'My goal was to become normal'-A qualitative investigation of coping with stigma, body image and self-esteem long-term after bariatric surgery.

Improved self-esteem and body image, as well as reduced experiences of weight stigma are important patient-reported obesity treatment outcomes. However, more knowledge is needed about how individuals who have undergone metabolic and bariatric surgery (MBS) perceive themselves and their bodies and use different coping strategies in relation to body image and self-esteem long-term after MBS. In this qualitative study body image, self-esteem, weight stigma and coping strategies were explored among 18 individuals who underwent MBS more than 10 years ago when interviewed. Using reflexive thematic analysis, two primary themes were identified: 'Experiences of living with a stigmatised body' and 'Coping with weight stigma, body image and self-esteem', and eight sub-themes. Findings capture frequent experiences of weight stigma before bariatric surgery, the need for coping with stigma and body dissatisfaction before and after MBS, and how different coping strategies are related to participants' perceptions of their bodies and self-concepts. More adaptive coping strategies, such as confrontation and cognitive restructuring may facilitate more positive body image outcomes, than more ruminative and avoidant strategies. Understanding adaptive coping strategies can be useful to develop interventions to reduce negative consequences of weight stigma on body image and self-esteem.

Assessing the state of obesity care: Quality, access, guidelines, and standards.

Background: An international panel of obesity medicine experts from multiple professional organizations examined patterns of obesity care and current obesity treatment guidelines to identify areas requiring updating in response to emerging science and clinical evidence. Aims: The panel focused on multiple medical health and societal issues influencing effective treatment of obesity and identified several unmet needs in the definition, assessment, and care of obesity. Methods: The panel was held in Leesburg, Virginia in September 2019. Results: The panelists recommended addressing these unmet needs in obesity medicine through research, education, evaluation of delivery and payment of care, and updating clinical practice guidelines (CPG) to better reflect obesity's pathophysiological basis and heterogeneity, as well as the disease's health, sociocultural, and economic complications; effects on quality of life; need for standards for quantitative comparison of treatment benefits, risks, and costs; and the need to more effectively integrate obesity treatment guidelines into routine clinical practice and to facilitate more direct clinician participation to improve public understanding of obesity as a disease with a pathophysiological basis. The panel also recommended that professional organizations working to improve the care of people with obesity collaborate via a working group to develop an updated, patient-focused, comprehensive CPG establishing standards of care, addressing identified needs, and providing for routine, periodic review and updating. Conclusions: Unmet needs in the definition, assessment and treatment of obesity were identified and a blueprint to address these needs developed via a clinical practice guideline that can be utilized worldwide to respond to the increasing prevalence of obesity.

Weight Stigma in Latin America, Asia, the Middle East, and Africa: A Scoping Review.

INTRODUCTION: Being stigmatized because of one's weight can pose physical, mental, and social challenges. While weight stigma and its consequences are established throughout Europe, North America, and Australasia, less is known about weight stigma in other regions. The objective of this study was to identify the extent and focus of weight stigma research in Latin America, Asia, the Middle East, and Africa. METHODS: A scoping review of weight stigma research in Latin America, Asia, the Middle East, and Africa was conducted. SCOPUS and PsychINFO databases were searched, and weight stigma experts were contacted to identify relevant literature. Sources were classified based on country/region, population, setting, and category of weight stigma researched. RESULTS: A total of 130 sources were identified from 33 countries and territories. Results indicate that weight stigma has been investigated across populations and settings, mainly focusing on manifestations of weight stigma through experiences, practices, drivers, and personal outcomes of these manifestations. CONCLUSIONS: Weight stigma is a developing global health concern not restricted to Europe, North America, and Australasia. The extent and focus of weight stigma research in Latin America, Asia, the Middle East, and Africa vary between countries and regions leaving several research gaps that require further investigation.

Intersecting Expectations when Expecting: Pregnancy-Related Weight Stigma in Women of Colour.

Weight stigma is a social justice issue that can lead to weight-based discrimination and mistreatment. In pregnancy, emerging evidence has highlighted that weight stigma predominantly affects individuals who have larger bodies and is associated with postpartum depression and avoidance of healthcare. Racial and ethnic background will influence perceptions of, and responses to, weight stigma and therefore it is necessary to ensure diverse voices are represented in our understanding of weight stigma. Semi-structured interviews were conducted with ten women who were within one year postpartum; nine identified as Black or African American and one as Hawaiian. Thematic analysis led to identification of three themes: (1) sources of weight stigma and their response to it, (2) support systems to overcome weight stigma, and (3) intersectional experiences. Women reported that sources of weight stigma included unsolicited comments made about their weight often coming from strangers or healthcare professionals that resulted in emotional distress. Support systems identified were family members and partners who encouraged them to not focus on negative remarks made about weight. Intersectional accounts included comparing their bodies to White women, suggesting that they may carry their weight differently. Women shared that, although they felt immense pressure to lose weight quickly postpartum, motherhood and childcare was their utmost priority. These findings inform further prospective examination of the implications of weight stigma in pregnancy among diverse populations, as well as inform inclusive public health strategies to mitigate weight stigma.

Core Set of Patient-Reported Outcome Measures for Measuring Quality of Life in Clinical Obesity Care.

