Thesis (M.A.)--Bowling Green State University, 2009. / Document formatted into pages; contains v, 90 p. Includes bibliographical references.

Thesis (Ph. D.)--University of California, San Diego and San Diego State University, 2002. / Vita. Includes bibliographical references (leaves 242-255).

Thesis (Ph.D.)--University of Alabama at Birmingham, 2009. / Title from PDF title page (viewed on Feb. 3, 2010). Includes bibliographical references (p. 84-94).

published_or_final_version / Dentistry / Master / Master of Orthodontics

Övervikt och obesitas är ett ökande hälsoproblem världen över. Det är genom den levda kroppen som vi upplever hälsa och ohälsa. Vi är helt enkelt vår kropp och genom den erfar vi världen. Övervikt beror till stor del av ohälsosamma levnadsvanor och det är viktigt att patienter får stöd att ändra dessa. Syftet med litteraturstudien är att undersöka hur sjuksköterskor kan stödja patienter med övervikt till att främja hälsosamma levnadsvanor. Metoden som använts är en litteraturöversikt, där granskning av 12 artiklar, både kvalitativa och kvantitativa genomfördes. Resultatet av detta bidrog till att vi fann ett antal likheter. Fyra kategorier identifierades: Stigmatisering och attityder, empowerment, motiverande samtal och hälsofrämjande arbete. Det visade sig att vårdpersonal ofta har någon form av negativ attityd gentemot överviktiga patienter och det kan påverka kvalitén av vården och dess effekter. Att använda och lära ut empowerment är ett sätt att få patienten att förändra sin livsstil. Genom att sjuksköterskan hjälper patienten att öka sina egna resurser finns det en större chans att patienten känner att han eller hon har kontroll över sitt eget liv och att också kunna lösa sina problem. Motiverande samtal, MI är en effektiv metod för att motivera patienter att ändra sin livsstil som används allt mer inom primärvården. Det är en riktad, patientcentrerad rådgivning baserad på många öppna frågor. Hälsofrämjande arbete är en viktig uppgift för sjuksköterskor i samhället. Diskussionen tar upp att empowerment är en stödjande process där individer eller grupper har möjlighet att förändra sin situation till det bättre. Det kom också fram att negativa attityder beror på vad man som sjuksköterska anser ha orsakat övervikten. Sjuksköterskor bör tillsammans med staten, skolor och kommuner stödja och förespråka förändringar i riktlinjer som skulle kunna förebygga och minska konsekvenser till övervikt och bidra till ett friskare samhälle.

Background: Liver fibrosis induced by non-alcoholic fatty liver disease causes peri-interventional complications in morbidly obese patients. We determined the performance of transient elastography (TE), acoustic radiation force impulse (ARFI) imaging, and enhanced liver fibrosis (ELF) score for fibrosis detection in bariatric patients. Patients and Methods: 41 patients (median BMI 47 kg/m2) underwent 14-day low-energy diets to improve conditions prior to bariatric surgery (day 0). TE (M and XL probe), ARFI, and ELF score were performed on days -15 and -1 and compared with intraoperative liver biopsies (NAS staging). Results: Valid TE and ARFI results at day -15 and -1 were obtained in 49%/88%and 51%/90%of cases, respectively. High skin-to-liver-capsule distances correlated with invalid TE measurements. Fibrosis of liver biopsies was staged as F1 and F3 in n = 40 and n = 1 individuals. However, variations (median/range at d-15/-1) of TE (4.6/2.6–75 and 6.7/2.9–21.3 kPa) and ARFI (2.1/0.7–3.7 and 2.0/0.7–3.8 m/s) were high and associated with overestimation of fibrosis. The ELF score correctly classified 87.5%of patients. Conclusion: In bariatric patients, performance of TE and ARFI was poor and did not improve after weight loss. The ELF score correctly classified the majority of cases and should be further evaluated.

Aim: Negative attitudes towards people with obesity are common even in health care settings. So far, the attitudes and causal beliefs of dietitians and nutritionists have not been investigated systematically. The aim of this article was to review the current state of quantitative research on weight-related stigma by dietitians and nutritionists. Method: A systematic literature review was conducted in 2014 using PubMed, PsycINFO, Web of Science and Cochrane Library. Results: Eight studies were found that differ in regard to study characteristics, instruments and the origin of the sample. Six out of eight studies reported weight stigma expressed by dietitians and nutritionists. Their believed causes of obesity indicated a defined preference for internal factors rather than genetics or biology. Discussion: Results of studies were not homogenous. The degree of negative attitudes by dietitians and nutritionists towards people with obesity appeared to be slightly less pronounced compared to the general public and other health care professionals. Stigma and its consequences should be included into educational programs to optimally prepare dietitians and nutritionists.

