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Hidden in Plain Sight: The Embedded Nature of Obesity in Primary Care Visits
Abstracts / Can J Diabetes 39 (2015) S38eS74
quantitative and qualitative data. Factors leading to discontinuation were rated on a 5-point Likert scale. Qualitative data was analyzed using constant comparative methodology. The response rate was 59% with a 40.3% completion rate. Surgical complications (3.60.2) and post-operative lifestyle adaptations (3.60.2) were identified as 2 key factors leading to program discontinuation, with 41% and 36% of subjects rating them as ‘most concerned’, respectively. Thematic analysis uncovered 11 major themes related to patient self-removal after program orientation. Several additional themes emerged in the qualitative analysis including perceived suitability for the surgery, family impact, communication with the family physician and orientation structure and delivery. As one of the first studies looking at the barriers to bariatric surgery in a pre-operative setting, the results offer new insight to patients’ self-removal after attending the program orientation. This helps to identify changes needed in the pre-operative process of the bariatric program.
P4.31 Understanding the Weight-Victimization Experiences and Interpersonal Relationships of Young Adult Bariatric Patients SHIRA YUFE*1, MARLENE TAUBE-SCHIFF 1, KAREN FERGUS 2, 3, SANJEEV SOCKALINGAM 1, 4 1 University Health Network, Toronto, ON, Canada 2 York University, Toronto, ON, Canada 3 Sunnybrook Health Sciences Centre, Toronto, ON, Canada 4 University of Toronto, Department of Psychiatry, Toronto, ON, Canada Introduction: Research shows that adolescents struggling with obesity-related issues report a significant reduction in quality of life (Swallen et al., 2005). Although weight-based bullying is common in this age group (Browne, 2012), little is known about its impact for young adults in terms of their interpersonal relationships. Objectives: In a sample of young adults (18-25 years old) seeking bariatric surgery we aim to: (1) identify themes across bullying experiences; (2) identify experienced psychosocial difficulties associated with weight-based bullying; and (3) understand how weight-based bullying affects interpersonal relationships. Method: In-depth, semi-structured individual interviews were used to gather data on retrospective bullying experiences in young adult bariatric patients. A total of 7 participants have been recruited for this study. Data collection is still underway as saturation of themes has not been reached, and we anticipate that saturation may be achieved with 10-15 subjects. A thematic analysis informed by grounded theory principles has been used to identify recurrent themes. Results: Preliminary analyses revealed the following themes: (1) parents as “supporters” and “controllers” (2) complicated relationships with food (3) school as danger zone (4) being the biggest kid and (5) layers of pain. Conclusions: Our results suggest a complex framework regarding the relationships of obese young adults facing weight-based bullying. Whereas peer relationships are negatively affected by weight-based bullying, parental relationships can be both supportive and intrusive. This knowledge might aid healthcare practitioners in addressing the negative experiences associated with weight-based bullying allowing for improved self-efficacy and enhanced social functioning.
P5.01 Hidden in Plain Sight: The Embedded Nature of Obesity in Primary Care Visits JODIE D. ASSELIN*, ADEDAYO OSUNLANA, AYODELE OGUNLEYE, ARYA M. SHARMA, DENISE CAMPBELL-SCHERER University of Alberta, Edmonton, AB, Canada Objective: Primary care is increasingly focusing on obesity as a chronic condition through tools and approaches that aim to address
S53
its complexity. The 5As Team (5AsT) study goal was to increase provider confidence in addressing patient weight issues. A barrier that emerged from this study was the embedded nature of weight management visits in Primary Care. Methods: The goal of this aspect of the study was to explore contextual factors that influence provider ability to undertake patient weight management. As part of this mixed method randomized controlled trial (RCT), interviews were conducted with 29 multi-disciplinary team providers (Nurses, Mental health Workers, Registered Dietitians). Interviews were semi-structured; analysis used a thematic analysis approach. Results: Participants reported that weight management visits seldom occurred as a discrete category; being often embedded within another reason for the patient visit (ex. prenatal visits, diabetes). This has implications for obesity treatment approaches and tools that assume a discrete “weight management visit”. It also may mean that some forms of obesity management may occur yet go unnoticed or unrecorded. The nature of primary care also offers some benefits to embedded conditions: the longterm nature of primary care relationships, increased opportunities to ask, and to address important underlying issues (ex. depression). Conclusion: Recognizing and addressing on-the-ground complex realities of weight management in primary care is a necessary step of meaningful knowledge translation concerning the treatment of obesity. The input of providers who are working to integrate weight management need to be given consideration by those promoting weight management within clinic settings.
