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1.
Obesity (Silver Spring) ; 28(7): 1184-1186, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32352650

RESUMO

Health inequities exist throughout the life course, resulting in racial/ethnic and socioeconomic disparities in obesity and obesity-related health complications. Obesity and its comorbidities appear to be linked to coronavirus disease 2019 (COVID-19) mortality. Approaches to reduce obesity in the time of COVID-19 closures are urgently needed and should start early in life. In New York City, a telehealth pediatric weight-management collaborative spanning NewYork-Presbyterian, Columbia University Vagelos College of Physicians and Surgeons, and Weill Cornell Medicine was developed during COVID-19 with show rates from 76% to 89%. To stave off the impending exacerbation of health disparities related to obesity risk factors in the aftermath of the COVID-19 pandemic, effective interventions that can be delivered remotely are urgently needed among vulnerable children with obesity. Challenges in digital technology access, social and linguistic differences, privacy security, and reimbursement must be overcome to realize the full potential of telehealth for pediatric weight management among low-income and racial/ethnic-minority children.


Assuntos
Infecções por Coronavirus/prevenção & controle , Manejo da Obesidade/métodos , Obesidade/terapia , Pandemias/prevenção & controle , Pediatria/métodos , Pneumonia Viral/prevenção & controle , Telemedicina/métodos , Betacoronavirus , Criança , Infecções por Coronavirus/etnologia , Infecções por Coronavirus/virologia , Feminino , Humanos , Masculino , Saúde das Minorias , Cidade de Nova Iorque/epidemiologia , Obesidade/etnologia , Obesidade/virologia , Pneumonia Viral/etnologia , Pneumonia Viral/virologia , Pobreza/etnologia , Fatores de Risco , Populações Vulneráveis
2.
BMC Health Serv Res ; 19(1): 748, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31651309

RESUMO

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.


Assuntos
Manejo da Obesidade/estatística & dados numéricos , Obesidade Mórbida/terapia , Cooperação do Paciente/estatística & dados numéricos , Ansiedade/etiologia , Pressão Sanguínea/fisiologia , Índice de Massa Corporal , Estudos de Casos e Controles , Pressão Positiva Contínua nas Vias Aéreas , Depressão/etiologia , Diabetes Mellitus Tipo 2/complicações , Feminino , Hospitalização/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Obesidade Mórbida/psicologia , Fatores de Risco , Apneia Obstrutiva do Sono/complicações
3.
Nutrients ; 11(9)2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31547312

RESUMO

Adiponectin exerts positive effects on metabolic and inflammatory processes. Adiponectin levels and some single-nucleotide polymorphisms (SNPs) seem to be associated with obesity. Here, we investigated the effects of a 4-week Hypocaloric diet and Physical exercise Program (HPP) on 268 young people with severe obesity. We evaluated the relationship between adiponectin levels and anthropometric and biochemical parameters, at baseline and after a 4-week HPP. Finally, we investigated some adiponectin gene variants and their correlation to biochemical parameters. Adiponectin levels were statistically lower in people with severe obesity than in controls. At the end of the HPP, all the people with severe obesity showed a Body Mass Index (BMI) reduction with a statistically significant increase in adiponectin levels. Genotyping, the adiponectin gene demonstrated a significant difference in 3 polymorphisms within the people with severe obesity. Besides, c.11377C>G and c.11391G>A homozygous subjects experienced more advantages by HPP. Furthermore, c.268G>A heterozygous subjects showed an enhancement in lipid profile as well in adiponectin levels. The best predictor of the changes in adiponectin levels was represented by the c.268G>A WT allele. Our study confirmed that a 4-weeks HPP in people with severe obesity results in metabolic amelioration associated with a significant increase of adiponectin levels. Importantly, we found that a specific genetic background in the ADIPOQ gene can predispose toward a more significant weight loss.


