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Prevalencia de sobrepeso y obesidad en el personal de enfermería
Abstract
RESuMEN Antecedentes: en México se reconoce que la obesidad es un problema de salud pública muy importante, por lo cual, en diciembre de 1998, se publicó la Norma Oficial Mexicana para el Manejo Integral de la Obesidad. En la actualidad, para determinar el sobrepeso y la obesidad la herramienta clínica de mayor utilidad es el índice de masa corporal. El control del sobrepeso y la obesidad en el personal de salud es un área poco estudiada en México, a diferencia de países anglosajones donde han demostrado las complicaciones relacionadas con esta enfermedad. Objetivo: determinar la prevalencia del sobrepeso y la obesidad en el personal de enfermería de la Clínica Hospital ISSSTECALI de Ensenada. Pacientes y método: se realizó un estudio observacional y transversal de 107 enfermeros que laboran en la Clínica Hospital ISSSTE-CALI de Ensenada, BC; se evaluaron las variables de peso, edad, género e índice de masa corporal; los datos se procesaron mediante programas de cómputo como STATS v. 1.1 y Excel XP Profesional. Resultados: en el estudio, 80% de los participantes fueron mujeres. Se encontró que la edad fue de 21 a 64 años, con media de 34.6; el peso osciló entre 48 y 108 kg, con media de 67.13, y la talla fue de 147 a 170 cm, con media de 159. La prevalencia del sobrepeso fue del 18% y de la obesidad del 37%. Conclusiones: los resultados de este estudio demuestran que 55% del personal de enfermería de la Clínica Hospital ISSSTECALI tiene algún grado de sobrepeso y obesidad. Se necesitan estudios de seguimiento, identificación y modificación de los factores que predisponen al aumento de peso en los enfermeros para lograr el control adecuado que evite las complicaciones relacionadas con estas enfermedades. Palabras clave: índice de masa corporal, prevalencia, obesidad, sobrepeso. ABSTRACT Background: Obesity in Mexico is a very important public health issue, therefore, in December 1998 it was published the Official Mexican Guideline for Integral Management of Obesity. Body mass index (BMI) is one of the best clinical indicators of overweight and obesity. Controlling overweight and obesity among health personnel is a seldom studied area, unlike English spoken countries where complications associated to obesity and overweight are well documented. order to identify and modify predisposing factors to increasing body weight in nurses, and achieve control in order to avoid known complications of these pathologies.
... 7 El personal de salud no escapa a este fenómeno epidemiológico, en el que se ha registrado una prevalencia de sobrepeso y obesidad mayor del 50%, según varios estudios. 3,8,9,10 Además, se ha señalado un porcentaje más alto en personal de enfermería respecto del resto de los trabajadores de salud. ...
... 17 En este sentido, la OMS refiere en el documento "Salud de los trabajadores: plan de acción mundial 60 a Asamblea Mundial de la Salud", en el objetivo 2 (Proteger y promover la salud en el lugar de trabajo), que es preciso insistir en la promoción de la salud y la prevención de las enfermedades no transmisibles en el lugar de trabajo, sobre todo al alentar entre los trabajadores una dieta sana y actividad física, y promover la salud mental y familiar en el trabajo. 18 En virtud de la elevada prevalencia de sobrepeso y obesidad en el personal de salud, como se menciona en los artículos ya citados, 8,9,10 y de la escasa evidencia científica referente a sobrepeso y obesidad en relación con la autoestima de los profesionales de la salud, surgió el interés en este grupo de investigadores de llevar a cabo el estudio; para ello se partió de la siguiente pregunta: ¿cuál es la relación que tiene el sobrepeso y la obesidad con la autoestima en trabajadores de la salud? Además, se formuló la siguiente hipótesis: a mayor autoestima, menor peso en los trabajadores de la salud. ...
