepiness Scale scores decreased from 8/24 to 6/24. Polysomnography referrals were made for 37% of all new patients, 87% of whom were diagnosed with varying degrees of obstructive sleep apnoea. We present these findings in the hope that they may serve as an example for data collection, individual service monitoring and comparison across multiple obesity services.

Perceptions of barriers to effective obesity management in Canada: Results from the ACTION study.

Obesity is a chronic disease with a significant and growing impact on Canadians. The "Awareness, Care and Treatment In Obesity MaNagement" (ACTION) Study investigated perceptions, attitudes and perceived barriers to obesity management among Canadian people with obesity (PwO), healthcare providers (HCPs) and employers. In this study adult PwO (body mass index ≥30 kg/m2 , based on self-reported height/weight), HCPs (physicians and allied HCPs managing PwO) and employers (≥20 employees; offering health insurance), completed online surveys between 3 August and 11 October 2017 in a cross-sectional design. Survey respondents (N = 2545) included 2000 PwO, 395 HCPs and 150 employers. Obesity was viewed as a "chronic medical condition" by most PwO (60%), HCPs (94%) and employers (71%) and deemed to have a large impact on overall health (74%, 78%, 81%, respectively). Many PwO (74%) believed weight management was their own responsibility. While PwO (55%) reportedly knew how to manage their weight, only 10% reported maintaining ≥10% weight reduction for >1 year. Despite low success rates, the most commonly reported effective long-term weight loss methods tried and/or recommended were "improvements in eating habits" (PwO 38%; HCP 63%) and "being more active" (PwO 39%; HCP 54%). PwO and HCPs reported very different perceptions of the quality and content of their interaction during obesity management discussions. These findings highlight the communication gaps and misunderstanding between PwO, HCPs and employers. This underscores the importance of, and need for, evidence-based management of obesity and a collaborative approach and understanding of the complex nature of this chronic disease.

Associations between change in sedentary behavior and outcome in standard behavioral weight loss treatment.

Sedentary behavior, particularly in prolonged periods, is an important determinant of health. Little research exploring changes in sedentary behavior during behavioral weight loss programs exists. This study evaluated the magnitude of changes in total and prolonged sedentary behavior and how these changes related to changes in weight and cardiovascular outcomes during a behavioral weight loss program. Participants (n = 450) in two lifestyle modification programs underwent assessments of sedentary behavior (by accelerometry), weight, waist circumference, blood pressure, and resting heart rate at baseline and after 6 months of treatment. Sedentary behavior was defined as both total and prolonged (≥30 continuous minutes) sedentary minutes/day. Reductions in total and prolonged sedentary time were significant and were accounted for by increases in moderate-to-vigorous physical activity (MVPA). Only changes in MVPA significantly predicted change in weight when entered into a model simultaneously with changes in sedentary behavior. Changes in total and prolonged sedentary time were not associated with changes in waist circumference, heart rate, or blood pressure. Change in sedentary time was not independently associated with change in health outcomes during a behavioral weight loss treatment. High variability in changes in sedentary time indicate that individual differences may be important to examine. Reducing sedentary time may not be powerful enough to impact these health outcomes above the effects of other changes made during these programs; alternatively, it may be that increasing focus in treatment on reducing sedentary time may engender greater decreases in sedentariness, which could lead to better health outcomes.

IFSO Worldwide Survey 2016: Primary, Endoluminal, and Revisional Procedures.

BACKGROUND AND AIM: The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO), being a Federation of 62 national societies, is the ideal network to monitor the number and type of procedures at a global level. The IFSO survey, enriched with a special section on revisional procedures, aims to report the number and types of bariatric procedures performed worldwide in 2016 and analyzes the surgical trends from 2008 to 2016. METHODS: The 2016 IFSO Survey form was emailed to all IFSO societies. Each Society was requested to indicate the number and type of bariatric procedures performed in the country. Trend analyses from 2008 to 2016 were also performed. RESULTS: The total number of bariatric/metabolic procedures performed in 2016 was 685,874; 634,897 (92.6%) of which were primary and 50,977 were revisional (7.4%). Among the primary interventions, 609,897 (96%) were surgical and 25,359 (4%) were endoluminal. The most performed primary surgical bariatric/metabolic procedure was sleeve gastrectomy (SG) (N = 340,550; 53.6%), followed by Roux-en-Y gastric bypass (N = 191,326; 30.1%), and one-anastomosis gastric bypass (N = 30,563; 4.8%). CONCLUSIONS: In 2016, there was an increase in the total number both of surgical and endoluminal bariatric/metabolic procedures. Revisional procedures represent about 7% of the total bariatric interventions. SG remains the most performed surgical procedure in the world.

Primary Care Provider Knowledge and Practice Patterns Regarding Childhood Obesity.

BACKGROUND: We aimed to evaluate current childhood obesity management by providers and improve management of pediatric obesity through a provider-focused educational intervention. METHODS: We surveyed family medicine and pediatric providers regarding documentation and intervention, knowledge gaps, and educational needs for childhood obesity. An educational program was implemented regarding detection, documentation, and follow-up/referral of pediatric obesity and comorbid conditions. We reviewed charts for 50 overweight or obese children before and after intervention. RESULTS: The survey identified lack of time (73%) and perception of parents (77%) as the most frequent provider barriers to pediatric obesity care. Provider referrals increased from 6% to 16% after intervention, and laboratory testing increased from 14% to 26%. No changes were noted in discussion of weight status, diagnosis/documentation, or billing. CONCLUSION: Provider education can improve appropriate ordering of laboratory studies and referrals for overweight children. Different intervention approaches may improve billing and documentation practices for pediatric obesity.

