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Objective:To analyze the association of pre-pregnancy body mass index (BMI) and gestational weight gain with macrosomia.Methods:In this retrospective cohort study, data of all puerperae and newborns in the Obstetrics Center of Peking Union Medical College Hospital from July 2020 to June 2021 were collected, including basic maternal information, pregnancy complications and neonatal conditions. A total of 2 422 pregnant women with full-term singleton live birth and their newborns were included in the analysis. The incidence of macrosomia (≥4 000 g) was calculated according to the birth weight of the newborns. Logistic regression and heat map were used to analyze the associations of pre-pregnancy BMI and gestational weight gain with macrosomia.Results:The incidence of macrosomia was 4.00% (97/2 422) in full-term singleton live birth newborns. Pre-pregnancy body weight, pre-pregnancy BMI, pre-pregnancy overweight/obesity rate, pre-delivery body weight, total weight gain during pregnancy, mean weekly weight gain during pregnancy, the proportion of excessive weight gain during pregnancy, duration of pregnancy, and the proportion of primiparity and education level of junior college or below were all significantly higher in the puerperae of the macrosomia group than those in the non-macrosomia group [(63.87±8.27) vs (58.14±7.86) kg, (23.33±2.97) vs (21.60±2.72) kg/m2, 35.1% vs 17.3%, (77.48±9.11) vs (70.02±8.79) kg, (13.61±4.56) vs (11.88±4.40) kg, (0.34±0.11) vs (0.30±0.11) kg, 58.8% vs 31.1%, (280.47±7.79) vs (276.14±7.83) d, 34.1% vs 23.7%, 18.6% vs 7.5%] (all P<0.05). Pre-pregnancy BMI ( OR=1.227, 95% CI: 1.145-1.314), mean weekly weight gain during the whole pregnancy ( OR=33.453, 95% CI: 5.172-217.947), duration of pregnancy ( OR=1.083, 95% CI: 1.055-1.112), primiparity ( OR=1.969, 95% CI: 1.232-3.101) and education level of junior college or below ( OR=2.525, 95% CI: 1.325-4.668) were all positively associated with occurrence of macrosomia (all P<0.05). The incidence of macrosomia increased with the pre-pregnancy body mass index and mean weekly weight gain during the whole pregnancy. Conclusions:High pre-pregnancy BMI and mean weekly weight gain during the whole pregnancy are associated with the increased risk of macrosomia. Appropriate weight management during pregnancy may help to reduce the incidence of adverse pregnancy outcomes.
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@#Introduction: Changes in our bodies can cause several problems, particularly for students who are concerned about maintaining an ideal body shape. Many of them try to diet, but their body returns to its previous weight or even increases in weight. Thus, this study aimed to determine the factors that influence the incidence of weight cycling in Indonesian students during the COVID-19 pandemic. Methods: This cross-sectional study used purposive sampling to collect data. Three hundred college students from West Java province, Indonesia, participated. Weight cycling was the dependent variable and the independent variables were physical activity, sex, and weight management. Multivariate logistic regression analysis was used to determine the factors influencing the incidence of weight cycling. Results: Sex, physical activity, skipping meals, and snacking were determinants related to weight cycling incidence. Females had a 0.7 times higher risk of experiencing weight cycling than males. Inactive students were 4.7 times more likely to become weight cyclers, and those who rarely skipped mealtime had lower risk of being weight cyclers. Students who sometimes and always consumed snacks had higher risk of becoming weight cyclers by 3.3 and 2.7 times, respectively, compared to those who rarely consumed snacks. Conclusion: Regular physical activity, not skipping meals, especially breakfast, and practising a healthy diet every day are recommended strategies to avoid weight cycling during a pandemic.