Resumen Introducción: el sobrepeso y la obesidad han tenido un alar-mante avance en las últimas décadas, por lo que la Organi-zación Mundial de la Salud señala que uno de los principales retos mundiales es el control del desmedido incremento ponderal de las sociedades, dado que se acompaña de en-fermedades metabólicas, años de vida perdidos ajustados por discapacidad y fallas psicológicas que la American Psychiatric Association considera un factor que altera el estado físico. Objetivo: identificar la relación que tiene el sobrepeso y la obesidad con la autoestima en los trabajadores de la salud. Metodología: estudio descriptivo y correlacional. El mues-treo fue aleatorio sistematizado. La muestra se constituyó con 220 trabajadores de la salud y personal administrativo. Para la recolección de los datos se utilizó una cédula sociodemo-gráfica, datos de sobrepeso, obesidad y la Escala de Autoestima de Rosenberg. Los datos se analizaron con el programa SPSS, versión 22. El estudio se apegó a lo dis-puesto en la Ley General de Salud en México. Resultados: se registró una prevalencia de obesidad de 43.6% y de sobrepeso de 37.3%. Ambas mostraron diferencias significa-tivas según la categoría laboral (chi cuadrada = 18.02, p = 0.05); se observó una relación entre la autoestima por género (chi cuadrada = 14.8, p = 0.05) y la categoría laboral (chi cuadra-da = 13.2, p = 0.02), y correlación negativa y significativa entre el sobrepeso, la obesidad y la autoestima (rs =-0.68, p = 0.01). Abstract Introduction: Overweight and obesity have presented an alarming advance in recent decades, which is why the World Health Organization points out that one of the main challenges facing countries worldwide is controlling the excessive weight increase that societies present, since this increase is associated with metabolic diseases, years of life adjusted for disability , and psychological failures that the American Psychiatric Association considers as a factor that affects physical status.
... Principalmente en lo tocante a conducta alimentaria, toxicomanías y actividad física. [7][8][9]13,[16][17][18][19] Lo anterior sugiere que pese a la amplia concepción de que el personal de la salud tiene conocimiento de las diversas causas de enfermedad y a que ha aprendido a reconocer el riesgo de eventos no saludables en sus pacientes, no siempre es capaz de reconocer el riesgo propio de enfermar o morir, 12 evidenciándose un pobre reconocimiento de su rol en la educación para la salud. Evento señalado como promotor de disminución en la frecuencia de las exhortaciones hechas a sus pacientes en estos tópicos 7 y, probablemente comprometiendo la credibilidad de su consejo. ...
... La década de los noventas marcó el inicio de la investigación en hábitos y estilos de vida entre profesionales de la salud en América Latina. [6][7][8][9]12,13,16,18,19 La difusión de sus resultados brindó elementos que, con el paso de los años, han conformado un panorama situacional bien definido y en términos de salud sumamente incongruente. El estilo de vida entre los trabajadores del ISEA es consistente a ese paradigma, máxime en lo concerniente a prácticas alimentarias y actividad física, fenómeno que ha determinado la gran incidencia de trastornos de la composición corporal (característicos de los estados de sobrenutrición) presentada en este estudio, más notoriamente en el grupo masculino. ...
Objetivo. Caracterizar el estilo de vida presente entre el personal adscrito al primer nivel de atención del Instituto de Salud del Estado de Aguascalientes (ISEA), México y analizar posibles factores promotores o limitantes de conductas saludables. Material y Métodos. Se realizó un estudio observacional descriptivo transversal, estudiando a 124 trabajadores con adscripción al primer nivel de atención sanitaria (centros de salud y oficinas centrales del ISEA, durante el periodo de enero a marzo de 2008. Previa adaptación, se aplicó el cuestionario de Prácticas y Creencias Sobre Estilos de Vida, tomado de Salazar y Arrivillaga, que con metodología autoaplicable compiló información sobre su estilo de vida y algunas características sociodemográficas. Conjuntamente, los participantes fueron evaluados antropométricamente y por prueba de inferencia de adiposidad corpórea por impedancia bioeléctrica, parámetros que fungieron como unidades de análisis para la categorización de los sujetos. Análisis estadísticos en tablas de contingencia utilizando la prueba Ji2 y medidas de asociación fueron realizadas. Resultados. Con una distribución por género de 79 mujeres (63.7%) por 45 hombres (36.29%), se encontró una prevalencia de sobrepeso y obesidad del 66.9% (por IMC) y un exceso de adiposidad corpórea en el 83.9% de los participantes; siendo los varones quienes contaron con la representación nutricia más desfavorable; en loque respecta al análisis glucémico, niveles de alteración glucémica en ayuno fueron detectados en 26 participantes (21%); 7 de los cuales (5.6%) llegaron a presentar cifras sugerentes de diabetes. La evaluación de la tensión arterial, proyectó a un total de 68 participantes (54%) con registros sistólico, diastólico o ambos, alterados. El 59.6% de los participantes cursó con sedentarismo y en línea de toxicomanías el 21.8% refirió tabaquismo activo; cifras pobremente diferenciadas de las de la población corriente de 20 años o más en Aguascalientes. No fue identificada asociación significativa entre los valores elevados de IMC, exceso de adiposidad corporal y ninguno de los escenarios socioeconómicos y conductuales considerados para el análisis, dado que los portadores de dichas condiciones mantuvieron una representación importante en todos los ámbitos. Asimismo, no fue identificada asociación respecto de los patrones de actividad física y la incidencia de tabaquismo. Conclusiones. El estilo de vida entre trabajadores del ISEA denota un pobre dominio de la conducta alimentaria y sedentarismo generalizado, determinando balances energéticos positivos de cronicidad evidente, dadas las elevadas prevalencias de sobrepeso, obesidad y exceso de adiposidad corpórea. Por otra parte, se aprecian frecuencias en los consumos de tabaco y alcohol pobremente diferenciadas de las de la población general. Quedando manifiesto que el mero conocimiento sobre los procesos de salud-enfermedad no es suficiente para sustentar conductas pertinentes para el mantenimiento de la salud entre los profesionales del ámbito, lo que podría detrimentar la promoción de hábitos saludables en sus pacientes.
