Factors influencing the adoption of health promoting behaviors in overweight pregnant women: a qualitative study.

BACKGROUND: The ability to adopt and implement health promotion behaviors is one of the most important determinants of health status. Various factors affect the successful changing of behaviors and choosing a healthy lifestyle. The present study aims at exploring the experiences of overweight pregnant women in terms of the factors influencing selection and adoption of health promoting behaviors during pregnancy. METHODS: This qualitative study reports the findings of individual and group in-depth interviews with 32 overweight pregnant women using semi-structured questions which was conducted in Tabriz-Iran in 2017 and lasted for 6 months. The data collection continued until the saturation of the data. Participants were selected using purposive sampling and study inclusion criteria. Interviews were recorded and transcribed. Thereafter, content analysis was made using MAXQDA v. 10. Strength of data was verified by both participants and external control. RESULTS: The reported effective factors led to identification of the two themes of two contextual perceived barriers and facilitators, which were classified into four main categories and nine subcategories: 1. Individual barriers (disabilities-additional needs in pregnancy and mental barriers) 2. Socio- environmental barriers (adverse effects of the environment, adverse effects of the relatives and financial pressures) 3. Individual facilitators (intrinsic incentives, abundance and individual skills) 4. Socio- environmental (social and family support, incentive environments, and raising awareness). CONCLUSION: The adoption of health behaviors and healthy lifestyle is under the mutual influence of individual characteristics and socio-environmental factors. What should be considered in planning and designing interventions is focused on removing barriers and strengthening facilitators, in particular by moderating social factors and taking into account individual needs and personal expectations.

The Role of the Faith Community Nurse in Weight Management.

Over two thirds of U.S. adults are overweight or obese; many view long-term behavior change as unachievable. Faith community nurses are ideally positioned to help people learn strategies for successful weight management. This article discusses the role of faith in lifestyle modification, and the use of the 5 A's Model for weight management.

Dietary advice on prescription: experiences with a weight reduction programme.

AIMS AND OBJECTIVES: To describe overweight persons' experiences with weight reduction and participation in the dietary advice on prescription. BACKGROUND: Approximately 20% of overweight individuals are able to successfully lose weight. Experiences from earlier weight reduction programmes indicate that those who succeed typically manage to avoid overeating to handle stress and have high motivation to lose weight. Those who fail have low self-control and engage in negative health behaviours such as eating when experiencing negative emotions and stress. DESIGN: The study used a descriptive qualitative design and was conducted at a Primary Health Care Centre in south-west Sweden. METHODS: The first nineteen study participants who completed the weight reduction programme in two years responded in writing to five open questions about their experiences with the programme. Data were analysed using inductive content analysis. RESULTS: The participants appreciated the face-to-face meetings with the nurse because they felt seen and listened to during these sessions. They also felt their life situations and self-discipline had an impact on how well they were able to follow the programme. Dietary advice on prescription advice was considered to be helpful for achieving behavioural changes and losing weight. People who succeeded in sustainably losing weight described the importance of support from partners or close friends. CONCLUSIONS: To achieve sustainable weight reduction, it is important to individualise the programme in order to address each person's life situation and the unique difficulties they may encounter. RELEVANCE TO CLINICAL PRACTICE: Motivational interviewing appears to be a good technique for developing a successful relationship between the nurse and the patient. The dietary advice on prescription advice was perceived to be a good way to improve food habits and can easily be used at many Primary Health Care Centres. Patient's partners should also be offered the opportunity to participate in the programme.

Implementing guidelines for preventing, identifying and treating adolescent overweight and obesity-School nurses' perceptions of the challenges involved.

AIMS AND OBJECTIVES: To gain a better understanding of school nurses' perceptions of the challenges involved in implementing national guidelines on managing overweight and obesity in adolescents. BACKGROUND: National guidelines for the management of childhood overweight and obesity are developed in many countries to translate scientific knowledge into practice. However, several challenges are involved in their implementation. DESIGN AND METHODS: A qualitative design with focus group interviews was chosen for data collection. Six focus group interviews with 21 school nurses were conducted. Data were analysed by qualitative content analyses. RESULTS: National guidelines provided new directions for managing overweight and obesity in school health services. School nurses were assigned new tasks and responsibilities, which they felt they were not sufficiently prepared for, nor were they supported by extra resources. Challenges in implementation of the guidelines were identified at various levels: system level (implementation strategy, available resources, training and support, professional collaboration, referral options); individual school nurse level (perceived competence, burden of responsibility, attitudes and emotions); subject level (sensitivity of weight-related issues); and professional level (scepticism to a body mass index cut-off of 25 kg/m2 as the starting point for intervention). CONCLUSIONS: School nurses felt overwhelmed in terms of implementing the guidelines. This indicates barriers not being sufficiently identified or acted upon during implementation. Further, the nurses' scepticism about the body mass index cut-off for intervention, and their experience that measuring and follow-up of adolescents' weight development was their responsibility alone, indicates that important discussions are needed on this as an adequate measure as well as on the professional division of responsibilities. RELEVANCE TO CLINICAL PRACTICE: Having a proper strategy for implementation, and ensuring that necessary clinical structures and resources are available, is crucial. Including school nurses in developing and implementing such strategies is vital for success in implementing national guidelines.

