scholarly journals New Horizons A New Paradigm for Treating to Target with Second-Generation Obesity Medications

2021 ◽  
Author(s):  
W Timothy Garvey
Keyword(s):  
Weight Loss ◽  
Chronic Disease ◽  
Second Generation ◽  
Clinical Status ◽  
Active Management ◽  
Treat To Target ◽  
New Paradigm ◽  
Therapeutic Goals ◽  
Treatment And Prevention ◽  
Baseline Weight

Abstract In treating obesity as a chronic disease, the essential goal of weight loss therapy is not the quantity of weight loss as an end unto itself, but rather the prevention and treatment of complications to enhance health and mitigate morbidity and mortality. This perspective on obesity care is consistent with the complications-centric AACE obesity guidelines and the diagnostic term of Adiposity-Based Chronic Disease (ABCD). Many complications require 10-20% weight loss to achieve therapeutic goals; however, existing obesity medications fail to produce ≥10% weight loss in the majority of patients. In June, 2021, semaglutide 2.4 mg/week was approved for chronic weight management. Phase 3 clinical trials demonstrated that this medication produced >10% placebo-subtracted weight loss, more than half of patents lost ≥15%, and over one third lost ≥20% of baseline weight. This essentially doubles effectiveness over existing obesity medications, provides sufficient weight loss to ameliorate a broad range of complications, and qualifies as the first member of a second-generation class of obesity medications. The advent of second-generation medications fully enables a treat-to-target approach for management of ABCD as a chronic disease. Specifically, with this degree of efficacy, second-generation medications permit active management of body weight as a biomarker to targets associated with effective treatment and prevention of specific complications. ABCD can now be managed similar to other chronic diseases such as type 2 diabetes, hypertension, and atherosclerosis which are treated to biomarker targets that can be modified based on the clinical status of individual patients (i.e., HbA1c, blood pressure, and LDL-c) to prevent the respective complications of these diseases.

scholarly journals Identifying and measuring the behavioural, dietary, and physical activity components of weight management consultations delivered by general practice nurses in routine care

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Heather Tong ◽  
Elizabeth Morris ◽  
Susan A. Jebb ◽  
Dimitrios A. Koutoukidis
Keyword(s):  
Physical Activity ◽  
Weight Loss ◽  
Weight Management ◽  
Care Group ◽  
Dietary Recommendations ◽  
Practice Nurses ◽  
Audio Recordings ◽  
Baseline Weight ◽  
Physical Activity Recommendations ◽  
Activity Recommendations

Abstract Background Many people with obesity receive weight loss consultations by general practice nurses (GPNs) in routine primary care. This exploratory study aimed to characterise the components of these consultations, including behaviour change techniques (BCTs), and dietary and physical activity recommendations. Methods We analysed audio recordings of weight management consultations conducted by 8 GPNs as part of the ‘usual care’ group in a randomised controlled trial (ISRCTN75092026). Consultations were coded against three taxonomies to classify BCTs, dietary recommendations, and physical activity recommendations. Associations between coded content and weight loss were assessed. Differences in the content of consultations where weight loss was < 5% or ≥ 5% from baseline weight at 6 months were explored. Results One hundred and fifty audio recordings were available from 53 out of 140 (38%) participants in the usual care group. Participants had on average 3 (SD = 1) recorded consultations over 3 months, lasting 14 (SD = 7) minutes each. Weight change at 3, 6, and 12 months was -3.6% (SD = 4.3), -5.5% (SD = 6.0) and -4.2% (SD = 6.5) for participants with audio recordings. GPNs used 3.9 (SD = 1.6) of 93 BCTs, 3.3 (SD = 2.7) of 30 dietary recommendations and 1.4 (SD = 1.2) of 10 physical activity recommendations per consultation. The most commonly employed BCTs were feedback on outcome of behaviour (80.0%), problem solving (38.0%), and social reward (34.3%). The most common dietary recommendations were about portion size (31.3%), nutrients (28.0%), and balanced diet (19.7%). The main physical activity recommendation was about walking (30.3%). There was no association between weight loss and the number of dietary recommendations, physical activity recommendations, or BCTs used per consultation, or per participant. Social reward was the only technique used significantly more in consultations of participants that lost ≥ 5% of their baseline weight at 6 months. Conclusions The study provides a new method that could be used to describe the content of weight management consultations. Specific dietary or physical activity recommendations and BCTs were used infrequently and inconsistently in this group of GPNs. Although replication is required in larger samples, this may point to a weakness in current practice.

