Weight bias reduction in health professionals: a systematic review.

Innovative and coordinated strategies to address weight bias among health professionals are urgently needed. We conducted a systematic literature review of empirical peer-reviewed published studies to assess the impact of interventions designed to reduce weight bias in students or professionals in a health-related field. Combination sets of keywords based on three themes (1: weight bias/stigma; 2: obesity/overweight; 3: health professional) were searched within nine databases. Our search yielded 1447 individual records, of which 17 intervention studies satisfied the inclusion criteria. Most studies (n = 15) included medical, dietetic, health promotion, psychology and kinesiology students, while the minority included practicing health professionals (n = 2). Studies utilized various bias-reduction strategies. Many studies had methodological weaknesses, including short assessment periods, lack of randomization, lack of control group and small sample sizes. Although many studies reported changes in health professionals' beliefs and knowledge about obesity aetiology, evidence of effectiveness is poor, and long-term effects of intervention strategies on weight bias reduction remain unknown. The findings highlight the lack of experimental research to reduce weight bias among health professionals. Although changes in practice will likely require multiple strategies in various sectors, well-designed trials are needed to test the impact of interventions to decrease weight bias in healthcare settings.

Metabolic effects of combined oral contraceptive preparations.

Fasting intermediary metabolite concentrations were measured in comparable groups of women either in the follicular or luteal phase of the menstrual cycle or taking low-dose estrogen combined oral contraceptive preparations. Blood total ketone bodies concentrations were significantly elevated in oral contraceptive users (p less than 0.05 v follicular and luteal groups) whilst blood alanine levels were lower (p less than 0.01 v follicular).

PIP: Intermediary metabolite concentrations were measured in overnight fasted young women either in the follicular or luteal phase of the menstrual cycle or taking oral contraceptive (OC) preparations to determine changes due to the female sex hormone. The 1st group of 10 subjects was studied around the midpoint of the follicular phase of the menstrual cycle. The 2nd group of 10 subjects was studied around the midpoint of the luteal phase. Subjects in these groups menstruated regularly, and the 1st day of menses was considered to be day 1 of the cycle. The 3rd group of 10 women was using combined OCs containing 30-35 mcg of ethinylestradiol with either 125-250 mcg levonorgestrel or 1 mg norethisterone as the progesterone. The studies were performed during the final week of pill taking with the oc taken the night prior to the morning of blood sampling. There were no significant differences between the group when comparing age, weight, or body mass index. In the luteal compared to follicular phase women, fasting levels of estradiol and progesterone were significantly higher. Significant differences were observed for blood alanine concentrations. These were significantly lower in the OC group compared to women in the follicular phase of the menstrual cycle. Results in the luteal phase women were intermediate between follicular phase and OC groups. Significant differences were found in 3-OHB concentrations with significantly higher levels in the OC group compared to women in the follicular or luteal phase of the menstrual cycle. There were no significant differences when comparing fasting data of OC users taking preparations containing either levonorgestrel or norethisterone. Compared to women in the follicular phase of the menstrual cycle, blood alanine concentrations were significantly lower with levonorgestrel and norethisterone containing preparations. Compared to the follicular phase of the menstrual cycle, 3-OHB concentrations were significantly higher with either levonorgestrel or norethisterone but not when compared to women in the luteal phase.

Colonic bacterial activity, biliary cholesterol saturation, and pathogenesis of gallstones.

The relation between colonic bacterial metabolites in bile and saturation of bile with cholesterol was investigated. Eleven healthy men ingested metronidazole (2 g daily) for 10 days to inhibit anaerobic bacterial activity. Bile composition was determined in fasting samples aspirated from the duodenum before metronidazole was given, at the end of 10 days on metronidazole, and a month after the drug was discontinued. Bile cholesterol saturation fell in ten of the eleven subjects from a mean of 1.00 to 0.83 and rose in all eleven after the drug was stopped. At the same time the proportion of deoxycholate in bile acid decreased from a mean of 24% to 7%, returning to 22% of the total a month after metronidazole had been stopped, and the proportion of chenodeoxycholate changed significantly from 33% to 46% and back to 33%. There was little change in cholate concentrations. Deoxycholate is formed exclusively by bacterial action in the colon. Its administration increases cholesterol saturation of bile, while chenodeoxycholate reduces it. These results suggest that colonic function is important in regulating bile composition. Dietary measures which reduce the return of newly formed deoxycholate from the colon to the bile reduce cholesterol saturation and so are likely to reduce the risk of gallstones.

The influence of sex, body weight, and renal function on the xylose test.

A low excretion of xylose may be due to malabsorption, renal disease, or old age. Malabsorption can be distinguished from other causes by performing a combined oral and intravenous test, the result being expressed as a fraction of these readings. Sex and body weight do not influence the xylose test.

Xylose test: effect of aspirin and indomethacin.

The xylose test was used to assess the effect of drugs on intestinal absorption. Both aspirin and indomethacin reduced the urinary output of xylose. By giving xylose intravenously as well as orally it was found that aspirin had a parenteral effect, probably impairing renal function, whereas indomethacin depressed intestinal absorption.

New measurement of the cosmic-ray positron fraction from 5 to 15 GeV.

We present a new measurement of the cosmic-ray positron fraction at energies between 5 and 15 GeV with the balloon-borne HEAT-pbar instrument in the spring of 2000. The data presented here are compatible with our previous measurements, obtained with a different instrument. The combined data from the three HEAT flights indicate a small positron flux of nonstandard origin above 5 GeV. We compare the new measurement with earlier data obtained with the HEAT-e(+/-) instrument, during the opposite epoch of the solar cycle, and conclude that our measurements do not support predictions of charge sign dependent solar modulation of the positron abundance at 5 GeV.

Measurement of the cosmic-ray antiproton-to-proton abundance ratio between 4 and 50 GeV.

We present a new measurement of the antiproton-to-proton abundance ratio, pbar/p, in the cosmic radiation. The HEAT-pbar instrument, a balloon borne magnet spectrometer with precise rigidity and multiple energy loss measurement capability, was flown successfully in Spring 2000, at an average atmospheric depth of 7.2 g/cm(2). A total of 71 antiprotons were identified above the vertical geomagnetic cutoff rigidity of 4.2 GV. The highest measured proton energy was 81 GeV. We find that the pbar/p abundance ratio agrees with that expected from a purely secondary origin of antiprotons produced by primary protons with a standard soft energy spectrum.