... En este trabajo no se encontró una relación entre el síndrome de fatiga crónica y esta variable; Young et al. 16 , encontraron una prevalencia de 43.4 % de sobrepeso y obesidad en trabajadores profesionales. Fong et al. 17 , en un estudio transversal realizado en México, en 107 trabajadores del personal de enfermería, encontraron una prevalencia de sobrepeso y obesidad del 55 %, sobrepasando la media nacional. Flores et al. 18 encontraron sobrepeso y obesidad en el 50 % de los pacientes diagnosticados con SFC. ...
El Síndrome de Fatiga Crónica (SFC) se caracteriza por cansancio persistente e inexplicado a pequeños esfuerzos tanto físicos como mentales, y suele acompañarse de un contexto sintomático tipo inflamatorio; su curso crónico y persistente ocasiona limitación funcional. Objetivo: Determinar la prevalencia del Síndrome de Fatiga Crónica y sus factores asociados en el personal de enfermería en un Hospital de Segundo Nivel. Métodos: Estudio prospectivo, transversal, analítico en personal de enfermería. Con una muestra total de 120 trabajadores, de las categorías de enfermera general y auxiliar enfermera general. Se aplicó un cuestionario ya validado con los criterios de diagnóstico del Síndrome de Fatiga Crónica del Center of Disease and Prevention (CDC), se realizó análisis de frecuencias simples. Resultados: La prevalencia fue de 6.7 %, afectando al género femenino, enfermeras en la cuarta década de la vida 4.2 %, la totalidad de los casos se presentaron en trabajadores con grado escolar de licenciatura, predominando en la categoría de auxiliar de enfermería 4.2 %. En cuanto a lo factores individuales, predomino el sobrepeso y la obesidad 5.8 %. Conclusión: La prevalencia en nuestra población de SFC es más alta de lo reportado en trabajos anteriores; la población más afectada similar a la reportada en diferentes estudios como es predominio en el sexo femenino y edad reproductiva.
... En cuanto a la distribución por grado de obesidad, 97 % comprendió los grados I y II en porcentaje similar y 3 % perteneció al grado III (Fong, Zazueta, Fletes y Pérez, 2006). ...
El objetivo de este trabajo fue determinar la relación entre el estado de peso/obesidad y la calidad de vida en una muestra del personal de enfermería que labora en la Clínica Hospital del Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE) Chilpancingo. Se trata de un estudio transversal, analítico, en el que participaron 109 enfermeras y enfermeros; se aplicó el Cuestionario de Salud SF-36. En el análisis de datos se calculó estadística descriptiva e inferencial y se contó con el consentimiento de la institución y de los participantes. Dentro de la muestra hubo 89.9 % mujeres y 10.1 % hombres. Y en relación con el estado de peso de los participantes, se identificó 38.5 % con sobrepeso, 19.5 % con obesidad grado I, 6.4 % con obesidad grado II y 35.8 % en su peso normal. Acerca de la calidad de vida de los participantes, el promedio del índice se encontró en 48.73 (DE = 7.31), correspondiente a características de una buena de calidad de vida. En cuanto a la relación de las variables entre calidad de vida y obesidad, fue positiva y estadísticamente significativa (X2 = 16.59 p < .05). Estos resultados muestran que existe una relación entre el estado de peso/obesidad y la calidad de vida del personal de enfermería. Asimismo, se recomienda diseñar estrategias para el estado de los participantes a partir de los resultados.
