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Weight stigma and bias: A guide for pediatric clinicians 体重污名和偏见:儿科临床医生指南
Pub Date : 2023-06-01 DOI: 10.1016/j.obpill.2023.100058
Amy Braddock , Nancy T. Browne , Marcella Houser , Giselle Blair , Dominique R. Williams

Introduction

Many children and adolescents with obesity experience weight stigma and bias, which can have detrimental mental health, medical, and social consequences. Weight stigma in the healthcare setting threatens the therapeutic relationship between health care providers and their pediatric patients and families.

Methods

Data supporting this guidance were derived from cited references.

Results

Based upon referenced citations, this review offers 7 best practices for pediatric providers to work to reduce weight stigma including: assess for personal weight bias, improve communication, provide a welcoming clinic environment, seek out additional training and informative experiences, evaluate the messaging and culture of the organization, screen for trauma and bullying, and enlist the help of board-certified obesity medicine specialists.

Conclusions

Providers have an important role in mitigating the harmful effects of weight stigma. It is our hope these recommendations, as well as the other resources provided, will help providers to begin to address their own individual weight biases, as well as the institutional weight biases where we care for patients.

引言许多肥胖儿童和青少年都会经历体重耻辱和偏见,这可能会对心理健康、医疗和社会造成不利影响。医疗保健环境中的体重污名威胁着医疗保健提供者与其儿科患者和家庭之间的治疗关系。方法支持本指南的数据来源于引用的参考文献。结果基于引用文献,本综述为儿科提供者减少体重污名提供了7种最佳实践,包括:评估个人体重偏见,改善沟通,提供一个受欢迎的诊所环境,寻求额外的培训和信息体验,评估组织的信息和文化,筛查创伤和欺凌,并寻求委员会认证的肥胖医学专家的帮助。结论提供者在减轻体重污名的有害影响方面发挥着重要作用。我们希望这些建议以及提供的其他资源将帮助提供者开始解决他们自己的个人体重偏见,以及我们照顾患者的机构体重偏见。
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引用次数: 0
A qualitative exploration on the needs of health care providers working with adolescents who are undergoing bariatric surgery 对正在接受减肥手术的青少年的卫生保健提供者的需求进行定性探讨
Pub Date : 2023-06-01 DOI: 10.1016/j.obpill.2023.100067
Biagina-Carla Farnesi , Kimiya Kaffash , Tamara R. Cohen , Angela S. Alberga

Background

With increasing prevalence of severe obesity in youth, more adolescents are becoming candidates for bariatric surgery. In Canada, bariatric surgery in adolescents is in its infancy, and long-term health outcomes are not well known. It is unknown what health care providers (HCPs) are using to prepare and guide their adolescent patients for bariatric surgery. The needs of HCPs should be explored with the aim to improve patient outcomes. Therefore, the purpose of this study was to investigate the resource needs of HCPs working with adolescents living with severe obesity who are undergoing bariatric surgery.

Methods

This qualitative study consisted of a focus group with seven HCPs from an adolescent bariatric program using a semi-structured interview guide. The focus group discussion was audio-recorded, and the recording was transcribed verbatim. A thematic analysis was conducted.

Results

Four data-generated themes emerged highlighting the perceived needs and challenges faced by HCPs. These included (1) gaps in patient education materials on the subject of the bariatric surgery process, obesity as a chronic disease and mental health, (2) the need for designing resources that are teen-friendly, adaptable, and accessible, (3) the need for resources to facilitate decision-making and patient evaluation delivering more streamlined care and; (4) challenges to addressing resource needs due to limited clinical time and budgets.

Conclusion

This needs assessment study highlights the need for appropriate resources for patient education, as well as pre and post-operative preparation. The hope is that HCPs can improve quality of care delivered and positively impact surgical outcomes in their patients.

