Facilitators and Barriers to Weight Loss Among Patients With Idiopathic Intracranial Hypertension.

IF 2 4区 医学 Q3 CLINICAL NEUROLOGY Journal of Neuro-Ophthalmology Pub Date : 2025-03-01 Epub Date: 2024-04-12 DOI:10.1097/WNO.0000000000002133
Olivia J Killeen, Lizbeth A Gonzalez, Amy E Rothberg, Sangeeta Khanna, Wayne T Cornblath, Tatiana Deveney, Sui H Wong, Lindsey B De Lott
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Abstract

Background: Little is known about motivation for weight loss and barriers to weight loss among patients with idiopathic intracranial hypertension (IIH). Such information is crucial for developing tailored weight management recommendations and novel interventions.

Methods: We administered a survey to patients with IIH presenting to neuro-ophthalmology clinics at The University of Michigan Kellogg Eye Center (Michigan, USA) and St. Thomas' Hospital (London, England). Participants rated importance and motivation to lose weight (1-10 scale; 10 = extremely important/motivated). Facilitators and barriers to weight loss were assessed using open-ended survey questions informed by motivational interviewing methodology. Open-ended responses were coded by 2 team members independently using a modified grounded theory approach. Demographic data were extracted from medical records. Descriptive statistics were used to analyze quantitative responses.

Results: Of the 221 (43 Michigan and 178 London) patients with IIH ( Table 1 ), most were female (n = 40 [93.0%] Michigan and n = 167 [94.9%] London). The majority of patients in the United States were White (n = 35 [81.4%] Michigan), and the plurality were Black in the United Kingdom (n = 67 [37.6%] London]) with a mean (SD) BMI of 38.9 kg/m 2 (10.6 kg/m 2 ) Michigan and 37.5 kg/m 2 (7.7 kg/m 2 ) London. Participants' mean (SD) level of importance to lose weight was 8.5 (2.2) (8.1 [2.3] Michigan and 8.8 [2.1] London), but their mean (SD) level of motivation to lose weight was 7.2 (2.2) (6.8 [2.4] Michigan and 7.4 [2.1] London). Nine themes emerged from the 992 open-ended coded survey responses grouped into 3 actionable categories: self-efficacy, professional resources (weight loss tools, diet, physical activity level, mental health, and physical health), and external factors (physical/environmental conditions, social influences, and time constraints). Most responses (55.6%; n = 551) were about barriers to weight loss. Lack of self-efficacy was the most discussed single barrier (N = 126; 22.9% total, 28.9% Michigan, and 20.4% London) and facilitator (N = 77; 17.5% total, 15.9% Michigan, and 18.7% London) to weight loss. Other common barriers were related to physical activity level (N = 79; 14.3% total, 13.2% Michigan, and 14.8% London) and diet (N = 79; 14.3% total, 9.4% Michigan, and 16.3% London). Commonly reported facilitators included improvements in physical activity level (N = 73; 16.6% total, 18.5% Michigan, and 15.1% London) and dietary changes (N = 76; 17.2% total, 16.4% Michigan, and 17.9% London).

Conclusions: Patients with IIH believe weight loss is important. Self-efficacy was the single most mentioned important patient-identified barrier or facilitator of weight loss, but professional resource needs and external factors vary widely at the individual level. These factors should be assessed to guide selection of weight loss interventions that are tailored to individual patients with IIH.

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特发性颅内高压症患者减轻体重的促进因素和障碍。
背景:人们对特发性颅内高压(IIH)患者的减肥动机和减肥障碍知之甚少。这些信息对于制定有针对性的体重管理建议和新型干预措施至关重要:我们对在密歇根大学凯洛格眼科中心(美国密歇根州)和圣托马斯医院(英国伦敦)神经眼科诊所就诊的特发性颅内高压患者进行了一项调查。参与者对减肥的重要性和积极性进行了评分(1-10 分;10 = 极其重要/积极)。根据动机访谈法,使用开放式调查问题对减肥的促进因素和障碍进行了评估。开放式回答由两名小组成员采用改良的基础理论方法进行独立编码。人口统计学数据来自医疗记录。描述性统计用于分析定量回答:在221名(密歇根州43名,伦敦178名)IIH患者中(表1),大多数为女性(密歇根州n = 40 [93.0%],伦敦n = 167 [94.9%])。美国的大多数患者为白人(密歇根州为 35 人 [81.4%]),英国的大多数患者为黑人(伦敦为 67 人 [37.6%]),密歇根州的平均(标清)体重指数为 38.9 kg/m2(10.6 kg/m2),伦敦为 37.5 kg/m2(7.7 kg/m2)。参与者对减肥重要性的平均(标清)水平为 8.5 (2.2)(密歇根为 8.1 [2.3],伦敦为 8.8 [2.1]),但他们对减肥积极性的平均(标清)水平为 7.2 (2.2)(密歇根为 6.8 [2.4],伦敦为 7.4 [2.1])。从 992 份开放式编码调查回复中得出了 9 个主题,并将其分为 3 个可操作的类别:自我效能、专业资源(减肥工具、饮食、体育锻炼水平、心理健康和身体健康)和外部因素(身体/环境条件、社会影响和时间限制)。大多数回答(55.6%;n = 551)都是关于减肥障碍的。缺乏自我效能感是讨论最多的减肥障碍(126 人;占总人数的 22.9%,密歇根州占 28.9%,伦敦市占 20.4%)和减肥促进因素(77 人;占总人数的 17.5%,密歇根州占 15.9%,伦敦市占 18.7%)。其他常见障碍与体育锻炼水平(79 人,占总人数的 14.3%,密歇根州占 13.2%,伦敦市占 14.8%)和饮食(79 人,占总人数的 14.3%,密歇根州占 9.4%,伦敦市占 16.3%)有关。常见的促进因素包括体育锻炼水平的提高(73 人,占总人数的 16.6%,密歇根州占 18.5%,伦敦占 15.1%)和饮食习惯的改变(76 人,占总人数的 17.2%,密歇根州占 16.4%,伦敦占 17.9%):结论:IIH 患者认为减肥很重要。自我效能感是患者提及最多的一个重要的减肥障碍或促进因素,但专业资源需求和外部因素在个体层面存在很大差异。应该对这些因素进行评估,以指导选择适合 IIH 患者的减肥干预措施。
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来源期刊
Journal of Neuro-Ophthalmology
Journal of Neuro-Ophthalmology 医学-临床神经学
CiteScore
2.80
自引率
13.80%
发文量
593
审稿时长
6-12 weeks
期刊介绍: The Journal of Neuro-Ophthalmology (JNO) is the official journal of the North American Neuro-Ophthalmology Society (NANOS). It is a quarterly, peer-reviewed journal that publishes original and commissioned articles related to neuro-ophthalmology.
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