Obesity is the most common nutritional disorder in small animal medicine and is closely related to the mortality and morbidity of various diseases. Decreasing the incidence of obesity is considered to be the most important way to maintain health, prevent disease, and contribute to longevity. Diet therapy using low glycemic index starch (LGIS) and diacylglycerol (DAG) may thus be a reasonable obesity management tool without unnecessary food restriction, forced physical activity, and impairment of health. Beagles were prepared for a weight loss study by inducing obesity using a high caloric/human snack food combination. These obese dogs were then fed diets containing either LGIS/HGIS and DAG/TAG for a 10 wk weight loss period. The LGIS groups lost more weight than the high glycemic index starch (HGIS) groups (2% vs 1% per wk) due to lower total diet digestibilities. Even though the dogs had consumed similar amounts of the diets on a weight basis, the amounts of metabolizable energy (ME) ingested overall differed between the two starch types. Diet effects were found for plasma triglyceride (TG) at both wk 1 and 8. Post-prandial TG lowering was observed only with a LGIS/DAG diet combination. LGIS groups showed less decreased post-prandial non esterified fatty acid (NEFA) concentrations compared with HGIS groups at both wk 1 and 8. At both wk 1 and 8, plasma insulin was significantly lower in the LGIS groups although glucose concentrations were similar among all groups. Plasma gastric inhibitory polypeptide (GIP) increased in all groups but tended to be lower in the LGIS groups. Significant time effects were seen in glucagon-like peptide-1 (GLP-1) at both wk 1 and 8; however, diet effects were not observed. Plasma adiponectin concentrations were significantly higher in the LGIS/DAG group vs. all other diet groups. Significantly lower plasma leptin concentrations were found, especially in the LGIS/DAG group. Combinations of LGI starch and oils decreased uncoupling protein-2 (UCP2) mRNA gene expression in the small intestine compared with the combinations of HGI starch and oils. These findings indicate that the LGIS/DAG combination beneficially supports more efficient and healthy weight loss in dogs along with improvement in biochemical and hormonal biomarkers. This combination may be preferred for healthy canine weight loss and to help prevent obesity related diseases.

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.

No description available.

Obesity affects over 100 million men, women, and children in North America alone and has reached what health professionals deem to be epidemic proportions. Being overweight can contribute to or cause chronic conditions such as diabetes, cardiovascular disease and cancer. Left unabated, it will lead to the premature death of millions. Clinical practice relies primarily on individual interventions to bring about lifestyle change. However, this may not be sufficient to reverse the trend on a population scale. Distance education is one area that is seen by some as one of the tools that is capable of reaching such a large audience. This mixed methods case study examined the perceived utility of a number of distance education tools and technologies and the likelihood of overweight and obese individuals adopting and using them. A number of distance education tools and technologies were found to be very useful, some that could be promising but will require further study, and still others that don't offer value and won't for the foreseeable future. / August 2011

Objective: To evaluate the SickKids Team Obesity Management Program (STOMP), an obesity management program for severely obese adolescents. Methods: Non-randomized study of 6 and 12 month outcomes in STOMP patients vs. a comparison group of obese adolescents. Results: At 6 months, STOMP patients stabilized their BMI (0.08±0.3 kg/m2;p=0.79) and reported improved psychological and health behaviour measures, whereas comparison participants increased their BMI (0.7±0.2 kg/m2;p=0.004) and had worsening of cardiometabolic outcomes. Between-group differences included improved cardiometabolic, psychological and health behaviour measures in STOMP patients. At 12 months, STOMP patients stabilized their BMI (0.8±0.5 kg/m2;p=0.07), had improvements in anthropometric and cardiometabolic outcomes and reported an increase in health behaviours, whereas comparison participants increased their BMI (1.2±0.4 kg/m2;p=0.001) and had worsening of cardiometabolic outcomes. Between-group differences included improved anthropometric, cardiometabolic and health behaviour outcomes in STOMP patients. Conclusions: Participation in STOMP improved anthropometric, cardiometabolic, psychological and health behaviour outcomes among severely obese adolescents.