P5.02 Challenges and Facilitators to Interdisciplinary Weight Management Collaboration in Primary Care JODIE D. ASSELIN*, ADEDAYO OSUNLANA, AYODELE OGUNLEYE, ARYA M. SHARMA, DENISE CAMPBELL-SCHERER University of Alberta, Edmonton, AB, Canada Objective: As a prevalent chronic condition obesity is increasingly being addressed in primary care through interdisciplinary teams that aim to collaborate in addressing its complexity. However the dynamics of individual clinics and diversity of provider approaches can hinder their efforts. The 5As Team (5AsT) weight management intervention’s goal was to increasing provider confidence in addressing patient weight issues. Interdisciplinary team relations were a key theme that emerged from study data and will be explored in this presentation. Methods: As part of this mixed methods randomized controlled trial (RCT), interviews were conducted with 29 multi-disciplinary team providers (Nurses, Mental health Workers, Registered Dietitians). Interviews were semi-structured, analysis was inductive and used a thematic analysis approach. Interview topics drew from the Theoretical Domains Framework and Complex Innovations Implementation Framework. Relations between providers and work environment emerged as important issues during these interviews. Results: We found that provider availability, appropriate referrals, role perception, and approach/messaging given by individual providers were key elements in weight management and were not always agreed upon by team members. Furthermore, the ability to negotiate these critical aspects of interdisciplinary obesity management was dependent upon supportive clinic relationships, open communication, and interdisciplinary confidence. Without the ability to negotiate the central components, collaboration and role distribution was less than optimal. Conclusion: Recognizing the underlying components of healthy clinic work environments and provider relationships could aid in supporting the treatment of conditions such as obesity that require multi-disciplinary care.
quantitative and qualitative data. Factors leading to discontinuation were rated on a 5-point Likert scale. Qualitative data was analyzed using constant comparative methodology. The response rate was 59% with a 40.3% completion rate. Surgical complications (3.60.2) and post-operative lifestyle adaptations (3.60.2) were identified as 2 key factors leading to program discontinuation, with 41% and 36% of subjects rating them as ‘most concerned’, respectively. Thematic analysis uncovered 11 major themes related to patient self-removal after program orientation. Several additional themes emerged in the qualitative analysis including perceived suitability for the surgery, family impact, communication with the family physician and orientation structure and delivery. As one of the first studies looking at the barriers to bariatric surgery in a pre-operative setting, the results offer new insight to patients’ self-removal after attending the program orientation. This helps to identify changes needed in the pre-operative process of the bariatric program.
P4.31 Understanding the Weight-Victimization Experiences and Interpersonal Relationships of Young Adult Bariatric Patients SHIRA YUFE*1, MARLENE TAUBE-SCHIFF 1, KAREN FERGUS 2, 3, SANJEEV SOCKALINGAM 1, 4 1 University Health Network, Toronto, ON, Canada 2 York University, Toronto, ON, Canada 3 Sunnybrook Health Sciences Centre, Toronto, ON, Canada 4 University of Toronto, Department of Psychiatry, Toronto, ON, Canada Introduction: Research shows that adolescents struggling with obesity-related issues report a significant reduction in quality of life (Swallen et al., 2005). Although weight-based bullying is common in this age group (Browne, 2012), little is known about its impact for young adults in terms of their interpersonal relationships. Objectives: In a sample of young adults (18-25 years old) seeking bariatric surgery we aim to: (1) identify themes across bullying experiences; (2) identify experienced psychosocial difficulties associated with weight-based bullying; and (3) understand how weight-based bullying affects interpersonal relationships. Method: In-depth, semi-structured individual interviews were used to gather data on retrospective bullying experiences in young adult bariatric patients. A total of 7 participants have been recruited for this study. Data collection is still underway as saturation of themes has not been reached, and we anticipate that saturation may be achieved with 10-15 subjects. A thematic analysis informed by grounded theory principles has been used to identify recurrent themes. Results: Preliminary analyses revealed the following themes: (1) parents as “supporters” and “controllers” (2) complicated relationships with food (3) school as danger zone (4) being the biggest kid and (5) layers of pain. Conclusions: Our results suggest a complex framework regarding the relationships of obese young adults facing weight-based bullying. Whereas peer relationships are negatively affected by weight-based bullying, parental relationships can be both supportive and intrusive. This knowledge might aid healthcare practitioners in addressing the negative experiences associated with weight-based bullying allowing for improved self-efficacy and enhanced social functioning.
