Clinical Obesity Services in Public Hospitals in Australia: a position statement based on expert consensus.

We aimed to describe the current state of specialist obesity services for adults with clinically severe obesity in public hospitals in Australia, and to analyse the gap in resources based on expert consensus. We conducted two surveys to collect information about current and required specialist obesity services and resources using open-ended questionnaires. Organizational level data were sought from clinician expert representatives of specialist obesity services across Australia in 2017. Fifteen of 16 representatives of current services in New South Wales (n = 8), Queensland (n = 1), Victoria (n = 2), South Australia (n = 3), and the Australian Capital Territory (n = 1) provided data. The composition of services varied substantially between hospitals, and patient access to services and effective treatments were limited by strict entry criteria (e.g. body mass index 40 kg/m2 or higher with specific complication/s), prolonged wait times, geographical location (major cities only) and out-of-pocket costs. Of these services, 47% had a multidisciplinary team (MDT), 53% had an exercise physiologist/physiotherapist, 53% had a bariatric surgeon and 33% had pharmacotherapy resources. Key gaps included staffing components of the MDT (psychologist, exercise physiologist/physiotherapist) and access to publicly funded weight loss pharmacotherapy and bariatric surgery. There was consensus on the need for significant improvements in staff, physical infrastructure, access to services, education/training in obesity medicine and targeted research funding. Based on the small number of existing, often under-resourced specialist obesity services that are located only in a few major cities, the vast majority of Australians with clinically severe obesity cannot access the specialist evidence based treatments needed.

Chronic disease trends due to excess body weight in Australia.

Trends in chronic diseases provide insights into strategies required to improve population health. The authors determined prevalence and multiple-adjusted population attributable risk (PAR) estimates of chronic diseases because of lifestyle factors among Australian adults between 1989-90 and 2004-5, accounting for demographic factors. Between 1989-90 and 2004-5, prevalence increased for diabetes (3.8-6.0%, P < 0.001) and high cholesterol (11.3-13.9%, P < 0.001), but decreased for high blood pressure (21.4-20.4%, P = 0.003) and cardiovascular disease (CVD, 6.2-5.4%, P < 0.001). Prevalence increased for body mass index (BMI) 25-29.9 (30.3-34.9%, P < 0.001), BMI 30-34.9 (7.4-13.5%, P < 0.001) and BMI 35+ (2.1-5.4%, P < 0.001), but decreased for metabolic equivalent-hours per week (MET-hr/week) 0 (36.8-33.1%, P < 0.001) and current smokers (27.6-24.4%, P < 0.001). Diabetes, high cholesterol and high blood pressure burden increased mostly for 60+ years, lowest income quintiles and high BMI (30-34.9 and 35+). Diabetes and CVD burden increased mostly for MET-hr/week 0. Many chronic disease cases would have been theoretically prevented if adults had no prior exposure to BMI 25-29.9 (PAR 9-17%), BMI 30+ (PAR 1-14%) and MET-hr/week 0 (PAR 6-14%). Reducing exposure to lifestyle hazards across the lifespan is required for reversing the rising burden of chronic diseases. Decreases in CVD and high blood pressure prevalence were likely due to targeted improvements in health care, indicating that more can and should be done.

Association between weight perception and psychological distress.

BACKGROUND: Obesity is a well-known cause of cardiovascular disease burden and premature death, but effects on depressive symptoms remain equivocal. Depressive symptoms may be more common among the obese individuals who perceive themselves as overweight, rather than those who perceive themselves as having an acceptable weight. Our aim was to determine whether weight status and weight perceptions are independently associated with psychological distress. METHODS: We conducted a cross-sectional study using data from the Australian National Health Survey 2004-2005 (N=17 253). All variables were collected by self-report. Adjusted multinomial logistic regression analysis was conducted to generate prevalence odds ratios with 95% confidence intervals (95% CI) for medium (Kessler Psychological Distress Scale (K10) scores of 20-29) and high (K10 scores of 30-50) psychological distress (compared with K10 scores of 10-19 as the reference) associated with weight status (standard body mass index (BMI) cutoffs for underweight, overweight and obesity vs normal weight), weight perception (perceived underweight and overweight vs acceptable weight) and weight misperception (incorrect with BMI vs correct with BMI) adjusting for numerous important covariates. RESULTS: Overweight and underweight perception increased the odds of medium (40 and 50%) and high (50 and 120%) psychological distress, whereas weight status and weight misperception were not associated with psychological distress in adjusted analysis. Gender, alcohol consumed per week and post-school education were not significant covariates (at P<0.10 level). CONCLUSIONS: Overweight and underweight perception rather than weight status or weight misperception are significant risk factors associated with medium and high psychological distress prevalence and effects appear to be uniform for men and women. Well-designed prospective studies are still needed to determine whether weight perceptions cause psychological distress, and if so, whether symptoms are significantly reduced following effective intervention.

Obesity effects on depression: systematic review of epidemiological studies.