Assuntos
Adiponectina/sangue , Manejo da Obesidade/métodos , Obesidade Mórbida/genética , Obesidade Mórbida/terapia , Perda de Peso/genética , Adulto , Alelos , Antropometria , Estudos de Casos e Controles , Dieta Redutora/métodos , Terapia por Exercício/métodos , Feminino , Genótipo , Homozigoto , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único/genética , Resultado do Tratamento
4.
Int J Behav Med ; 26(6): 580-590, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31512155

RESUMO

BACKGROUND: Behavioral treatment strategies improve adherence to lifestyle intervention for adults with obesity, but can be time and resource intensive when delivered via traditional face-to-face care. This study aimed to investigate the efficacy and optimal timing of using telephone calls and text message as adjunctive tools to support a community-based obesity management program. METHOD: This 8-month randomized controlled crossover trial recruited 61 adults with class III obesity (BMI > 40 kg/m2) enrolled in a publicly funded obesity management service (OMS). Participants were randomly assigned to receive telephone and text message support in addition to standard OMS care, or standard OMS care alone. After 4 months, participants crossed over to the alternative sequence. The technological support was based on self-determination theory. Outcome measures included diet, physical activity, anthropometry, self-efficacy, and treatment self-regulation. RESULTS: Telephone and text message support improved lifestyle intervention adherence and clinical outcomes when compared with standard care. Participants who received the intervention in the first 4-month period lost 4.87 kg, compared with no weight loss (+ 0.38 kg) in the standard care only group. There was no evidence to indicate an optimal timing of the intervention, with both groups achieving significant results by the end of the intervention. CONCLUSION: These results suggest a high degree of promise for the incorporation of telephone and text message support into community-based obesity management services. The findings have the potential to improve existing practices and reduce the burden on the health care system by demonstrating a resource-effective improvement to obesity management service delivery.


Assuntos
Terapia Comportamental/métodos , Manejo da Obesidade/métodos , Obesidade/terapia , Cooperação do Paciente/psicologia , Telemedicina/métodos , Adulto , Estudos Cross-Over , Dieta/psicologia , Exercício Físico/psicologia , Feminino , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Obesidade/psicologia , Autocuidado/psicologia , Telefone , Envio de Mensagens de Texto , Resultado do Tratamento , Perda de Peso
5.
Clin Obes ; 9(5): e12329, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31294535

RESUMO

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.


Assuntos
Manejo da Obesidade/métodos , Manejo da Obesidade/estatística & dados numéricos , Adulto , Atitude Frente a Saúde , Canadá , Comunicação , Estudos Transversais , Dieta Redutora , Emprego , Exercício Físico , Comportamento Alimentar , Feminino , Pessoal de Saúde , Nível de Saúde , Humanos , Colaboração Intersetorial , Masculino , Pessoa de Meia-Idade , Obesidade/terapia , Percepção , Inquéritos e Questionários , Resultado do Tratamento , Perda de Peso
6.
Clin Obes ; 9(4): e12325, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31207135

RESUMO

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.


Assuntos
Obesidade/terapia , Adulto , Terapia por Exercício , Feminino , Serviços de Saúde , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/dietoterapia , Obesidade/psicologia , Manejo da Obesidade/economia , Manejo da Obesidade/estatística & dados numéricos , Pacientes/estatística & dados numéricos
7.
Obes Facts ; 12(2): 199-210, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30928989

RESUMO

OBJECTIVE: The aim of this study was to assess the short-term effectiveness of an intensive inpatient multidimensional rehabilitation program (MRP), including diet, exercise, and behavioral therapy, in elderly patients with severe obesity. METHODS: Forty-four elderly patients (old; age 69.3 ± 3.5 years, BMI 41.9 ± 14.9) were analyzed against 215 younger patients (young; age 48.2 ± 18.5 years, BMI 43.9 ± 9.4), who were used as controls. All patients underwent MRP, based on group therapy guided by a multidisciplinary team (physicians, dietitians, exercise trainers, psychologists). We evaluated changes in anthropometry, cardiovascular risk factors, physical fitness, quality of life, and eating behavior. RESULTS: After 3 weeks of MRP, we observed a reduction in body weight (old -3.8%, young -4.3%), BMI (old -3.9%, young -4.4%), waist circumference (old -3.4%, young -4.1%), total cholesterol (old -14.0%, young -15.0%), and fasting glucose (old -8.3%, young -8.1%), as well as improved performance in the Six-Minute-Walk Test (old +28.7%, young +15.3%), chair-stand test (old +24.8%, young +26.9%), and arm-curl test (old +15.2%, young +27.3%). Significant improvement was registered in all other analyzed domains. CONCLUSION: Our 3-week MRP provided significant clinical and functional improvement, which was similar between elderly and younger patients with severe obesity. In the long-term, this may be translated into better quality of life, through better management of obesity-associated morbidities and reduced frailty.