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@#Introduction: Obesity is a global issue called as “globesity”. Overweight and obesity may lead to many noncommunicable diseases (NCDs). Primary care is the first centre to monitor and follow-up the progress of NCD patients. Therefore, the objective of this study was to determine the effectiveness of an integrated-Weight Management Programme (i-WMP) to reduce body weight among NCD patients from two Government primary care clinics from Hulu Langat District. Methods: This study was single-blinded randomised controlled trial by design. There were 244 eligible patients were randomised into intervention (n = 122) or wait-list control group (n = 122). The i-WMP was developed based on the behaviour change wheel through the operationalization of behaviour change techniques. The duration of this intervention programme was four weeks. Data collected at week 0, week 4, and week 12. The software IBM SPSS was used to analyse the data. Generalized linear mixed model analysis with intention-to-treat principle was applied. Results: The retention rate was 74.2%. Findings showed that the i-WMP was significantly effective in reducing not only body weight as primary outcome but also secondary outcomes such as waist-to-height ratio, waist circumference, body mass index, and total sitting time. It also improved effectively other secondary outcomes such as participants’ knowledge, attitude, and practice towards dietary and towards physical activity. However, no significant changes were reported for body fat percentage and total physical activity metabolic equivalent of task-minutes/week. Conclusion: Implications surrounding the implementation of i-WMP in the primary care clinics are recommended.
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Objective@#To investigate the motivation for weight self-management and analyze its influencing factors among pregnant women in a tertiary hospital in Hohhot City, Inner Mongolia Autonomous Region, so as to provide insights into body weight management during pregnancy. @*Methods@#Pregnant women at ages of 18 years and older that underwent prenatal examinations in a tertiary hospital in Hohhot City from January to March, 2022 were sampled using a convenience sampling method. Subjects' age, height, weight, occupation, residence, monthly household income, history of gestation and childbirth and gestational period were collected, and the motivation for weight self-management was evaluated among pregnant women using a pregnancy weight management protein motivation scale. The factors affecting the motivation for weight self-management were identified among pregnant women using a multivariable linear regression model. @*Results@#Totally 969 pregnant women were recruited, including 841 women at ages of <35 years (86.79%), 780 women with an educational level of diploma and above (80.50%), 794 women living in urban areas (81.94%), 729 primiparas (75.23%), 421 women in the third trimester of gestation (43.45%) and 758 women with pre-pregnancy body mass index (BMI) of <25 kg/m2 (78.22%). The mean score of motivation for weight self-management was 127.53±14.60 among the pregnant women. Multivariable linear regression analysis showed that an educational level of high school and below (β′=-0.201), unemployed/self-employed individuals (β′=-0.077), living in rural areas (β′=-0.059), monthly household income of <10 000 yuan (<5 000 yuan, β′=-0.238; 5 000 to 10 000 yuan, β′=-0.169), in the third trimester of gestation (β′=-0.135), pre-pregnancy BMI of 25 kg/m2 and higher (β′=-0.214) and reduced the motivation for weight self-management among pregnant women.@*Conclusion@#The motivation for weight self-management correlates with gestational period, pre-pregnancy BMI, residence, occupation, educational level and monthly household income among pregnant women.
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Objective:To explore the effects of nursing intervention with pregnant body mass management combined with role -based health education on stage of labor, pelvic floor function recovery, psychological status changes, maternal and neonatal outcomes in primiparas. Methods:From March 2019 on, pregnant body mass management combined with role -based health education nursing was implemented in the hospital. On basis of the theory, nursing regimens of pregnant body mass management combined with role-based health education we formulated. During the period from August 2018 to February 2019, 120 primiparas who underwent delivery in the hospital were randomly enrolled as control group. During the period from August 2019 to February 2020, 120 primiparas were randomly enrolled as observation group. The duration of labor stages, postpartum pelvic muscle strength, scores of Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA), and delivery outcomes were compared between the two groups. Results:After nursing, the cesarean section rate was 20.83% (25/120) in observation group and 32.50% (39/120) in control group, there was significant difference between the two groups ( χ 2 value was 4.176, P<0.05). The spending time of ending the first, second and third stage of labor was (517.27±8.95), (48.33±5.62), (10.26±1.63) min in observation group and (537.31±7.92), (57.29±5.58), (18.28±1.61) min in control group, there was significant difference between the two groups ( t values were 18.369, 12.393, 38.347, P<0.001). After nursing, normal rate of pelvic floor muscle strength was 68.33% (82/120) in observation group and 54.17% (65/120) in control group, there was significant difference between the two groups ( χ 2 value was 5.074, P<0.05). After nursing, scores of HAMD and HAMA were (4.43±1.02), (5.56±0.87) points in observation group and (6.09±1.15), (6.88±0.93) points in control group, there was significant difference between the two groups ( t values were 11.830, 11.354, P<0.05). After nursing, adverse outcome rates of primiparas and neonates were 3.33% (4/120) and 5.83% (7/120) in observation group, and 10.00% (12/120), 15.83% (19/120) in control group, there was significant difference between the two groups ( χ 2 values were 4.286, 6.211, P<0.05). Conclusions:Pregnant body mass management combined with role-based health education nursing is conducive to shortening labor stages of primiparas, improving postpartum pelvic floor muscle strength and adverse emotions, and thus reducing the occurrence of maternal and neonatal adverse outcomes.