P5.01 Hidden in Plain Sight: The Embedded Nature of Obesity in Primary Care Visits JODIE D. ASSELIN*, ADEDAYO OSUNLANA, AYODELE OGUNLEYE, ARYA M. SHARMA, DENISE CAMPBELL-SCHERER University of Alberta, Edmonton, AB, Canada Objective: Primary care is increasingly focusing on obesity as a chronic condition through tools and approaches that aim to address
S53
its complexity. The 5As Team (5AsT) study goal was to increase provider confidence in addressing patient weight issues. A barrier that emerged from this study was the embedded nature of weight management visits in Primary Care. Methods: The goal of this aspect of the study was to explore contextual factors that influence provider ability to undertake patient weight management. As part of this mixed method randomized controlled trial (RCT), interviews were conducted with 29 multi-disciplinary team providers (Nurses, Mental health Workers, Registered Dietitians). Interviews were semi-structured; analysis used a thematic analysis approach. Results: Participants reported that weight management visits seldom occurred as a discrete category; being often embedded within another reason for the patient visit (ex. prenatal visits, diabetes). This has implications for obesity treatment approaches and tools that assume a discrete “weight management visit”. It also may mean that some forms of obesity management may occur yet go unnoticed or unrecorded. The nature of primary care also offers some benefits to embedded conditions: the longterm nature of primary care relationships, increased opportunities to ask, and to address important underlying issues (ex. depression). Conclusion: Recognizing and addressing on-the-ground complex realities of weight management in primary care is a necessary step of meaningful knowledge translation concerning the treatment of obesity. The input of providers who are working to integrate weight management need to be given consideration by those promoting weight management within clinic settings.
P5.02 Challenges and Facilitators to Interdisciplinary Weight Management Collaboration in Primary Care JODIE D. ASSELIN*, ADEDAYO OSUNLANA, AYODELE OGUNLEYE, ARYA M. SHARMA, DENISE CAMPBELL-SCHERER University of Alberta, Edmonton, AB, Canada Objective: As a prevalent chronic condition obesity is increasingly being addressed in primary care through interdisciplinary teams that aim to collaborate in addressing its complexity. However the dynamics of individual clinics and diversity of provider approaches can hinder their efforts. The 5As Team (5AsT) weight management intervention’s goal was to increasing provider confidence in addressing patient weight issues. Interdisciplinary team relations were a key theme that emerged from study data and will be explored in this presentation. Methods: As part of this mixed methods randomized controlled trial (RCT), interviews were conducted with 29 multi-disciplinary team providers (Nurses, Mental health Workers, Registered Dietitians). Interviews were semi-structured, analysis was inductive and used a thematic analysis approach. Interview topics drew from the Theoretical Domains Framework and Complex Innovations Implementation Framework. Relations between providers and work environment emerged as important issues during these interviews. Results: We found that provider availability, appropriate referrals, role perception, and approach/messaging given by individual providers were key elements in weight management and were not always agreed upon by team members. Furthermore, the ability to negotiate these critical aspects of interdisciplinary obesity management was dependent upon supportive clinic relationships, open communication, and interdisciplinary confidence. Without the ability to negotiate the central components, collaboration and role distribution was less than optimal. Conclusion: Recognizing the underlying components of healthy clinic work environments and provider relationships could aid in supporting the treatment of conditions such as obesity that require multi-disciplinary care.