Person-first language in diabetes and obesity scientific publications.

AIMS: We aimed to quantify the use of person-first language (PFL) among scholarly articles focusing on diabetes or obesity. METHODS: PFL and condition-first language (CFL) terms for diabetes and obesity (e.g. diabetic, obese) were identified from existing guidelines and a review of the literature. Exact phrase literature searches were conducted between 2011 and 2020 and results were categorised as PFL, CFL or both. RESULTS: Among diabetes articles, 43% used PFL, 40% used CFL and 17% contained both. Among obesity articles, 0.5% used PFL, 99% used CFL and 0.2% used both. The use of PFL increased by 3% per year for diabetes articles, compared to 117% for obesity articles. The rate of adoption of PFL in diabetes articles was unchanged in 2018-2020 compared to the 3 years prior. CONCLUSIONS: While the use of person-first language in diabetes articles had increased over the review period, its rate of adoption has started to slow. Conversely, the use of PFL in obesity articles is nascent and increasing.

Patient perspectives on personalised medicine for obesity: An IMI2 SOPHIA Study.

OBJECTIVE: Personalised medicine is seen as an exciting opportunity to improve the health outcomes of people with obesity. As research on phenotyping and personalised treatment for obesity rapidly advances, this study sought to understand patient preferences and perspectives on personalised medicine for obesity. METHODS: A participatory world café methodology was used to garner the perspectives of people living with obesity on the potential opportunities and limitations associated with a personalised approach to obesity risk identification and treatment. Data were recorded by participants on tablemats and analysed thematically using thematic analysis. RESULTS: Patients expressed the hope that personalised medicine for obesity would reduce stigma, support understanding of obesity as a disease, and improve treatment outcomes and acceptance. They also expressed concern about the accuracy of personalised medicine for obesity, its implications for insurance and that further advances in individual, personalised medicine, would detract attention from social, environmental, economic and psychological drivers of obesity. CONCLUSIONS: This study highlights how patients are generally very optimistic about the potential for personalised obesity medicine but also raise a number of legitimate concerns that will be of interest to clinicians, industry, and policy makers.

coreNASH: Multi-stakeholder Consensus on Core Outcomes for Decision Making About Nonalcoholic Steatohepatitis Treatment.

The increasing prevalence and burden of nonalcoholic steatohepatitis (NASH) has spurred the development of new treatments and a need to consider outcomes used for NASH treatment decision making. Development of a NASH core outcome set (COS) can help prioritize outcomes of highest importance by incorporating the perspectives from a variety of decision makers. coreNASH was an initiative to develop a COS for NASH using a modified Delphi consensus process with a multi-stakeholder voting panel. A candidate outcome list was created based on a literature review and key informant interviews. The candidate outcome list was then condensed and prioritized through three rounds of online voting and through discussion at an in-person meeting. Outcomes were retained or eliminated based on predetermined consensus criteria, which included special weighting of patients' opinions in the first two voting rounds. The coreNASH Delphi panel included 53 participants (7 patients, 10 clinicians and researchers, 7 health technology assessors, 22 industry representatives, 2 regulators, and 5 payers) who considered outcomes for two NASH-related COS: one for NASH without cirrhosis (F2-F3) and one for NASH with cirrhosis (F4). The initial candidate outcome list for both disease stages included 86 outcomes. The panel agreed on including two core outcomes for NASH without cirrhosis and nine core outcomes for NASH with cirrhosis in the COS. Conclusion: A consensus-based COS has been developed that can be used across the life cycle of NASH treatments. Outcomes included can contribute to decision making for regulatory, market access, and on-market decision making. Including the coreNASH COS in clinical development programs will facilitate improved comparisons and help decision makers assess the value of new products.

Implications of differing attitudes and experiences between providers and persons with obesity: results of the national ACTION study.

Objective: Our aim was to explore how differing attitudes, expectations, and experiences among people with obesity (PwO) and healthcare providers (HCPs) might have an impact on effectively implementing current obesity treatment guidelines. Methods: Online surveys were conducted among 3,008 adult PwO (BMI≥30 by self-reported height and weight) and 606 HCPs. Results: PwO with weight loss ≥ 10% during the previous three years were more likely to have been diagnosed with obesity and to have discussed a weight loss plan with an HCP. However, only 21% believe HCPs have a responsibility to actively contribute to their obesity treatment. Further, HCPs tend not to effectively communicate the diagnosis of obesity, its nature as a serious and chronic disease, the full range of treatment options, and obesity's implications for health and quality of life. Regarding treatment goals, HCPs more often focus on BMI reduction, while PwO's goals focus on improved functioning, energy, and appearance. HCPs also tend to underestimate their patients' motivation to address their obesity. Twenty-eight percent of HCPs 'completely agreed' that losing weight was a high priority for PwO, whereas more than half of PwO 'completely agreed' that losing weight was a high priority for them. When asked how their HCP could better support them, PwO most often expressed a desire for helpful resources, as well as assistance with specific and realistic goal-setting to improve health. Conclusions: HCPs can more effectively implement obesity treatment guidelines by more clearly and proactively communicating with PwO about their diagnosis, health implications of obesity, desired treatment goals, and the full range of treatment options. HCPs should understand that most PwO believe that managing their disease is solely their own responsibility. HCPs can also encourage more effective conversations by better appreciating their patients' motivation and treatment goals.