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@#Obesity is a growing global concern, and Singapore is not spared from the global epidemic. Apart from the increased risk for many serious diseases and health conditions, obese individuals are vulnerable to many psychological comorbidities. Obesity management through lifestyle changes can be limited by various barriers, increasing the challenge of implementation and leaving some clinicians feeling frustrated and stressed. The paper examines the barriers identified in the literature, discusses the use of cognitive behavioural concepts and techniques to facilitate the lifestyle change process and explores the use of motivation and readiness to change to guide the clinician’s strategies.
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@#The prevalence of obesity and obesity-related comorbidities is rising. Primary care physicians are the frontline of healthcare and play a central role in the management of obesity. In this article, we discuss the 5As framework (Ask, Assess, Advise, Agree, and Assist) as a practical framework for obesity counselling, focusing on initiating the conversation and assessing the person with obesity. The assessment includes taking a weight history, excluding secondary causes, understanding lifestyle factors contributing to weight gain and assessing for complications of obesity. This assessment then makes it possible for subsequent patient engagement, including advising, agreeing (goal setting), and assisting the patient on an individualised care plan.
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OBJECTIVE@#To evaluate the clinical efficacy of weight management combined with pharyngoplasty for treatment of obesity-related obstructive sleep apnea-hypopnea syndrome (OSAHS).@*METHODS@#Sixty obese patients with OSAHS were randomly assigned into the combined treatment group and control group (@*RESULTS@#After 6 months of treatment, the patients receiving the combined treatment showed significant reductions of BMI, neck circumference and waist circumference as compared with the measurements before treatment and with those in the control group (@*CONCLUSIONS@#Weight management combined with uvulopalatopharyngoplasty can produce a good clinical efficacy for treatment of OSAHS with obesity, and the patients should have strengthened continuous family weight management while receiving surgical treatment.
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Humans , Body Mass Index , Obesity/surgery , Plastic Surgery Procedures , Sleep Apnea, Obstructive/surgery , Waist CircumferenceABSTRACT
Objectives@#The study aims to determine whether there is an association of perceived weight status with unhealthy diet practices. @*Method@#An analytic cross-sectional study was conducted among 625 adult undergraduate students from U.P. Manila. The survey included questions regarding sociodemographic status, habits related to diet and weight management, and perceived body mass index (BMI). Actual BMI were obtained and calculated from actual anthropomorphic measurements. @*Results@#In the population surveyed, it was seen that 53.28% of the students accurately perceived their BMI status, 26.08% overestimated their BMI status, while 17.28% underestimated their BMI status. It was also seen that over-estimating of BMI status is more associated with unhealthy diet practices. Those who over estimated their BMI were 1.95 times more likely to skip meals (p=0.001) and 1.56 times more likely to engage in cutting of food (p=0.034). Physical activity was also seen to be associated with these practices. @* Conclusion@#Over-estimation of BMI may be linked to unrealistic goals in weight loss resulting in unhealthier diet-related habits.