Nurse provision of healthy lifestyle advice to people who are overweight or obese.

A cross-sectional survey was conducted in a regional area in Australia to measure nurses' perceptions, practices, and knowledge in regard to providing healthy lifestyle advice to people who are overweight or obese. Responses were compared between geographic regions. Participation was voluntary and anonymous. Of the 79 nurse participants, 68% considered that provision of healthy lifestyle advice was within their scope of practice. Only 28% reported frequently estimating body mass index in the practice setting. Nurses often recommended increasing activity levels (44%), but recommended reducing daily caloric intake less often (25%). Nurses' knowledge about weight management was variable and the proportion of correct answers to knowledge items ranged from 33-99%. Nurses have many opportunities to deliver healthy lifestyle advice in a range of practice settings. The variation in practices and knowledge of nurses indicates a need for improved healthy lifestyle education for undergraduate and practicing nurses.

The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) study.

BACKGROUND: Because early life growth has long-lasting metabolic and behavioral consequences, intervention during this period of developmental plasticity may alter long-term obesity risk. While modifiable factors during infancy have been identified, until recently, preventive interventions had not been tested. The Intervention Nurses Starting Infants Growing on Healthy Trajectories (INSIGHT). Study is a longitudinal, randomized, controlled trial evaluating a responsive parenting intervention designed for the primary prevention of obesity. This "parenting" intervention is being compared with a home safety control among first-born infants and their parents. INSIGHT's central hypothesis is that responsive parenting and specifically responsive feeding promotes self-regulation and shared parent-child responsibility for feeding, reducing subsequent risk for overeating and overweight. METHODS/DESIGN: 316 first-time mothers and their full-term newborns were enrolled from one maternity ward. Two weeks following delivery, dyads were randomly assigned to the "parenting" or "safety" groups. Subsequently, research nurses conduct study visits for both groups consisting of home visits at infant age 3-4, 16, 28, and 40 weeks, followed by annual clinic-based visits at 1, 2, and 3 years. Both groups receive intervention components framed around four behavior states: Sleeping, Fussy, Alert and Calm, and Drowsy. The main study outcome is BMI z-score at age 3 years; additional outcomes include those related to patterns of infant weight gain, infant sleep hygiene and duration, maternal responsiveness and soothing strategies for infant/toddler distress and fussiness, maternal feeding style and infant dietary content and physical activity. Maternal outcomes related to weight status, diet, mental health, and parenting sense of competence are being collected. Infant temperament will be explored as a moderator of parenting effects, and blood is collected to obtain genetic predictors of weight status. Finally, second-born siblings of INSIGHT participants will be enrolled in an observation-only study to explore parenting differences between siblings, their effect on weight outcomes, and carryover effects of INSIGHT interventions to subsequent siblings. DISCUSSION: With increasing evidence suggesting the importance of early life experiences on long-term health trajectories, the INSIGHT trial has the ability to inform future obesity prevention efforts in clinical settings. TRIAL REGISTRATION: NCT01167270. Registered 21 July 2010.

[Nursing: promoting the health of overweight children and adolescents in the school context]. / Enfermagem: promoção da saude de crianças e adolescentes com excesso de peso no contexto escolar.

The study aimed to analyze the nursing interventions related to the competencies of health promotion of overweight children and adolescents in the school context, in light of the Galway Consensus through an integrative review. Articles published between 1988 and June, 2013 were found in the databases CINAHL, SCOPUS, MEDLINE/PubMed, Cochrane, LILACS and SciELO. A total of 139 publications were obtained from indexed descriptors. Ten articles were selected after reading. The most evident competencies for health promotion were: catalyzing change, needs assessment and impact assessment. The highlights were activities of health education and partnerships with other health professionals and the families of students. It was found that the skills of health promotion developed by nurses can contribute to the adoption of healthy habits by overweight children and adolescents.