... De acuerdo con los criterios de la OMS, el personal de enfermería mostró mayor obesidad abdominal y si se toma en cuenta el ATP III, un mayor riesgo cardiovascular asociado a la alteración del ICC. Miller et al. reportaron una prevalencia aproximada del 54% de sobrepeso y obesidad en enfermeras de Las Vegas; 17 Mata et al., en personal de enfermería en su mayoría mujeres de 21 a 64 años de edad, de la Clínica Hospital ISSSTE-CALI de Ensenada, Baja California, México, reportaron una prevalencia de 55% de presencia de sobrepeso y obesidad; 18 Zonana Nacach et al. reportaron 9.6% de circunferencia de cintura anormal, 19 mientras que Martínez-Hernández et al. reportaron en el 2012 una prevalencia de obesidad central del 47.1%. 20 En relación con esto Smith et al. reportaron que enfermeras canadienses que trabajan en el turno nocturno o mixto presentan un IMC mayor que aquellas que tienen un horario regular diurno. ...
Background:
Anthropometric and blood pressure measurements are significant parameters in the assessment of cardiovascular risk (CVR). The aim was to establish the distribution of clinical-anthropometric parameters in health care workers according to the criteria established by WHO/JNC 7/ATP III.
Methods:
Observational, cross-sectional study in 350 workers of a general hospital. Definitions of anthropometric alterations were made considering the criteria established by WHO and the Asian ATP III, while altered blood pressure was defined by criteria JNC 7 and ATP III.
Results:
The average age of workers was 34 years. The prevalence of obesity, abdominal obesity, and impaired waist-hip ratio (WHR) was higher according to the ATP III criteria. The distribution of obesity prevailed in females, administrative personnel, and nursing according to WHO criteria, but there were no differences according to ATP III criteria. The WHR predominated in females and impaired blood pressure in males. 50% showed impaired capillary glucose. The number of anthropometric and clinical abnormalities, as well as its combinations, varied; most often it was found in one and three alterations with WHO and ATP III criteria, respectively.
Conclusions:
The prevalence of CVR factors in health workers is high, which is why we suggest to implement immediate action strategies to reduce its comorbidities and the institutional and personal costs related to these factors; we also encourage to apply the ATP criteria to decrease the subdiagnostic of CVR in this population.
... El síndrome de burnout fue descrito por el psiquiatra estadounidense interés innumerables autores desde principios de la década de los ochenta 19 . Diferentes estudios han encontrado difeburnout con el IMC 20,21 . ...
Objetivos: Estimar la prevalencia de síndrome metabólico (SM) entre las enfermeras del Hospital Juan A. Fernández (HJAF) y determinar si trabajo, descanso, dieta y estado de salud son sus predictores.
Material y métodos: Para el primer objetivo, el diseño del estudio es descriptivo, observacional y transversal. Para el segundo, comparación de muestras independientes, multivariable, observacional y transversal. Se estudió a 192 enfermeras entre octubre de 2008 y marzo de 2009. Se les realizó una encuesta autoaplicable con indicadores que podrían ser predictores de SM. Se tomaron mediciones antropométricas, presión arterial y extracción sanguínea para analizar glucemia en ayunas, colesterol unido a lipoproteínas de alta densidad y triglicéridos plasmáticos.
Resultados: El 35 y el 41% del personal de enfermería tenían sobrepeso y obesidad respectivamente. Un 92% del total tenía obesidad centroabdominal. La prevalencia de SM hallada es del 33,3% (intervalo de confianza del 95%, 26,7%-40,5%). Las afectas de SM tenían una media de edad de 53 ± 9 años. En el análisis bivariable se encontraron diferencias estadísticamente significativas entre el SM y las variables edad, tiempo de ejercicio profesional, tiempo trabajado en turno de noche y estudios realizados.
Conclusiones: La prevalencia de SM de enfermeras del HJAF fue de 64/192 (33,3%; intervalo de confianza del 95%, 26,7%-40,5%). Frente a la edad, los indicadores tiempo trabajado durante turno noche y estudios realizados no muestran diferencias estadísticamente significativas. Estos resultados indicarían que la edad es la variable más relevante para predecir la aparición de SM en la población de enfermeras.