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Body Mass Index , Weight Perception , Feeding Behavior , Diet , ExerciseABSTRACT
Background:Bariatric surgery is an effective treatment for obesity. However, around one in five people experience significant weight regain. In the months following surgery, loss of food as a hedonic reward, increased sensitivity to food-related cues, alcohol use and depression may translate into new obesogenic behaviours which can be targeted in therapy. Acceptance and Commitment Therapy (ACT) teaches acceptance of and defusion from thoughts and feelings which influence behaviour,and commitment to act in line with personal values. We will test whether people who have had bariatric surgery over one year ago find 10 weeks of ACT group therapy an acceptable treatment and whether a larger trial to test whether ACT can improve long-term post-operative outcomes would be feasible.Methods:This will be a feasibility randomised controlled trial (RCT) with participants randomised to either ACT or a Usual Care Support Group control. Participants will be recruited at 15-18 months post-surgery and compared at baseline, 3, 6 and 12 months. The trial will provide information about recruitment and characteristics of the proposed outcome measures to inform a definitive RCT.Conclusions: Trials big enough to determine whether a treatment approach works are costly, so this small study will help determine whether the methods used, such as how people are recruited, allocated to groups, and how data are collected, are likely to work on a bigger scale. This project is the first step in testing whether ACT can help people who have had bariatric surgery.Trial Registration:Researchregistry.com, UIN: 3959 (date registered: 10 April 2018); ISRCTN registry ID: ISRCTN52074801
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Objective To evaluate the effect of weight managementfor the quality of life of patients with chronic heart failure. Methods The randomized controlled trials (RCT) on the effect of weight management for the quality of life of patients with chronic heart failure interventions were collected using the databases of China National Knowledge Infrastructure (CNKI), The Wan fang database, CBM, Chinese Science and Technology Periodical Databases (VIP), PubMed, Cochrane Library, Web of Science, Embase, time for the construction of the database to December 2017. Quality evaluation and data extraction of the included literature. Data were analyzed with Revman5.3 software. Results Five RCTs were included in the study, with a total of 739 people. The results of Meta-analysis showed that the total score of QOL [MD=-10.38(95％CI-19.83--0.93), Z=2.15,P=0.03], QOL emotional domain score [MD=-2.45(95％CI-4.35--0.55), Z=2.53, P=0.01] and body domain score [MD=-6.61(95％CI-12.81--0.41), Z=2.09, P=0.04] of patients with chronic heart failure in weight management group were lower and statistically significant. Conclusions Weight management improve the quality of life in patients with chronic heart failure, weight management improve the quality of life in patients with chronic heart failure and the physical and emotional areas. However, it is necessary to carry out high-quality, large sample randomized controlled trials to confirm the above results.
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Obesity is the greatest risk factor of nonalcoholic fatty liver disease(NAFLD),and the prevalence of NAFLD is over 90% in severe obesity. Losing weight can improve and even reverse NAFLD to varying degrees. Dietary modification is the most efficacious method in the weight reduction of NAFLD, for it can effectively reduce fatty and chang inflammation of liver cells by controlling calorie intake and regulating the proportion of nutrients, and the fibrillation can also be improved. In this paper, we discuss the calorie intake and dietary pattern of general population, the elderly and school-aged children, focusing on how NAFLD patients control their weight through dietary modification.
