Background and Purpose: More than one-third of American adults are obese. The prevalence of extreme obesity is rapidly rising. Nine medications are currently approved for weight loss yet they remain under utilized with the focus primarily on lifestyle modifications. The study's objective was to determine current prescribing patterns and attitudes of weight loss medications in the management of obesity among primary care providers (PCPs). Methods: PCPs were surveyed to determine practice patterns, attitudes, barriers, and facilitators for prescribing weight loss medications. Conclusions: A total of 105 surveys were completed. 76% of all PCPs did not prescribe weight loss medications for long-term weight loss therapy and 58% of PCPs had negative perceptions of pharmacotherapy as a treatment. Significant differences existed between prescribing patterns and attitudes of advanced practice clinicians and physicians. Safety concerns were identified as the greatest barrier. Having 2+ comorbidities and severe obesity were identified as facilitators for prescribing weight loss medications. Under utilization of pharmacotherapy suggests that PCPs may not have sufficient knowledge about medication safety profiles and efficacy. Delaying treatment until patients have reached a high level of morbidity may be less efficacious than earlier treatment. Implications for Practice: Education regarding effectiveness and risks of weight loss medications for obesity management is needed and earlier interventions with pharmacotherapy may prevent significant morbidity and mortality.

The role of a psychologist within bariatric services is predominately focussed on the completion of preoperative psychological assessments (NICE, 2006; Ratcliffe et al, 2014). This role requires the psychologist to determine the suitability of the patient for surgery (Bauchowitz et al., 2005; Fabricatore et al., 2006; Sogg & Mori, 2004; UK Faculty of clinical health psychology; Psychologists in weight management network meeting, 2013), however no research to date has been able to reliably determine which variables could be associated with sub optimal weight loss (Sarwer, Wadden, & Fabricatore, 2005; Van Hout, Verschure, and van Heck, 2005; Wadden, Sarwer, Fabricatore, 2007). The first part of this study examines the empirical evidence for a range of variables considered by professionals to be clear contraindications to surgery. The variables were collated from surveys conducted in America (Bauchowitz et al., 2005; Fabricatore et al., 2006). Due to conflicting evidence and various problems with the studies it is difficult for a clinician to draw any firm conclusions from the review. Therefore, an ideographic approach is suggested, which leads onto the second part of the researcher dossier. The empirical chapter presents an interpretative phenomenological analysis (IPA) of interviews with 14 bariatric participants who were 12 months to three years post-operative to explore their experience of - 21 surgery. This time frame was chosen to capture the participants after the ‘honeymoon phase’ when the participants have hit their weight plateau (Yale & Weiler, 1991; Brolin, 1992). The themes from the study were ‘pre op’ ‘phases’ weight maintenance’ ‘impact of the operation’ and an overall psychological theme of ‘locus of control’. Support was a key area for the participants, they described the lack of support they felt from professionals and means of seeking support elsewhere. The themes also highlighted the psychological struggle the participants go through post operatively with eating, however, this is balanced with the positive changes in identity and their ability to engage with life, no longer impeded by their weight. Recommendations from the study suggest the importance of psychologists being available to bariatric patients, in accordance with NICE guidance, and that all bariatric patients start their journey to surgery in a level three service (which is a weight management service with consists of a multi-disciplinary team) before being referred to the tier four surgical team. Finally weight loss prior to surgery is recommended, with an alternative method of achieving this than that presented in the recent British Obesity and Metabolic Surgery Society (2014) publication.