... Respecto de las condiciones que incrementan el riesgo cardiovascular, la obesidad, que en nuestro estudio fue reportada en el 24,3% de los casos, con mayor frecuencia en varones, resultó más prevalente que el 18% hallado en población general en la Encuesta Nacional de Factores de Riesgo (ENFR) 39 , aunque inferior al publicado en un estudio sobre el personal de enfermería de un hospital en México donde se halló que el 37% padecía obesidad y el 18% sobrepeso 40 . La tensión arterial elevada (12,4%) tiene una prevalencia mucho menor a la detectada en la segunda ENFR, estimada en el 34,8% de la población general. ...
The purposes of this research were to describe work conditions, to identify work risks
detected by the worker and to estimate the frequency of health problems informed by
members of health teams in hospital in the city of Cordoba reporting to the Secretary of
Health of the province of Cordoba.
A cross sectional study was carried out on 453 workers belonging to provincial public
hospitals in the city of Cordoba, selected by simple random probability sampling, with a
level of confidence of 95% and sampling error of 5%; a self administered questionnaire
was used during the second half of 2012.
It was found that 35% of the staff have no permanent contracts. Having more than one
job is the case in 36% of those polled. Perception of biological risks affects 77.9%; 50.7% is
exposed to chemical substances and 51.7% handles heavy loads. The most frequent health
problems were: gastritis (28.3%), obesity (24.3%), low back pain (19.6%), sleep disorders
(14.1%), and high blood pressure (12.4%). The proportions of non stable workers and
employees with more than one job, as well as the high perception of risks in the work
environment should motivate the formulation of policies and regulations to improve work
and employment conditions.
Background
Overweight adults are at an increased risk of developing numerous chronic diseases.
Methods
Ten-year follow-up (1986-1996) of middle-aged women in the Nurses' Health Study and men in the Health Professionals Follow-up Study to assess the health risks associated with overweight.
Results
The risk of developing diabetes, gallstones, hypertension, heart disease, and stroke increased with severity of overweight among both women and men. Compared with their same-sex peers with a body mass index (BMI) (calculated as weight in kilograms divided by the square of height in meters) between 18.5 and 24.9, those with BMI of 35.0 or more were approximately 20 times more likely to develop diabetes (relative risk [RR], 17.0; 95% confidence interval [CI], 14.2-20.5 for women; RR, 23.4; 95% CI, 19.4-33.2 for men). Women who were overweight but not obese (ie, BMI between 25.0 and 29.9) were also significantly more likely than their leaner peers to develop gallstones (RR, 1.9), hypertension (RR, 1.7), high cholesterol level (RR, 1.1), and heart disease (RR, 1.4). The results were similar in men.
Conclusions
During 10 years of follow-up, the incidence of diabetes, gallstones, hypertension, heart disease, colon cancer, and stroke (men only) increased with degree of overweight in both men and women. Adults who were overweight but not obese (ie, 25.0≤BMI≤29.9) were at significantly increased risk of developing numerous health conditions. Moreover, the dose-response relationship between BMI and the risk of developing chronic diseases was evident even among adults in the upper half of the healthy weight range (ie, BMI of 22.0-24.9), suggesting that adults should try to maintain a BMI between 18.5 and 21.9 to minimize their risk of disease.
To compare levels of physical function, across levels of body mass index (BMI), among middle- to older-aged women.
Cross-sectional study. Physical function, body weight and other covariates were measured in 1992.
56510 women aged 45-71 y, free of cardiovascular disease and cancer, participating in the Nurses' Health Study.
The four physical function scores on the Medical Outcomes Study (MOS) Short Form-36 (SF36) Health Survey: physical functioning, vitality, bodily pain and role limitations.
After adjusting for age, race, smoking status, menopausal status, physical activity and alcohol consumption, there was a significant dose-response gradient between increasing levels of BMI in 1992 and reduced function. For example, women with a BMI between 30-34.9 kg/m2 averaged: 9.0 point lower physical functioning score (95% Confidence interval (CI) -9.5, -8.5), 5.6 point lower vitality score (95% CI: -6.1, -5.1), and 7.0 point lower freedom from pain score (95% CI: -7.6, -6.4). These declines represent an approximate 10% loss of function compared to the reference category of women with BMIs ranging from 22.0-23.9 kg/m2. For the same BMI comparison, heavier women were at 66% increased risk of limitations in ability to work or perform other roles (RR = 1.66; 95% odds ratio (OR) CI: 1.56, 1.76). These findings were replicated when the sample was restricted to women who had maintained their BMI over a ten year period.
In addition to increasing risk of chronic health conditions, greater adiposity is associated with lower every day physical functioning, such as climbing stairs or other moderate activities, as well as lower feelings of well-being and greater burden of pain.