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Objective To investigate the effect of weight management on serum HIF -1αand tumor necrosis factor α( TNF-α) in patients with obese type 2 diabetic nephropathy .Methods 180 patients with obese diabetic nephropathy were selected .According to weight management , the patients were divided into BMI increased group ( BMI compared with the basic value increased more than or equal to 3％) with 51 cases, BMI stable group ( BMI compared with the basic value changes of <3％) with 64 cases, BMI decreased group ( compared with baseline values BMI reduction of 3％) with 65 cases.The serum contents of HIF -1αand TNF-αwere measured by double antibody sandwich enzyme -linked immunosorbent assay .Results Compared with BMI decreased group ,the fasting blood glucose,glycosylated hemoglobin,postprandial 2h blood glucose in the BMI increased group and BMI stable group were increased (BMI increased group:t=10.816,17.839,12.912,BMI stable group:t=6.950,9.878,8.301, all P<0.05).Compared with the BMI stable group,the fasting blood glucose,glycosylated hemoglobin,postprandial 2h blood glucose in the BMI increased group were increased (t=5.298,8.475,5.874,all P<0.05).Compared with BMI decreased group ,the serum creatinine and blood urea nitrogen in BMI increased group and BMI stable group were increased(BMI increased group:t=13.477,27.254,BMI stable group:t=13.820,11.073,all P<0.05).Compared with the BMI stable group ,the serum creatinine and blood urea nitrogen in the BMI increased group were increased (t=6.502,14.154,all P<0.05).Compared with BMI decreased group ,the HIF-1αand TNF-αlevels of the BMI increased group and BMI stable group were elevated (BMI increased group:t=30.050,22.963,BMI stable group:t=16.261,16.476,all P <0.05).Compared with the BMI stable group,the HIF -1αand TNF -αlevels of BMI ascending group were increased(t=17.951,9.601,all P<0.05).Conclusion The serum levels of HIF -1αand TNF-αin type 2 diabetic nephropathy patients with increased BMI are significantly increased ,and the serum levels of HIF-1αand TNF-αare decreased significantly by weight management .
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Polycystic ovary syndrome (PCOS) women often deal with the main characteristics of obesity, obesity is caused by the endocrine disorder, the menstrual cycle changes, etc. The main causes of infertility, easy cause anxiety, women have a negative impact on the quality of life through the fueling weight management of patients with PCOS were reviewed, summarized method, explore new train of thought, for fueling beset with PCOS patients provide better health and weight management method.
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Objective To explore a new outpatient mode for pregnancy nutrition to adapt to digital hospital.Methods The outpatient management mode and methods were analyzed for pregnancy nutrition.A new outpatient mode combining the technologies of mobile internet and remote monitoring was developed with consideration on standardization,and the effect of the new mode was discussed on pregnancy nutrition outpatient.Results Mobile internet technology and remote monitoring technology contributed to enhancing the efficiency of pregnancy nutrition outpatient,and facilitated the nutrition service of common pregnant women as well as the precision and individualized nutrition management of high-risk ones such as those with gestational diabetes mellitus.Conclusion The new outpatient mode enhances the doctor's efficiency and pregnancy care,and thus is worthy promoting practically.
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Introduction: This study aimed to (i) determine rapid weight loss (RWL) practices among Malaysian elite combat sports athletes and (ii) examine the relationship between the characteristics of athletes, self-reported history of weight loss, perceived influence on weight loss and RWL practices. Methods: This was a cross-sectional study conducted at the Malaysian National Sports Institute among elite combat sports athletes (n=40) recruited via a convenience sampling method. The athletes completed a self-administered validated Rapid Weight Loss Questionnaire. Each response was provided a score and the total RWL score corresponded to the aggressiveness of weight management methods. Partial correlations were used to assess the relationships between total RWL score and independent variables. Results: The prevalence of RWL among the athletes was high (92.5%). Training with rubber or plastic suits (62.2%) and meal-skipping (27.0%) were the most common RWL techniques practised by the respondents. Aggressive weight-cutting as depicted by a higher total RWL score that correlated with most weight ever lost, duration taken to lose weight, influence of training colleagues and coaches, BMI, current weight and post-competition weight regain (all p<0.05). In contrast, negative correlations were seen between total RWL score, and the age at which the athletes began competing (p<0.001), duration of competition (p<0.001), age at first participation (p<0.05), duration of participation (p<0.05) and influence of nutritionists on weight loss (p<0.05). Conclusion: A high prevalence of aggressive weight loss among elite combat sports athletes and its association with perceived influence of sports professionals, colleagues and actual weight-related characteristics are of great concern.
