Attaining successful weight loss with an ideal macronutrient balance

A dramatic increase in the number of people who are overweight or obese in this country presents a growing public health problem. Successful weight loss requires diet, physical activity, and behavior modification interventions. Weight loss diets with distinctively different macronutrient profiles have resulted in short-term weight loss. There is great interest in identifying the most effective strategies to achieve long-term weight loss. Individualizing weight loss interventions, including diet, will be important to facilitate significant weight loss on a population basis. Nurses and nurse practitioners can play an integral role in supporting their patient's weight loss efforts.     

How to help your patients lose weight: current therapy for obesity

Obesity is epidemic and dangerous. Weight loss is difficult but worth the effort. Although new weight-loss drugs are available, there are no magic bullets: to lose weight and keep it off, people must eat less and exercise more. This article presents a practical approach on how physicians can help their patients lose weight through diet, behavior modification, and adjunctive pharmacologic therapy. An appropriate initial goal is to lose 5% to 10% of one's baseline weight over 3 to 6 months. Drug therapy should not be used in isolation, but it can be an adjunct to diet, exercise, and behavior modification if a patient is committed and able to make necessary changes in eating and activity, and if the patient has a BMI of 30 or higher or a BMI greater than 27 with weight-related comorbid conditions. Anorectic therapy is unlikely to succeed and should be stopped if the patient does not lose at least 4 lb in the first 4 weeks of therapy. Orlistat is unlikely to be of benefit if patients do not lose at least 3% of their baseline weight by 12 weeks. Because obesity is a chronic disease, drug treatment should be continued indefinitely. The physician and patient must understand the intention to treat long-term. The weight loss plan devised should improve upon previous plans: for example, implementing a regular, convenient exercise program that had not been included in the past, or offering pharmacotherapy.     

Obesity in adults and children: a call for action

Obesity/overweight in adults and children is a worldwide health problem associated with substantial economic burden as measured by paid sick leave, life and disability insurance rates, and obesity-related physician visits and hospital stays. Overweight/obese people experience hypertension, elevated cholesterol, and type 2 diabetes and suffer more joint and mobility problems than people within the normal weight for height range. While there is need to understand individual behaviors that can be modified to promote weight loss and weight maintenance, there is as great a need to consider contextual factors at the societal level that can impede or even sabotage weight control efforts. In every country with improved living standards people will continue to eat too much and engage in too little physical activity. The call for action is for all modernized societies to alter environments and attitudes to support, rather than hinder, healthy dietary intake and being physically active.     

Weight management issues and strategies for people with high cardiovascular risk undertaking an Australian weight loss program: A focus group study

Obesity is particularly hazardous for people with multiple cardiovascular risk factors and existing cardiovascular disease, although few studies investigate experiences and perceptions of weight loss in this population. This study provides an understanding of participants' knowledge, attitudes, and experiences of managing multiple risk factors and/or existing cardiovascular disease of participants who were undertaking a weight loss program. Thirty‐five participants were recruited from the first 50 completing a multicomponent group‐based weight loss intervention designed to follow cardiovascular disease and diabetes disease management programs. Four focus group interviews were conducted using a semistructured interview schedule. Data were analyzed using an inductive approach, and themes developed. Participants found the process of weight loss to be complex, dynamic, and challenging, as the conflicting needs of existing health conditions, social support, ambivalence, and time limitations required careful balance. In response, participants determinedly developed and tested strategies based on simplified principles, establishing routines for new health habits and portion control, and going back to basics in food selection. Therefore, weight loss programs for this population need to be specifically tailored to support patients' efforts and strategies.     