Reducing pediatric overweight: nurse-delivered motivational interviewing in primary care.

The purpose of this study was to test the Let's Go 5-2-1-0 program delivered through motivational interviewing by nurses with 4-18-year-old overweight children and parents in primary care (PC). A quasi-experimental design allocated 60 control families to standard clinical care (SCC) and 70 families to SCC plus the 5-2-1-0 intervention. Drop-out rates were 9 and 35% at 6 months and 25 and 41% at 12 months, respectively for control and intervention participants. BMI percentile trended (p = .057) toward decline (M change = -3.0 versus -1.5) for intervention children at 6 months (n = 52 control, 44 intervention), and nonsignificantly (p = 0.14) for both groups (43 control, 40 intervention) at 12 months (controls -1.9, intervention -4.6). Intervention effects were found for self-reported daily fruit/vegetable consumption, physical activity, and screen time. Satisfaction was high. Further study of the PC nursing intervention is warranted.

Objective and subjective sleep disturbances in individuals with psychiatric disabilities.

Sleep disturbances are common complaints in individuals with psychiatric disabilities, frequently occurring at onset and with exacerbation of illness. A small descriptive study of community-based overweight individuals (N = 9) completed the Pittsburgh Sleep Quality Index, wore an ActiGraph and kept a sleep diary for 7 to 14 days. All but two participants had poor sleep efficiency based on actigraphy scores, an objective measure of sleep. These scores were in agreement with the Pittsburgh Sleep Quality Index, a self-report measure, in all but one participant. The findings indicate the Pittsburgh Sleep Quality Index is a comprehensive measure to use in assessing sleep in individuals who have psychiatric disabilities.

Therapies for obesity and medication-associated weight gain.

Compared to the general population, individuals with psychiatric illness, especially serious and chronic mood and psychotic disorders, are more likely to be overweight or obese, have higher rates of weight-related medical conditions, and have greater non-suicide mortality rates. Lorcaserin (Belviq(®)), phentermine/topiramate combination (Qsymia(®)), and bupropion/naltrexone combination have been demonstrated to be effective for the treatment of obesity, as an adjunct to a reduced-calorie diet and physical activity, although their absolute safety has yet to be established with more widespread use or longer use. Bariatric surgery is an effective approach for morbid obesity, but careful psychiatric assessment before and follow up after surgery is necessary. Behavioral lifestyle interventions to promote weight loss are effective and should be implemented along with or instead of drug therapies or surgery.

Female-to-male transmasculine adult health: a mixed-methods community-based needs assessment.

BACKGROUND: There is a dearth of health research about transgender people. OBJECTIVES: This mixed-methods study sought to formatively investigate the health and perceived health needs of female-to-male transmasculine adults. DESIGN: A cross-sectional quantitative needs assessment (n = 73) and qualitative open-ended input (n = 19) were conducted in June 2011. A latent class analysis modeled six binary health indicators (depression, alcohol use, current smoking, asthma, physical inactivity, overweight status) to identify clusters of presenting health issues. RESULTS: Four clusters of health indicators emerged: (a) depression; (b) syndemic (all indicators); (c) alcohol use, overweight status; and (d) smoking, physical inactivity, overweight status. Transphobic discrimination in health care and avoiding care were each associated with membership in the syndemic class. Qualitative themes included personal health care needs, community needs, and resilience and protective factors. CONCLUSIONS: Findings fill an important gap about the health of transmasculine communities, including the need for public health efforts that holistically address concomitant health concerns.

[Development of an evidence-based self-management programme for patients in the first year after renal transplantation with a focus on prevention of weight gain, physical exercise and drug adherence]. / Entwicklung eines evidenzbasierten Selbstmanagementprogramms für Patient(inn)en im ersten Jahr nach Nierentransplantation mit Fokus auf die Prävention von Gewichtzunahme, Bewegung und Medikamentenadhärenz.

In the first year after kidney transplantation patients are challenged with incorporating new behaviour patterns into their daily lives. Due to the higher risk of cardiovascular disease amongst kidney transplant recipients, behaviours such as preventing undesired weight gain, exercising, avoiding smoking, and managing medications take on crucial importance. The aim of the project was to develop a programme based on prevailing evidence to promote self-management skills in this patient population. To this end a participatory action research approach was chosen. The programme was developed with inter-professional collaboration under the direction of an advanced practice nurse. As theoretical framework for the development of the intervention models of behaviour change and self-management were chosen. The content is based on current literature and includes the viewpoints of both patients and nursing experts. The programme consists of three elements: 1) Educational brochures developed through inter-professional collaboration and evaluated in a pilot survey. These brochures provide a framework for appointments with nursing professionals. 2) The appointments are a forum in which the patient can gain access to relevant information and can be supported in putting sustainable health-related behaviours into practice in daily life. 3) A peer programme that uses treatment plans to encourage patients deviating from preferred health-related behaviours to make changes in their behaviour. The programme evaluation started in May of 2012. Results of the pilot study are expected in 2014.

