Clinical Obesity最新文献

To understand the prevalence, incidence and sequence of obesity-related comorbidities (ORCs) among people with obesity compared with those with a normal body mass index (BMI). People with obesity (BMI ≥30 kg/m²) and normal BMI (BMI 18.5 to <25 kg/m²) were matched 1:1 using a large United States claims-linked electronic health record database. The index date was the date of the first qualifying BMI. Prevalence was assessed at baseline (12 months pre-index date); incidence and sequence of new ORCs were assessed during follow-up. Each cohort included 57 978 people. At least 1 ORC was present at baseline in 61.1% and 49.6% of the obesity and normal BMI cohorts, respectively. During follow-up (median 61 months) event rates per 1000 person-years of new ORCs were higher in the obesity cohort than the normal BMI cohort (572 vs. 378, respectively). In both cohorts, musculoskeletal pain was the most frequent new ORC, followed by dyslipidemia and hypertension. Median times to the first, second and third new ORC were shorter in the obesity cohort compared with the normal BMI cohort by 0.67, 0.81 and 0.66 years, respectively. People with obesity had a higher prevalence and incidence, and accelerated onset of ORCs compared with those with normal BMI.

The Impact of Weight on Daily Activities Questionnaire (IWDAQ) is a patient-reported outcome measure that uses a novel, adaptive design to assess the limitations in daily activities that are most important to individuals attempting to lose weight. During the first round of completing the IWDAQ, respondents are presented with 18 everyday activities that can be limited by excess weight and asked to choose the three activities they would most like to see improve with weight loss. They are then asked to rate the degree of limitation they experience with these three activities at baseline and at follow-up assessments. Using data from a weight-management clinical trial (OASIS 1, NCT05035095), we evaluated the IWDAQ's measurement properties, determined optimal scoring, and estimated thresholds of meaningful within-patient change. Our analyses demonstrated that the IWDAQ Composite Score offers a reliable and valid personalized measure of limitations in daily activities due to excess weight. The adaptive design of the IWDAQ ensures the patient-centricity of the measure, thereby complementing existing measures of functioning in the context of weight-management clinical trials. Evaluations using data from additional studies would be valuable in extending the psychometric evidence for the IWDAQ.

Andreassen P, Jensen SD, Bruun JM, et al. Managing the new wave of weight loss medication in general practice: a qualitative study. Clin Obes. 2024;14(3):e12666. doi:10.1111/cob.12666

The equal authorship designation was missing from this article at the time of publication. Pernille Andreassen and Sissel Due Jensen contributed equally to this article.

We apologize for the error.

To examine ethnic differences in how individuals respond to obesity management therapies, a retrospective chart review of the Wharton Medical Weight Management Clinic electronic medical records was used (n = 21 709; 14 695 patients with weight loss data). South and East Asian, Middle Eastern and Other ethnicities had a significantly lower body mass index (BMI) at enrollment than White adults (39.7 vs. 35.4–38.7 kg/m²), with higher or similar BMIs in Indigenous and Black adults (39.9–42.2 kg/m²). Whites, East Asians and Other Ethnicities had the greatest weight loss (4.3–4.9 kg), while Blacks (3.3 kg), Latin (3.0 kg), Middle Eastern (2.7 kg), and South Asians (3.5 kg) lost significantly less weight as compared to Whites (4.9 kg) (p < .05). There were also weight loss differences between Black sub-groups. African American females lost the least weight (1.4 kg), while West Indian Black females lost much more weight (4.3 kg, p = .01). African American males also lost the least amount of weight (0.9 kg), while African Black males lost the most (7.4 kg, p = 0.01). There are differences in the weight loss achieved during a clinical obesity management program between individuals of various ethnicities.

Weight stigmatization is persistent and pervasive, leading to numerous negative consequences. This study developed a weight stigma reduction intervention rooted in Cognitive Dissonance Theory aimed at reducing stigma towards individuals living in larger bodies. Undergraduate students (N = 325) were randomized to one of three conditions: Cognitive Dissonance (i.e., Written Advocacy or Written + Vocalized Advocacy) or Control. Participants in both Cognitive Dissonance conditions provided a written statement advocating for a proposal benefiting individuals living in larger bodies that would be somewhat costly to participants. Those in the Written + Vocalized Advocacy condition also vocalized their arguments to further enhance dissonance. It was hypothesized that compared to Controls, participants in both Cognitive Dissonance conditions would report reduced weight stigma and greater commitment to a prosocial action, with the strongest effects for the Written + Vocalized Advocacy condition. There was a significant reduction in weight stigma across all conditions, but minimal support for significant differences between conditions. Participants in the Cognitive Dissonance conditions did not commit significantly more hours towards the prosocial action compared to Controls. There was limited support that cognitive dissonance was induced. Future studies should pre-screen participants endorsing stronger weight stigma to help ensure they are advocating for a counter-attitudinal cause.

In 2021 a Nationally Enhanced Service (NES) incentive for weight management in primary care was rolled out in England. This paid general practices £11.50 for every eligible referral they made to a weight management programme. We explored primary care staff's perceptions, experiences and attitudes toward the NES by conducting 37 semi-structured interviews with General Practitioners (GPs), administrative staff and nurses preceding the introduction of the NES (May to September 2021) and 1 year later following its introduction (September to December 2022). Data were analysed using normalisation process theory. The NES for weight management solidified the position of staff already supportive of referring patients to weight management programmes. For staff less supportive of weight management services, the dissonance between the perceived lack of benefit of services and making referrals to services was reduced with referrals becoming more habitual. Facilitators to implementation included the presence of a coherent national policy; having a ‘champion’ explain key aspects; and a financial incentive if framed as benefiting the practice at large. Barriers included a perception that primary care has been shouldered with a complex and difficult health crisis; a worry over workload burdens; and inefficient and unclear referral systems. The implementation of the NES was broadly welcomed and accepted by primary care staff. Interviewees expressed concerns around the acceptance of weight management policies in primary care, the provision of training to raise the topic of weight and whether the responsibility of weight management fell with primary care, public health or with the patient.

Bariatric surgery is an effective treatment for obesity, but long-term can lead to health-related issues. Guidelines highlight the importance of long-term post-bariatric surgery follow-up. However, in the UK, there is currently no specific funding to support the delivery of this care. Our aim was to understand the views and experiences of healthcare professionals (HCPs) around long-term post-bariatric surgery follow-up, and barriers and enablers to care. Semi-structured interviews with HCPs in UK primary care or specialist weight management services were conducted. The topic guide was theoretically informed by the Capability-Opportunity-Motivation-Behaviour model and the Theoretical Domains Framework. Thematic analysis was undertaken. Twenty-six HCPs were interviewed. Three core themes were interpreted: Existing Challenges, Mediating Factors and Future Directions. While there was agreement on the need for long-term support, current provision was variable and hampered by a paucity of referral options. Follow-up care could be contingent upon the patients' surgical pathway and the culture and expertise within the general practitioner surgery. Participants discussed potential ways to improve care, including using technology, adapting approaches used in other chronic conditions, shared care models and harnessing the potential for peer-based support to improve wellbeing and quality of life. Healthcare professionals' views and experiences shared in this study highlight the complex issues associated with long-term bariatric surgery follow-up. The findings will inform future research to design and implement care pathways that are urgently needed to improve service provision for these patients.