背景随着青少年严重肥胖的患病率越来越高,越来越多的青少年成为减肥手术的候选者。在加拿大,青少年减肥手术尚处于起步阶段,长期健康结果尚不清楚。目前尚不清楚医疗保健提供者(HCP)正在使用什么来准备和指导青少年患者进行减肥手术。应探讨HCP的需求,以提高患者的治疗效果。因此,本研究的目的是调查HCP对正在接受减肥手术的严重肥胖青少年的资源需求。方法这项定性研究由一个焦点小组组成,由来自青少年减肥项目的七名HCP组成,使用半结构化访谈指南。焦点小组的讨论是录音的,录音是逐字转录的。进行了专题分析。结果出现了四个数据生成的主题,突出了HCP所感知的需求和面临的挑战。其中包括(1)在减肥手术过程、肥胖作为一种慢性病和心理健康等主题的患者教育材料方面存在差距,(2)需要设计对青少年友好、适应性强和可访问的资源,(3)需要资源来促进决策和患者评估,提供更精简的护理;(4) 由于临床时间和预算有限,解决资源需求面临挑战。结论这项需求评估研究强调了对患者教育以及术前和术后准备的适当资源的需求。希望HCP能够提高提供的护理质量,并对患者的手术结果产生积极影响。
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引用次数: 0
Letter to the Editor of Obesity Pillars from the Obesity Medicine Fellowship Council 肥胖医学奖学金委员会致肥胖支柱编辑的信
Pub Date : 2023-06-01 DOI: 10.1016/j.obpill.2023.100068
Yoon Ji Ahn , John Michael Taormina , Beverly G. Tchang, Gitanjali Srivastava, Stacy L. Schmidt, Lee M. Kaplan
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引用次数: 0
Obesity medicine as a subspecialty and United States certification – A review 肥胖医学作为亚专科与美国认证综述
Pub Date : 2023-06-01 DOI: 10.1016/j.obpill.2023.100062
Angela Fitch , Deborah B. Horn , Christopher D. Still , Lydia C. Alexander , Sandra Christensen , Nicholas Pennings , Harold Edward Bays

Background

Certification of obesity medicine for physicians in the United States occurs mainly via the American Board of Obesity Medicine (ABOM). Obesity medicine is not recognized as a subspecialty by the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA). This review examines the value of specialization, status of current ABOM Diplomates, governing bodies involved in ABMS/AOA Board Certification, and the advantages and disadvantages of an ABMS/AOA recognized obesity medicine subspecialty.

Methods

Data for this review were derived from PubMed and appliable websites. Content was driven by the expertise, insights, and perspectives of the authors.

Results

The existing ABOM obesity medicine certification process has resulted in a dramatic increase in the number of Obesity Medicine Diplomates. If ABMS/AOA were to recognize obesity medicine as a subspecialty under an existing ABMS Member Board, then Obesity Medicine would achieve a status like other ABMS recognized subspecialities. However, the transition of ABOM Diplomates to ABMS recognized subspecialists may affect the kinds and the number of physicians having an acknowledged focus on obesity medicine care. Among transition issues to consider include: (1) How many ABMS Member Boards would oversee Obesity Medicine as a subspecialty and which physicians would be eligible? (2) Would current ABOM Diplomates be required to complete an Obesity Medicine Fellowship? If not, then what would be the process for a current ABOM Diplomate to transition to an ABMS-recognized Obesity Medicine subspecialist (i.e., “grandfathering criteria”)? and (3) According to the ABMS, do enough Obesity Medicine Fellowship programs exist to recognize Obesity Medicine as a subspecialty?

Conclusions

Decisions regarding a transition to an ABMS recognized Obesity Medicine Subspecialty versus retention of the current ABOM Diplomate Certification should consider which best facilitates medical access and care to patients with obesity, and which best helps obesity medicine clinicians be recognized for their expertise.