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OBJECTIVE: The current study evaluates the usability perception of an e-therapeutic platform (supported by electronic processes and communication), aiming to promote the behavior change and to improve the adolescent health status through increased and interactive contact between the adolescent and the clinical staff. METHODS: This was a correlational study with a sample of 48 adolescents (12-18 years) who attended a Pediatric Obesity Clinic between January and August of 2012. Participants were invited to access, during 24 weeks, the e-therapeutic multidisciplinary platform (Next.Step) in addition to the standard treatment program. A usability questionnaire was administered and the platform performance and utilization indicators were analyzed. RESULTS: The users' perception of satisfaction, efficiency, and effectiveness regarding the Next.Step platform was clearly positive. However, only 54.17% of the enrolled adolescents accessed the platform, with a mean task-completion rate of 14.55% (SD = 18.853). The higher the number of the platform consulted resources, the greater the tendency to enjoy the platform, to consider it exciting and quick, to consider that the time spent in it was useful, to consider the access to information easy, and to login easier. Post-intervention assessment revealed a significant reduction in anthropometric and behavioral variables, including body mass index z-score, waist circumference percentile, hip circumference, and weekly screen time. CONCLUSION: These results highlight the importance of information and communication technologies in the health information access and the healthcare provision. Despite the limited adherence rate, platform users expressed a positive overall perception of its usability and presented a positive anthropometric and behavioral progress. .
OBJETIVO: O estudo atual avalia a percepção de usabilidade de uma plataforma e-terapêutica (apoiada por processos e comunicação eletrônicos), com vistas a promover a mudança comportamental e melhorar o estado de saúde dos adolescentes por meio do contato aumentado e interativo entre o adolescente e a equipe clínica. MÉTODOS: Estudo correlacional com uma amostra de 48 adolescentes (12-18 anos) que frequentaram uma clínica de obesidade infantil entre janeiro e agosto de 2012. Os participantes foram convidados a aceder, durante 24 semanas, à plataforma multidisciplinar e-terapêutica (Next.Step) e, além disso, a participar do programa de tratamento padrão. Um questionário de usabilidade foi administrado e foram analisados os indicadores de desempenho e uso da plataforma. RESULTADOS: A percepção de satisfação, eficiência e eficácia dos usuários com relação à plataforma Next.Step foi claramente positiva. Contudo, apenas 54,17% dos adolescentes inscritos acederam à plataforma, com uma taxa média de conclusão das tarefas de 14,55% (DP = 18,853). Quando maior o número de recursos consultados na plataforma, maior a tendência de gostar da plataforma e considerá-la excitante e rápida, pois o tempo gasto nela é útil e o acesso a informações e ao registro é mais fácil. A avaliação pós-intervenção mostrou uma redução significativa nas variáveis antropométricas e comportamentais, inclusive no z-score do Índice de Massa Corporal, no percentil de circunferência da cintura, na circunferência do quadril e no tempo de tela semanal. CONCLUSÃO: Esses resultados destacam a importância das tecnologias de informação e comunicação no acesso a informações sobre saúde e prestação de cuidados. Apesar da limitada taxa de adesão, os usuários da plataforma expressaram uma percepção geral positiva de sua usabilidade e apresentaram um progresso antropométrico e comportamental positivo. .