Brain function predictors and outcome of weight loss and weight loss maintenance

Obesity rates are associated with public health consequences and rising health care costs. Weight loss interventions, while effective, do not work for everyone, and weight regain is a significant problem. Eating behavior is influenced by a convergence of processes in the brain, including homeostatic factors and motivational processing that are important contributors to overeating. Initial neuroimaging studies have identified brain regions that respond differently to visual food cues in obese and healthy weight individuals that are positively correlated with reports of hunger in obese participants. While these findings provide mechanisms of overeating, many important questions remain. It is not known whether brain activation patterns change after weight loss, or if they change differentially based on amount of weight lost. Also, little is understood regarding biological processes that contribute to long-term weight maintenance. This study will use neuroimaging in participants while viewing food and non-food images. Functional Magnetic Resonance Imaging will take place before and after completion of a twelve-week weight loss intervention. Obese participants will be followed though a 6-month maintenance period. The study will address three aims: 1. Characterize brain activation underlying food motivation and impulsive behaviors in obese individuals. 2. Identify brain activation changes and predictors of weight loss. 3. Identify brain activation predictors of weight loss maintenance. Findings from this study will have implications for understanding mechanisms of obesity, weight loss, and weight maintenance. Results will be significant to public health and could lead to a better understanding of how differences in brain activation relate to obesity.     

Protocol for Partner2Lose: A randomized controlled trial to evaluate partner involvement on long-term weight loss

BackgroundBehavioral interventions produce clinically significant weight reduction, with many participants regaining weight subsequently. Most interventions focus on an individual, but dietary and physical activity behaviors occur with, or are influenced by, domestic partners. According to interdependence theory, couples who approach behavior change as a problem to be tackled together versus independently are more likely to utilize communal coping processes to promote behavior change. We utilized interdependence theory to develop a partner-assisted intervention to increase long-term weight loss.MethodsCommunity-dwelling individuals (index participants) cohabitating with a partner with 1) overweight and at least one obesity-related comorbidity or 2) obesity are randomized to participate in a standard weight management program alone or with their partner. The weight management program involves biweekly, in-person, group sessions focusing on weight loss for six months, followed by three group sessions and nine telephone calls focusing on weight loss maintenance for twelve months. In the partner-assisted arm, partners participate in half of the group sessions and telephone calls. Couples receive training in principles of cognitive behavioral therapy for couples, including sharing thoughts and feelings and joint problem solving, to increase communal coping. The primary outcome is participant weight loss at 24 months, with caloric intake and moderate-intensity physical activity as secondary outcomes. Partner weight and caloric intake will also be analyzed. Mediation analyses will examine the role of interdependence variables and social support.DiscussionThis trial will provide knowledge about effective ways to promote long-term weight loss and the role of interdependence constructs in weight loss.Clinical trials identifier: NCT 03801174.     

The influence of nurses' attitudes, subjective norms and perceived behavioral control on maintaining patients' privacy in a hospital setting

The research reported in this article examined the influence of nurses' attitudes, subjective norms and perceived behavioral control on maintaining patients' privacy during hospitalization. The data were gathered from 109 nurses in six internal medicine wards at an Israeli hospital. The research was based on the theories of reasoned action and planned behavior. A positive and significant correlation was shown between nurses' attitude to promoting and maintaining patient privacy and their planned behavior, while perceived behavioral control was the best variable for predicting the nurses' behavior. Better educated nurses believed that they had fewer resources and anticipated more obstacles in acting to promote and maintain patient privacy. This research adds a new dimension to what is already known about nurses' attitudes to maintaining patients' privacy, nurses' planned behavior and their actual behavior. The practical implications of the findings are the identification of factors that influence the attitudes and behavior of nursing staff, which, in turn, will enable allocation of resources for solving difficulties and removing obstacles. The results will allow the formulation of educational programs to guide staff and also the application of policies based on both patient and nursing staff needs.     

Attitudes toward dementia‐related aggression among staff in Japanese aged care settings