背景美国医生的肥胖医学认证主要通过美国肥胖医学委员会(ABOM)进行。肥胖医学不被美国医学专业委员会(ABMS)或美国骨病协会(AOA)承认为亚专业。这篇综述考察了专业化的价值、当前ABOM文凭的地位、参与ABMS/AOA委员会认证的管理机构,以及ABMS/AAA认可的肥胖医学亚专业的优势和劣势。方法本综述的数据来源于PubMed和应用网站。内容是由作者的专业知识、见解和观点驱动的。结果现有的ABOM肥胖医学认证程序导致肥胖医学文凭的人数急剧增加。如果ABMS/AOA承认肥胖医学是现有ABMS成员委员会下的一个亚专业,那么肥胖医学将获得与其他ABMS认可的亚专业一样的地位。然而,ABOM文凭医生向ABMS认可的亚专科医生的转变可能会影响公认专注于肥胖医学护理的医生的种类和数量。需要考虑的过渡问题包括:(1)有多少ABMS成员委员会将监督肥胖医学作为一个亚专业,哪些医生有资格?(2) 目前的ABOM文凭是否需要完成肥胖医学奖学金?如果没有,那么目前的ABOM文凭转为ABMS认可的肥胖医学亚专科医生的过程是什么(即“祖父标准”)?(3)根据ABMS,是否有足够的肥胖医学奖学金项目将肥胖医学视为一个亚专业?结论关于向ABMS认可的肥胖医学亚专业过渡与保留当前ABOM文凭证书的决定应考虑哪种最有利于肥胖患者的医疗服务和护理,哪种最能帮助肥胖医学临床医生的专业知识得到认可。
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引用次数: 3
Artificial intelligence and obesity management: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2023 人工智能与肥胖管理:肥胖医学协会(OMA)临床实践声明(CPS)2023
Pub Date : 2023-06-01 DOI: 10.1016/j.obpill.2023.100065
Harold Edward Bays , Angela Fitch , Suzanne Cuda , Sylvia Gonsahn-Bollie , Elario Rickey , Joan Hablutzel , Rachel Coy , Marisa Censani

Background

This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) provides clinicians an overview of Artificial Intelligence, focused on the management of patients with obesity.

Methods

The perspectives of the authors were augmented by scientific support from published citations and integrated with information derived from search engines (i.e., Chrome by Google, Inc) and chatbots (i.e., Chat Generative Pretrained Transformer or Chat GPT).

Results

Artificial Intelligence (AI) is the technologic acquisition of knowledge and skill by a nonhuman device, that after being initially programmed, has varying degrees of operations autonomous from direct human control, and that performs adaptive output tasks based upon data input learnings. AI has applications regarding medical research, medical practice, and applications relevant to the management of patients with obesity. Chatbots may be useful to obesity medicine clinicians as a source of clinical/scientific information, helpful in writings and publications, as well as beneficial in drafting office or institutional Policies and Procedures and Standard Operating Procedures. AI may facilitate interactive programming related to analyses of body composition imaging, behavior coaching, personal nutritional intervention & physical activity recommendations, predictive modeling to identify patients at risk for obesity-related complications, and aid clinicians in precision medicine. AI can enhance educational programming, such as personalized learning, virtual reality, and intelligent tutoring systems. AI may help augment in-person office operations and telemedicine (e.g., scheduling and remote monitoring of patients). Finally, AI may help identify patterns in datasets related to a medical practice or institution that may be used to assess population health and value-based care delivery (i.e., analytics related to electronic health records).

Conclusions

AI is contributing to both an evolution and revolution in medical care, including the management of patients with obesity. Challenges of Artificial Intelligence include ethical and legal concerns (e.g., privacy and security), accuracy and reliability, and the potential perpetuation of pervasive systemic biases.

背景本肥胖医学协会(OMA)临床实践声明(CPS)为临床医生提供了人工智能的概述,重点是肥胖患者的管理。方法作者的观点得到了已发表引文的科学支持,并与来自搜索引擎(即谷歌公司的Chrome)和聊天机器人(即聊天生成预训练转换器或聊天GPT)的信息相结合,在最初编程后,具有不同程度的操作,独立于直接的人类控制,并基于数据输入学习执行自适应输出任务。人工智能在医学研究、医学实践以及与肥胖患者管理相关的应用方面都有应用。聊天机器人可能对肥胖医学临床医生有用,作为临床/科学信息的来源,对写作和出版物有帮助,也有助于起草办公室或机构的政策和程序以及标准操作程序。人工智能可以促进与身体成分成像分析、行为指导、个人营养干预&;体育活动建议,预测模型,以确定有肥胖相关并发症风险的患者,并帮助临床医生进行精准医学。人工智能可以增强教育编程,如个性化学习、虚拟现实和智能辅导系统。人工智能可能有助于加强面对面的办公室操作和远程医疗(例如,患者的日程安排和远程监测)。最后,人工智能可能有助于识别与医疗实践或机构相关的数据集中的模式,这些模式可用于评估人群健康和基于价值的护理提供(即与电子健康记录相关的分析)。结论人工智能有助于医疗保健的演变和革命,包括肥胖患者的管理。人工智能的挑战包括伦理和法律问题(如隐私和安全)、准确性和可靠性,以及普遍存在的系统性偏见的潜在永久性。
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引用次数: 14
A whole new world: Managing pediatric obesity 一个全新的世界:管理儿童肥胖
Pub Date : 2023-06-01 DOI: 10.1016/j.obpill.2023.100063
Suzanne E. Cuda
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引用次数: 0
Compounded peptides: An Obesity Medicine Association Position Statement 复合多肽:肥胖医学协会立场声明
Pub Date : 2023-06-01 DOI: 10.1016/j.obpill.2023.100061
Angela Fitch , Anthony Auriemma , Harold Edward Bays
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引用次数: 1
Clinical review: Implementation of trauma informed care to optimally impact the treatment of childhood obesity 临床回顾:创伤知情护理的实施对儿童肥胖的治疗有最佳影响
Pub Date : 2023-03-01 DOI: 10.1016/j.obpill.2022.100052
Dominique R. Williams , Eileen Chaves , Sharon M. Karp , Nancy T. Browne

