[Show abstract][Hide abstract] ABSTRACT: To assess the impact on sexual function attributed to lower urinary tract dysfunction in a female obese population.
We performed a case-control study based on the registry of a university hospital obesity unit. A consecutive sample of women with body mass index(BMI) >or=30 (obese) was randomly matched by age, gender and residential county to control subjects using the computerized Register of the Total Population. Data were collected by a self-reported postal survey including the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12).
The questionnaire was completed and returned by 279/446 patients (62%) and 430/892 control subjects (48%). Obese women reported significantly lesser satisfaction with their sexual life, more frequent symptoms of urinary incontinence at intercourse, more often fear of urine leakage at intercourse, a higher tendency toward avoiding intercourse and more frequent feelings of guilt and disgust during intercourse (P<0.001). While considering sexual function in a subset of women with urge or stress urinary incontinence, the overall PISQ-12 scores were significantly lower in obese women compared to their age-matched nonobese controls for both the conditions (P<0.001). In an adjusted multivariate analysis, a BMI >30 was independently associated with a significantly increased risk for sexual dysfunction (odds ratio (OR) 1.8; 95% confidence interval (CI) 1.1-2.9), as were symptoms of urge or stress urinary incontinence (OR, 2.0; 95% CI, 1.3-3.1 and OR, 2.6; 95% CI, 1.7-4.0), respectively.
Urge and stress urinary incontinences are more common and have greater impact on sexual function in obese women.
International journal of obesity (2005) 06/2008; 32(8):1312-8. DOI:10.1038/ijo.2008.67 · 5.39 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objectives of this study was to estimate the risk of anal incontinence in morbidly obese women and to identify risk factors associated with anal incontinence in an obese population sample. A case-control study based on the registry of a university hospital obesity unit. A consecutive sample of women with body mass index > or = 35 (obesity class II) was randomly matched by age, gender and residential county to control subjects using the computerised Register of the Total Population. Data were collected by a self-reported postal survey including detailed questions on medical and obstetrical history, obesity history, socioeconomic indices, life style factors and the validated Cleveland Clinic Incontinence Score. The questionnaire was returned by 131/179 (73%) of the cases and 453/892 (51%) of the control subjects. Compared to the control group, obese women reported a significantly increased defecation frequency (p < 0.001), inability to discriminate between flatus and faeces (p < 0.001) and flatus incontinence (p < 0.001). Compared with non-obese women, the adjusted odds ratio (OR) for flatus incontinence in morbidly obese women was 1.5 [95% confidence interval (CI) 1.1-4.1]. A history of obstetric sphincter injury was independently associated with an increased risk of flatus incontinence (OR, 4.3; 95% CI, 2.0-9.2) and incontinence of loose stools (OR, 6.6; 95% CI, 1.4-31.4). Other medical and life style interactions did not remain at significant levels in an adjusted multivariable analysis. Obese women are at increased risk for mild to moderate flatus incontinence.
International Urogynecology Journal 11/2007; 18(11):1283-9. DOI:10.1007/s00192-007-0341-9 · 2.16 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Aims: To estimate the prevalence and severity of nocturia and lower urinary tract symptoms in obese women and to identify risk factors associated with nocturia in an obese population.Methods: We performed a case-control study based on the registry of a university hospital obesity unit. A consecutive sample of women with body mass index ≥30 (obese) was randomly matched by age, gender and residential county to control subjects using the computerised register of the total population. Data were collected by a self-reported postal survey.Results: The questionnaire was completed and returned by 279/446 of the patients (62%) and 430/892 control subjects (48%). Compared to the non-obese control group, obese women reported a significantly increased prevalence and bother of nocturia (p < 0.001), frequent urination (p < 0.001) and bothersome experience of urination (p = 0.037). Moreover, they experienced significantly increased frequency of urinary urgency (p < 0.001), of urge urinary incontinence (p < 0.001) and of bladder emptying difficulties (p = 0.002). The adjusted odds ratio (95% CI) in obese women was 2.8 (1.0-7.9) for nocturia, 4.7 (1.5-14.6) for frequent urination, 5.5 (1.7-17.2) for strong urge to empty bladder and 7.2 (2.2-23.3) for urine leakage related to the feeling of urgency.Conclusion: Obese women are at substantially increased risk for nocturia and overactive bladder symptoms.
