Preliminary examination of metabolic syndrome response to motivational interviewing for weight loss as compared to an attentional control and usual care in primary care for individuals with and without binge-eating disorder.

Motivational interviewing (MI) treatment for weight loss is being studied in primary care. The effect of such interventions on metabolic syndrome or binge eating disorder (BED), both highly related to excess weight, has not been examined in primary care. This study conducted secondary analyses from a randomized controlled trial to test the impact of MI for weight loss in primary care on metabolic syndrome. 74 adult participants with overweight/obesity recruited through primary care were randomized to 12weeks of either MI, an attentional control, or usual care. Participants completed measurements for metabolic syndrome at pre- and post-treatment. There were no statistically significant differences in metabolic syndrome rates at pre-, X2(2)=0.16, p=0.921, or post-, X2(2)=0.852, p=0.653 treatment. The rates in metabolic syndrome, however, decreased for MI (10.2%) and attentional control (13.8%) participants, but not for usual care. At baseline, metabolic syndrome rates did not differ significantly between participants with BED or without BED across treatments. At post-treatment, participants with BED were significantly more likely to meet criteria for metabolic syndrome than participants without BED, X2(1)=5.145, p=0.023, phi=0.273. Across treatments, metabolic syndrome remitted for almost a quarter of participants without BED (23.1%) but for 0% of those with BED. These preliminary results are based on a small sample and should be interpreted with caution, but they are the first to suggest that relatively low intensity MI weight loss interventions in primary care may decrease metabolic syndrome rates but not for individuals with BED.

Medication Use and Metabolic Syndrome Among Overweight/Obese Patients With and Without Binge-Eating Disorder in a Primary Care Sample.

OBJECTIVE: To examine metabolic factors among overweight/obese individuals with binge-eating disorder (BED) and non-binge-eating overweight/obese (NBO) patients recruited from primary care and to examine and compare medication use by these groups. METHOD: Participants were 102 adults recruited for a weight loss study within primary care centers who were assessed for BED (28 [38%] met DSM-5 BED criteria). Participants completed a medication log, had physiologic measurements taken, and were evaluated for the presence of metabolic syndrome using 2 methods. Data were collected between February 2012 and October 2012. RESULTS: The BED group had a higher mean body mass index (BMI), a higher pulse, and a larger waist circumference than the NBO group. Of the sample, 65% reported current medication use (prescription and/or over-the-counter medications): 19.6% took 3 to 4 medications and 15.7% took ≥ 5 medications. Aside from vitamin and over-the-counter allergy pill use, there were no differences in medication use between BED and NBO patients. Full metabolic syndrome (≥ 3 criteria met) was present in 31.5% of the sample when using objective measurement alone, and 39.1% of the sample when defined by objective measurement and pharmacologic management. No significant differences were observed regardless of definition. CONCLUSIONS: Despite higher BMI, pulse, and waist circumference, the current sample of BED patients in primary care did not present with poorer metabolic health than NBO patients.

Unplanned extubation in the NICU.

Unplanned extubation (UE) in the neonatal intensive care unit (NICU) is a significant patient safety and quality control issue. I describe the implementation of a quality improvement program using multifactorial prevention strategies, including staff education, identification of neonates at risk for UE, extubation and weaning, standardization of procedures, and comprehensive documentation. Additional research on quality improvement with strategies for neonates may prove beneficial in reducing UE rates in neonates.

Implications of weight-based stigma and self-bias on quality of life among individuals with schizophrenia.

Obesity has been associated with significant stigma and weight-related self-bias in community and clinical studies, but these issues have not been studied among individuals with schizophrenia. A consecutive series of 70 obese individuals with schizophrenia or schizoaffective disorder underwent assessment for perceptions of weight-based stigmatization, self-directed weight bias, negative affect, medication compliance, and quality of life. The levels of weight-based stigmatization and self-bias were compared with levels reported for nonpsychiatric overweight/obese samples. Weight measures were unrelated to stigma, self-bias, affect, and quality of life. Weight-based stigmatization was lower than published levels for nonpsychiatric samples, whereas levels of weight-based self-bias did not differ. After controlling for negative affect, weight-based self-bias predicted an additional 11% of the variance in the quality of life measure. Individuals with schizophrenia and schizoaffective disorder reported weight-based self-bias to the same extent as nonpsychiatric samples despite reporting less weight stigma. Weight-based self-bias was associated with poorer quality of life after controlling for negative affect.

Association of prescription H1 antihistamine use with obesity: results from the National Health and Nutrition Examination Survey.

The incidence of obesity in the United States has reached epidemic proportions. Previous research has shown several medications exert noticeable effects on body-weight regulation. Histamine-1 (H1) receptor blockers commonly used to alleviate allergy symptoms are known to report weight gain as a possible side effect. Therefore, we investigated the association between prescription H1 antihistamine use and obesity in adults using data from the 2005-2006 National Health and Nutrition Examination Survey (NHANES). Adults taking prescription H1 antihistamines were matched by age and gender with controls and compared on the basis of body measurements, plasma glucose, insulin concentrations, and lipid levels. Prescription H1 antihistamine users had a significantly higher weight, waist circumference, and insulin concentration than matched controls. The odds ratio (OR) for being overweight was increased in prescription H1 antihistamine users. H1 antihistamine use may contribute to the increased prevalence of obesity and the metabolic syndrome in adults given these medications are also commonly used as over-the-counter remedies.

Monitoring the dissemination of peer support in the VA Healthcare System.

This study illustrates a monitoring system for peer support programs, focusing on Vet-to-Vet, a program for veterans with chronic psychiatric disorders. The sample consisted of 1,847 anonymous surveys from 38 veteran peer support programs. Program satisfaction and recovery orientation were positively associated with duration and frequency of participation in peer support. Program satisfaction was also associated with the Vet-to-Vet model and location at a VA medical center (vs. other model & location types). Payment for peer facilitators was positively associated with recovery orientation, spirituality, and engagement in meaningful activity. Additional research using experimental design methods is needed to determine the impact of peer support on mental health outcomes.