Assuntos
Serviços de Saúde para Idosos , Hospitais de Reabilitação , Manejo da Obesidade/métodos , Obesidade/reabilitação , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Terapia Comportamental , Dietoterapia , Exercício Físico/fisiologia , Feminino , Serviços de Saúde para Idosos/organização & administração , Hospitais de Reabilitação/métodos , Hospitais de Reabilitação/organização & administração , Humanos , Pacientes Internados , Comunicação Interdisciplinar , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Manejo da Obesidade/organização & administração , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/reabilitação , Equipe de Assistência ao Paciente , Aptidão Física/fisiologia , Qualidade de Vida , Resultado do Tratamento
9.
Nurse Educ Today ; 77: 59-64, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30954857

RESUMO

BACKGROUND: Obesity, the most prevalent chronic disease affecting multiple systems, is associated with increased mortality and a decreased life expectancy. OBJECTIVES: The purpose of this study was to identify Advanced Practice Nursing (APN) students' confidence of obesity management as well as satisfaction of APN curriculum on and curricular recommendations regarding obesity management. DESIGN: Modified convergent mixed-methods design. SETTING: A university-based college of nursing in the Deep South. PARTICIPANTS: Graduate APN Students. METHODS: An exploratory mixed methods online survey was administered to APN students. The survey included demographics; confidence in obesity management; knowledge of pharmacological treatment; self-reported height and weight; experiences and challenges related to obesity management; and suggestions of curricular content changes for the treatment of obesity that would increase student expertise and confidence. RESULTS: Ninety-nine surveys were completed by 94 female and five male APN students aged 26 to 61 years. The majority (70.7%) were white with BMIs ranging from 19.57 to 51.37 (x̅=27.81). Areas where students were least comfortable were prescribing anti-obesity medications and accurately billing for obesity management. Fourteen percent of APN students reported feeling that their graduate nursing education program did not prepare them well in obesity management, 25.3% reported feeling slightly well prepared, 32% reported feeling moderately well prepared, and 27.8% reported feeling very well or extremely well prepared. Qualitative responses accentuated insecurity in areas such as initiating a discussion on obesity management with patients who have obesity. CONCLUSIONS: Overall, APN students requested that their curriculum incorporate more instruction on how to begin the discussion of weight loss and provide clear evidence-based guidelines that include diet, exercise, and medication options. An efficient way to affect the management and treatment of obesity is to ensure that the next generation of providers is thoroughly prepared to implement the best evidence-based obesity management for patients.


Assuntos
Prática Avançada de Enfermagem/educação , Competência Clínica/normas , Manejo da Obesidade/métodos , Estudantes de Enfermagem/estatística & dados numéricos , Adulto , Prática Avançada de Enfermagem/normas , Competência Clínica/estatística & dados numéricos , Currículo/normas , Educação de Pós-Graduação em Enfermagem/métodos , Avaliação Educacional/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Inquéritos e Questionários , Universidades/organização & administração , Universidades/estatística & dados numéricos
10.
Obes Facts ; 12(2): 179-189, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30893684