Obesity Research & Clinical Practice 10/2007; 1(3):I-II. DOI:10.1016/j.orcp.2007.07.001 · 1.18 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to explore the outcome and the problems of drop-out in the treatment of obese outpatients at an academic obesity unit.
A two-year clinical treatment evaluation.
A total of 117 obese subjects, 83 women and 34 men, mean aged 50 (23-70) years, with an average body mass index (BMI) of 39.0 kg/m2 (28.8- 64.7).
All treatment was based on group therapy and included behaviour modification and nutrition counselling. A team of nurses, dieticians, a physiotherapist, a psychotherapist and a physician supervised the treatment. Two programmes were used. Group 1 initially received a low-calorie diet (LCD) for seven weeks combined with the behaviour treatment programme. Group 2 was treated with the behaviour treatment programme only. All subjects were offered complementary treatment according to their medical needs.
There was a continuous drop-out of subjects during the two-year treatment period with an overall drop-out rate of 53%. Anthropometric characteristics, medical history or reasons for drop-out had no impact on the drop-out rate. In completers the weight reduction after two years was 9.2 [+/-10.8 standard deviation (S.D.) kg. In non-completers the weight reduction of the last observed weight measurement was 4.7 (+/-7.9 S.D.) kg. After year two, the weight reduction in Group 1 was 8.8 (+/-12.2 S.D.) kg, and in Group 2 was 9.7 (+/-8.0 S.D.) kg.
This study has showed the difficulties of long-term clinical treatment of obese outpatients, even in a specialised obesity clinic. The findings demonstrate that educated and experienced staff together with an extended package of treatment options is not enough to keep patients in treatment for two years. However though the drop-out rate was high, two thirds of the included subjects reduced their weight, which is a satisfactory result in a clinical setting. The drop-out rate and the reasons for dropping out could give a clue in which direction the diagnostics and analysis of the subject's individual needs in health care should be directed.
[Show abstract][Hide abstract] ABSTRACT: The objective of this study was to explore whether there were differences in organisational setting and professional intervention between health professionals who, after 1 year of education, and ongoing supervision for all together 30 months, started obesity treatment and those who did not. Furthermore to analyse what factors facilitate the start of obesity treatment. One hundred and seventy-one health professionals from different parts of Sweden were included in the education. One hundred and thirty-five health professionals remained in the study for up to 2.5 years. Eighty-seven subjects started the obesity treatment program, whereas 48 subjects had no possibility to start treatment. Significantly more of those who started the behavioural treatment program had previous theoretical education and clinical experience of obesity. They also, to a greater degree, had a go-ahead from the management and support from physicians, colleagues and were more likely to be part of a team or had a colleague to work with. In addition, they could find the time to organise and plan the treatment. Supervision had a significant positive influence on starting up the treatment program. Education, working organization, a structural behavioural treatment program, seems to be significant factors in facilitating and increasing the likelihood for a start.
[Show abstract][Hide abstract] ABSTRACT: To compare two group treatment programmes for obese outpatients. Both programmes included behaviour modification, nutrition counselling, very-low-calorie diet (VLCD) and a continuous measuring of metabolic and anthropometrical status, but they differed regarding the treatment intensiveness. The main aim was to study whether intensive treatment gives a larger weight reduction compared with less intensive treatment and what level of input from health care personnel is needed to reach adequate treatment results.
A 2-y randomised clinical trial.
A total of 43 obese subjects aged 24-60 y, BMI 35 kg/m(2) (29-48).
Two programmes were used. Both were based on group therapy and were supervised by a dietitian and a psychologist. Group 1 received a continuous intensive treatment with planned group meetings every fortnight during the first year and six group meetings the second year. Group 2 had planned group meetings every third month. Anthropometrical and metabolic data were measured every third month in both groups. The VLCD periods were the same.