Objective: To evaluate the SickKids Team Obesity Management Program (STOMP), an obesity management program for severely obese adolescents. Methods: Non-randomized study of 6 and 12 month outcomes in STOMP patients vs. a comparison group of obese adolescents. Results: At 6 months, STOMP patients stabilized their BMI (0.08±0.3 kg/m2;p=0.79) and reported improved psychological and health behaviour measures, whereas comparison participants increased their BMI (0.7±0.2 kg/m2;p=0.004) and had worsening of cardiometabolic outcomes. Between-group differences included improved cardiometabolic, psychological and health behaviour measures in STOMP patients. At 12 months, STOMP patients stabilized their BMI (0.8±0.5 kg/m2;p=0.07), had improvements in anthropometric and cardiometabolic outcomes and reported an increase in health behaviours, whereas comparison participants increased their BMI (1.2±0.4 kg/m2;p=0.001) and had worsening of cardiometabolic outcomes. Between-group differences included improved anthropometric, cardiometabolic and health behaviour outcomes in STOMP patients. Conclusions: Participation in STOMP improved anthropometric, cardiometabolic, psychological and health behaviour outcomes among severely obese adolescents.

This research study focuses on examining the views of patients, their families, and staff member providers of the Centre for Healthy Active Living a clinical obesity management program for children and youth at the Children’s Hospital of Eastern Ontario, in Ottawa, Canada. Qualitative methodology was used and content analysis was conducted with data obtained from family questionnaires and a provider focus group. Analysis of obtained data was conducted to determine alignment of views between patient, family, and provider views, and the formal goals of the program. Emerging themes from the data indicated that patients and families place higher value on the formal goals of “improve quality of life; improve eating behaviours; improving fitness, increasing activity levels; and empower/strengthen families.” (Children’s Hospital of Eastern Ontario, 2012). Specific recommendations with regards to each component of these goals were provided. Instrumental, procedural, systemic, and conceptual recommendations of program components were also provided.

This research study focuses on examining the views of patients, their families, and staff member providers of the Centre for Healthy Active Living a clinical obesity management program for children and youth at the Children’s Hospital of Eastern Ontario, in Ottawa, Canada. Qualitative methodology was used and content analysis was conducted with data obtained from family questionnaires and a provider focus group. Analysis of obtained data was conducted to determine alignment of views between patient, family, and provider views, and the formal goals of the program. Emerging themes from the data indicated that patients and families place higher value on the formal goals of “improve quality of life; improve eating behaviours; improving fitness, increasing activity levels; and empower/strengthen families.” (Children’s Hospital of Eastern Ontario, 2012). Specific recommendations with regards to each component of these goals were provided. Instrumental, procedural, systemic, and conceptual recommendations of program components were also provided.

This study aimed to provide an in-depth understanding of the way in which the macro, meso, and micro levels of the health care system affects nutrition care practices of family physicians (FPs) and nurse practitioners (NPs). It also examined how current practices compare to the clinical practice guidelines on the management and prevention of obesity. Three different types of team-based primary care settings were included: 2 Family Health Teams, 3 Community Health Centres and 1 Nurse Practitioner-Led Clinic. Within each type of setting, six to eight FPs and NPs were interviewed (for a total n= 20). Site-specific documents and government reports were also analyzed. Findings suggest that the team-based nature improves nutrition care due to the accessibility to dietitians and cost-free service. Electronic Medical Records was an important enabler for chronic disease management. Duration of medical visits and increasing prevalence of complex patients were barriers for addressing nutrition and weight. Despite the importance of addressing obesity in primary care, the topic was approached in terms of chronic disease management rather than prevention. FPs and NPs spared the dietitian on site for patients who have more severe chronic conditions. Nevertheless, the presence of a dietitian on site increased the likelihood of primary care providers bringing up the topic of nutrition. Addressing site-specific barriers could improve nutrition care practices for weight management and chronic disease prevention in the primary care setting.