RESUMO

OBJECTIVE: Current lifestyle interventions for children and adolescents with obesity often exclude patients with an eating pathology, leaving the impact of eating pathologies on treatment outcomes largely unconsidered. We investigated the predictive value of disordered eating symptoms on BMI z-score reduction in a sample of 111 German children and adolescents with overweight (90th percentile ≤ BMI < 97th percentile) and obesity (BMI > 97th percentile) aged 7-15 years in an outpatient lifestyle intervention program. METHODS: We defined a BMI z-score reduction of more than 5% after 12 months as a successful outcome. Disordered eating symptoms (i.e., dietary restraint, emotional eating, external eating, and binge eating) were assessed at baseline with the Eating Pattern Inventory (EPI-C) and the "bulimia" scale of the Eating Disorder Inventory (EDI-2). Covariates were: baseline z-BMI, age, gender, and maternal education level. RESULTS: Multiple regression analysis revealed that dietary restraint significantly predicted change in BMI z-scores between baseline and T1. Higher levels of dietary restraint were associated with a lower BMI z-score reduction between T0 and T1. To compare non-completers with completers on the 4 eating behavior scales, we used MANCOVA. At baseline, children who subsequently dropped out of the program prematurely showed significantly higher dietary restraint scores than children who completed the intervention, irrespectively of their gender, age, and BMI z-score at baseline and their mother's education level. DISCUSSION: Our results provide further evidence that the analysis of treatment processes in lifestyle intervention programs for children and adolescents with overweight and obesity should take into account a broader multidimensional approach including eating and dietary habits.


Assuntos
Comportamento Alimentar/fisiologia , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Estilo de Vida , Manejo da Obesidade/métodos , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/terapia , Adolescente , Terapia Comportamental/métodos , Índice de Massa Corporal , Criança , Dieta , Emoções , Comportamento Alimentar/psicologia , Transtornos da Alimentação e da Ingestão de Alimentos/complicações , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Feminino , Seguimentos , Humanos , Masculino , Sobrepeso/terapia , Obesidade Pediátrica/epidemiologia , Obesidade Pediátrica/psicologia , Prognóstico , Resultado do Tratamento
11.
Nurse Educ Pract ; 36: 54-57, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30861412

RESUMO

INTRODUCTION: Fifty percent of Australian women enter pregnancy overweight or obese. Unfortunately, few women receive weight management advice from health professionals during pregnancy. The aim of this study was to investigate current midwifery curricula from Australian universities to identify strengths and deficits in the teaching of preconception and antenatal weight management. METHODS: Midwifery courses from 20 universities were identified. Of the 568 units taught at these universities, 252 course outlines were obtained. Data were coded using the qualitative analysis technique of Framework Analysis for the following main themes: 1) the effect of weight, diet and physical activity on health outcomes for women who are pregnant or planning a pregnancy; 2) weight management advice in any population; and 3) health behaviour change techniques in any context. RESULTS: Analysis revealed a variety of teaching methods and skills training that emphasised the importance of clinical judgement and autonomous clinical practice, in conjunction with critical enquiry and sourcing reputable evidence. There was little evidence, however, that weight management advice was taught explicitly to midwifery students in the curricula. DISCUSSION: A greater emphasis on skilling midwifery students to address weight gain during pregnancy, and behavioural techniques to achieve this, is required.


Assuntos
Terapia Comportamental/educação , Currículo/normas , Tocologia/educação , Manejo da Obesidade/métodos , Adulto , Austrália , Terapia Comportamental/normas , Terapia Comportamental/estatística & dados numéricos , Currículo/estatística & dados numéricos , Educação de Pós-Graduação em Enfermagem/métodos , Educação de Pós-Graduação em Enfermagem/normas , Feminino , Humanos , Manejo da Obesidade/normas , Gravidez , Complicações na Gravidez/prevenção & controle , Universidades/organização & administração , Universidades/estatística & dados numéricos
12.
Am J Gastroenterol ; 114(4): 679-683, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30848732

RESUMO

OBJECTIVES: To familiarize medical providers with the Food and Drug Administration approval process for antiobesity devices and to provide a brief overview of current and promising endoscopy-based bariatric devices. METHODS: Literature review of published scholarly articles. RESULTS: There has been a rapid development of novel endoscopic bariatric therapies in recent years, resulting in the approval of multiple devices. Several promising endoscopic strategies are currently under investigation and review. The Food and Drug Administration has laid down an objective-tiered model to review antiobesity device applications. DISCUSSION: Endoscopic bariatric devices provide a new and promising paradigm in obesity management both as first-line therapy and as adjunctive treatment to medical and surgical strategies. Physicians who plan to offer endoscopic bariatric therapy in their practice need appropriate understanding of the regulatory processes involved in the development and approval of such devices.


