Needs Assessment for Weight Management: The Learning Health System Network Experience.

OBJECTIVE: To assess patients' weight management needs and experiences across multiple sites within the Learning Health System Network. PATIENTS AND METHODS: A total of 19,964 surveys were sent to patients identified with overweight or obesity through medical record query at 5 health care systems throughout 11 states. The survey collected patients' experiences with and opinions about weight management in clinical care from October 27, 2017, through March 1, 2018. RESULTS: Among the 2380 responders, being younger, female, nonwhite, and single and having some college education or less were all significantly associated with higher body mass index (BMI). The most frequent weight loss barriers included food cravings (30.7%-49.9%) and having a medical condition limiting physical activity (17.7%-47.1%) (P<.001). Higher BMI was associated with a higher frequency of comorbidities and lower health status (P<.001). Higher BMI was also associated with a higher belief that primary care providers (PCPs) should be involved in weight loss management (P=.01) but lower belief that the PCP had the necessary skills and knowledge to help (P<.001). Responders with a higher BMI were more likely to feel judged (P<.001) and not always respected (P<.001) by their PCP. In addition, those with a higher BMI more frequently reported avoiding health care visits because of weight gain, not wanting to undress or be weighed, and not wanting to discuss their weight with their PCP (P<.001). CONCLUSION: Physician involvement in weight management is important to patients whose needs and experiences differ by BMI. These data may inform clinical weight management efforts and create greater alignment with patient expectations.

Early severe fetal Graves disease in a mother after thyroid ablation and thyroidectomy.

BACKGROUND: Fetal Graves disease rarely presents before 26 weeks of gestation. We report a case of severe fetal Graves disease at 18 weeks of gestation in a mother who had very elevated Graves disease antibodies despite being several years post-thyroid ablative therapy and thyroidectomy. CASE: A 36-year-old woman, gravida 1 para 0, with severe Graves disease post-radioiodine ablation followed by thyroidectomy on levothyroxine presented at 18 weeks of gestation for ultrasound examination. Her fetus was found to be severely tachycardic with a goiter. Propylthiouracil was initiated for fetal therapy. Delivery at 34 weeks of gestation was undertaken as a result of preterm premature rupture of membranes. The neonate experienced heart failure and pulmonary hypertension at birth but recovered with appropriate medical therapy. CONCLUSION: It is possible for fetal Graves disease to develop as early as 18 weeks of gestation, and women who have had thyroid ablation and postsurgical hypothyroidism remain at risk for this serious pregnancy complication.

Subcutaneous adipose tissue insulin resistance is associated with visceral adiposity in postmenopausal women.

OBJECTIVE: Whole body and subcutaneous adipose tissue (SAT) insulin resistance association with regional fat mass (FM) was determined. METHODS: Postmenopausal women (mean ± SD; age 56 ± 4 years, n = 25) who were overweight or obese (BMI 29.9 ± 5.1 kg/m(2) ) were studied. Whole body and regional FM were measured by dual-energy X-ray absorptiometry (DXA) and computed tomography (CT). Women were studied during basal and insulin-stimulated (3-stage euglycemic clamp) conditions. Whole-body lipolysis was assessed by [(2) H5 ]-glycerol rate of appearance and abdominal and femoral SAT lipolysis by interstitial glycerol (microdialysis). RESULTS: Whole body insulin resistance in skeletal muscle (insulin-stimulated glucose disposal) and adipose tissue (insulin-suppressed lipolysis) were independently related to trunk FM (r = -0.336 and 0.484, respectively), but not leg FM (r = -0.142 and -0.148, respectively). Local antilipolytic insulin resistance in abdominal, but not femoral, SAT was positively related to trunk FM (r = 0.552) and visceral FM (r = 0.511) but not related to leg FM (r = -0.289). Whole body and abdominal, but not femoral, adipose tissue insulin sensitivity were strongly related to skeletal muscle insulin sensitivity (r = -0.727 and -0.674, respectively). CONCLUSIONS: The association of SAT insulin sensitivity (lipolysis) with adiposity and skeletal muscle insulin sensitivity was specific to the abdominal region.