Subject(s)
Adolescent , Humans , Adolescent Behavior/psychology , Internet , Obesity/therapy , Body Mass Index , Life Style , Motivation , Obesity/psychology , Patient Satisfaction , Statistics, Nonparametric , Surveys and Questionnaires , Waist CircumferenceABSTRACT
Background: Morbid obesity has multiple negative consequences for psychological health. These patients are described as depressed, anxious, and impulsive, with low self-esteem and impaired quality of life. The severity of these psychological disorders has been related to the degree of obesity Abiles et al, [1]. In addition, emotional eating is a driver of weight gain in the obese, and depression is linked to disrupted eating patterns. Therefore, an effective weight loss program should include psychological management of these patients. The Specialist Weight Management Service (SWMS) offers clinical psychology intervention, alongside diet and exercise, with the hope that improving psychological health, leads to improved clinical outcomes for patients. Aim: This service evaluation aims to investigate if specialist psychological intervention of patients with moderate to high depression and/or anxiety scores; enrolled in the specialist weight management service is improved during their treatment in the service, and if clinical outcomes (specifically weight) are therefore improved. Methods: All patients assessed by the SWMS team were asked to complete an anxiety and depression measurement score (GAD7 and PHQ9) Spitzer et al, [2] before coming to their assessment appointment with the dietitian. The PHQ9 (Patient Health Questionnaire) is a multiplechoice self-report inventory, used as a screening and diagnostic tool for mental health disorders of depression, anxiety, alcohol, eating, and somatoform. It was designed for use in the primary care setting. The GAD7 (Generalized Anxiety Disorder 7) is a self-reported questionnaire for screening and severity measuring of generalized anxiety disorder. A score above 10 in either questionnaire indicated there may be a need for psychological input, and patients were referred to the SWMS clinical psychologist for further assessment. Patients were then assessed by the psychologist to see if further psychological intervention was required. Psychological interventions and treatments included motivational interviewing, brief solution focused therapy, cognitive behavioural therapy, and acceptance and commitment therapy. Treatment was tailored to each individual patient and their personal treatment needs. The number of sessions each patient received was between 2 and 10. With most patients having an average of 6 one-hour sessions on a fortnightly basis. The same questionnaires were then repeated at the 3 month point. As this project was a service evaluation, ethics were not required. All data was anonymised before being evaluated. Results: N= 297 patients were assessed by the SWMS team dietitian during the review period (2010 to 2012). A further psychological assessment was indicated for n=119 patients, n=67 of these required psychological intervention as described above. The mean BMI in cohort was 42.7kg/m2. The mean PHQ9 score at baseline was 14 and GAD7 9. Table 1 shows the basic demographic data of the cohort. Table 1 Shows the demographic details the cohort. Table 2 shows the mean PHQ9 scores at baseline and 3 months, mean change after 3 months, range of change in scores and % of patients who improved their scores in the treatment and nontreatment group. Fisher’s exact test was used to compare the changes in PHQ9 scores in the two groups over 3 months: p=0.72. Chi squared test used to see if there is a significant difference between the numbers of those that improved their PHQ9 scores between the two groups: p=0.47. Therefore the change was not statistically significant. Table 3 shows the % of patients in the treatment and non-treatment group that gained weight, lost ≤5% of their initial body weight or >5%. Using chi squared test to see if there is a significant difference between the intervention and non-intervention group in terms weight change. Non of the weight changes were statistically significant. Table 4 shows the mean GAD7 score at baseline and after 3 months, the mean change in scores between the two groups, the range of change and the of % patients who improved their scores amongst the two groups. Fisher’s exact test was used to compare the changes in scores of the treatment and non-treatment group: p=1. Chi squared test was used to compare the numbers of those that improved their GAD7 scores between the two groups: p=0.64. The results were not statistically significant. Discussion: This evaluation looked at the effect of psychology intervention on weight loss and self-reported anxiety and depression using patient questionnaires in a community SWMS. It was observed that the intervention group had a higher proportion of patients who gained weight. Possible explanations for this from anecdotal observation may be due to the complex relationships these patients have with food and emotional eating, however, without further research it is difficult to ascertain the reason for is. Therefore, further long-term research into this area is required. Although not statistically significant, the results suggest that depression scores did improve with intervention after 3 months. However, there was no indication that the intervention had any effect on anxiety scores. Conclusions: The results suggest that psychological intervention helps improve patients depression scores, although in this evaluation this did not translate into weight loss. Further long term research in needed to see if weight loss increases with increased length of intervention in SWMS.