Assuntos
Cirurgia Bariátrica/instrumentação , Aprovação de Equipamentos , Endoscopia Gastrointestinal/instrumentação , Manejo da Obesidade/tendências , Obesidade Mórbida/cirurgia , Terapia por Estimulação Elétrica/instrumentação , Balão Gástrico , Humanos , Estados Unidos , United States Food and Drug Administration
14.
Clin Obes ; 9(3): e12301, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30761766

RESUMO

We aimed to develop an expert consensus on standardizing data collections in specialist obesity management clinics in Australia. A panel of 16 experts participated in a structured consensus-driven Delphi process to reach agreement on a minimum set of baseline patient data collections for consideration in specialist obesity services. The panel included surgeons, clinicians, allied health professionals (dietician, exercise physiologist, psychologist), a bariatric nurse and obesity researchers. We produced a recommended list of core and useful data items that should comprise the baseline patient data set. Consensus was achieved for recommended measures of demographic, anthropometric, biochemical, weight-loss history, medication, medical history and comorbidity data items using a 70% agreement threshold. In this iterative process, there was also consideration of specific data items for patients referred for bariatric surgery. We present the first expert panel consensus on recommendations for a minimum and standard set of baseline patient data collections in obesity management services in Australia. These may be relevant to other countries with similar obesity management service models. Implementation of these recommendations should facilitate data pooling for clinical audits and research collaborations across clinics seeking to improve the quality of specialist obesity care.


Assuntos
Coleta de Dados/normas , Manejo da Obesidade/normas , Obesidade/terapia , Adulto , Antropometria/métodos , Austrália , Consenso , Coleta de Dados/métodos , Técnica Delfos , Feminino , Humanos , Masculino , Manejo da Obesidade/métodos , Especialização/normas
15.
Complement Ther Med ; 42: 184-204, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30670241

RESUMO

OBJECTIVES: The gut dysbiosis has been implicated as a mediator to obesity and its manipulation could be an appropriate approach to sustainable weight loss. In this systematic review, our primary objective was to assess the potential manipulation of gut microbiota by herbal products in obesity. MATERIALS AND METHODS: We did a comprehensive search in PubMed, Web of Science, Scopus and Cochrane databases for all clinical trials and animal studies exploring the effects of various herbal products on gut microbiota composition in obesity documented up to May 2017. RESULTS: Our initial search yielded 2766 articles. After screening abstracts and full texts, 68 articles were included (55 animal studies and 13 clinical trials). The studies differed in their methodologies, type of interventions and intervention lengths. The weight loss was only reported in 23% of trials and in 64% of animal studies. An increasing tendency in Bifidobacterium species and butyrate-producing bacteria such as Faecalibacterium prausnitzii were observed after consuming non-digestible carbohydrates, although these changes did not always correlate with weight loss. Supplementation with high concentration of polyphenols reduced body weight gain in animal studies and inhibited growth of detrimental species such as Clostridia and Enterobacteria while the growth of Lactic acid bacteria and Akkermansia muciniphila is enriched. CONCLUSIONS: Alteration of gut microbiota after interventions has been affected by the baseline composition of gut microbiota. This systematic review shows that consumption of herbal products might have beneficial effects on restoring healthy gut microbiome besides body fat reduction.


Assuntos
Microbioma Gastrointestinal/efeitos dos fármacos , Obesidade/tratamento farmacológico , Preparações de Plantas/farmacologia , Preparações de Plantas/uso terapêutico , Animais , Ensaios Clínicos como Assunto , Disbiose/tratamento farmacológico , Humanos , Manejo da Obesidade/métodos , Perda de Peso/efeitos dos fármacos
16.
J Obstet Gynaecol ; 39(4): 485-491, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30634891

