Towards Precision Health in Weight Reduction: Thematic Content Analysis of an Open-Ended Survey on Reasons Why Morbidly Obese Patients Want to Lose Weight

@#Introduction: Addressing motivation to lose weight among morbidly obese patients increases successful weight management outcomes. We aimed to understand the motivations and reasons why morbidly obese patients attending hospital-based weight management programmes wanted to lose weight. Methods: A qualitative thematic content analysis was used to analyse responses from a self-administered open-ended question, “What is the main factor why you want to lose your weight?”. A total of 225 new patients attending obesity clinics program run by endocrinologists, dietitians and occupational therapists in two tertiary hospitals in Klang Valley responded to the questionnaire. Results: Patients’ mean BMI was 45.6±8.05 kg/m2 . Four themes emerged and they are health, function, appearance and perceived stigma. Health, the most commonly inferred theme (84%), highlighted concerns over obesity complications and concomitant morbidities, which include infertility, impact on surgical procedures as well as general physical and psychological well-being. Patients regard being functional to care for themselves, family members, religious and career needs as the next most crucial theme (25.8%). They relate to the theme appearance (12.9%) by wanting to look and feel beautiful. The theme perceived stigmatization recount the time when they were mocked and laughed at for their appearance (3.1%). Conclusion: Patients with morbid obesity in this study had expressed their main personal motivational reasons to lose weight. Identifying and addressing these unique personal motivations in a focused approach is vital for health care professionals to manage the complexity of the health, social and psychological needs among patients with morbid obesity.

Treatment for weight loss of grade iii obese patients in the hospital environment: comparative study between hospitalization and ambulatory programs / Tratamiento para la pérdida de peso en pacientes con obesidad grado iii en ambiente hospitalario: estudio comparativo entre programas de internación y ambulatorio

Introduction: Obesity is a disease characterized by excessive accumulation of body fat with health damaging effects. Objective: To assess the impact of two programs for the treatment of grade III obesity, hospitalization and ambulatory care, on weight loss and body composition. Methods: This was a retrospective study based on the analysis of the medical records ofpatients submitted to the above programs between 1990 and2005, with evaluation of weight evolution, body circumferences (abdominal, hip and arm), fat mass (FM, kg) and fat-free mass (FFM, kg). Results: A total of 50 medical records were evaluated, 54% of them concerning patients of the hospitalization program (HP). Both programs were efficient in promoting weight loss, however, it was greater for HP. HP led to reduction of all body circumferences and of FM but its cost was 80 times higher than the ambulatory program. Conclusion: On the basis of the data evaluated, despite its much higher cost, the HP yielded more effective results in terms of weight loss and change of body composition.

Introducción: La obesidad es una enfermedad caracterizada por la acumulación excesiva de grasa corporal, con efectos nocivos para la salud. Objetivo: Evaluar el impacto de dos programas para el tratamiento de la obesidad grado III: hospitalización y ambulatorio, en la pérdida de peso y composición corporal. Método: Se realizó un estudio retrospectivo basado en el análisis de las historias clínicas de los pacientes sometidos a los dos programas, entre 1990 y 2005, con la evaluación de la evolución del peso, circunferencias corporales (cadera, abdominal, y del brazo), la masa grasa (MG, kg) y masa libre de grasa (MLG, kg). Resultados: Un total de 50 historias clínicas fueron evaluadas, siendo la mayoría (54%), de los pacientes del programa de hospitalización (PH). Los dos programas fueron eficaces en la promoción de la pérdida de peso, pero esta pérdida fue mayor para el PH; que llevó a una reducción de todas las medidas de las circunferencias corporales y de la MG. Sin embargo, su costo fue 80 veces mayor que el del programa de ambulatorio. Conclusión: Sobre la base de los datos evaluados, a pesar de su costo mucho más alto, el HP dió resultados más eficaces en términos de pérdida de peso y en el cambio de la composición corporal.

Da dieta à reeducação alimentar: algumas notas sobre o comer contemporâneo a partir dos programas de emagrecimento na Internet / From diet to eating re-education: some notes on the contemporary eating based on weight loss programs on the Internet

