Setting Up a Tier 3 Service and Barriers to It

The COVID-19 pandemic put unprecedented pressure on weight management services. These services were required to adapt to continue to provide care for people living with obesity. This study sought to develop consensus recommendations on the best practice solutions adopted by weight management services in the United Kingdom during the COVID-19 pandemic. This study utilised a semi-structured interview and a modified Delphi methodology to develop a consensus of best practice recommendations identified by specialist weight management services during the pandemic. Twenty-three healthcare professionals working in weight management service across the United Kingdom participated in the study. Analysis of interview transcripts identified four key thematic domains: outpatient, patient education and support, perioperative care and team working. Of the initial 43 unique recommendations, 30 reached consensus agreement. Outpatient recommendations focused on communication strategies, patient self-monitoring and remote patient tracking. Patient education and support recommendations addressed the development of online educational resources and support groups. Perioperative care recommendations emphasised case prioritisation, waiting list support and postoperative care. Team working recommendations targeted the use of digital collaboration tools and strategies for effective teamwork. Developing consensus recommendations on best practice is a critical step for weight management and outpatient services to achieve higher standards of care. These recommendations provide a springboard for departmental discussions, paving the way for improved experiences for individuals living with obesity as they progress along their weight management journey.

Patients' perceptions of a pharmacist-managed weight management clinic in a community setting

Providing effective weight management services to the growing number of overweight or obese hospital patients necessitates long-term service provision; however, it is arguably not within the acute-care hospital remit to provide such extended services. Referral to community-based programs is required to provide continuing weight management services. The Get Healthy Service is a free six-month, telephone-delivered lifestyle program, now offered in several states of Australia with potential for wide population reach. However, health practitioner referral into the service has been low. The study aimed to examine awareness and suitability of the Get Healthy Service for referral of hospital outpatients for weight management, among key health-care decision-makers. Nine key decision-makers from metropolitan and rural Queensland Health hospitals took part in semi-structured telephone interviews that were audio-recorded (January-July 2014), transcribed verbatim and thematically analysed. Interviews revealed that most decision-makers had limited awareness of the Get Healthy Service but perceived the telephone service to be suitable for patient referrals. Incorporating Get Healthy Service referrals into patient care was seen to be potentially valuable and relatively easy to implement, with most interviewees suggesting that they would provide a Get Healthy Service brochure to patients who could then self-refer into the service. The Get Healthy Service provides a referral model for weight management service provision that appears feasible for use in Queensland hospital settings. Increased awareness and a more integrated approach to referrals would likely result in improved enrolment to the service, with future research needed to demonstrate this.

AimsChildhood obesity is a significant health burden, with limited resources to manage severe obesity including co-morbidities. Obese children and young people (CYP) require a tier-3 obesity service. There is a...

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The increasing prevalence of obesity and overweight adults creates a significant public health burden and there is great potential for pharmacists to be involved in the provision of weight management services, other than the mundane supply of commercial products. In order to provide optimal services that can be integrated into the healthcare system, a best practice model for weight management services in community pharmacy should be in place. We sought experts' and key stakeholders' opinions on this matter. (1) To identify components of a best practice model of a weight management service feasible in Australian community pharmacy. (2) To identify the role of pharmacists and the training requirements to up-skill pharmacists to competently provide weight management services. (3) To elicit any practical suggestions that would contribute to successful implementation of weight management services in pharmacy. Australian primary care sector. Semi-structured interviews were conducted with a purposive sample of 12 participants including Australian experts in obesity and representatives of main Australian professional organisations in pharmacy. Interviews were digitally recorded, transcribed verbatim and thematically analysed using the framework approach. Recommended components of pharmacy-based weight management services and training requirements. Participants perceived two potential roles for pharmacists involved in weight management: health promotion and individualised service. Multi-component interventions targeting all three areas: diet, physical activity and behaviour change were emphasised. Physical assessment (e.g. weight, waist circumference measurements), goal setting, referral to allied healthcare professionals and on-going support for weight maintenance were also proposed. Participants suggested pharmacists should undergo formal training and identified various training topics to improve pharmacists' knowledge, attributes and skills to acquire competencies necessary for delivery of this service. Some physical and financial barriers in providing these services were also identified including infrastructure, pharmacists' time and cost-effectiveness. Pharmacists are well-positioned to promote healthy weight and/or implement weight management interventions. Furthering pharmacists' role would involve training and up-skilling; and addressing key practice change facilitators such as pharmacy layout and remuneration. This study provides some insight into the design and implementation of a best practice model for pharmacy-based weight management services in Australia.