To examine the relationship of obesity, measured as BMI, and weight change to incidence of coronary heart disease (CHD) among women with diabetes.
We followed 5,897 women with type 2 diabetes in the Nurses' Health Study for < or = 20 years. Women were aged 40-74 years and had no history of cardiovascular disease or cancer at the beginning of the follow-up period. BMI values from three time points (age 18 years, year 1976, and current) were derived from the reported height (1976) and corresponding reported weight. Weight changes between age 18 years and 1976 and after diagnosis of diabetes were calculated. Women reported diagnoses of diabetes and CHD every 2 years. Incident CHD cases were confirmed by medical record review.
During follow-up, we documented 418 incident cases of CHD (236 of nonfatal myocardial infarction and 182 of fatal CHD). After adjustment for age, smoking, and other coronary risk factors, current BMI was strongly associated with increased risk of CHD among diabetic women. The multivariate relative risks across increasing categories of BMI (<23.0, 23.0-24.9, 25.0-26.9, 27.0-29.9, 30.0-34.9, and > or = 35.0 kg/m(2)) were 1.0, 1.58, 1.85, 1.95, 2.80, and 3.21, respectively (P for trend <0.001). Increasing BMI values from age 18 years to 1976, before diagnosis of diabetes, were also positively associated with risk of CHD. Weight gain before the diagnosis of diabetes was related to increased risk of CHD. In contrast, weight change after diagnosis of diabetes was not associated with risk of CHD.
These findings provide strong evidence that obesity and weight gain before diagnosis of diabetes are associated with future risk of CHD among women with type 2 diabetes.
New treatment strategies have failed to control the global increase in obesity. Here two scientists discuss common barriers that need to be overcome by both healthcare professionals and patients if weight reduction is to be achieved and maintained
The 1980s and ‘90s witnessed alarming increases in obesity across the globe.1 This epidemic has not been slowed by new treatment strategies, leading some health professionals to doubt if they can help their patients. A recent audit documented wide variation in the management of overweight and obese patients in general practices in England and uncertainty about which treatments were most effective.2 Healthcare providers may fail to address obesity for many reasons, including cynicism about the efficacy of treatments, lack of time, perceived non-compliance of patients, and lack of training in counselling and motivating patients to change their behaviour. 3 4 Although the control of obesity ultimately requires population based strategies, doctors can and should provide effective individual care. We review evidence based recommendations for managing overweight and obese adults.
#### Summary points
We searched Medline (1966-March 2002) using the terms “obesity or overweight” and “practice guideline, systematic review, …
To examine general practitioners' (GPs) and practice nurses' (PNs) perceptions of obesity, their strategies and attitudes towards weight management, and their views on the major obstacles to (and need for) better weight management in primary care.
A qualitative study was carried out using semi-structured interviews with GPs and PNS within the Greater Glasgow Healthboard area.
GPs and PNs understood the problem of obesity but generally had little enthusiasm for weight management. Most of the GPs felt it was an inappropriate use of their time and passed obese patients onto the PNs; the PNs felt that obese patients were "off-loaded" onto them. Stated management objectives were aimed at "healthy lifestyle" rather than "unrealistic" weight loss, yet frustration at "lack of success" was a major theme. Lack of motivation on the part of the patient was seen as the major problem. GPs were keener to be directly involved when a concomitant disease was present. Suggested requirements to improve weight management at the level of primary care included more time, better facilities, community dieticians and more training courses. However, many felt that Government, media and public health had to take a leading role in order to deal with the problem effectively.
A comprehensive and integrative primary care-led approach to weight management may be possible but will need substantial shifts of resources, organisation, training and attitudes in order to maximise its potential impact.