Clinical epidemiology in complementary medicine (discussion)

2021 ◽  
pp. 465-474
Author(s):  
Yuriy Olegovich Novikov ◽  
Mikhail Borisovich Tsykunov ◽  
Ayrat Rafikovich Shayakhmetov
Keyword(s):  
Complementary Medicine ◽  
Clinical Epidemiology ◽  
Response To Treatment ◽  
Evidence Based ◽  
New Paradigm ◽  
Treatment And Prevention ◽  
Healthcare It ◽  
Analytical Review ◽  
Based Medicine ◽  
The Impact

The article presents an analytical review of the literature on the application of the principles of evidence-based medicine in modern healthcare. It is noted that in some areas of medicine, scientifically based standards of treatment significantly fall behind the general trends. Complementary medicine, including osteopathy, is an important healthcare resource, the use of which is officially recognized in 94 countries around the world. However, despite certain achievements in the treatment and prevention of many chronic diseases, there are scientific articles that criticize its effectiveness. Therefore, the relevance of obtaining new, strictly evidence-based data on the impact of osteopathy on health is beyond doubt. For osteopathy, as for other types of complementary medicine, a new paradigm of evidence-based clinical research is probably needed. Three types of the organism response to treatment — instant, fast and delayed — are identified.

scholarly journals PREVALENCE OF DYSGLYCEMIA-BASED CHRONIC DISEASE (DBCD) IN EUROPEAN POPULATION: A NEW PARADIGM TO ADDRESS DIABETES BURDEN. THE KARDIOVIZE STUDY

2020 ◽  
Author(s):  
Juan P. Gonzalez-Rivas ◽  
Jeffrey I. Mechanick ◽  
Maria M. Infante-Garcia ◽  
Jose R. Medina-Inojosa ◽  
Iuliia Pavlovska ◽  
...  
Keyword(s):  
Chronic Disease ◽  
European Population ◽  
New Paradigm

scholarly journals Use of the Nursing Outcomes Classification - NOC to assess the knowledge of patients with venous ulcer

2020 ◽  
Vol 41 (spe) ◽  
Author(s):  
Viviane Maria Osmarin ◽  
Fernanda Guarilha Boni ◽  
Taline Bavaresco ◽  
Amália de Fátima Lucena ◽  
Isabel Cristina Echer
Keyword(s):  
Chronic Disease ◽  
Disease Management ◽  
Chronic Disease Management ◽  
Management Strategies ◽  
Venous Ulcer ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Nursing Outcomes ◽  
Treatment And Prevention ◽  
Nursing Outcomes Classification

Abstract Objective: To evaluate the knowledge of patients with venous ulcers (VU) on their chronic disease, treatment, and prevention of complications, according to the Nursing Outcomes Classification-NOC. Methods: This is a cross-sectional study conducted between 2017 and 2018 in a Brazilian hospital. The sample consisted of 38 patients with VU attended in outpatient nursing consultations. The study analyzed sociodemographic, clinical and nine indexes from the Knowledge: Chronic Disease Management (1847) of the NOC, assessed using a five-point Likert scale, analyzed using descriptive statistics. Results: The mean of the result Knowledge: Chronic Disease Management (1847) was 3.56±1.42. The clinical index Procedures involved in treatment regimen had the highest mean 4.18±0.21, followed by Pain management strategies with 3.92±0.27. In the association between knowledge and healing, the best scores were in patients with at least one healed VU. Conclusion: The knowledge of the patients was moderate and it was necessary to promote educational actions according to individual demands.

Abstract P199: Keep Moving, Your Health Depends On It: Impact Of Improved Physical Activity And Weight Loss In A Wellness Program

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Ebenezer T Oni ◽  
Ehimen Aneni ◽  
Maribeth Rouseff ◽  
Thinh Tran ◽  
Henry Guzman ◽  
...  
Keyword(s):  
Physical Activity ◽  
Blood Pressure ◽  
Weight Loss ◽  
Intervention Program ◽  
South Florida ◽  
Metabolic Equivalents ◽  
Baseline Weight ◽  
The Mean ◽  
The Difference