Obesity is a public health challenge faced worldwide. Community pharmacists may be well placed to manage Australia's obesity problem owing to their training, accessibility and trustworthiness. However, determining consumers' needs is vital to the development of any new services or the evaluation of existing services. To explore Australian consumers' perspectives regarding weight management services in the community pharmacy setting, including their past experiences and willingness to pay for a specific pharmacy-based service. An online cross-sectional consumer survey was distributed through a marketing research company. The survey instrument comprised open-ended and closed questions exploring consumers' experiences of and preferences for weight management services in pharmacy. It also included an attitudinal measure, the Consumer Attitude to Pharmacy Weight Management Services (CAPWMS) scale. A total of 403 consumers from New South Wales, Australia, completed the survey. The majority of respondents had previously not sought a pharmacist's advice regarding weight management. Those who had previously consulted a pharmacist were more willing to pay for and support pharmacy-based services in the future. Most consumers considered pharmacists' motivations to provide advice related to gaining profit from selling a product and expressed concerns about the perceived conflicts of interest. Participants also perceived pharmacists as lacking expertise and time. Although Australian consumers were willing to seek pharmacists' advice about weight management, they perceived several barriers to the provision of weight management services in community pharmacy. If barriers are addressed, community pharmacies could be a viable and accessible setting to manage obesity.

IntroductionMaternal weight management services have been recognised as a good opportunity to influence lifestyle and dietary behaviour of mothers and families. Exploring women’s views of maternal weight management services is paramount to understand what constitutes the most suitable service. This study therefore explored experiences among women with a raised body mass index (BMI) of maternal weight management service provision and the barriers and facilitators to weight management during pregnancy.MethodThirteen women with a BMI≥40kg/m² undertook semi-structured interviews around weight management experiences during pregnancy. Interviews were audio recorded and transcribed verbatim. Inductive thematic analysis was undertaken.ResultsFour themes emerged. 1). "Understanding where I am at" showed current readiness and motivation of women varied, from being avoidant to being motivated to make changes. 2). "Getting information" revealed inconsistent information provision during pregnancy. Women particularly wanted practical advice. Some attempted to find this for themselves from friends or the internet, however this left some women feeling confused when different sources provided inconsistent advice. 3). "Difficulties I face" identified physical, emotional and financial barriers and the strategies some women used to overcome these. 4). "Encountering professionals–a mixed experience" demonstrated women wanted to be treated with respect and sensitivity and that how weight management information was addressed was more important than who provided it. The fine line professionals tread was demonstrated by women thinking that they had received inadequate information and yet too much focus was placed on their weight and the associated risks during pregnancy without practical solutions to their weight management challenges.DiscussionWomen were empowered when practical advice was provided, not just the continual repetition of the risks of being obese during pregnancy. Antenatal weight management services need to be clear, sensitive and respectful. Services centred on individual women’s needs and on their current and previous experiences are required. The psychological and social contexts of weight management also need to be addressed.