Background

Traumatic events that occur in infancy, childhood, and adolescence can be impactful over the course of a lifespan. Adverse childhood experiences (ACEs) are associated with chronic health problems and mental illness, and can negatively impact educational and job opportunities. There is a growing body of evidence about the relationship between ACEs and the risk of childhood obesity. Trauma informed care (TIC) is an approach to patient care both at the clinical and organizational level that is responsive to the impact past trauma can have on an individual.

Methods

This clinical review will focus on the impact of toxic stress from trauma on the child through threats to normal physiology, including the manifestation of obesity through energy regulation pathophysiology, followed by a discussion of TIC principles. Available resources and how trauma informed principles can be used in practice are discussed using case study methodology.

Results

TIC programs recognize the impact of trauma on both patients and clinicians. TIC implementation includes application of TIC four assumptions and six key principles out-lined by Substance Abuse and Mental Health Services Administration's guidance. Clinicians supported by well-designed systems recognize that disclosure is not the goal of TIC; instead, broad trauma inquiry, proceeding to risk and safety assessment if indicated, and connection to interventions is the focus. Best practice communication allows clinicians to access information without retraumatizing the patient with ongoing repetition of their trauma experience.

Conclusion

Combining the pillars of obesity treatment (i.e., nutrition, physical activity, behavior therapy, medical management) with the tenets of TIC (realize, recognize, respond, resist re-traumatization) affords patients holistic, intentional care and family support. The desired outcomes of TIC align with goals of obesity treatment in children, namely improvement of health and quality of life, sense of self (e.g., body image and self-esteem), and prevention of negative health outcomes.

背景发生在婴儿期、儿童期和青少年期的创伤事件可能在一生中产生影响。儿童不良经历与慢性健康问题和精神疾病有关,并可能对教育和工作机会产生负面影响。越来越多的证据表明ACE与儿童肥胖风险之间的关系。创伤知情护理(TIC)是一种在临床和组织层面对患者护理的方法,对过去的创伤可能对个人产生的影响做出反应。方法本临床综述将通过对正常生理的威胁,包括通过能量调节病理生理学的肥胖表现,重点关注创伤对儿童的毒性应激的影响,然后讨论TIC原理。使用案例研究方法讨论了可用资源以及如何在实践中使用创伤知情原则。结果TIC项目认识到创伤对患者和临床医生的影响。TIC的实施包括应用药物滥用和精神卫生服务管理局指南中列出的TIC四项假设和六项关键原则。临床医生在精心设计的系统的支持下认识到,披露不是TIC的目标;相反,重点是广泛的创伤调查,如果需要,进行风险和安全评估,以及与干预措施的联系。最佳实践沟通使临床医生能够在不重复患者创伤经历的情况下访问信息。结论将肥胖治疗的支柱(即营养、体育活动、行为治疗、医疗管理)与TIC的原则(意识到、认识到、应对、抵抗再创伤)相结合,为患者提供全面、有意识的护理和家庭支持。TIC的预期结果与儿童肥胖治疗的目标一致,即改善健康和生活质量、自我意识(如身体形象和自尊)以及预防负面健康结果。
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引用次数: 4
Future of Obesity Medicine: Fearless 5-year predictions for 2028 肥胖医学的未来:2028年无畏的5年预测
Pub Date : 2023-03-01 DOI: 10.1016/j.obpill.2023.100057
Harold Edward Bays
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引用次数: 1
Feeding, television, and sleep behaviors at one year of age in a diverse sample 喂养,看电视,以及一岁时不同样本的睡眠行为
Pub Date : 2023-03-01 DOI: 10.1016/j.obpill.2022.100051
Michelle C. Gorecki , Eliana M. Perrin , Colin J. Orr , Michelle J. White , H. Shonna Yin , Lee M. Sanders , Russell L. Rothman , Alan M. Delamater , Tracy Truong , Cynthia L. Green , Kori B. Flower