Class of 2006 Abstract / Objectives: To determine if Polycystic Ovarian Syndrome (PCOS) patients treated with lifestyle changes and metformin resulted in ovulation after six months of treatment. Methods: A retrospective chart review of initial patient visits at an infertility clinic were obtained. Patients that were given a diagnosis of PCOS were further reviewed for age at initial diagnosis, weight, height, ovarian cysts, lifestyle recommendations (diet, exercise, and vitamin use), metformin recommendations and usage, and if ovulation occurred after six months of treatment. Results: A total of 1011 charts were reviewed. At the initial office visit, 206 (20.38%) of these patients were classified as having PCOS. Of PCOS patients, 113 (54.85%) patients ovulated after six months of treatment. In the average initial weight, ovulators averaged slightly less weight than did non-ovulators (171.77 pounds ± 44.26 vs. 188.65 pounds ± 51.37, p=0.0121). This also follows true for the initial BMI of ovulators vs. non-ovulators (29.53 kg/m2 ± 10.14 vs. 32.69 kg/m2 ± 13.03, p=0.0521). There was a significant difference in metformin use between ovulators and non-ovulators (90.27% vs. 73.12%, p=0.0024). More ovulators were found to continue metformin treatment as compared to non-ovulators. Conclusions: In this specific infertility clinic setting, 20.3% of patients were diagnosed with PCOS at the initial office visit. Of these PCOS patients, treatment with lifestyle changes and metformin use resulted in 55% of patients achieving ovulation at six months. This study shows that weight loss, through lifestyle modification and metformin treatment, increases this population’s chances of ovulation within six months of therapy.

Aim: This study aims to examine the factors that are perceived to contribute to lasting weight loss. To try to understand the psychosocial factors- and what aspects of physical activity and the relationship with food is perceived as supporting and/or inhibiting for lasting weight loss. Method: Participants (n=7) who lost weight and kept it off during a minimum of six months were interviewed about their experience of weight loss maintenance using a semistructured interview. To participate in this study one of the criterias was to have a BMI over 25 from start, but a BMI under 30 after their weight loss. The age varied between 23-48 years old, and they had lost 5-15 % of total body weight. Results: The participants had a strong internal motivation and has enjoyed physical activity since early age. Avoiding fast food, and the sugar and fast carbohydrates it contains, and instead make home cooked food was a success factor for the participants in this study. Emotional eating, injuries interfering with physical activity, lack of motivation to perform certain exercises perceived as boring, difficulties getting started with physical activity and certain living conditions are listed as inhibiting factors. The participants received no or neutral social support, this didn't seem to affect the results but contradicts other research findings. Conclusion: To achieve lasting weight loss, factors of success are strong internal motivation and a healthy relationship to food. Early contact with physical activity, and the enjoyment of performing it are also key aspects. The inhibiting factors for weight loss maintenance consisted in emotional eating, injuries interfering with physical activity, lack of motivation to perform certain exercises perceived as boring, difficulties getting started with physical activity and certain living conditions. / Syfte och frågeställningar: Den här studien syftar till att undersöka vilka faktorer som upplevs bidra till varaktig viktminskning. Frågeställningarna var designade för att försöka förstå de psykosociala faktorerna och vilka aspekter av fysisk aktivitet samt relation till mat som upplevs som främjande och/eller hämmande för varaktig viktminskning. Metod: Individer (n=7) som gått ner i vikt och bibehållit sin viktminskning i minst sex månader deltog i semistrukturerade intervjuer om deras upplevelse av varaktig viktminskning. Inklusionskriterierna var att deltagarna ska ha haft ett BMI över 25 vid viktminskningsfasens start och ett BMI under 30 vid dess slut samt att viktminskningen ska omfatta 5-15 % av deras kroppsvikt. Deltagarnas ålder sträckte sig mellan 23 och 48 år. Resultat: Deltagarna hade en stark inre motivation och har uppskattat fysisk aktivitet sedan tidigt ålder. De försöker undvika snabbmat som består av socker och snabba kolhydrater och gör istället hemlagad mat. Dessa var framgångsfaktorer för deltagarna i denna studie. Känslomässigt ätande, skador som förhindrar fysisk aktivitet, bristande motivation att utföra vissa träningsformer som ansågs svåra/jobbiga/tråkiga, svårt att komma igång, och vissa levnadsförhållanden som exempelvis arbetstid och boendesituation uppges som hämmande faktorer. Deltagarna fick inget eller neutralt socialt stöd, något som inte verkar ha påverkat resultatet, men motsäger de resultat som återfinns i annan forskning. Slutsats: Främjande faktorer för varaktig viktminskning är stark inre motivation, en hälsosam relation till kost, tidig kontakt med fysisk aktivitet samt att se den som ett roligt och avslappnande inslag i livet. De hämmande faktorerna för varaktig viktminskning består av känslomässigt ätande, skador som försvårar fysisk aktivitet, bristande motivation för att utföra aktiviteter som upplevs vara svåra/jobbiga/tråkiga, svårt att komma igång med fysisk aktivitet samt vissa levnadsförhållanden.