Improving child weight management uptake through enhanced National Child Measurement Programme parental feedback letters: A randomised controlled trial

Atypical antipsychotics offer clear advantages in the management of schizophrenia, compared with conventional neuroleptics, but weight gain is a significant adverse effect with some of these agents. To review the literature on weight gain associated with atypical antipsychotic treatment in schizophrenia. Relevant sources were identified from Medline searches to February 2003 using combinations of keywords including 'schizophrenia', 'antipsychotics', 'weight gain', 'adverse events', 'obesity', and 'diabetes'. Most atypical antipsychotics induce some weight gain, but the magnitude of the effect varies markedly. The greatest increases are seen with clozapine and olanzapine: risperidone has a slight effect, comparable with that of conventional neuroleptics, while ziprasidone and aripiprazole appear from current data to have little effect. In addition, atypical antipsychotics have been associated with metabolic disturbances, particularly glucose dysregulation and dyslipidemia. These effects tend to be more marked with olanzapine and clozapine than with other agents. Weight gain associated with atypical antipsychotics imposes substantial morbidity, in addition to that associated with schizophrenia itself. Furthermore, weight gain can significantly impair patients' quality of life, and leads to non-adherence with treatment. Effective weight management should include the selection of an appropriate atypical antipsychotic and for effective weight management, as well both diet and exercise, formal weight management programs tailored to the needs of schizophrenic patients may be useful, and some patients may benefit from weight-reducing drugs. Weight gain associated with atypical antipsychotics is a common problem that requires effective management. The selection of an agent with a low risk of weight gain, such as risperidone or ziprasidone, is central to such management.

BackgroundAdults living with overweight/obesity are eligible for publicly funded weight management (WM) programmes according to national guidance. People with the most severe and complex obesity are eligible for bariatric surgery. Primary care plays a key role in identifying overweight/obesity and referring to WM interventions. This study aimed to (1) describe the primary care population in England who (a) are referred for WM interventions and (b) undergo bariatric surgery and (2) determine the patient and GP practice characteristics associated with both.Methods and findingsAn observational cohort study was undertaken using routinely collected primary care data in England from the Clinical Practice Research Datalink linked with Hospital Episode Statistics. During the study period (January 2007 to June 2020), 1,811,587 adults met the inclusion criteria of a recording of overweight/obesity in primary care, of which 54.62% were female and 20.10% aged 45 to 54. Only 56,783 (3.13%) were referred to WM, and 3,701 (1.09% of those with severe and complex obesity) underwent bariatric surgery. Multivariable Poisson regression examined the associations of demographic, clinical, and regional characteristics on the likelihood of WM referral and bariatric surgery. Higher body mass index (BMI) and practice region had the strongest associations with both outcomes. People with BMI ≥40 kg/m2 were more than 6 times as likely to be referred for WM (10.05% of individuals) than BMI 25.0 to 29.9 kg/m2 (1.34%) (rate ratio (RR) 6.19, 95% confidence interval (CI) [5.99,6.40], p < 0.001). They were more than 5 times as likely to undergo bariatric surgery (3.98%) than BMI 35.0 to 40.0 kg/m2 with a comorbidity (0.53%) (RR 5.52, 95% CI [5.07,6.02], p < 0.001). Patients from practices in the West Midlands were the most likely to have a WM referral (5.40%) (RR 2.17, 95% CI [2.10,2.24], p < 0.001, compared with the North West, 2.89%), and practices from the East of England least likely (1.04%) (RR 0.43, 95% CI [0.41,0.46], p < 0.001, compared with North West). Patients from practices in London were the most likely to undergo bariatric surgery (2.15%), and practices in the North West the least likely (0.68%) (RR 3.29, 95% CI [2.88,3.76], p < 0.001, London compared with North West). Longer duration since diagnosis with severe and complex obesity (e.g., 1.67% of individuals diagnosed in 2007 versus 0.34% in 2015, RR 0.20, 95% CI [0.12,0.32], p < 0.001), and increasing comorbidities (e.g., 2.26% of individuals with 6+ comorbidities versus 1.39% with none (RR 8.79, 95% CI [7.16,10.79], p < 0.001) were also strongly associated with bariatric surgery. The main limitation is the reliance on overweight/obesity being recorded within primary care records to identify the study population.ConclusionsBetween 2007 and 2020, a very small percentage of the primary care population eligible for WM referral or bariatric surgery according to national guidance received either. Higher BMI and GP practice region had the strongest associations with both. Regional inequalities may reflect differences in commissioning and provision of WM services across the country. Multi-stakeholder qualitative research is ongoing to understand the barriers to accessing WM services and potential solutions. Together with population-wide prevention strategies, improved access to WM interventions is needed to reduce obesity levels.