Background

Healthy lifestyle behaviors that can prevent adverse health outcomes, including obesity, are formed in early childhood. This study describes feeding, television, and sleep behaviors among one-year-old infants and examines differences by sociodemographic factors.

Methods

Caregivers of one-year-olds presenting for well care at two clinics, control sites for the Greenlight Study, were queried about feeding, television time, and sleep. Adjusted associations between sociodemographic factors and behaviors were performed by modified Poisson (binary), multinomial logistic (multi-category), or linear (continuous) regression models.

Results

Of 235 one-year-olds enrolled, 81% had Medicaid, and 45% were Hispanic, 36% non-Hispanic Black, 19% non-Hispanic White. Common behaviors included 20% exclusive bottle use, 32% put to bed with bottle, mean daily juice intake of 4.1 ± 4.6 ounces, and active television time 45 ± 73 min. In adjusted analyses compared to Hispanic caregivers, non-Hispanic Black caregivers were less likely to report exclusive bottle use (odds ratio: 0.11, 95% confidence interval [CI] 0.03–0.39), reported 2.4 ounces more juice (95% CI 1.0–3.9), 124 min more passive television time (95% CI 60–188), and 37 min more active television time (95% CI 10–64). Increased caregiver education and higher income were associated with 0.4 (95% CI 0.13–0.66) and 0.3 (95% CI 0.06–0.55) more servings of fruits and vegetables per day, respectively.

Conclusion

In a diverse sample of one-year-olds, caregivers reported few protective behaviors that reduce the risk for adverse health outcomes including obesity. Differences in behavior by race/ethnicity, income, and education can inform future interventions and policies. Future interventions should strive to create culturally effective messaging to address common adverse health behaviors.

背景健康的生活方式行为可以预防包括肥胖在内的不良健康后果,在儿童早期就形成了。这项研究描述了一岁婴儿的喂养、电视和睡眠行为,并通过社会人口学因素检验了差异。方法询问在绿光研究的对照点两个诊所接受良好护理的一岁儿童的护理人员的喂养、电视时间和睡眠情况。社会人口统计因素和行为之间的调整关联通过修正的泊松(二进制)、多项式逻辑(多类别)或线性(连续)回归模型进行。结果在235名一岁儿童中,81%的人有医疗补助,45%是西班牙裔,36%是非西班牙黑人,19%是非西班牙裔白人。常见的行为包括20%的人只使用奶瓶,32%的人带着奶瓶上床睡觉,平均每天摄入4.1±4.6盎司的果汁,活跃的电视时间为45±73分钟。在调整后的分析中,与西班牙裔护理人员相比,非西班牙牙裔黑人护理人员报告单独使用奶瓶的可能性较小(比值比:0.11,95%置信区间[CI]0.03-0.39),报告多喝2.4盎司果汁(95%CI 1.0-3.9),多看124分钟被动电视(95%CI 60-188),多37分钟主动电视(95%CI 10-64)。护理人员教育程度的提高和收入的增加分别与每天多吃0.4份(95%CI 0.13–0.66)和0.3份(95%CI 0.06–0.55)水果和蔬菜有关。结论在一岁儿童的不同样本中,护理人员报告的保护行为很少能降低包括肥胖在内的不良健康后果的风险。种族/民族、收入和教育的行为差异可以为未来的干预和政策提供信息。未来的干预措施应努力创造文化上有效的信息,以解决常见的不良健康行为。
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引用次数: 0
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Obesity Pillars
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