PURPOSE: The focus of measuring success in obesity treatment is shifting from weight loss to patients' health and quality of life. The objective of this study was to select a core set of patient-reported outcomes and patient-reported outcome measures to be used in clinical obesity care. MATERIALS AND METHODS: The Standardizing Quality of Life in Obesity Treatment III, face-to-face hybrid consensus meeting, including people living with obesity as well as healthcare providers, was held in Maastricht, the Netherlands, in 2022. It was preceded by two prior multinational consensus meetings and a systematic review. RESULTS: The meeting was attended by 27 participants, representing twelve countries from five continents. The participants included healthcare providers, such as surgeons, endocrinologists, dietitians, psychologists, researchers, and people living with obesity, most of whom were involved in patient representative networks. Three patient-reported outcome measures (patient-reported outcomes) were selected: the Impact of Weight on Quality of Life-Lite (self-esteem) measure, the BODY-Q (physical function, physical symptoms, psychological function, social function, eating behavior, and body image), and the Quality of Life for Obesity Surgery questionnaire (excess skin). No patient-reported outcome measure was selected for stigma. CONCLUSION: A core set of patient-reported outcomes and patient-reported outcome measures for measuring quality of life in clinical obesity care is established incorporating patients' and experts' opinions. This set should be used as a minimum for measuring quality of life in routine clinical practice. It is essential that individual patient-reported outcome measure scores are shared with people living with obesity in order to enhance patient engagement and shared decision-making.

Review of an international pilot project to adapt the Canadian Adult Obesity Clinical Practice Guideline.

Background: The evidence-based Canadian Adult Obesity Clinical Practice Guideline (CPG) released in August 2020 were developed through a systematic literature review and patient-oriented research process. This CPG is considered a paradigm shift for obesity care as it introduced a new obesity definition that is based on health not body size, incorporates lived experiences of people affected by obesity, and addresses the pervasive weight bias and stigma that patients face in healthcare systems. The purpose of this pilot project was to assess the feasibility of adapting the Canadian CPG in Chile and Ireland. Methods: An International Clinical Practice Guideline Adaptation Committee was established to oversee the project. The project was conducted through four interrelated phases: 1) planning and preparation; 2) pilot project application process; 3) adaptation; and 4) launch, dissemination, and implementation. Ireland used the GRADE-ADAPTE framework and Chile used the GRADE-ADOLOPMENT approach. Results: Chile and Ireland developed their adapted guidelines in one third of the time it took to develop the Canadian guidelines. In Ireland, 18 chapters, which underpin the 80 key recommendations, were contextually adapted. Chile adopted 18 chapters and 76 recommendations, adapted one recommendation, and developed 12 new recommendations.. Conclusion: The pilot project demonstrated it is feasible to adapt the Canadian CPG for use in other countries with different healthcare systems, languages, and cultural contexts, while retaining the Canadian CPG's key principles and values such as the treatment of obesity as a chronic disease, adoption of new clinical assessment approaches that go beyond anthropometric measurements, elimination of weight bias and stigma, shifting obesity care outcomes to improved health and well-being rather than weight loss alone, and the use of patient-centred, collaborative and shared-decision clinical care approaches.

Obesidad en adultos: guía de práctica clínica adaptada para Chile / Obesity in adults: Clinical practice guideline adapted for Chile

Introducción La Sociedad Chilena de Cirugía Bariátrica y Metabólica, junto a otras sociedades científicas, lideró el proceso de adaptación de la guía de práctica clínica de obesidad en adultos para Chile, tomando como base las directrices desarrolladas para Canadá. La guía canadiense buscó, entre sus principales objetivos, proponer cambios en el enfoque del manejo de la obesidad como una enfermedad crónica y para mejorar los desenlaces de salud centrados en los pacientes, en lugar de enfocarse en la pérdida de peso como principal y único objetivo. Métodos Se convocó a un grupo de 58 profesionales para el desarrollo del proyecto, quienes revisaron y utilizaron el método para el análisis de las recomendaciones originales y desarrollo de recomendaciones . Para la elaboración de nuevas recomendaciones, se llevó a cabo una búsqueda de revisiones sistemáticas en la base de datos Epistemonikos, y se utilizó metodología GRADE y el marco para la evaluación de la evidencia y la descripción de la recomendación. Resultados Se adoptaron 76 de las 80 recomendaciones de la guía canadiense, se adaptó una recomendación y se desarrollaron 12 preguntas nuevas con sus respectivas recomendaciones. Conclusiones El proceso de adaptación permitió acortar el tiempo necesario para elaborar una guía de práctica clínica en obesidad del adulto para nuestro país. El cambio en el enfoque hacia una aproximación sin estigma y centrada en la salud y no en el peso, es universal y posible de aplicar en diferentes países y contextos.

Introduction The Chilean Society of Bariatric and Metabolic Surgery, together with other scientific societies, led a process for adapting the Canadian clinical practice guideline for obesity in adults for Chile. The aim of the Canadian guideline, among its main objectives, was to propose changes in obesity management using a chronic disease framework and focusing on improving patient-centered health outcomes, rather than focusing on weight loss alone. Methods A group of 58 healthcare professionals applied the GRADE-Adolopment method to analyze and adapt the original recommendations and to create de novo recommendations. New recommendations were developed through a systematic review of the evidence using the Epistemonikos database and based on the GRADE-Evidence to Decision (EtD) framework. Results Seventy-six (76) of the 80 original recommendations were adopted, one recommendation was adapted, and 12 new recommendations were created. Conclusions The adaptation process reduced the time needed to develop a Chilean clinical practice guideline for the management of obesity in adults. The change in obesity management approaches towards non-stigmatizing and patient-centered strategies focused on improving health outcomes and not solely on weight reduction is universal and it is possible to apply this approach in different countries and contexts.

Training in nutrition, physical activity and obesity in primary care settings: course workbook

WHO training course for nutrition, physical activity and obesity in primary care settings - course workbook.The purpose of this training course is to provide primary health care professionals with a sound outline of nutrition, physical activity and obesity prevention and management approaches in children, adolescents and adults. The goal is to make the course as practical as possible by integrating experiential learning and a variety of case studies wherever appropriate.