O texto tem como objetivo refletir sobre o comer contemporâneo, partindo de um estudo sobre estratégias educativas utilizadas pelos programas de emagrecimento oferecidos via Internet, o qual detecta uma possível transição da ideia de fazer dieta para a de reeducação alimentar. Identifica que a principal mensagem preconizada pelos sites é "emagrecer, de uma forma saudável, equilibrada e natural, através da adoção de novos hábitos alimentares, em que se pode comer de tudo, sem privações e sacrifícios, com prazer, sem privar-se da vida social", e que os mesmos utilizam o conjunto das estratégias combinando três elementos fundamentais: o estímulo e motivação com um forte apoio psicológico e de marketing; "comer de tudo" com a promessa de não abrir mão do prazer e o "sem passar fome" como controlar o apetite. O texto ainda discute aspectos sobre a ressignificação do comer, da comida e dos alimentos que passam pela construção de uma nova distinção alimentar. Finaliza destacando que o momento atual parece construir bases que sustentam a disciplina alimentar contemporânea. Esta nova disciplina, se assim pode-se denominar, transpõe da negação plena do comer, presente nas dietas tradicionais, para uma tentativa de afirmação da dieta, a partir do resgate da dimensão do prazer em comer.

The paper aims to reflect on contemporary eating based on a study on educational strategies used by weight-loss programs offered through the Internet, which detect a possible transition from the idea of dieting for the eating re-education. It identifies the main message put forward by the sites is "lose weight in a healthy, balanced and natural way, through the adoption of new eating habits, where you can eat everything without hardship and sacrifice, with pleasure, without deprivation of social life" and that they use the sort of strategies combining three elements: the encouragement and motivation with a strong psychological and marketing, "eat everything" with the promise of not giving up the pleasure and the "no hunger" how to control the appetite. The paper also discusses aspects of the new meaning of eating and food that involves the construction of a new eating distinction. Finally, we remark that the present moment seems to build basis that support the contemporary eating discipline. This new discipline, if we can call it so, crosses the complete denial of food, found in traditional diets, to an attempt to reaffirm diet, by recovering the pleasure of eating.

THE EFFECT OF A SHORT-TERM WEIGHT-LOSS PROGRAM IN OBESE MEN WITH SLEEP DISORDERED BREATHING / 体力科学

A number of studies have shown that sleep disordered breathing (SDB) has a strong relation with obesity. The purpose of this study was to examine the effect of a short-term weight-loss program in obese men with SDB. In our 14-week weight-loss program, forty-one obese men (mean±SD, age ; 49.6±10.8 yr, body mass index ; 27.9±2.5 kg/m²) were assigned to 2 subgroups : diet only (DO ; n=19) and diet plus aerobic exercise (DE ; n=22). 2%, 3%, and 4% oxygen desaturation index (ODI) were measured by pulse oximetry before and after the weight-loss program. Weight and %fat significantly (<i>p</i><0.05) decreased in the total subject pool consisting of DO plus DE (weight ; -8.4±3.5 kg, %fat ; -7.5±3.5%). 2%, 3%, and 4% ODI significantly decreased by -3.46±5.01 event/hour, -2.37±3.57 event/hour, and -1.99±2.84 event/hour, respectively. Significant correlations were found between 2%, 3%, and 4% ODI at baseline and changes of 2%, 3%, and 4% ODI during the weight-loss program (2% ODI ; r=0.48, 3% ODI ; r=0.51, 4% ODI ; r=0.67). Weight loss and %fat loss did not differ significantly between DO and DE (DO : -7.6±3.2 kg, -6.8±3.2%, DE : -9.2±3.7 kg, -8.1±3.7%). The increase in maximal oxygen uptake was slightly larger for DE (4.7±4.6 ml/kg/min) compared to DO (2.5±3.3 ml/kg/min), but there was no significant interaction. Changes of 2%, 3%, and 4% ODI did not differ significantly between groups. These results suggest that for obese men with SDB, the weight-loss program is an effective method, leading to improvement in SDB, although the combination of aerobic exercise to diet may not produce additional effects to SDB, compared with the diet only.

Seasonal variation may have an effect on body composition alterations induced by exercise training / 体力科学

The purpose of this study was to determine whether body composition alterations induced by aerobic exercise training show seasonal varition. Ninety-five middle-aged Japanese obese women volunteered as subjects. All subjects participated in our “exercise+diet” program for 3 months. The subjects were categorized into two groups (Summer group : S, and Winter group : W) based on the season when they participated in the program. Body composition, cardiorespiratory variables and dietary habituation were evaluated before and after the programs. More desirable changes in body composition were observed in Group W than in Group S. Group W showed a significant decrease in body mass from 62.2±8.7 kg to 60.3±8.6 kg, and in percentage body fat from 34.0±7.0% to 30.5±6.0%, while fat-free mass increased significantly from 41.0±3.9 kg 41.9±3.6 kg. However, alterations in cardiorespiratory variables were not associated with body composition alterations. It is concluded that season may have an effect on body composition alterations, but has no effect on cardiorespiratory variables, and that body composition may be improved by an exercise+diet program more effectively in winter than in summer.