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Background: According to current reports, 26% of adults in the United Kingdom are obese, Royal College of Physicians [1]. This highlights a need for practical, affordable and scalable intervention strategies that induce and effectively maintain clinically significant levels of weight loss. The Drop in to Stay on Track (DIST) service offers patients post weight loss intervention (WLI) support for weight maintenance and lifestyle changes. The purpose of the investigation was to evaluate a current community based dietitian led weight maintenance service to determine whether long term support and monitoring assist with weight maintenance/ weight loss post intervention. Methods: Over a period of a year, patients (n=44) attended an initial dietitian developed and led WLI. Upon competition patients were invited to attend the DIST service for long term support. Weights were collected pre and post WLI as well as at each time the patient utilized the DIST service. Weight changes were analysed using SPSS 20 statistical software and compared with DIST attendance frequency. Results: The majority (84%) of participants had either maintained (10%) or lost (74%) weight at their last recorded DIST session. Table 1 highlights the various statistically significant weight decreases from WLI referral. Discussion: It is clear from the findings of numerous studies that preventing weight regain is extremely challenging Perri et al. [2]. Recent reviews suggest that weight maintenance efforts should be long in duration with a focus on relapse prevention and problem solving to combat regain Brantley et al. [3]. Our findings from our evaluation suggest long term support and monitoring is beneficial for weight maintenance/weight loss post weight management intervention and further research is required to analyse greater numbers. Conclusion: Extended care is a necessary and effective method to optimise both continuous weight loss and long term weight maintenance.
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Background: The aim of a tier 3 specialist weight management service (SWMS) is to encourage patients to lose and maintain clinically significant levels (5-10%) of weight, NICE CG43 [1], through a holistic, patient centred multidisciplinary approach. The service consists of specialist dietitians, clinical psychologist, physiotherapist and consultant endocrinologist. As levels of obesity worldwide increase, bariatric surgery is not a viable and long-term, population wide treatment option (secondary to the associated costs and patient risk). The aim of this service evaluation was to identify the cost effectiveness of a community based specialist weight management service. Methods: Using SWMS outcome database, patients were identified within this retrospective study if they had attended at least one 3 month review and had available anthropometric information. Weight changes were analysed using SPSS 20 statistical software and compared with costs identified in the literature search. Costs associated with providing the service were obtained via the service's finance department which accounts for the salaries of the healthcare professionals, room hire, and other overhead costs. A literature search was performed and manual identification within references, to determine weight loss and associated cost savings of type 2 diabetes mellitus (T2DM) diagnosis occurrence and bariatric surgery costs. This retrospective analysis was logged with the service's Trust clinical governance and did not require ethical approval. Results: Of the 249 patients within the database, 128 patients were included in this evaluation with a mean starting BMI of 42.4 kg/m2 (SD±5.6). Patients within this study had been within the service for different lengths of time ranging from 3-15 months. The mean weight loss of the cohort was 3.5% of their starting body weight, with 37 (28.9%) of patients achieving >5% weight loss. The average BMI reduction for males and females were 1.2 and 1.6 units respectively. The literature search found bariatric surgery costs ranging from £5,500 to £17,900 (depending on surgical costs, pre and post-operative appointments and complications) per person. Projected costs using UK literature of T2DM occurrence and associated treatment costs were £6411.76/ year/patient. The possibility of diagnosis of T2DM for patients of high risk was 11% diagnosis/ year. The cost of the SWMS service was £242, 000 per year. Discussion: It has been estimated that the direct cost of treating obesity and associated co-morbidities is £480m to the national health service (NHS) expenditure in England NationalAudit Office [2]. If the above findings were applied to the SWMS weight loss results, 15% of patients would no long qualify for bariatric surgery which equates to a saving of £71500-232000/ year. For patients that achieved a 5% weight loss reduction, 1.86 of these patients are less likely to develop T2DM with a potential saving of £11925.87. Savings identified in this evaluation sample total to £83,425.87-£243,925.87. Further savings associated with the reduction in obesity would be recommended for future investigations including cardiovascular disease treatments, prescription drug utilisation and other health care costs. Conclusions: There is an indication that the SWMS has the potential to be a cost neutral weight loss provider. Further research is required to gain a greater understanding of it's broader cost savings