Motivation and Limiting Factors for Adherence to Weight Loss Interventions among Patients with Obesity in Primary Care.

The cornerstones of obesity management are diet, physical activity and behavioral change. However, there is considerable scientific evidence that lifestyle interventions to treat obesity are rarely implemented in primary care. The aim of this study is to analyze motivation to lose weight among patients with obesity, the resources implemented by primary care centers to promote behavioral change and the limiting factors reported by the patients themselves when attempting to lose weight. A total of 209 patients diagnosed with obesity were interviewed. The variables were obtained from both electronic clinical records (sex, age, BMI, diagnosis of metabolic syndrome and records of activities prescribed to promote behavioral change) and a self-administered personal questionnaire. A total of 67.5% of the respondents reported not having sufficient motivation to adhere to a weight loss program. Records of behavioral change activities were identified in only 3% of the clinical records reviewed. The barriers to adherence to diet and exercise plans most frequently mentioned by patients were not having a prescribed diet (27.8%), joint pain (17.7%), getting tired or bored of dieting (14.8%) and laziness (11.5%). Both the high percentage of patients reporting insufficient motivation to lose weight and the barriers to weight loss identified suggest that patients feel the need to improve their motivation, which should be promoted through primary care.

Evaluation of Obesity Management Recorded in Electronic Clinical History: A Cohort Study.

BACKGROUND: The prevalence of obesity is increasing worldwide. Because of their close proximity to the population, primary care physicians and nurses are in a unique position to motivate and advise patients with obesity on a healthy diet and increased physical activity. Drawing from information recorded in electronic clinical records, we evaluated how the general recommendations included in obesity guidelines are being implemented in routine clinical practice. METHODS: This study drew from the following data from a cohort of 209 patients with obesity that attended primary care consultations: electronic clinical records, body mass index (BMI), waist circumference (WC), cardiovascular risk factors, comorbidities and whether their health professional documented compliance with the recommendations of the evidence-based obesity guidelines in their electronic history. RESULTS: Only 25.4% of the clinical records met all the criteria established in the therapeutic guidelines regarding diet prescription, 1.4% for physical activity and 1.5% for behavioral change activities. The patients whose records mentioned diet prescription and physical activity and who received follow-up consultations for both factors had lower average BMI and WC, although this relationship was not significant after adjusting for baseline. CONCLUSIONS: We found that only a small number of records in the electronic clinical histories followed the evidence-based obesity guidelines. Recording dietetic prescription and physical exercise in the patient's clinical record is associated with better control of obesity.

In-hospital dietary intake and the course of mobilization among older patients with hip fracture in the post-surgical period.

BACKGROUND AND PURPOSE: Most older persons who suffer hip-fracture are frail and show comorbidities and functional deterioration, with poor short and long-term prognosis, high morbidity rates, and premature death. The aim of this work was to assess the association between in-hospital dietary intake and the course of mobilization of hip-fractured older patients in the post-surgical period until hospital discharge. METHODS: Prospective, observational, cohort study, n = 90 hip-fracture ≥ 65 years old patients. Pfeiffer questionnaire, Barthel Index, Charlson Comorbidity Index, Mini Nutritional Assessment, mobilization and dietary assessment, body mass index, arm and calf circumferences and blood analytical determinations. The mobilization progress was assessed measuring the ability to sit down and walking, at 2nd and 3rd-4th days post-surgery until discharge, respectively. RESULTS: Charlson Comorbidity Index was associated with ability to sit down, and energy intake was associated with ability to walk. Energy and protein intake is an important factor influencing mobilization success in older patients after surgery. Poor mobilization is related to high Charlson Comorbidity Index. CONCLUSIONS: In hip-fractured older patients, energy-protein intake and comorbidities assessed by Charlson Comorbidity Index are the main factors associated with poor mobilization in the post-surgical period.