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Overweight patients feel judged by their doctors

May 21, 2014 at 12:00 AM

Overweight and obese people who feel their physicians are judgmental of their size are more likely to try to lose weight but are less likely to succeed, according to results of a study by Johns Hopkins researchers.

The findings, reported in the journal Preventive Medicine, suggest that primary care physicians should lose the negative attitudes their patients can sense if the goal is to get patients with obesity to lose 10 percent or more of their body weight (an amount usually sufficient to reduce blood pressure, cholesterol and diabetes risk).

"Negative encounters can prompt a weight loss attempt, but our study shows they do not translate into success," said study leader, Dr Kimberly A Gudzune, an assistant professor in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine. "Ideally, we need to talk about weight loss without making patients feel they are being judged. It's a fine line to walk, but if we can do it with sensitivity, a lot of patients would benefit."

Gudzune and her team suspected the pervasiveness of negative provider attitudes and weight stigma may be limiting the effectiveness of advice from primary care providers for these patients.

To test that idea, the researchers conducted a national Internet-based survey of 600 adults with a BMI >25 who regularly see their primary care doctors. The participants were asked, "In the last 12 months, did you ever feel that this doctor judged you because of your weight?"

Overall, 21% perceived that their primary care physician judged them about their weight. Respondents who perceived judgment were significantly more likely to attempt weight loss [odds ratios (OR) 4.67, 95% confidence interval (CI) 1.96–11.14], although they were not more likely to achieve ≥10% weight loss [OR 0.87, 95%CI 0.42–1.76].

Among patients whose primary care physicians discussed weight loss, 20.1% achieved ≥10% weight loss if they did not perceive judgment by their primary care physicians, compared to 13.5% who perceived judgment.

Ninety six percent of those who felt judged did report attempting to lose weight in the previous year, compared to 84 percent who did not.

Having a weight loss conversation clearly helped people lose more weight, the study found. Only 9 percent of those who felt judged but did not discuss weight loss with their doctor lost more than 10 percent of their body weight, while 6 percent of those who neither felt judged nor discussed weight loss with their doctor did.

Overall, just two-thirds of participants reported that their doctors brought up weight loss.

"Many doctors avoid the conversation because they don't want to make anyone feel bad, worrying they'll create a rift with their patients if they even bring it up. But that is not in the patients' best interest in terms of their long-term health," said Gudzune.

She added that doctors may need to be taught how to talk about the topic in ways that make patients feel understood and supported. It may also be helpful to start with smaller weight loss steps, such as a 10 percent reduction in weight. A larger long-term goal of losing 70 or 100lbs can be a setup for frustration and failure when tackled all at once.

"We don't want to overwhelm them and if we are their advocates in this process - and not their critics - we can really help patients to be healthier through weight loss.”

The US Preventive Services Task Force has recommended that health care providers counsel obese patients to lose weight, and the Centers for Medicare and Medicaid Services now covers some behavioural counselling related to weight loss.

Other Johns Hopkins researchers who contributed to this study were Wendy Drs L Bennett, Lisa A Cooper and Sara N Bleich.

The research was supported by trainee awards from the National Institutes of Health's National Heart, Lung and Blood Institute's Center for Population Health and Health Disparities, as well as by other NHLBI grants.

Post Surgery Support

March 25, 2014 at 12:00 AM

Having Major Surgery is a big decision and it is normal to worry about the operation and the initial recovery period.

At Betterlife Surgery we are focused on getting you through this period as easily as possible. While you are in hospital you will be cared for by nurses who are very experienced with post bariatric surgery patients.

It is important to let your nurses know if your symptoms are not being well controlled with the medications as we want you to be as comfortable as possible during your hospital stay. Once you leave hospital you will have a clear set of guidelines as to how to eat and drink in order to keep you as comfortable as possible and make the transition to your new life a smooth one. 

It is essential to keep things as simple as possible which means keeping your fluid intake up during the day, eating food of a consistency that would easily come up a thick straw and stopping eating as soon as you feel your full feeling.

All of this will be very new to you and it takes a bit of patience and time to make these new habits for your new life from here on in.

Post operative support within the first three weeks is through direct contact with Dr Ulmer via email, txt or phone calls. It is essential that you realise that help is at hand whether it be for advice or urgent attention. 

Your first post operative visit will be three weeks following surgery. By this time you will be starting to reintroduce normal soft foods into your diet and your routines and new habits will be becoming second nature to you. I would expect your weight loss to be between6 and 15 kilograms and you will be starting to feel like you can get back into some light exercise. Generally speaking the surgical pain has subsided and all your systems should be back to normal.

It is after the 3 week mark that we start reintroducing normal foods into your diet with the understanding that eating slowly with small mouthfuls and stopping eating when you feel full. These are the principals that you will be following.

It is important to have protein at all your meals in order to avoid becoming protein depleted. It is also essential that you are drinking at least one litre of water a day in order to maintain hyderation and the feeling of health.

Study finds Gastric Banding can be used to prevent diabetes

February 13, 2014 at 12:00 AM

Weight loss could be crucial in preventing patients with impaired fasting glucose (IGF) developing diabetes, according to a study published in Diabetologia. The authors from the Centre for Obesity Research and Education (CORE), Monash University,the Walter and Eliza Hall Institute, University of Melbourne, and the Baker IDI Heart and Diabetes Institute, Australia, report that patients who received a laparoscopic adjustable gastric band (LAGB) had a reduced risk of progressing from IFG to diabetes.

“We show that the rate of progression from IFG to diabetes is substantially reduced in obese people who undergo LAGB surgery…these findings strengthen the case for a randomised trial to determine whether LAGB surgery is a safe and cost-effective approach to preventing type 2 diabetes in this population.”

Study

The investigators note that patients with IFG are at high risk of developing type 2 diabetes and obesity is a major risk factor. Therefore, they assessed whether LAGB in obese patients with IFG reduced the risk of developing type 2 diabetes.

This retrospective cohort study looked at the outcomes of obese people with IFG who underwent LAGB and compared them with those of Australian adults with IFG from a population-based study (AusDiab).

A total of 3,174 patients underwent LAGB between October 1995 and August 2007, 333 (248 women and 85 men) had IFG (5.6–6.9mmol/l) and no history of diabetes or of glucose-lowering drug use. Of the 333 patients, 281 (84%; 210 women and 71 men) had follow-up weight and FPG data.

At five years, the LAGB patients lost an average of 25kg. After a minimum follow-up period of four years, 14 patients developed diabetes (12 women) and 169 did not. There was a strong relationship between the weight change and the occurrence of diabetes.

When they compared these results with those of 1,043 AusDiab patients who had IFG and were followed for five years, 65 AusDiab participants developed diabetes. Importantly, when they examined obese AusDiab patients, the incidence of diabetes increased significantly (p<0.001) and was greater than the LAGB group (p<0.02).

GASTRIC BANDING WAS ASSOCIATED WITH A REDUCED RISK OF DIABETES OF MORE THAN 75%

To assess whether banding was independently associated with diabetes, they combined the data from both groups, replacing percentage weight change with the presence or absence of LAGB surgery. They found that from 1,324 patients, LAGB was associated with a reduced risk of diabetes of more than 75% (OR 0.239 [95% CI 0.095, 0.571], p =0.004), with female sex and baseline FPG also significantly associated with progression to diabetes.

Conclusion

“Taken together with the findings of the multivariable analysis, we conclude that weight loss in obesity complicated by IFG prevents progression to diabetes,” the authors write. “This accords with the recent Swedish Obese Subjects findings, trials of weight loss drugs and other reports of remission of diabetes after medical or surgically induced weight loss.”

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