Negative impact of CVD as the leading cause of death in the US is worsened by the significant burden of obesity and associated morbidity and concerns about the growing population inactivity. The American Heart Association has emphasized worksite-based interventions to improve CV health. We evaluated the benefits of improved physical activity(PA) and weight loss(WL) among employees of the Baptist Health South Florida enrolled in a wellness intervention program. Methods: Employees with two or more Cardio-metabolic risk factors , such as total cholesterol ≥ 200 mg/dl, systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg, hemoglobin A1C ≥ 6.5%, and body mass index (BMI) ≥ 30 were enrolled in an intervention program themed “My unlimited potential”. Interventions were focused on diet and PA modifications. We defined improved physical activity as the difference in the metabolic equivalents (METs) at 12 weeks follow-up and at baseline. WL (lbs) was the difference in weight at follow-up. The relationship between WL and changes in METs was explored in an ordered logistic regression. Results: Overall 203 (48±10 years, 78% females) employees were enrolled with a retention rate of 89% (n=181) at 12 weeks follow-up. At baseline the median weights was 211 lbs., and mean METs- 8.6, while at follow-up the median weight was 200 lbs, and the mean METs 11. At 12 weeks follow up 38% had significant WL (lost >5% of baseline weight). The median WL was 8.4 (IQR 4.8-13.0) lbs and the mean change in METs was 2.4±1.8. Median WL increased with increasing tertiles of METs change; tertile1- 6.5(4-11) lbs., tertile2- 9(6-13)lbs. tertile3- 11(7-15)lbs. Increased PA was related to increased WL across BMI categories adjusting for age, gender and baseline weight. Conclusion: This study points strongly toward the benefit of increasing PA among other lifestyle modification interventions in controlling weight. Although further follow-up of this population to evaluate sustainability of change is needed, our results clearly relate improved PA and health.

Promoting Better Healthcare for Patients in Critical Condition

2019 ◽  
pp. 97-117
Author(s):  
Itamir Barroca ◽  
Gibeon Aquino ◽  
Maria Alzete Lima
Keyword(s):  
Chronic Disease ◽  
Internet Of Things ◽  
Remote Monitoring ◽  
Critical Condition ◽  
Healthcare Services ◽  
The Internet ◽  
New Paradigm ◽  
Underdeveloped Countries ◽  
Global Concern ◽  
The Internet Of Things

The high cost of healthcare services, the aging population and the increase of chronic disease is becoming a global concern. Several studies have indicated the need to minimize the process of hospitalization and the high cost of patient care. A promising trend in healthcare is to move the routines of medical checks from a hospital to the patient's home. Moreover, recent advances in microelectronics have boosted the advent of a revolutionary model involving systems and communication technology. This new paradigm, the Internet of Things (IoT), has a broad applicability in several areas, including healthcare. Based on this context, this chapter aims to describe a computer platform based on IoT for the remote monitoring of patients in critical condition. Furthermore, it is planned to approach the current advances and challenges of conceiving and developing a set of technology-centric, targeting issues relevant to underdeveloped countries, particularly in regards to Brazil's health infrastructure.

Weight Loss Education: The Challenge of a New Paradigm

1998 ◽  
Vol 25 (4) ◽  
pp. 464-473 ◽  
Author(s):  
Julie Gast ◽  
Steven R. Hawks
Keyword(s):  
Weight Loss ◽  
New Paradigm

Lifestyle Intervention’s Effect and Predictive Value on Weight Loss for University Employees

2020 ◽  
pp. 019394592094700
Author(s):  
Elizabeth Wang ◽  
Azza H. Ahmed ◽  
Pi-Ju Liu ◽  
Elizabeth A. Richards
Keyword(s):  
Blood Pressure ◽  
Weight Loss ◽  
Chronic Disease ◽  
Linear Model ◽  
Disease Risk ◽  
Health Improvement ◽  
Regression Analyses ◽  
Post Intervention ◽  
Improvement Program ◽  
Biometric Data

Obesity is a costly and pervasive risk factor that requires attention to reduce chronic disease rates. This study evaluated the effect of a lifestyle medicine intervention, Complete Health Improvement Program (CHIP), on reducing weight, blood pressure, lipid levels, and hemoglobin A1c. A secondary aim was to build a preliminary predictive model for computing new participants’ potential weight change from CHIP. We evaluated pre- and post-intervention biometric data of 68 individuals who completed a 10-week CHIP intervention at a Midwestern university clinic. Significant reductions ( p < 0.05) were observed in weight, diastolic blood pressure, total cholesterol, low-density lipoprotein, and A1c. Regression analyses indicated that the best linear model for predicting change in weight was a one-predictor model with systolic blood pressure. The CHIP intervention effectively promoted weight loss and meaningful reductions in chronic disease risk factors. Larger samples are needed for future regression analyses to create a more robust linear model.

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