Background: Obesity and rapid weight loss in obese persons are known risk factors for gallstones. However, the effect of intentional, long-term, moderate weight changes on the risk for gallstones is unclear. Objective: To study long-term weight patterns in a cohort of women and to examine the relation between weight pattern and risk for cholecystectomy. Design: Prospective cohort study. Setting: 11 U.S. states. Participants: 47 153 female registered nurses who did not undergo cholecystectomy before 1988. Measurements: Cholecystectomy between 1988 and 1994 (ascertained by patient self-report). Results: During the exposure period (1972 to 1988), there was evidence of substantial variation in weight due to intentional weight loss during adulthood. Among cohort patients, 54.9% reported weight cycling with at least one episode of intentional weight loss associated with regain. Of the total cohort, 20.1% were light cyclers (5 to 9 Ib of weight loss and gain), 18.8% were moderate cyclers (10 to 19 Ib of weight loss and gain), and 16.0% were severe cyclers (≥20 Ib of weight loss and gain). Net weight gain without cycling occurred in 29.3% of women; net weight loss without cycling was the least common pattern (4.6%). Only 11.1% of the cohort maintained weight within 5 Ib over the 16-year period. In the study, 1751 women had undergone cholecystectomy between 1988 and 1994. Compared with weight maintainers, the relative risk for cholecystectomy (adjusted for body mass index, age, alcohol intake, fat intake, and smoking) was 1.20 (95% CI, 0.96 to 1.50) among light cyclers, 1,31 among moderate cyclers (CI, 1.05 to 1.64), and 1.68 among severe cyclers (CI, 1.34 to 2.10). Conclusion: Weight cycling was highly prevalent in this large cohort of middle-aged women. The risk for cholecystectomy associated with weight cycling was substantial, independent of attained relative body weight.
The relationship between the degree of obesity and the incidence of cardiovascular disease (CVD) was reexamined in the 5209 men and women of the original Framingham cohort. Recent observations of disease occurrence over 26 years indicate that obesity, measured by Metropolitan Relative Weight, was a significant independent predictor of CVD, particularly among women. Multiple logistic regression analyses showed that Metropolitan Relative Weight, or percentage of desirable weight, on initial examination predicted 26-year incidence of coronary disease (both angina and coronary disease other than angina), coronary death and congestive heart failure in men independent of age, cholesterol, systolic blood pressure, cigarettes, left ventricular hypertrophy and glucose intolerance. Relative weight in women was also positively and independently associated with coronary disease, stroke, congestive failure, and coronary and CVD death. These data further show that weight gain after the young adult years conveyed an increased risk of CVD in both sexes that could not be attributed either to the initial weight or the levels of the risk factors that may have resulted from weight gain. Intervention in obesity, in addition to the well established risk factors, appears to be an advisable goal in the primary prevention of CVD.
To examine practice nurses' beliefs about obesity and their current practices and the role of the weight management context and their own BMI on these factors.
Cross sectional questionnaire.
Questionnaires concerning beliefs about obesity and current practices were completed by 586 practice nurses.
The subjects rated lifestyle as the main cause and cardiovascular problems as the main consequences of obesity, regarded weight loss as beneficial and reported high confidence in their ability to give advice to obese patients. However, their expectations of patient compliance and actual weight loss were low indicating that practice nurses rate their advice giving skills as independent to the outcome of this advice. Further, failed weight loss was explained in terms of patient and not professional factors. In addition, the results indicated variability in their beliefs and behaviour according to the location of this advice and the practice nurse's own BMI. In particular, practice nurses who run weight loss clinics reported giving weight loss advice more frequently, spending longer counselling obese patients, reported greater confidence in giving weight loss advice and more optimism about outcomes. Further, those with low BMIs rated obesity as more preventable, reported being less likely to advise patients to use a calorie controlled diet and more likely to suggest eating less in general.
Education programmes for practice nurses should not only include skills training but emphasise both the factors involved in advice giving and self appraisal. Such appraisal should include a role for both the practice nurse's and the patient's behaviour to minimise the 'operation was a success but the patient died' approach to obesity management.
Obesity increases the risk for hypertension, but the effects of modest long-term weight changes have not been precisely quantified.
To investigate body mass index (BMI) and weight change in relation to risk for hypertension.
Cohort study.
General community.
Cohort of 82,473 U.S. female nurses 30 to 55 years of age followed every 2 years since 1976. The follow-up rate was 95%.
Primary risk factors examined were 1) BMI at age 18 years and midlife and 2) long-term and medium-term weight changes. The outcome was incident cases of hypertension.
By 1992, 16,395 incident cases of hypertension had been diagnosed. After adjustment for multiple covariates, BMI at 18 years of age and midlife were positively associated with occurrence of hypertension (P for trend < 0.001). Long-term weight loss after 18 years of age was related to a significantly lower risk for hypertension, and weight gain dramatically increased the risk for hypertension (compared with weight change < or = 2 kg, multivariate relative risks were 0.85 for a loss of 5.0 to 9.9 kg, 0.74 for a loss > or = 10 kg, 1.74 for a gain of 5.0 to 9.9 kg, and 5.21 for a gain > or = 25.0 kg). Among women in the top tertile of baseline BMI at age 18 years, weight loss had a greater apparent benefit. The association between weight change and risk for hypertension was stronger in younger (< 45 years of age) than older women (> or = 55 years of age). Medium-term weight changes after 1976 showed similar relations to risk for hypertension.