RESUMO

This study aimed to explore the knowledge and practice of New Zealand (NZ) general practitioners (GPs) regarding gestational weight gain (GWG), and identify the current level of involvement NZ GPs have in early pregnancy care. In NZ, the majority of antenatal care is carried out by a midwife lead maternity carer (LMC), with government funding for one first trimester appointment with the woman's GP. A mixed methods survey was conducted on a randomly selected sample of 470 NZ GPs. Survey responses were analysed using descriptive statistics and a general inductive approach for free text data. A total of 200 GPs (42.5%) responded. Half of the GPs regularly saw women in their early pregnancy, but the discussion of recommended GWG was uncommon. The knowledge and practice regarding GWG was not in keeping with the national guidance. Free text analysis identified time pressures, funding issues, loss of skill and a poor communication with LMCs as the barriers to care. Education, promotion of guidance, appropriate funding and improved communication between carers are critical to address the current shortfalls. Impact statement What is already known on this subject? Excess gestational weight gain (GWG) is a modifiable risk factor for the vast majority of obstetric complications. It is more likely in pregnant women who overestimate the appropriate GWG. Current literature suggests that the antenatal advice on GWG is insufficient. In New Zealand (NZ), there is provision for one funded general practitioner (GP) appointment in the first trimester, in addition to that provided by the lead maternity carer (LMC). GPs are expected to provide a range of services at this appointment including health information and education on nutrition. What the results of this study add? The results demonstrate that while GPs are seeing women in early pregnancy, specific GWG discussion is uncommon. The results suggest knowledge gaps are partially responsible for this along with GP self-reported frustrations at lack of time, funding issues, loss of relevant skills, and minimal contact with LMCs. What the implications are of these findings for clinical practice and/or further research? Mediocre gestational weight management is not acceptable in our current obesity climate. This research identifies a need to improve GP knowledge on the management of GWG as part of the wider maternity healthcare team, address GP concerns regarding funding for their provision of maternity care, and aid communication between GPs and LMCs.


Assuntos
Clínicos Gerais/psicologia , Manejo da Obesidade , Obesidade/psicologia , Complicações na Gravidez/psicologia , Cuidado Pré-Natal/psicologia , Adulto , Feminino , Ganho de Peso na Gestação , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Obesidade/terapia , Gravidez , Complicações na Gravidez/terapia , Cuidado Pré-Natal/métodos , Inquéritos e Questionários
17.
Obes Facts ; 12(1): 40-66, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30673677

RESUMO

The first contact for patients with obesity for any medical treatment or other issues is generally with General Practitioners (GPs). Therefore, given the complexity of the disease, continuing GPs' education on obesity management is essential. This article aims to provide obesity management guidelines specifically tailored to GPs, favouring a practical patient-centred approach. The focus is on GP communication and motivational interviewing as well as on therapeutic patient education. The new guidelines highlight the importance of avoiding stigmatization, something frequently seen in different health care settings. In addition, managing the psychological aspects of the disease, such as improving self-esteem, body image and quality of life must not be neglected. Finally, the report considers that achieving maximum weight loss in the shortest possible time is not the key to successful treatment. It suggests that 5-10% weight loss is sufficient to obtain substantial health benefits from decreasing comorbidities. Reducing waist circumference should be considered even more important than weight loss per se, as it is linked to a decrease in visceral fat and associated cardiometabolic risks. Finally, preventing weight regain is the cornerstone of lifelong treatment, for any weight loss techniques used (behavioural or pharmaceutical treatments or bariatric surgery).


Assuntos
Manejo da Obesidade/normas , Obesidade/terapia , Assistência Centrada no Paciente/normas , Guias de Prática Clínica como Assunto , Atenção Primária à Saúde/normas , Adulto , Comorbidade , Europa (Continente)/epidemiologia , Clínicos Gerais/organização & administração , Clínicos Gerais/normas , Humanos , Obesidade/epidemiologia , Manejo da Obesidade/métodos , Manejo da Obesidade/organização & administração , Qualidade de Vida , Circunferência da Cintura , Perda de Peso
18.
Popul Health Manag ; 22(4): 308-314, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30383482

RESUMO

Lack of both awareness and application of evidence-based principles for obesity care for people with obesity (PwO) limit employers' role in supporting effective obesity management among employees with obesity (EwO). The aim of the ACTION (Awareness, Care, and Treatment In Obesity maNagement) study was to explore the current state of employer wellness programs related to obesity management, evaluate the impact of obesity in the workplace, assess attitudes regarding the role of employers in managing obesity, and identify challenges in implementing workplace wellness programs as perceived by employer representatives (ERs) and EwO. An online survey was conducted among ERs and adult PwO (BMI ≥30 by self-reported height and weight) using a cross-sectional, US-based stratified sample design. There were 153 ER respondents and 3008 adult PwO respondents; 1478 PwO were employed full-time, part-time, or were self-employed. ERs recognize the seriousness of obesity and its negative impact on work productivity; however, wellness programs tend to fall short of addressing specific needs of EwO, evidenced by low participation and success rates reported by EwO. This study highlights the need for programs that address the complexities of obesity and the specific needs of EwO, which currently are inadequately addressed according to EwO.