Thesis (MNutr)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Obesity has become one of the major conditions contributing towards chronic lifestyle diseases. The management of obesity, in order to prevent chronic lifestyle disease, requires a combination of treatment modalities. There is therefore a constant need to search for innovative behavioural and awareness programmes regarding the treatment of obesity, and to develop innovative strategies to improve compliance and ultimately to change lifestyles. The notion of utilizing short message services (SMS), during a weight reduction progamme to provide regular reminders and information to achieve the aforementioned goals, was therefore used as an intervention in the study. Furthermore a questionnaire validating the effectiveness of the short message service was devised and completed by the recipients of the intervention. The purpose of the questionnaire was to statistically quantify the effectiveness of the SMS as an intervention. Each question had four graded answers, with a score allocated to each - 1 being the least effective and 4 being the most. These values were converted to percentages and according to these percentages a rating of effectiveness was ascertained. Ultimately the study set out to determine whether the intervention had a statistically significant effect on weight reduction, compliance in attending appointments and on the attrition rate. This was a double blinded randomized, controlled study in which 75 participants were recruited at a general medical practice in Gauteng. The sample comprised of three groups. Group 1 (N = 25) had no intervention; Group 2 (N = 25) received a SMS weekly and Group 3 (N = 25) received a SMS three times per week. The weight reduction programme, which included dietary modifications and lifestyle advice was standardized and remained the same for each group. The programme extended over a 12 week period and the questionnaire was completed at the end of the programme. Upon analysis of the results there was a decrease in the mean BMI and waist circumference for all the three groups, with no statistically significant difference (p-value > 0.05) between them. The percentages of the participants completing the programme in each group were – Group 1: 44%, Group 2: 60% and Group 3: 68%. The effectiveness of the intervention was manifested by the compliance of attendance at each visit and the reduced attrition rate in the intervention groups, although this was not found to be statistically significant. The analysis of the scores allocated to the responses of the questionnaire, equated to an outcome of above 75% and was assessed as being very successful in both the intervention groups. In conclusion the use of short message servicing in this weight reduction programme improved the compliance and reduced the attrition rate although not statistically and was perceived by the participants as a successful intervention. / AFRIKAANSE OPSOMMING: Vetsug (obesiteit) het een van die primêre kondisies geword wat bydrae tot chroniese leefstyl siektes. Die hantering van obesiteit vereis 'n kombinasie van behandelingsmodaliteite, ten einde hierdie siektes te voorkom, Daar is dus 'n konstante soeke na innoverende gedrags- en bewustheidsprogramme rakende die behandeling van obesiteit, asook 'n behoefte om innoverende strategieë te ontwikkel om inskiklikheid te verbeter en uiteindelik leefstyle te verander. Die idee om kortboodskapdienste (SMS) gedurende 'n gewigsverliesprogramme te gebruik om gereelde aanmanings en inligting te kommunikeer ten einde die genoemde doelwitte te bereik, is aangewend as intervensie in hierdie studie. 'n Vraelys is ontwikkel wat die effektiwiteit van die kortboodskapdiens valideer, en is voltooi deur die ontvangers van die intervensie. Die doel van die vraelys was om die effektiwiteit van die SMS as 'n intervensie te kwantifiseer. Elke vraag het vier gegradeerde antwoorde gehad, met 'n telling wat aan elk toegeken is – 1 wat aandui minste effektief en 4 wat aandui die meeste. Hierdie waardes was omgeskakel tot persentasies en na aanleiding van die persentasies is 'n waarde van effektiwiteit bepaal. Uiteindelik was die doel van die studie dus om vas te stel of die intervensie ʼn statisties beduidende effek op gewigsverlies, die nakom van afsprake en uitvalskoerse het. Hierdie was 'n dubbelblind, ewekansige gekontroleerde studie waarin 75 deelnemers gewerf was by 'n algemene mediese praktyk in Gauteng. Die steekproef het bestaan uit 3 groepe. Groep 1 (N = 25) het geen intervensie gehad nie; Groep 2 (N = 25) het 'n weeklikse SMS ontvang en Groep 3 (N = 25) het 'n SMS ontvang drie keer per week. Die gewigsverliesprogramme, wat dieetaanpassings en leefstyl advies ingesluit het, was gestandardiseer en het dieselfde gebly vir elke groep. Die programme het gestrek oor 'n 12 weke periode en die vraelys was voltooi aan die einde van die programme. Analise van die resultate het 'n afname getoon in die gemiddelde LMI (Liggaamsmassa indeks) en middelomtrek vir al drie groepe, met geen statisties beduidende verskil (p-waarde > 0.05) tussen groepe nie. Die persentasies van die deelnemers wat die programme voltooi het in elke groep was Groep 1: 44%, Groep 2: 60% en Groep 3: 68%. Die effektiwiteit van die intervensie was gemanifesteer deur die inskiklikheid van bywoning tydens elke besoek en die verlaagde uitvalkoers in die intervensie groepe, alhoewel dit nie statisties beduidend was nie. 'n Analise van die tellings geallokeer aan die response tot die vraeslys, dui 'n uitkoms aan van bo 75% en was beskou as baie suksesvol in albei die intervensie groepe. Die gebruik van kortboodskapdienste (SMS) in hierdie gewigsverliesprogramme het inskiklikheid verbeter en uitvalskoerse verlaag, alhoewel nie statisties beduidend nie, en was deur die deelnemers beskou as 'n suksesvolle intervensie.