Objective: To improve chronic disease health outcomes through a culturally competent, preventive care intervention for the underserved, economically disadvantaged, underinsured, and other people of a rural Alabama county. Design: One-group pre-test/post-test design. Setting: Public health department in a rural county in the Southeastern part of the United States. Methods: A free, weekly clinic was held at the county health department. The clinic was staffed by Samford University pharmacy and exercise science faculty, a public health pharmacy practice resident, senior pharmacy students, and undergraduate exercise science majors. During weekly visits patients had baseline measures assessed and they were interviewed on medication therapy, dietary practice, and exercise regimen. Weekly follow-up to previous sessions provided opportunities for health coaching and monitoring of goal-setting. Results: The intervention clinic averaged 10 patients per week. Adult participants (n=357) had a mean age of 53.6±17.3. Comparison of year 1 (201.3±51.5) and year 2 (187.1±67.6) weight was statistically significant (p=0.004). Year 1 systolic blood pressure was 141.6±18.4 mmHg and diastolic blood pressure was 79.2±10.6. Where follow-up measures were available (n=81), the year 2 systolic blood pressure was 139.2±20.4 mmHg while the year 2 diastolic blood pressure was 77.1±11.8 mmHg. Year 1 BMI was 32.1±12.7 and year 2 BMI was 31.5±14.9 (n=23). Conclusion: Preventive services provided by pharmacists and health educators had a statistically significant effect on weight loss. While not statistically significant, clinical significance is noted on other key measures as blood pressure and BMI were trending in a positive direction. Further efforts towards weight loss will likely result in statistically significant changes to blood pressure and BMI.

Free AccessExcessive Weight Gain, Metabolic Syndrome and Psychotropic Treatments Of Children and AdolescentsStan KutcherStan KutcherStan Kutcher, MD is the editor of Child and Adolescent Psychopharmacology News.Search for more papers by this authorPublished Online:May 2007https://doi.org/10.1521/capn.2006.11.4.10PDFPDF PLUS ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations About"Excessive Weight Gain, Metabolic Syndrome and Psychotropic Treatments Of Children and Adolescents." , 11(4), p. 10Suggested ReadingsReilly J.J., , Wilson D. (2006). ABC of Obesity: Childhood Obesity BMJ, 333(7580), 1207–1210. Crossref, Google ScholarSacks F.M. (2004), Metabolic syndrome: Epidemiology and consequences. J Clin Psychiatry. 65, Suppl, 18, 3–12. Google ScholarRatzoni G., , Gothelf D, , Brand–Gothelf A. (2002). Weight gain associated with olanzapine and risperidone in adolescent patients: A comparative prospective study J Am Acad Child Adolesc Psychiatry, 41(3), 337–343. Crossref, Google ScholarMensah G.A., , Mokdad A.H., , Ford E. et al., (2004). Obesity, metabolic syndrome and type 2 diabetes: Emerging epidemics and their cardiovascular implications Cardiology Clin, 4, 485–504. Crossref, Google ScholarCorrell C.U., , Penzner J.B., , Mughal T. (2006). Recongizing and monitoring adverse events of second generation antipsychotics in children and adolescents Child Adolescent Psychiatry Clinics of North America, 15(1), 177–206. Crossref, Google Scholar Previous article FiguresReferencesRelatedDetails Volume 11Issue 4Jun 2006 Information© Guilford Publications Inc.PDF download

ObjectivesTo review the characteristics of children and young people assessed at medical clinic of level 3 weight management service To reflect on the service model evolution and investment areaMethodsData (demography,...

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