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Most people have difficulty maintaining a healthy diet. Both social and individual factors play a role in shaping one's diet, and individual factors might be differentially associated with eating depending on social conditions. The present research focuses on eating to regulate emotion and body weight in the context of couple relationships. Forty-three committed heterosexual couples reported on emotion-regulation strategies including the use of eating to regulate emotion (ERE). During a lab visit, participants discussed their health habits with their partners and their body composition was measured (e.g.: weight, height, percent body fat). Finally, participants completed daily diaries assessing their emotions as well as their food intake relative to their own normal eating. I first tested whether ERE was associated with other measures of emotion regulation as well as body composition at an individual level. As predicted, ERE demonstrated internal consistency, was moderately correlated with an established measure of emotion-eating, and uncorrelated with other measures of emotion regulation. High ERE was associated with higher body mass index, as well as higher waist circumference and percent body fat among older women, and with higher percent body fat among younger men. Secondly, I tested whether self-reported ERE predicted connections between daily emotional fluctuations and eating. Consistent with my hypothesis, those who reported high ERE ate worse when they experienced negative emotions or did not eat better when they experienced positive ones (which was the case among people with low ERE). Finally, I tested whether ERE in couples was associated with body composition under specific relationship conditions. As predicted, when both partners had high ERE, women who used more we-talk during a discussion of health habits also had higher BMI. However, women who used high I-talk in such couples had lower BMI despite having high ERE. Moreover, in such couples expression of negative emotion by partners was associated with higher BMI. Identifying individual and couple-level factors shaping dietary practices adds to development of interventions for poor health habits. It is an important step in shifting disease-focused models of medical care towards more comprehensive, patient-centered care.

For many women, body weight is a health concern both in relation to physical health and to social and psychological health. Both overweight and underweight are associated with increased risks to health. Furthermore, the literature largely supports the view that sociological and psychological factors influence a woman's perception of weight and body image. In the Western world, weight loss efforts among women are high, and even those who are within or below the healthy weight range are trying to lose weight. Relatively little is known about weight loss efforts among Yukon women.. Moreover, it is not known whether societal pressures surrounding weight are similar in the Yukon and the rest of Canada. For reasons related mainly to its northern geographical location and culture, and because of the health implications related to women's weight issues, this study was conducted to determine the prevalence of Yukon women trying to lose weight; to determine the weight loss practices of Yukon women; and to compare the characteristics of women who are trying to lose weight vs. those who are not; women who are satisfied with their weight vs. those who are not; and women who are at health risk due to overweight or underweight vs. those with healthy weights. Data for a representative sample of non-pregnant, non-institutionalized women > 15 years of age (n=711) were obtained from the population-based 1993 Yukon Health Promotion Survey. Those living in the census unorganized portions of the Yukon were not included in the sample. The prevalence of weight loss efforts in the Yukon (51.8%) was higher than the published value for women in the rest of Canada (39%). Among Yukon women with body mass index (BMI) values classified as overweight, possible overweight, healthy weight, and underweight, 80%, 67%, 46%, and 9%, respectively, were trying to lose weight. The corresponding values for the rest of Canada are lower. The most frequent weight loss practices were dieting (35.8%), changing diet and exercise (26.1%), and sensible eating (17.2%). Compared to women not trying to lose weight, women trying to lose weight were younger (35.8 ± 13.2 vs 38.6 ± 15.0 yr, P<0.01), were more likely to be employed (71.6% vs 64%, P<0.05), had higher BMI values (25.7 ± 4.1 vs 22.3 ± 3.9 kg/m2, P<0.0001), and were more likely to be dissatisfied with their current weight (88.5% vs 35.6%, P<0.0001). Both groups reported similar food consumption and activity patterns, yet women trying to lose weight had more positive nutrition behaviours and health knowledge. The mean eating knowledge index (EKI) score was significantly higher (2.36 ± 2.89) for women trying to lose weight than for women not trying to lose weight (1.75 ± 3.44). Similarly, the mean eating behaviour index (EBI) score was higher (4.19 ± 3.83 vs. 3.46 ± 4.94, respectively). Weight loss efforts did not appear to be related to the Yukon environment since neither First Nations status nor length of residence in the Yukon varied for women trying to lose weight and women not trying to lose weight. Yukon women who were overweight were less likely to live in Whitehorse, were older, were more likely to be poor, and were less likely to engage in vigorous physical activity three or more times per week compared to those with healthy weights; however, their food consumption patterns and nutrition knowledge and behaviour scores did not differ. Overweight women expressed less satisfaction with their quality of life and with their physical health and social relationships. Yukon women who were underweight were more likely to be poor and to find it difficult to afford the basic necessities and less likely to indicate they were eating well enough to maintain good health compared to healthy weight women. Both groups had similar activity patterns and food consumption patterns; yet, underweight women had lower scores for nutrition knowledge and behaviour (EKI: 1.03 ± 2.97 vs. 2.38 ± 3.24; EBI: 2.68 ± 4.71 vs. 4.07 i 4.51). Underweight women and healthy weight women rated their quality of life similarly. Based on this study, it appears that many Yukon women, regardless of weight status, are engaging in weight loss efforts. Furthermore, the goal of losing weight, rather than relative weight status, seems to be an important motive for healthy eating and for seeking health knowledge. Being physically active in the Yukon appears to be influenced by time of year and other barriers. Self-ratings of health were associated with engaging in weight loss efforts and with relative weight status. Overall, the findings of this study suggest that weight loss efforts of Yukon women are similar to those of the dominant Western society. In view of the findings of this study, health promotion messages should incorporate healthy eating, regular physical activity, and the concept of healthy weight and positive body image to deter weight loss efforts among women who do not need to lose weight. Tailored approaches which consider the different characteristics of the groups in this study may prove to be useful.