Excess weight and even modest adult weight gain substantially increase risk for hypertension. Weight loss reduces the risk for hypertension.
Obesity and rapid weight loss in obese persons are known risk factors for gallstones. However, the effect of intentional, long-term, moderate weight changes on the risk for gallstones is unclear.
To study long-term weight patterns in a cohort of women and to examine the relation between weight pattern and risk for cholecystectomy.
Prospective cohort study.
11 U.S. states.
47,153 female registered nurses who did not undergo cholecystectomy before 1988.
Cholecystectomy between 1988 and 1994 (ascertained by patient self-report).
During the exposure period (1972 to 1988), there was evidence of substantial variation in weight due to intentional weight loss during adulthood. Among cohort patients, 54.9% reported weight cycling with at least one episode of intentional weight loss associated with regain. Of the total cohort, 20.1% were light cyclers (5 to 9 lb of weight loss and gain), 18.8% were moderate cyclers (10 to 19 lb of weight loss and gain), and 16.0% were severe cyclers (> or = 20 lb of weight loss and gain). Net weight gain without cycling occurred in 29.3% of women; net weight loss without cycling was the least common pattern (4.6%). Only 11.1% of the cohort maintained weight within 5 lb over the 16-year period. In the study, 1751 women had undergone cholecystectomy between 1988 and 1994. Compared with weight maintainers, the relative risk for cholecystectomy (adjusted for body mass index, age, alcohol intake, fat intake, and smoking) was 1.20 (95% CI, 0.96 to 1.50) among light cyclers, 1.31 among moderate cyclers (CI, 1.05 to 1.64), and 1.68 among severe cyclers (CI, 1.34 to 2.10).
Weight cycling was highly prevalent in this large cohort of middle-aged women. The risk for cholecystectomy associated with weight cycling was substantial, independent of attained relative body weight.
On the basis of a review of the current literature and recommendations, the American College of Preventive Medicine presents a practice policy statement on weight management counseling of overweight adults.
Obesity is a complex, multifactorial condition in which excess body fat may put a person at health risk. National data indicate that the prevalence of obesity in the United States is increasing in children and adults. Reversing these trends requires changes in individual behavior and the elimination of societal barriers to healthy lifestyle choices. Basic treatment of overweight and obese patients requires a comprehensive approach involving diet and nutrition, regular physical activity, and behavioral change, with an emphasis on long-term weight management rather than short-term extreme weight reduction. Physicians and other health professionals have an important role in promoting preventive measures and encouraging positive lifestyle behaviors, as well as identifying and treating obesity-related comorbidities. Health professionals also have a role in counseling patients about safe and effective weight loss and weight maintenance programs. Recent evidence-based guidelines from the National Heart, Lung, and Blood Institute, as well as recommendations from the American Academy of Pediatrics, American Association of Clinical Endocrinologists/American College of Endocrinology, American Obesity Association, U.S. Clinical Preventive Services Task Force, Institute of Medicine, and World Health Organization can be consulted for information and guidance on the identification and management of overweight and obese patients.
We studied whether several modifiable factors were associated with the risk of total hip replacement due to hip osteoarthritis among women.We identified 568 women from the Nurses' Health Study who reported total hip replacement due to primary hip osteoarthritis on questionnaires from 1990 to 1996, using a validated algorithm. The relation of potential risk factors, such as age, body mass index, physical activity, smoking, alcohol intake, and hormone use, to hip replacement was assessed using pooled logistic regression models. Higher body mass index was associated with an increased risk of hip replacement due to osteoarthritis (P for trend = 0.0001). Compared with women in the lowest category of body mass index (<22 kg/m(2)), those in the highest category of body mass index (> or =35 kg/m(2)) had a twofold increased risk (95% confidence interval [CI]: 1.4 to 2.8), whereas those in the highest category of body mass index at age 18 years had more than a fivefold increased risk (95% CI: 2.5 to 10.7). Age also had a positive association; women aged > or =70 years were nine times more likely to have hip replacement than those aged <55 years (95% CI: 5.4 to 13.9). Recreational physical activity, smoking, alcohol use, and postmenopausal hormone use were not associated with an increased risk of hip replacement. In the Nurses' Health Study, higher body mass index and older age significantly increased the risk of total hip replacement due to osteoarthritis. Part of this risk appeared to be established early in life.
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- Norma Oficial
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