Assuntos
Promoção da Saúde , Manejo da Obesidade , Obesidade/terapia , Serviços de Saúde do Trabalhador , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Saúde do Trabalhador , Estados Unidos
19.
West J Nurs Res ; 41(5): 728-742, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30541407

RESUMO

This study was conducted on 60 male adult technicians in the worksite to examine the impact of the obesity management program on their eating habits, exercise self-efficacy, quality of life, and body components. This was a nonrandomized pretest and posttest intervention study. The obesity management program was applied for 16 weeks on diet education, exercise, and counseling provided by the occupational health nurse in the worksite. The questionnaire for measure included the general characteristics, eating habits, exercise self-efficacy, and quality of life. Body components were measured by using the InBody 720 device. The participants who received the obesity management program showed better eating habits, a higher level of exercise self-efficacy, a higher level of quality of life, lower levels of body weight and body mass index (BMI), a smaller waist and hip circumference, and a higher level of muscle mass as compared with the preapplication.


Assuntos
Obesidade/terapia , Enfermagem do Trabalho/métodos , Adulto , Índice de Massa Corporal , Humanos , Masculino , Manejo da Obesidade/métodos , Enfermagem do Trabalho/estatística & dados numéricos , Psicometria/instrumentação , Psicometria/métodos , República da Coreia , Autoeficácia , Inquéritos e Questionários , Local de Trabalho/psicologia
20.
J Public Health Manag Pract ; 25(3): E11-E18, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29595578

RESUMO

CONTEXT: In recent years, several states have adopted new regulations concerning nutrition, physical activity, and screen time in early care and education (ECE) settings to help prevent childhood obesity. OBJECTIVE: To disseminate a menu of factors that facilitate and/or impede implementation of obesity prevention regulations in ECE settings. DESIGN: To create the menu, we condensed and categorized factors identified in the literature and through field work by placing them within domains. We applied the menu by conducting semistructured interviews during a pilot test assessing implementation of ECE regulations in Colorado. SETTING AND PARTICIPANTS: We first interviewed state and local government agency leaders responsible for policy oversight, and state employees and contractors who acted as intermediaries to direct implementers. We then interviewed directors at ECE centers in the Denver, Colorado, area. We selected 21 ECE centers for a site visit on the basis of feasibility, percentage of low-income families, and diversity in race and ethnicity at each center. Seven centers participated. MAIN OUTCOME MEASURES: Minor and major facilitators and impediments to implementation of childhood obesity prevention regulations in ECE settings. RESULTS: The resulting menu includes 7 domains and 39 factors influential for implementation of ECE regulations. Of these 39 factors, interviewees identified 7 facilitating factors (4 major and 3 minor) and 2 impeding factors (both major). Major facilitating factors were buy-in from parents/caregivers, training and communication provided by governing authority and their contractors, and low level of change required by the regulations themselves. Major impeding factors were timing of implementation and balancing the demands of the regulations against other priorities. CONCLUSIONS: The menu developed by our research team, combined with existing frameworks in dissemination and implementation research, can be used by researchers, practitioners, and policy makers to anticipate factors that facilitate and/or impede implementation of ECE policies to prevent childhood obesity.


Assuntos
Manejo da Obesidade/métodos , Educação de Pacientes como Assunto/legislação & jurisprudência , Obesidade Pediátrica/prevenção & controle , Colorado , Promoção da Saúde/legislação & jurisprudência , Promoção da Saúde/métodos , Promoção da Saúde/tendências , Humanos , Manejo da Obesidade/tendências , Educação de Pacientes como Assunto/métodos , Educação de Pacientes como Assunto/tendências , Obesidade Pediátrica/psicologia , Desenvolvimento de Programas/métodos , Serviços de Saúde Escolar/legislação & jurisprudência , Serviços de Saúde Escolar/tendências
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