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Health-Related Quality of Life in Overweight and Obese Adolescents: Results from a Multidisciplinary Therapy
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Abstracts / Can J Diabetes 37 (2013) S217eS289
of subjects achieving 5% of weight loss, 0.2% were categorized on EOSS stage 0, 3% were categorized on stage 1, 85% were categorized on stage 2, and 11% on stage 3 (p<0.001). Median of weight loss was not associated with improvement in the EOSS stage (p¼0.38). EOSS improvement was positively associated with having type 2 diabetes on visit 1 (p¼0.02) and with better functional status (p¼0.002), and negatively associated with mental health stage 3 (p<0.001). Conclusion: With moderate weight loss, global health was improved in a multidisciplinary obesity treatment. Functional and mental factors need to be adressed additionally to medical treatments.
313 Effectiveness of Implementing The 5As of Obesity ManagementÔ in a Primary Care Setting CHRISTIAN RUEDA-CLAUSEN, ELEANOR BENTERUD, TARA BOND, REGINA OLSZOWKA, T MICHAEL VALLIS, ARYA M. SHARMAON BEHALF OF THE CANADIAN OBESITY NETWORK WORKING GROUP University of Alberta, Edmonton, Alberta, Canada Introduction: Obesity remains poorly managed in primary care. The 5As of Obesity ManagementÔ provide a theory-driven, evidence-based minimal intervention designed to facilitate weigh management interventions. The aim of this project was to test the effectiveness of implementing this tool in primary care. Methods: Electronic self-administered surveys were completed by pre-screened obese subjects at the end of their appointments in four clinics (over 25 health care providers; HCP) from the SCPCN. These measurements were performed before (Baseline, n¼51) and 4 weeks after a implementing the 5As of Obesity ManagementÔ (post-intervention, n¼51). Intervention consisted of one online training session (90min) and distribution of the 5As toolkit among HCPs of participating clinics. Results: Subjects completing the survey before and after the intervention were comparable in terms of age, sex, BMI, comorbidities, satisfaction and self-reported health status (p>0.2). Implementing the 5As of Obesity ManagementÔ resulted in a 2-fold increase in obesity management discussion initiation (19 vs. 39%, p¼0.03) and caused a significant increase the perceived Follow-up/Coordination efforts (self-reported PACIC components, 4522 vs. 6712 pts, p¼0.002), as well as the Assess (5029 vs. 6615 pts, p¼0.03) and Assist (5426 vs. 7213 pts, p¼0.01) components of the 5As framework. Conclusion: Our results suggest that implementing the 5As of Obesity ManagementÔ facilitates weight management in primary care by favoring dialog initiation and providing and a structured management framework.
314 Effectiveness and Safety of Long-term Management with Lowcalorie Diet on Severely Obese Patients Non-eligible for Surgical Treatment CHRISTIAN RUEDA-CLAUSEN, F. ALABDALI, SARAH ROBBINS, ARYA M. SHARMA University of Alberta, Edmonton, Canada, Edmonton, Alberta, Canada Introduction: Obese patients who have failed to achieve adequate weight loss with standard medical management have limited nonsurgical therapeutic options. Low calorie diets (LCDs) providing 900 kcal/day are typically used as short-term interventions to achieve weight loss. However, little is known regarding the long-term efficacy and safety of LCDs in individuals with complex obesity. Methods: To better understand this therapeutic alternative, charts from a hospital-based out patient bariatric program were reviewed. Eight patients (75% male, age 60.17.8 Yrs.) with severe obesity (BMI 57.18.8 Kg/m2) and undergoing long-term LCD (3310 months) were identified. Variables of interest included anthropometric, cardiovascular risk and nutritional parameters, thyroid, renal and liver function, changes in medications, side effects and adverse events.