Aim and objective. This study investigated attitudes of Japanese aged care staff toward aggression by people with dementia. Relationships between staff attitudes, professional characteristics and clinical practice were explored. Background. Aggressive behaviour is often demonstrated by people with dementia and may be influenced by many factors including an inability by the individual to appropriately express their needs, difficulties with assessment, as well as organisational and practice issues. Design. Survey. Method. Twenty‐seven facilities/organisations located in the western and middle parts of Japan were surveyed. Staff (n = 675) employed in these facilities provided personal and professional information and completed the Attitudes Towards Aggression Scale. Results. Staff who were older, had more clinical experience, higher education and/or a higher position reported more positive attitudes towards patient aggression. Staff with negative attitudes towards patients who are aggressive reported using chemical and/or physical restraint more often than staff with positive attitudes. Conclusions. Dementia education as well as restraint policy will be useful in addressing negative staff attitudes, in particular it may help to reverse the myth that restraint is necessary for staff protection. Furthermore, staff counseling may help to reduce stressors and to change staff negative attitudes towards people with dementia who display aggression. Relevance to clinical practice. The findings show that negative staff attitudes may adversely affect clinical decision making and patient care. Measuring attitudes can identify areas requiring education or skill development and enable changes in attitudes to be monitored over time.     

Cultural, ethnic, racial, and religious factors: implications for ophthalmic nursing practice and research.

In her book, 9226 Kercheval: The storefront that did not burn, Milio (1970) states ... the one who would change others must himself be changed (p.xi). Thus if ophthalmic nursing practice is to have a positive impact upon patient outcomes in the twenty-first century, our nursing interventions and the empirical research that validates and legitimizes these interventions must be predicated upon factors that view the patient holistically. In particular, the integration of orthodox or traditional ophthalmic procedures with the patient's perceptions of health, cultural norms, values, religious doctrines, etc. If compromises between the nurse and the patient are not negotiated, nursing services will be avoided and nursing interventions such as patient education will be ignored (Reinhardt & Quinn, 1977). Sensitivity to cultural, ethnic, racial and religious factors will enhance ophthalmic nursing practice by helping to unravel such issues as patient compliance, differential responses to pain (Davitz, Sameshima, & Davitz, 1976; 1972; Zborowski, 1969; 1952), the relevance for utilizing a variety of teaching strategies for patient education, and family and community influence in the prescribed care of the patient. Having had our philosophy of health care shaped by a middle-class white, and traditionally patriarchal, value and belief paradigm (Donnelly & Sutterly, 1985), we tend to unconsciously gravitate toward ethnocentric attitudes and stereotypic behaviors when caring for patients who hold health beliefs and values different from our own. However, as we become acquainted with and learn to appreciate the norms and values of differing populations, there will be a diminution in ethnocentric attitudes and stereotypic behavior.     

Faut-il faire maigrir les sujets obèses avant une intervention chirurgicale ? Le cas particulier de la chirurgie bariatrique

Obese patients due to undergo elective surgery often find that they are expected to lose weight before the surgeon performs the bariatric operation. Is there any sound basis for this attitude? For the surgeon, patient weight loss will make the actual surgery easier and safer. But involuntary loss of weight before an operation is associated with a greater risk of postoperative complications. Few studies (N = 14) are available that might aid an objective analysis of the effects of preoperative weight loss. Their aims were chiefly to improve long-term results with respect to weight-loss or make the surgery easier to perform. Four of these studies, of which only one was randomised, mention the prevalence of postoperative complications. There was no significant effect on this parameter in 3 of the 4 studies. In the 4th, with respect to which significant preoperative weight-loss had been a precondition, the mortality rate and complications rate were higher than those found in the literature. Despite the small number of subjects, the lack of standardisation of procedures and the varying amounts of weight lost, there was no apparent benefit arising from preoperative weight-loss. Subjects who had been happy to lose weight before their operation, and who might therefore be supposed to be more highly motivated, were not necessarily more successful in terms of long-term weight-loss than other candidates for this type of surgery. Preoperative weight-loss improves comorbidity rates and the risk profile of such surgery. Nonetheless, no objective decrease in the risk of undergoing surgery has been observed. Preoperative weight-loss may even have a negative effect, as can be seen when the patient loses weight against his/her will.     