Identificación y consecuencias de la edorexia / Identification and consequences of binge eating disorder

Introducción: Mediante la comprensión de los procesos biopsicosociales que subyacen a la ingesta excesiva de alimentos, se desea encontrar la solución a la epidemia de la obesidad. La edorexia constituye un síndrome psicológico en el que las personas que lo presentan tienen un apetito desproporcionado y excesivo. El diagnóstico diferencial de la edorexia se debe hacer con algunos de los trastornos de la conducta alimentaria y la hiperfagia inducida por fármacos. Objetivo: Realizar una breve revisión sobre la edorexia, sus aspectos conceptuales, algunas dimensiones con las que se relaciona, y su repercusión en la salud del ser humano. Método: Se utilizó como buscador de información científica Google Académico. Se emplearon como palabras clave: edorexia, trastornos de la conducta alimentaria, obesidad. Fueron evaluados artículos de revisión e investigación que, en general, tenían menos de 10 años de publicados. La búsqueda se realizó en idioma español, portugués e inglés. Los artículos seleccionados están indexados en diferentes bases de datos (PubMed, LILACS, Cochrane y SciElo), así como páginas web. Fueron excluidos aquellos que no cumplieron con los objetivos y criterios enunciados, lo que permitió el estudio de 60 documentos, de los cuales, 33 fueron referenciados. Conclusiones: Edorexia, o comer por apetito, enfatiza las conductas problemas asociadas a la obesidad, y se compone de 4 elementos fundamentales: la dependencia, la evitación, el componente emocional y el déficit de bienestar psicológico. Es causa de frecuentes secuelas físicas y psicológicas. Se debe prevenir e identificar precozmente, para realizar su adecuado tratamiento y así evitar la afectación de la calidad de vida del paciente(AU)

Introduction: A solution to the obesity epidemic is intended to be found by understanding the biopsychosocial processes underlying excessive food intake. Binge eating disorder (BED) is a psychological syndrome in which sufferers have excessive, disproportionate appetite. A differential diagnosis should be made between binge eating disorder and other eating disorders as well as drug-induced hyperphagia. Objective: Conduct a brief review about binge eating disorder, its conceptual aspects, some dimensions with which it relates, and its impact on human health. Method: Scientific information was obtained from the search engine Google Scholar using the key words binge eating disorder, eating disorders and obesity. Most of the reviews and research studies evaluated had been published in the past 10 years. The search was conducted in Spanish, Portuguese and English. The papers selected were indexed on various databases (PubMed, LILACS, Cochrane, SciELO) and webpages. After excluding papers not meeting the stated aims and criteria, the sample was composed of 60 documents of which 33 were referenced. Conclusions: Binge eating disorder, aka compulsive overeating, enhances the problem behavior associated to obesity, and consists of 4 main elements: dependence, avoidance, the emotional component and psychological well-being deficit. On the other hand, it is the cause of frequent physical and psychological disorders. Early prevention and identification as well as indication of the appropriate treatment are all fundamental so that the quality of life of patients is not affected(AU)

Avaliação do índice de massa corporal de adolescentes e de seu conhecimento sobre nutrição

Nas últimas décadas ocorreu uma inversão nos padrões dos problemas nutricionais,passando da desnutrição à obesidade. O objetivo desse trabalho foi avaliar o IMC de adolescentes e seu conhecimento sobre a pirâmide alimentar e Nutrição. Participaram 122 alunos de uma escola particular de São Paulo, SP. Cada aluno recebeu uma folha contendo dados pessoais, três atividade lúdicas e uma questão aberta sobre alimentação saudável. A partir de peso e altura referidos, calculou-se o IMC, analisado pelas curvas de crescimento da OMS de 2006. Grande parte dos adolescentes (77,1 %) apresentou peso adequado; 20,5% sobrepeso; 1,6% obesidade e 0,8% baixo peso. A primeira atividade lúdica avaliou o conhecimento sobre nutrição (jogo de palavras cruzadas) e a maioria (63,9%) acertou todos os itens. No jogo dos erros (segunda atividade), 16,4% dos alunos identificaram todos os erros e 81,1% identificou 4, 5 ou 6 dos erros. Na questão sobre o nome dos grupos da Pirâmide Alimentar, 43% identificou todos os grupos. Na pergunta aberta, 39,4% respondeu que uma alimentação saudável é composta por todos os alimentos, sem exageros. Conclui-se que os adolescentes apresentaram bom conhecimento sobre a pirâmide alimentar e sobre conceitos de Nutrição e que,apesar da maioria apresentar estado nutricional adequado, ações educativas devem ser planejadas com o objetivo da reversão do excesso de peso.

In recent decades a reversal occurred in the patterns of nutritional problems, from malnutrition to obesity. The objective of this work was to evaluate the BMI of adolescents and their degree of knowledge about the Food Pyramid and healthful eating. The study was conducted with 122 students from a particular teaching unit in São Paulo, SP. Each student received an activity sheet containing personal data and four questions, three closed questions and one open question about healthful eating. From the reported height and weight, BM! for age was calculated and analyzed by WHO 2006 growth charts. Most adolescents 77.1% had normal weight, 20.5% were overweight, 1.6% with obesity and 0.8% had low weight. The first question assessed the knowledge about nutrition (crossword game) and most adolescents (63.9%) had a majority of correct answers. On the second question, 16.4% of students identified all errors, 81.1% identified 4, 5 or 6 errors. In the fourth question, the majority (43%) had a great performance by identifying all the groups of food pyramid. Regarding the open question, many of the students, 39.4% responded that a healthy diet is composed by all kinds of foods, without exaggeration. It can be concluded that adolescents are able to deal with the issue, revealing a smooth and broad knowledge. Healthy and educations actions are needed to treat cases of obesity, overweight and low weight.