The Weighty Matter intervention: a family-centered way to tackle an overweight childhood.

The complexity of childhood overweight and obesity requires that researchers continue to investigate potential solutions. We developed "The Weighty Matter" intervention to prevent obesity in mildly overweight 4- and 6-year-old children. This article describes the intervention protocol, the health habits of families (n=86), and the effect of the intervention on children's weight for height, parents' body mass indices, and family health habits after a 12-month follow-up. Positive changes were seen in families' health habits, although the results did not reach statistical significance. As a result of this study, a new and practical method was developed to focus on the issue of family health habits.

Treatment strategies for overweight and obesity.

PURPOSE: To review the health problem of overweight and obesity in adults, the available treatment options, and clinical implications for nursing. ORGANIZING CONSTRUCT: Overweight and obesity. FINDINGS: Today, obesity is considered a pandemic that is present in developed and developing countries. Obesity, considered a chronic condition, is associated with numerous comorbid conditions (e.g., cardiovascular disease, diabetes, and some cancers). There are three approaches to the treatment of overweight and obesity: lifestyle modification, pharmacotherapy, and bariatric surgery. The most effective approach uses a combination of behavioral strategies and diet and exercise to support sustained lifestyle change. Pharmacotherapy and bariatric surgery have better outcomes when augmented by lifestyle treatment compared with either approach alone. Bariatric surgery, which is being performed increasingly more often, is reserved for those with a body mass index (BMI) of greater than or equal to 40, or a BMI of 35 to 39.9 in the presence of comorbidities. The biggest treatment challenge is the prevention of weight regain. CONCLUSIONS: The most effective treatment approach is the use of lifestyle modification, which can be delivered alone or to augment pharmacotherapy or bariatric surgery. CLINICAL RELEVANCE: Similar to other chronic conditions, obesity needs ongoing management, which is a role that nursing can help fill in the clinical setting.

[The prevalence of metabolic syndrome]. / La prévalence du syndrome métabolique.

Numerous studies of comorbidity have shown excess mortality and excess morbidity in people suffering from mental disorders. Monitoring of the waist circumference is an essential indicator for screening for metabolic syndrome.

Effect of remote nursing monitoring on overweight in women: clinical trial.

OBJECTIVE: to evaluate the effect of remote nursing monitoring on the improvement of anthropometric measurements of overweight women. METHOD: controlled, randomized clinical trial, carried out in a reference outpatient clinic for treatment of obesity. The baseline sample was composed of 101 women randomly assigned to two groups, 51 in the intervention group (IG) and 50 in the control group (CG). The IG received remote monitoring through telephone calls and conventional monitoring, and the CG received conventional monitoring. Women were assessed at the baseline and after three months of intervention. A paired t-test and analysis of covariance were used to evaluate intragroup differences in anthropometric measurements, and the statistical significance of 5% was adopted. Eighty one women completed the study. RESULTS: in the intergroup comparison after the intervention, a reduction of 1.66 kg in the mean weight (p = 0.017) and of 0.66 kg/m2 in the mean BMI (p = 0.015) was found in the intervention group. There was a borderline statistically significant (p = 0.055) reduction of 2.5 cm in WC with in the intervention group. CONCLUSION: the remote monitoring was beneficial in reducing anthropometric measurements. RBR-3hzdgv.

Addressing Food Insecurity and Overweight/Obesity in Hospitalized Low-Income Latino Patients.

Food insecurity (FI), the limited or unreliable availability of safe and nutritious food, is a pressing public health concern affecting millions of U.S. citizens. Unfortunately, FI tends to impact those who are most vulnerable (e.g., low-income minorities) and potentially increases obesity risks, diet-sensitive disease risks (e.g., hypertension and type 2 diabetes), and hospital utilization. Low-income Latino patients may be particularly sensitive to adverse outcomes based on unaddressed socioeconomic needs. Nurses are in a prime position to assess and address FI in these patients. Our article will discuss how nurses can be advocates in combating FI in Latino patients with overweight/obesity.