Results: Average weight loss was 4415 kg (2713% of initial weight) at 24 months. Long-term management with LCD resulted in substantial and sustained improvements in glucose homeostasis (fasting glucose 6.32mM at baseline vs. 4.90.2mM at 30 months, p¼0.02), blood pressure (SBP 14010 mmHg at baseline vs 1327 mmHg at 30 months, p¼0.008) and lipid profile (HDL cholesterol 10.2 mM at baseline vs 1.2 0.3 at 430 months, p¼0.002). LCD was well tolerated with minor self-limited side effects. Over the follow up period, two subjects underwent coronary re-vascularization and one patient underwent knee replacement surgery e all recovered without complications. Conclusions: These findings suggest that in selected obese patients (non-eligible for surgery), long-term management with LCD may provide an alternative option for substantial and sustainable weight loss with significant improvements in metabolic and cardiovascular health. 315 Health-Related Quality of Life in Overweight and Obese Adolescents: Results from a Multidisciplinary Therapy JOSIANE APARECIDA ALVES BIANCHINI, DANILO FERNANDES DA SILVA, VANESSA DRIELI, SERON ANTONINI, CARLOS ANDRES LOPERA, CLAUDIA CHRISTINA, SANCHEZ NARDO, NELSON NARDO JUNIOR State University of Maringa, Maringa, Brazil Aim: To analyze the effects of a Multidisciplinary Program of Obesity Treatment (MPOT) on health-related quality of life (HRQoL) in adolescents and its impact on parent-proxy perception. Methods: One hundred and fifty nine adolescents with excess weight aged 10 to 18 years were allocated to two groups: intervention group (IG; n¼92) and control group (CG; n¼67). It was assessed weight, height, BMI, waist (WC) and hip circumference (HC), absolute and relative body fat and lean body mass. HRQoL was assessed with the Pediatric Quality of Life Inventory, PedsQL version 4.0, which was used in adolescents and their parents/guardians. This questionnaire is composed by 6 domains focused on the assessment of physical and psychosocial aspects. The intervention lasted 16 weeks, with a multidisciplinary team based on Cognitive Behavioral Therapy. It was tested normality with Shapiro-Wilk test. Mixed ANOVA for repeated measures was used to compare both moments and groups and significance was preset at 5%. Results: IG improved physical, social, psychosocial and total domains. With regards to parent-proxy perception, it was found improvements for all domains in IG, except for school domain. At baseline, parents underestimated adolescents’ HRQoL for all domains except for school domain, however after the intervention no differences were observed between adolescents’ report and those of their parents. Conclusions: The results showed that a multidisciplinary intervention is effective in improving anthropometric variables, body composition and HRQoL in overweight adolescents. The results were also similar between adolescents and their parents’ perception in all domains after the intervention. 316 Self-Regulation, Executive Function & Childhood Obesity: A Theoretical Model SARAH HUTCHISON, ULRICH MÜLLER University of Victoria, Victoria, British Columbia, Canada Emerging research suggests that deficits in Execution Function (EF) have been associated with obesity (e.g. Lokken et al., 2009). EF broadly refers to cognitive processes that are involved in the conscious control of action and thought and includes working memory, inhibitory control, and shifting, among other processes. EF overlaps with another theoretical construct, self-regulation (SR), which refers to: a) commitment to standards, b) monitoring of the self and it’s behaviors, and c) the capacity to make change. EF can be conceptualized as a process mediator to SR (Hofmann et al., 2012). EF’s (working memory, inhibitory control, and shifting) support mechanisms in an
Abstracts / Can J Diabetes 37 (2013) S217eS289
of subjects achieving 5% of weight loss, 0.2% were categorized on EOSS stage 0, 3% were categorized on stage 1, 85% were categorized on stage 2, and 11% on stage 3 (p<0.001). Median of weight loss was not associated with improvement in the EOSS stage (p¼0.38). EOSS improvement was positively associated with having type 2 diabetes on visit 1 (p¼0.02) and with better functional status (p¼0.002), and negatively associated with mental health stage 3 (p<0.001). Conclusion: With moderate weight loss, global health was improved in a multidisciplinary obesity treatment. Functional and mental factors need to be adressed additionally to medical treatments.
313 Effectiveness of Implementing The 5As of Obesity ManagementÔ in a Primary Care Setting CHRISTIAN RUEDA-CLAUSEN, ELEANOR BENTERUD, TARA BOND, REGINA OLSZOWKA, T MICHAEL VALLIS, ARYA M. SHARMAON BEHALF OF THE CANADIAN OBESITY NETWORK WORKING GROUP University of Alberta, Edmonton, Alberta, Canada Introduction: Obesity remains poorly managed in primary care. The 5As of Obesity ManagementÔ provide a theory-driven, evidence-based minimal intervention designed to facilitate weigh management interventions. The aim of this project was to test the effectiveness of implementing this tool in primary care. Methods: Electronic self-administered surveys were completed by pre-screened obese subjects at the end of their appointments in four clinics (over 25 health care providers; HCP) from the SCPCN. These measurements were performed before (Baseline, n¼51) and 4 weeks after a implementing the 5As of Obesity ManagementÔ (post-intervention, n¼51). Intervention consisted of one online training session (90min) and distribution of the 5As toolkit among HCPs of participating clinics. Results: Subjects completing the survey before and after the intervention were comparable in terms of age, sex, BMI, comorbidities, satisfaction and self-reported health status (p>0.2). Implementing the 5As of Obesity ManagementÔ resulted in a 2-fold increase in obesity management discussion initiation (19 vs. 39%, p¼0.03) and caused a significant increase the perceived Follow-up/Coordination efforts (self-reported PACIC components, 4522 vs. 6712 pts, p¼0.002), as well as the Assess (5029 vs. 6615 pts, p¼0.03) and Assist (5426 vs. 7213 pts, p¼0.01) components of the 5As framework. Conclusion: Our results suggest that implementing the 5As of Obesity ManagementÔ facilitates weight management in primary care by favoring dialog initiation and providing and a structured management framework.