M.Fam.Med. Faculty of Health Sciences, University of the Witwatersrand, 2009. / Worldwide, obesity prevalence is rapidly rising. Doctors have poor understanding of what patients experience and expect from them regarding weight-loss management. This qualitative study explored what obese patients with Non-insulin Dependent Diabetes Mellitus experience and expect from their primary care doctors concerning weight-loss management. Free attitude interviews were conducted with eight participating patients. The findings showed that doctors encouraged and counselled patients regarding weight-loss, mainly giving dietary advice, but did not routinely weigh them. Patients accepted responsibility for losing weight, trusted their doctors, valued their advice highly and did not want referrals to gymnasiums or dieticians. They expected doctors to advise them practically about exercise, diet and weight-loss goals, weigh them regularly and communicate effectively. They believed that doctor-patient relationships and interaction are important in weight-loss management, patients should be treated on an individual basis and the process should be empowering. Medical intervention costs were not problematic for this group. Generally patients were satisfied with their doctors but there were areas concerning patients’ expectations that primary care doctors should take cognisance of.

Bariatric surgery has emerged as the most effective method for producing substantial long-term weight loss and inducing remission or reducing severity of many comorbidities for individuals with severe obesity. However, maintaining these successes from surgery requires that individuals combine the surgical intervention with numerous behavioral changes including dietary, physical activity, and lifestyle behaviors. Despite the positive weight and health outcomes associated with bariatric surgery, a proportion of the population experiences insufficient weight loss or weight regain, which may depend on the individual’s adherence to the bariatric behavioral recommendations. Few studies have investigated specific bariatric behaviors and whether they are impactful on weight outcomes. The purpose of this study was to (1) examine the extent to which constructs of the extended Theory of Planned Behavior (TPB) predicted six bariatric behaviors: (a) eating protein at the start of a meal, (b) eating three to five daily servings of fruits and vegetables, (c) avoiding sweet foods, (d) avoiding salty snack foods, (e) avoiding sugar sweetened beverages, and (f) exercising for 30 minutes daily at moderate to vigorous intensity; (2) to evaluate the relationship of the aforementioned behaviors with excess weight loss outcomes; and (3) to explore the facilitators and barriers successful bariatric patients identify as factors that influence their adherence to bariatric dietary and exercise behaviors. A sequential explanatory mixed methods approach was used to address the purpose of this study. The first component consisted of collecting quantitative data from bariatric patients between 6-24 months post-operative while the second was completed by collecting qualitative data from participants, who based on certain criteria, were considered to be successful one year or more after their bariatric surgeries. Quantitative component: A cross sectional design examined a convenience sample of 136 mainly female (89.7%) and Hispanic (72.1%) bariatric patients that underwent either a Roux-en-Y gastric bypass or sleeve gastrectomy in one ethnically diverse New York City hospital. Instruments for this study were developed based on previous research and translated into Spanish. Reliability estimates and content validity were assessed with a sample similar to that used in the study for both the English and Spanish instruments. The variables found in the extended TPB were assessed through instrument items that measure intention, attitudes, subjective norms, perceived behavioral control, anticipated behavioral outcomes, normative beliefs, control beliefs, and the additional constructs of anticipated emotions and self-identity in relation to the six bariatric behaviors. Adherence to bariatric behaviors was measured by a frequency instrument. Pre- and post-operative weight measures were obtained from participants’ electronic medical records. Multiple regressions were used to establish the predictors for each behavior. For each behavior, attitudes towards the behavior contributed to the model for predicting behavioral intention. On the other hand, subjective norms were not found to be predictive for all behaviors with the exception of avoiding sweet foods. Behavioral intention for all behaviors was low and mainly non-significant, suggesting other constructs may be involved in order to adhere to the behavior. The level of adherence to these six behaviors remained consistent over the 6 to 24 post-operative