Toward dignity in care: An in-service model

How can the dignity or well being of people in the terminal phase of their lives be fostered? A short-term educational program model was developed to assist a group of personnel (N = 83) in a hospital for the chronically HI to become more responsive to this challenge. Three major considerations basic to the design of the program were: (1) application of the learning model to other sites within the hospital and to similar agencies; (2) on-site saturation technique to involve all members of the staff over a relatively short but intensive period; (3) heterogeneous grouping to bring together professional, parapro-fessional, and service personnel for a common learning experience. Data from personal interviews conducted with a representative sample population of health personnel yielded a contextual understanding that was used as a basis for the program design. Individual and group strategies were used to increase the participants'awareness of the dimensions of pain, loneliness, intrusiveness, and loss in the lives of terminal patients; to encourage participants' reflection of their own attitudes toward this patient population; and to develop preferred norms of patient care that would be more congruent with new emerging insights. Although an evaluation of the program's goal of promoting a greater sense of patient dignity can be attained only by long-term measures, several indicators of success were demonstrated.     

BEST: Bypass equipoise sleeve trial; rationale and design of a randomized,registry-based,multicenter trial comparing Roux-en-Y gastric bypass with sleeve gastrectomy

BackgroundLaparoscopic gastric bypass (LGBP) is a well-documented surgical intervention for severe obesity. Recently, laparoscopic sleeve gastrectomy (LSG) has gained increased popularity. Short-term follow-up in limited-sized randomized trials comparing LGBP and LSG show no major differences in weight-loss, adverse events, or effect on comorbidities; however, there is a lack of sufficiently powered, pragmatic, randomized controlled trials comparing the mid- and long-term results of the two methods.MethodBEST is a randomized, registry-based, multicenter trial comparing LGBP and LSG. The trial has two primary outcomes; rates of substantial complications (SC) and total body weight loss. We hypothesize that patients treated with LSG will experience 35% fewer substantial complications during the 5-year follow-up compared to patients treated with LGBP, and that the efficacy of LSG will remain within a non-inferiority margin of 5% in terms of weight loss. Our sample size calculation, using data from the Scandinavian Obesity Surgery Registry (SOReg), shows a power of 80% for SC and > 95% for weight loss at p < .025 with a total of 2100 included patients.The design of the trial will also enable comparisons within several relevant patient subgroups.ConclusionsAs a large-sized, pragmatic, randomized trial, BEST will provide robust data comparing LGBP with LSG by generating long-term results on weight loss and SC's, as well as secondary outcomes and comparisons within patient subgroups. The use of a well-established registry for registration of all data facilitates a large multicenter trial, and combines the strengths of registry studies with those of a randomized trial.Clinical Trials registry: NCT 02767505.     

Weight regain after bariatric surgery: Promoters and potential predictors

Obesity is globally viewed as chronic relapsing disease. Bariatric surgery offers the most efficient and durable weight loss approach. However, weight regain after surgery is a distressing issue as obesity can revert. Surgical procedures were originally designed to reduce food intake and catalyze weight loss, provided that its role is marginalized in long-term weight maintenance. Consequently, it is essential to establish a scientifically standardized applicable definitions for weight regain, which necessitates enhanced comprehension of the clinical situation, as well as have realistic expectations concerning weight loss. Moreover, several factors are proposed to influence weight regain as psychological, behavioral factors, hormonal, metabolic, anatomical lapses, as well as genetic predisposition. Recently, there is a growing evidence of utilization of scoring system to anticipate excess body weight loss, along with characterizing certain biomarkers that identify subjects at risk of suboptimal weight loss after surgery. Furthermore, personalized counseling is warranted to help select bariatric procedure, reinforce self-monitoring skills, motivate patient, encourage mindful eating practices, to avoid recidivism.     

Ethical dilemmas in charging for care: contrasting the views of social work and legal professionals

This article draws on the findings of a recent study funded by the Nuffield Foundation. The study explored attitudes, practices and policy in relation to charging and assessing older people who were considering entering residential and nursing home care. In five differing local authorities, a sample of social services practitioners (care managers) completed a postal questionnaire and interviews were held at a number of levels with staff. At the same time, independent legal practitioners in these areas, who are involved in advising older people, were surveyed and a small number of individual practitioners were interviewed. The focus of this article is on contrasting the attitudes and views of care managers and legal practitioners towards their work in relation to older people, finances and charging for long-term care. In particular, there will be an emphasis on the ethical dilemmas identified by the respondents from the different professions involved in the study.     