314 Effectiveness and Safety of Long-term Management with Lowcalorie Diet on Severely Obese Patients Non-eligible for Surgical Treatment CHRISTIAN RUEDA-CLAUSEN, F. ALABDALI, SARAH ROBBINS, ARYA M. SHARMA University of Alberta, Edmonton, Canada, Edmonton, Alberta, Canada Introduction: Obese patients who have failed to achieve adequate weight loss with standard medical management have limited nonsurgical therapeutic options. Low calorie diets (LCDs) providing 900 kcal/day are typically used as short-term interventions to achieve weight loss. However, little is known regarding the long-term efficacy and safety of LCDs in individuals with complex obesity. Methods: To better understand this therapeutic alternative, charts from a hospital-based out patient bariatric program were reviewed. Eight patients (75% male, age 60.17.8 Yrs.) with severe obesity (BMI 57.18.8 Kg/m2) and undergoing long-term LCD (3310 months) were identified. Variables of interest included anthropometric, cardiovascular risk and nutritional parameters, thyroid, renal and liver function, changes in medications, side effects and adverse events.
Results: Average weight loss was 4415 kg (2713% of initial weight) at 24 months. Long-term management with LCD resulted in substantial and sustained improvements in glucose homeostasis (fasting glucose 6.32mM at baseline vs. 4.90.2mM at 30 months, p¼0.02), blood pressure (SBP 14010 mmHg at baseline vs 1327 mmHg at 30 months, p¼0.008) and lipid profile (HDL cholesterol 10.2 mM at baseline vs 1.2 0.3 at 430 months, p¼0.002). LCD was well tolerated with minor self-limited side effects. Over the follow up period, two subjects underwent coronary re-vascularization and one patient underwent knee replacement surgery e all recovered without complications. Conclusions: These findings suggest that in selected obese patients (non-eligible for surgery), long-term management with LCD may provide an alternative option for substantial and sustainable weight loss with significant improvements in metabolic and cardiovascular health. 315 Health-Related Quality of Life in Overweight and Obese Adolescents: Results from a Multidisciplinary Therapy JOSIANE APARECIDA ALVES BIANCHINI, DANILO FERNANDES DA SILVA, VANESSA DRIELI, SERON ANTONINI, CARLOS ANDRES LOPERA, CLAUDIA CHRISTINA, SANCHEZ NARDO, NELSON NARDO JUNIOR State University of Maringa, Maringa, Brazil Aim: To analyze the effects of a Multidisciplinary Program of Obesity Treatment (MPOT) on health-related quality of life (HRQoL) in adolescents and its impact on parent-proxy perception. Methods: One hundred and fifty nine adolescents with excess weight aged 10 to 18 years were allocated to two groups: intervention group (IG; n¼92) and control group (CG; n¼67). It was assessed weight, height, BMI, waist (WC) and hip circumference (HC), absolute and relative body fat and lean body mass. HRQoL was assessed with the Pediatric Quality of Life Inventory, PedsQL version 4.0, which was used in adolescents and their parents/guardians. This questionnaire is composed by 6 domains focused on the assessment of physical and psychosocial aspects. The intervention lasted 16 weeks, with a multidisciplinary team based on Cognitive Behavioral Therapy. It was tested normality with Shapiro-Wilk test. Mixed ANOVA for repeated measures was used to compare both moments and groups and significance was preset at 5%. Results: IG improved physical, social, psychosocial and total domains. With regards to parent-proxy perception, it was found improvements for all domains in IG, except for school domain. At baseline, parents underestimated adolescents’ HRQoL for all domains except for school domain, however after the intervention no differences were observed between adolescents’ report and those of their parents. Conclusions: The results showed that a multidisciplinary intervention is effective in improving anthropometric variables, body composition and HRQoL in overweight adolescents. The results were also similar between adolescents and their parents’ perception in all domains after the intervention. 316 Self-Regulation, Executive Function & Childhood Obesity: A Theoretical Model SARAH HUTCHISON, ULRICH MÜLLER University of Victoria, Victoria, British Columbia, Canada Emerging research suggests that deficits in Execution Function (EF) have been associated with obesity (e.g. Lokken et al., 2009). EF broadly refers to cognitive processes that are involved in the conscious control of action and thought and includes working memory, inhibitory control, and shifting, among other processes. EF overlaps with another theoretical construct, self-regulation (SR), which refers to: a) commitment to standards, b) monitoring of the self and it’s behaviors, and c) the capacity to make change. EF can be conceptualized as a process mediator to SR (Hofmann et al., 2012). EF’s (working memory, inhibitory control, and shifting) support mechanisms in an