BACKGROUND: Obesity is a well-known cause of cardiovascular disease burden and premature death, but effects on psychological morbidity remain uncertain. This article reports findings following a systematic review of epidemiological studies to determine whether obesity causes depression. METHODS: Multiple databases were searched for English-language studies of etiology of obesity (exposure variable, analyzed as an ordered category) on depression outcomes (dependent variables, continuous or categorical). Studies in children and in women during pregnancy or postpartum were excluded, as were nonrepresentative cross-sectional studies. Searches and identification of studies for inclusion were performed by EA, whereas a descriptive synthesis of important study characteristics was undertaken independently by us. RESULTS: We reviewed 24 out of approximately 4500 potentially relevant studies; 4 were prospective cohort studies and 20 were cross-sectional studies (10 from the United States). Effect measures reported in all prospective cohort studies were consistent and suggested that obesity may increase the odds of future depression outcomes (symptoms or nonclinical diagnosis of depression). Effect measures reported in most cross-sectional studies from the United States supported the hypothesized association between obesity and prevalence of depression outcomes for women but not men, in contrast most cross-sectional studies from populations other than the United States consistently failed to find such associations. CONCLUSIONS: Overall, there is a weak level of evidence supporting the hypothesis that obesity increases the incidence of depression outcomes. Few high-quality prospective cohort studies exist, and cross-sectional studies account for the vast body of published evidence, and therefore firm conclusions for causality cannot yet be drawn. Our finding warrants additional high-quality etiological research on this topic.

Weight status and perception barriers to healthy physical activity and diet behavior.

BACKGROUND: Physical inactivity and insufficient fruit and vegetable consumption are key risk factors for obesity and noncommunicable diseases. Weight perceptions may affect physical activity and diet behaviors. We report current prevalence estimates of Australian adults meeting recommended levels of leisure-time physical activity (LTPA) (> or =150 min/week or more of at least moderate-intensity physical activity (including walking) on > or =5 days/week) and fruit (> or =2 servings/day) and vegetable (> or =5 servings/day) consumption for health benefits, by weight status and perceptions. METHODS: We conducted a cross-sectional survey analysis of data for 16 314 adults from the Australian National Health Survey 2004-2005. All variables were collected by self-report. Weighted estimates were age- and gender-specific, and data were analyzed using logistic regression with acceptable weight referent categories, adjusting for covariates. RESULTS: Among acceptable, overweight and obese adults, the prevalence of LTPA was 26.8, 26.1 and 19.3% for men, and 27.7, 23.7 and 19.7% for women, respectively. Approximately 55 and 15% of adults consumed sufficient fruit servings/day and vegetable servings/day, respectively, and less than 5% of adults met combined LTPA and diet guidelines. Overweight decreased the odds ratio for LTPA among women but not men, and obesity decreased the odds ratio for LTPA among both men and women. Overweight perception conferred odds ratios of 0.83 (95% CI 0.70-0.97, P=0.021) for overweight men, and of 0.74 (95% CI 0.62-0.88, P=0.001) and 0.69 (95% CI 0.59-0.80, P<0.001) for obese men and women, respectively; for LTPA, whereas no significant associations were found for acceptable weight perception. No consistent associations between weight status or perceptions and diet behaviors were found. CONCLUSIONS: Overweight perception may be another barrier to physical activity participation among men and women with excess body weight. Public health strategies might need to focus on overcoming weight perception as well as weight status barriers to adopting healthy physical activity behaviors.

Efficacy of exercise for treating overweight in children and adolescents: a systematic review.

BACKGROUND: Overweight prevalence among children/adolescents is increasing, while adult obesity may potentially cause a decline in life expectancy. More exercise is uniformly recommended, although treatment efficacy remains unclear. OBJECTIVE: To determine the efficacy of exercise alone for treating overweight in children/adolescents. DESIGN: A systematic review and meta-analysis of randomized trials published in English were completed following multiple database searches performed on December 10, 2004. Studies of isolated or adjunctive exercise/physical activity treatment in overweight/obese children or adolescents which reported any overweight outcome were included. Literature searches identified 645 papers which were manually searched, of which 45 were considered for inclusion, of which 13 papers which reported 14 studies were included (N=481 overweight boys and girls, aged approximately 12 years). Two reviewers independently identified relevant papers for potential inclusion and assessed methodological quality. Principal measures of effects included the mean difference (MD) (between treatment and control groups), the weighted MD (WMD), and the standardized MD (SMD). RESULTS: Few studies were of robust design. The pooled SMD was -0.4 (-0.7, -0.1, P=0.006) for percent body fat, and -0.2 (-0.6, 0.1, P=0.07) for central obesity outcomes, whereas the pooled WMD was -2.7 kg (-6.1 kg, 0.8 kg, P=0.07) for body weight, all of which favored exercise. Pooled effects on body weight were significant and larger for studies of higher doses, whereas nonsignificant and smaller effects were seen for studies of lower doses of exercise (155-180 min/weeks vs 120-150 min/weeks). CONCLUSIONS: Based on the small number of short-term randomized trials currently available, an aerobic exercise prescription of 155-180 min/weeks at moderate-to-high intensity is effective for reducing body fat in overweight children/adolescents, but effects on body weight and central obesity are inconclusive. Recommendations for future study designs are discussed.