months. To note, participants were not adherent to fruit and vegetable consumption and physical activity recommendations. Qualitative component: A purposeful sample of 11 bariatric patients that were considered successful based on study criteria participated in in-depth, semi-structured, individual interviews using a questionnaire developed from the main theoretical constructs of the TPB. In an effort to increase the understanding of the facilitators of and barriers to adherence, the addition of constructs found in the Health Action Process Approach framework were used to identitfy emerging themes. Content analysis of audio recording revealed (a) outcome expectations, (b) nutrition knowledge and skills, (c) social support, (d) attitudes towards adherence, (e) perceived behavioral control, (f) coping and planning strategies, and (g) recovery self-efficacy as major themes that influenced participants’ behaviors. A main facilitator to adhere to bariatric recommendations was outcome expectation, as post-operative patients saw the improvements in their health and quality of life following the bariatric surgery intervention as motivators to continue following recommendations and therefore preserve positive outcomes. At the same time, many participants stated difficulty in adhering to the recommendation of exercising at a moderate or vigorous intensity for 30 minutes on a daily basis. Conclusion: Using a behavioral change theory provides a valuable framework for explaining adherence to healthy dietary and physical activity behaviors for bariatric patients. Nutrition education and behavioral interventions should focus on improving adherence to the recommendations of consuming fruits and vegetable and exercising daily, aiming to enhance attitudes towards these post bariatric surgery behaviors and addressing barriers to physical activity.

O presente estudo teve como objetivos: desenvolver e validar um questionário e avaliar a prevalência, magnitude e métodos de perda rápida de peso entre atletas de judô; investigar o impacto da perda rápida de peso seguida de um período de recuperação sobre o desempenho relacionado ao judô. Os resultados indicaram que o questionário desenvolvido tem boa validade convergente, é capaz de discriminar dois grupos com diferentes comportamentos de perda de peso e tem elevados índices de estabilidade para todas as suas questões. Sendo considerado válido, ele foi aplicado a ampla e heterogênea amostra de competidores de judô (n=790). Os resultados mostraram que cerca de 90% perde ou já perdeu peso para competir. Eles começam a reduzir o peso no início da adolescência e utilizam, na maior parte das vezes, métodos que resultam em restrição da ingestão energética e em hipoidratação. No outro estudo, 14 atletas do sexo masculino foram alocados em 2 grupos de sete sujeitos cada: controle (CON) e perda de peso (PP). Ambos realizaram uma bateria de testes inicial (PRÉ) e após cinco dias (PÓS). Nesse tempo, o grupo PP reduziu o peso corporal em ~5% utilizando dietas típicas. O grupo CON manteve seu padrão normal de ingestão de alimentos e de treinamento. Os resultados mostraram que ambos os grupos apresentaram ligeira melhora do PRÉ para o PÓS no teste de Wingate. Entretanto, essa melhora foi ligeiramente maior no grupo PP em relação ao grupo CON, indicando que a perda de até 5%, quando seguida por período de 4 horas de recuperação, não tem impacto negativo sobre a performance / The present study aimed: to develop and validate a questionnaire and evaluate prevalence, magnitude and methods of rapid weight loss among judo players; to investigate the impact of rapid weight loss followed by a recovery period on judo-related performance. The results indicated that the questionnaire has good convergent validity, it is able to discriminate athletes with different patterns of weight behavior and it has good indexes of stability for all of its questions. Being a valid instrument, it was applied to a great sample of judo competitors (n=790). The results showed that about to 90% of athletes lose weight to compete. They begin to lose weight at early phases of adolescence and uses methods that results in energy restriction and hipohydration. In the other study, 14 male athletes were allocated to two groups of 7 subjects each: control (CON) and weight loss (WL). Both performed a test battery at the beginning of the study (PRE) and after 5 days (POST). During this period, WL group reduced ~5% of body weight by means of typical regimen. CON group kept their normal pattern of food intake and training. The results showed that both groups experienced slight improvements on Wingate performance from PRÉ to POST test. However, this improvement was somewhat greater in WL group compared to CON, which means that up to 5% of body weight loss followed by 4 hour recovery period does not affect negatively judorelated performance.