Toward dignity in care: An in-service model

Abstract

How can the dignity or well being of people in the terminal phase of their lives be fostered? A short-term educational program model was developed to assist a group of personnel (N = 83) in a hospital for the chronically HI to become more responsive to this challenge. Three major considerations basic to the design of the program were: (1) application of the learning model to other sites within the hospital and to similar agencies; (2) on-site saturation technique to involve all members of the staff over a relatively short but intensive period; (3) heterogeneous grouping to bring together professional, parapro-fessional, and service personnel for a common learning experience. Data from personal interviews conducted with a representative sample population of health personnel yielded a contextual understanding that was used as a basis for the program design. Individual and group strategies were used to increase the participants'awareness of the dimensions of pain, loneliness, intrusiveness, and loss in the lives of terminal patients; to encourage participants' reflection of their own attitudes toward this patient population; and to develop preferred norms of patient care that would be more congruent with new emerging insights. Although an evaluation of the program's goal of promoting a greater sense of patient dignity can be attained only by long-term measures, several indicators of success were demonstrated.     

The perfectionistic patient.

Family members, residents, and care givers often react negatively when perfection is demanded by the geriatric patient. This type of reaction presents a challenge to the nurse providing care. When a geriatric patient is perfectionistic, it is important to step back, to observe and assess, and to plan appropriate strategies that will facilitate the patient's adjustment. When the behavior is related to situational stressors, it may be appropriate to respond to the stressors and ignore the behavior. When the behavior results from a feeling of loss of control and powerlessness, intervention should be directed in that direction. In any case, actions of the nurse should respond to the patient's need for self-esteem and improved ability to cope with the environment. Responding to the perfectionistic geriatric patient presents a particular challenge to the nurse in long-term care, and the nurse's strategic intervention can significantly increase the patient's ability to adjust to the ongoing changes that accompany the aging process.     

HIV/AIDS Related Knowledge, Attitudes, and Preventive Behavior of Pregnant Korean Women

Objective :To assess HIV-AIDS-related knowledge, attitudes, and preventive behavior of pregnant Korean women before designing patient and public education programs.
Design: Pre-experimental cross-sectional survey.
Population, Sample, Setting, Years: Convenience sample of 409 women at six prenatal clinics in Seoul, Korea, in 1993.
Outcome Measures: HIV-AIDS-related knowledge, attitudes, and preventive behavior.
Methods: Self-administered questionnaires.
Findings: The women described high levels of knowledge about HIV and AIDS risk factors but less knowledge about transmission of the virus, as well as attitudes of rejection toward unrelated people with HIV/AIDS; 16% provided condoms for their husband's use in extramarital sex, the primary risk behavior.
Conclusions: Korean women are at risk for heterosexual transmission of HIV despite knowledge of risk factors.
Clinical Implications: Korean education programs for women should focus on modes of heterosexual transmission, care of individuals with HIV or AIDS, self-assessment of HIV-AIDS risk, and self protection.     

Management of overweight and obesity in adults: behavioral intervention for long-term weight loss and maintenance.

BACKGROUND: The World Health Organization has identified obesity as a global epidemic. While weight loss is a considerable challenge, long-term maintenance of weight loss is an even greater problem. AIMS: This review of the assessment and management of overweight and obesity in adults covers factors contributing to overweight and obesity, components of weight-loss management, and interventions and effects of behavioral treatment for long-term weight loss and maintenance. METHODS: A thorough search of the medical and nursing literature recorded in the MEDLINE database from 1995 to 2003 was conducted by using the keywords "overweight", "obesity", and "behavioral therapy". RESULTS: Obesity is a complex, multifaceted condition in which excessive body fat places a person at risk of multiple health problems. Excessive body fat results from energy intake that exceeds energy expenditure. CONCLUSIONS: Increasing evidence suggests that obesity is not simply a problem of will power or self-control but a complex disorder involving appetite regulation and energy metabolism that is associated with a variety of comorbid conditions. Effective strategies of weight loss require management strategies in a combined approach of dietary therapy and physical activity by using behavioral interventions.