There was no evidence that a more intensive treatment promotes a larger weight reduction. Weight reduction after 1 y: group 1, -7.6 (+/-0.97) kg, BMI -2.6 (+/-0.3) kg/m(2); group 2, -6.4 (+/-1.16) kg, BMI -2.2 (+/-0.4) kg/m(2). Weight reduction after 2 y: group 1, -6.8 (+/-1.4) kg, BMI -2.4 (+/-0.3) kg/m(2); group 2, -8.6 (+/-1.6) kg, BMI -3.0 (+/-0.3) kg/m(2). The dropout rate was 26%.
There were no significant differences in weight reduction, compliance or dropout rate between the groups and there was no evidence that a more intensive treatment promotes a larger weight reduction. This observation is of value when setting up treatment programmes. To measure the metabolic and anthropometrical status during the treatment and to give continuous feedback to the subjects seem to be important factors for compliance. Both treatment programmes gave highly significant weight reductions in the range of 5-10%, which has been referred to as a realistic goal for the treatment of obese patients.
International Journal of Obesity 10/2003; 27(9):1127-35. DOI:10.1038/sj.ijo.0802372 · 5.39 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objective was to create a method/model that works in practical clinical treatment for health care personnel as well as for the patients, to educate and supervise health care staff according to this model and to initiate long-term treatment of obese patients in a health care setting. The hypothesis was that it is possible to successfully initiate behavior-modified treatment in the form of a structured treatment program as a method and a tool adapted to use in health care. The aim of this article is to describe an extensive structural cognitive behavioral treatment program for patients. The treatment program is documented in a handbook for supervisors and a self-monitoring book for patients. This handbook is used in the education of the health care personnel and supports the supervisor in the clinical work with the patients. The main purpose of all individual or group treatment is to bring about reduction of body weight or weight control. To obtain weight control through lifestyle changes a balance has to be found between eating behavior, physical activity and body weight control. To reach this kind of balance it is important to have treatment programs where the aim and goals are clearly declared. The structure and the content of the program shall motivate and create interest for changes in the overweight person's behavior. This treatment program includes a schematic survey and an example of a structured treatment program. Over the last few years, 850 nurses, dietitians and other health care personnel have been educated, representing 400 primary health care centers and hospitals within Sweden. Overall these participants find their education and supervision meaningful and valuable.
[Show abstract][Hide abstract] ABSTRACT: The object of this study was to examine whether eating behavior, food preference, gastric emptying, and gut hormone patterns are altered after jejunoileal bypass (JIB) in patients with severe obesity. Eight obese [mean (+/- SD) body mass index (BMI; in kg/m2) 42.9 +/- 4] subjects were studied prospectively before and 9 mo after JIB with eight age- and sex-matched normal-weight control subjects. Total energy intake, data from the universal eating monitor (VIKTOR), eating motivation measured by visual analog scales, a food-preference checklist, a forced-choice list, solid-phase gastric emptying, and postprandial concentrations of cholecystokinin, motilin, and neurotensin were studied. BMI was reduced by 29% after JIB. Compared with normal subjects, the JIB patients showed a reduced desire to eat, decreased hunger, and reduced prospective consumption before a test meal. After surgery, obese subjects selected fewer food items and showed a reduced preference for high-carbohydrate and high-fat items before a test meal. There was a trend from an accelerated toward a decelerated eating pattern in obese subjects after JIB. After JIB, gastric emptying of obese subjects was slowed and similar to that in control subjects. Obese subjects had lower postprandial cholecystokinin concentrations that were lower than those of control subjects both before and after JIB. Postprandial concentrations of neurotensin were higher after JIB. We conclude that after JIB, the desire to eat and preference for high-carbohydrate and high-fat items is reduced, resulting in decreased energy intake. That gastric emptying is prolonged and gut hormone patterns are altered with low postprandial plasma cholecystokinin and high neurotensin plasma concentrations may at least partly account for these observations.
American Journal of Clinical Nutrition 08/1997; 66(1):26-32. · 6.92 Impact Factor