Submitted by LUISA FOURNIER ARAUJO null (luhfournier@yahoo.com.br) on 2017-03-13T15:05:59Z No. of bitstreams: 1 DISSERTACAO LUISA FOURNIER.pdf: 1448990 bytes, checksum: 2f1266701041a2c76dd899bf05730b15 (MD5) / Approved for entry into archive by LUIZA DE MENEZES ROMANETTO (luizamenezes@reitoria.unesp.br) on 2017-03-20T13:02:31Z (GMT) No. of bitstreams: 1 araujo_lf_me_bot.pdf: 1448990 bytes, checksum: 2f1266701041a2c76dd899bf05730b15 (MD5) / Made available in DSpace on 2017-03-20T13:02:31Z (GMT). No. of bitstreams: 1 araujo_lf_me_bot.pdf: 1448990 bytes, checksum: 2f1266701041a2c76dd899bf05730b15 (MD5) Previous issue date: 2017-02-22 / A hepatite C crônica é uma doença causada pelo vírus da hepatite C e que cursa com inflamação hepática crônica, podendo levar à cirrose, insuficiência hepática terminal e carcinoma hepatocelular. O tratamento tem o objetivo de inibir permanentemente a replicação viral, porém quando se utiliza interferon peguilado e ribavirina alguns efeitos colaterais são comuns, como a perda de peso, que pode levar à interrupção do tratamento. A hipótese do estudo foi que o grau de fibrose e as doses de ribavirina pudessem influenciar a perda de peso e de outras medidas antropométricas durante o tratamento antiviral. O objetivo foi verificar a relação entre o grau de acometimento hepático, a idade, o sexo, a dose de ribavirina e a perda de medidas antropométricas em pacientes com hepatite C crônica em tratamento com interferon peguilado e ribavirina. Participaram do estudo 76 pacientes ambulatoriais avaliados por mensuração de peso, altura, dobra cutânea triciptal, circunferência do braço, circunferência muscular do braço e área muscular do braço, medidos antes e depois de 24 semanas de tratamento. Dados epidemiológicos foram obtidos do prontuário dos pacientes, analisando também resultados de biópsia hepática. Inicialmente a amostra foi dividida em dois grupos de acordo com a presença ou não de fibrose hepática avançada, sendo então realizada comparação entre valores observados em cada grupo ao longo do tratamento, utilizando o teste t pareado ou o teste de Wilcoxon. A seguir as alterações antropométricas ao longo do tratamento antiviral foram avaliadas através de um modelo proposto para mensurar o papel do grau de fibrose, do sexo, da idade e da dose de ribavirina nas alterações antropométricas, utilizando métodos estatísticos como a análise de resíduo e o coeficiente de determinação ajustado. Foi possível observar que o tratamento antiviral levou a reduções de várias medidas antropométricas, e o modelo utilizado mostrou que as principais variáveis envolvidas nessas alterações foram a idade e o sexo, sem que houvesse papel relevante do grau de fibrose ou das doses de ribavirina. / Chronic hepatitis C is a disease caused by the hepatitis C virus and causes chronic hepatic inflammation, which can lead to cirrhosis, terminal liver failure and hepatocellular carcinoma. The treatment aims to stop viral replication definitively, but when using pegylated interferon and ribavirin some side effects are common, such as weight loss, which can lead to treatment discontinuation. The hypothesis of this study was that the degree of liver fibrosis and the ribavirin doses could have a role on the reductions of anthropometric measures during antiviral treatment. The aim was to assess the relationship between the degree of hepatic impairment, ribavirin doses, age, gender and anthropometric changes in patients with chronic hepatitis C submitted to 24 weeks of treatment with pegylated interferon and ribavirin. Seventy-six patients were included and their weight, height, triceps skin fold, arm circumference, arm muscle circumference and arm muscle area were measured before and after 24 weeks of treatment. Epidemiological data and liver biopsy findings were obtained from patients' charts. The sample was divided into two groups according to the presence or absence of advanced hepatic fibrosis. The values observed in each group were compared by paired t test or Wilcoxon test. Then, the anthropometric changes throughout the antiviral treatment by a model aimed to measure the role of fibrosis degree, age, sex and ribavirin doses on the anthropometric changes, using statistical methods such as residual analysis and adjusted determination coefficient. It was possible to observe that the antiviral treatment caused reductions of many anthropometric measures, and the model proposed showed that the main variables involved in such reductions were age and sex, without a significant role that could be attributed to the degree of liver fibrosis or to the ribavirin doses.