Objectively measured pediatric obesity prevalence using the OneFlorida Clinical Research Consortium.

We characterized the prevalence of obesity among Florida children 2-19years old using electronic health records (EHRs). The obesity prevalence for 331,641 children was 16.9%. Obesity prevalence at 6-11years (19.5%) and 12-19years (18.9%) were approximately double the prevalence of obesity among children 2-5years (9.9%). The highest prevalence of severe obesity occurred in rural Florida (21.7%) and non-Hispanic children with multiple races had the highest obesity prevalence (21.1%) across all racial/ethnic groups. Our results highlight EHR as a low-cost alternative to estimate the prevalence of obesity and severe obesity in Florida children, both overall and within subpopulations.

Perceptions of Barriers to Effective Obesity Care: Results from the National ACTION Study.

OBJECTIVE: ACTION (Awareness, Care, and Treatment in Obesity maNagement) examined obesity-related perceptions, attitudes, and behaviors among people with obesity (PwO), health care providers (HCPs), and employer representatives (ERs). METHODS: A total of 3,008 adult PwO (BMI ≥ 30 by self-reported height and weight), 606 HCPs, and 153 ERs completed surveys in a cross-sectional design. RESULTS: Despite several weight loss (WL) attempts, only 23% of PwO reported 10% WL during the previous 3 years. Many PwO (65%) recognized obesity as a disease, but only 54% worried their weight may affect future health. Most PwO (82%) felt "completely" responsible for WL; 72% of HCPs felt responsible for contributing to WL efforts; few ERs (18%) felt even partially responsible. Only 50% of PwO saw themselves as "obese," and 55% reported receiving a formal diagnosis of obesity. Despite HCPs' reported comfort with weight-related conversations, time constraints deprioritized these efforts. Only 24% of PwO had a scheduled follow-up to initial weight-related conversations. Few PwO (17%) perceived employer-sponsored wellness offerings as helpful in supporting WL. CONCLUSIONS: Although generally perceived as a disease, obesity is not commonly treated as such. Divergence in perceptions and attitudes potentially hinders better management. This study highlights inconsistent understanding of the impact of obesity and need for both self-directed and medical management.

Obesity coverage gap: Consumers perceive low coverage for obesity treatments even when workplace wellness programs target BMI.

OBJECTIVE: Evidence-based obesity treatments, such as bariatric surgery, are not considered essential health benefits under the Affordable Care Act. Employer-sponsored wellness programs with incentives based on biometric outcomes are allowed and often used despite mixed evidence regarding their effectiveness. This study examines consumers' perceptions of their coverage for obesity treatments and exposure to workplace wellness programs. METHODS: A total of 7,378 participants completed an online survey during 2015-2016. Respondents answered questions regarding their health coverage for seven medical services and exposure to employer wellness programs that target weight or body mass index (BMI). Using χ2 tests, associations between perceptions of exposure to employer wellness programs and coverage for medical services were examined. Differences between survey years were also assessed. RESULTS: Most respondents reported they did not have health coverage for obesity treatments, but more of the respondents with employer wellness programs reported having coverage. Neither the perception of coverage for obesity treatments nor exposure to wellness programs increased between 2015 and 2016. CONCLUSIONS: Even when consumers have exposure to employer wellness programs that target BMI, their health insurance often excludes obesity treatments. Given the clinical and cost-effectiveness of such treatments, reducing that coverage gap may mitigate obesity's individual- and population-level effects.

Answers to Clinical Questions in the Primary Care Management of People with Obesity: Communication and Patient Self-Management.

Body weight is a sensitive subject for most people; this statement is particularly true for people who are overweight or have obesity, because social stigmatization is common not only in society but also in the health care setting. Health care providers are often unaware of their own biases toward patients with obesity. Here's how to improve your communication and support of these patients.

The influence of an individual's weight perception on the acceptance of bariatric surgery.

OBJECTIVE: This study assessed the proportion of US adults with excess weight and obesity who consider bariatric surgery to be appropriate for themselves and how their own weight perception influences this consideration. METHODS: A stratified sample of 920 US adults in June 2014 was obtained through an online survey. The respondents were queried about bariatric surgery acceptability and personal weight perception. Average body mass index (BMI) was determined for each demographic variable, and responses were characterized according to BMI and concordance with perceived weight status. Chi-square analyses served to assess perceived weight concordance in relation to bariatric acceptance. RESULTS: Only 32% of respondents with Class III obesity indicated that bariatric surgery would be an acceptable option for them, most often because they considered it to be too risky. Respondents with Class III obesity and concordant perception of weight status were more likely (P < 0.03) than discordant Class III respondents to accept bariatric surgery. Likewise, concordant respondents with excess weight, but not obesity, were more likely (P < 0.001) to correctly consider bariatric surgery to be inappropriate for them. CONCLUSIONS: Despite good safety and efficacy, many persons still believe bariatric surgery is too risky. Weight perception concordance or discordance influences one's decision to consider this treatment option.