Objective: The purpose of this pilot study was to examine the effect of an online social network used as an adjunct to a behavioral weight loss intervention on participants’ perceived social support and perceived self-efficacy using constructs of Social Cognitive Theory as a basis for website development. Methods: 13 adult women (mean age: 43 years of age, range: 25-63 years) participated in a 12-week behavioral weight-loss intervention with the option to access the Transformation Challenge Online Community (TCOC), an internet-based support and informational website. The TCOC was developed using constructs of the Social Cognitive Theory. Data analyzed included online site usage software and pre- and post-questionnaire results. Time spent online, unique visits to the webpage, and pre and post-intervention data were analyzed using a mixed methods approach. Results: Average time spent on TCOC was 95.6 minutes over the entire three month intervention (range: 0 – 287 minutes). Website usage varied widely ranging from a participant who never accessed the site to another participant who logged on daily and commented a total of 27 times. Perceived self-efficacy to maintain a learned health behavior without the aid of a professional, as well as overall perceived social support were statistically significantly greater post-intervention. Confidence in the TCOC’s ability to aid in making healthy lifestyle changes decreased significantly from pre- to post-intervention while website usage also decreased over time. Conclusions: The internet may be a valuable tool for improving perceptions of social support and increasing access to reliable information and education. A web-based intervention can be used as an adjunct to a face-to-face intervention to provide additional support and information, as well as used to reach groups who may not have access to a face-to-face option. Considerations should be given to the structure of the online program; the potential for dynamic, aesthetically pleasing self-regulation tools; and content that is tailored to the individual. Decreased usage of the website over time may reflect similar difficulties in maintaining participation in face-to-face weight loss interventions. Attention should also be given to the target audience as participant comfort levels and feelings towards using the internet may differ significantly between users and therefore impact outcomes.

Applications of locus of control theory to weight loss programs have yielded inconsistent results. This study attempts to clarify "control" by looking at two different factors. Maximum control is the degree of perceived control inherent in the event itself, and personal control is the degree to which the event is perceived controllable by the individual. These two factors were also examined in two types of situations to determine whether individuals have one global outlook on control, or if they make a distinction between control in some situations as opposed to control in other situations. Seventy-four female subjects completed a 16 item questionnaire on their perceived control in weight-related and non-weight-related situations. Subjects demonstrated that attitudes of control are situation specific. The two separate attitudes, maximum control and personal control, operate independently. Some individuals who felt that events were highly controllable, still felt they had very little control. Converse perceptions were also demonstrated.