Amelia Hollywood

Undergoing prenatal screening for Down's syndrome: presentation of choice and information in Europe and Asia

To date, studies assessing whether the information given to people about screening tests facilitates informed choices have focussed mainly on the UK, US and Australia. The extent to which written information given in other countries facilitates informed choices is not known. The aim of this study is to describe the presentation of choice and information about Downs syndrome in written information about prenatal screening given to pregnant women in five European and two Asian countries. Leaflets were obtained from clinicians in UK, Netherlands, Spain, Italy, Czech Republic, China and India. Two analyses were conducted. First, all relevant text relating to the choice about undergoing screening was extracted and described. Second, each separate piece of information or statement about the condition being screened for was extracted and then coded as either positive, negative or neutral. Only Downs syndrome was included in the analysis since there was relatively little information about other conditions. There was a strong emphasis on choice and the need for discussion about prenatal screening tests in the leaflets from the UK and Netherlands. The leaflet from the UK gave most information about Downs syndrome and the smallest proportion of negative information. By contrast, the Chinese leaflet did not mention choice and gave the most negative information about Downs syndrome. Leaflets from the other countries were more variable. This variation may reflect cultural differences in attitudes to informed choice or a failure to facilitate informed choice in practice. More detailed studies are needed to explore this further.

Taking Orlistat: Predicting Weight Loss over 6 Months

This study explored the predictors of weight loss following orlistat with a focus on both baseline variables and changes in beliefs and behaviours occurring over the course of taking the drug. Patients (n = 566) prescribed orlistat completed a questionnaire at baseline and after 6 months concerning their weight, beliefs and behaviours. By 6 months the majority had lost some weight and showed improvements in diet. Many had also stopped taking the drug and a large minority reported using it flexibly as a lifestyle drug. Those who lost most weight showed a decrease in beliefs in a medical solution, a decrease in unhealthy eating, an increased belief in treatment control and an increased belief that the unpleasant consequences are both due to their eating behaviour and just part of the drug. When taken with fatty food orlistat causes symptoms such as anal leakage and oily stools. These may encourage some patients to focus on the behavioural aspects of their weight problem thus promoting the dietary changes needed for both short and longer term weight loss. When prescribing orlistat, clinicians should encourage patients to see the consequences as an education as a means to promote the effectiveness of this form of medical management.

The impact of a bariatric rehabilitation service on weight loss and psychological adjustment--study protocol.

BackgroundBariatric surgery is currently the most effective form of obesity management for those whose BMI is greater than 40 (or 35 with co morbidities). A minority of patients, however, either do not show the desired loss of excess weight or show weight regain by follow up. Research highlights some of the reasons for this variability, most of which centres on the absence of any psychological support with patients describing how although surgery fixes their body, psychological issues relating to dietary control, self esteem, coping and emotional eating remain neglected.The present study aims to evaluate the impact of a health psychology led bariatric rehabilitation service (BRS) on patient health outcomes. The bariatric rehabilitation service will provide information, support and mentoring pre and post surgery and will address psychological issues such as dietary control, self esteem, coping and emotional eating. The package reflects the rehabilitation services now common place for patients post heart attack and stroke which have been shown to improve patient health outcomes.Methods/DesignThe study is a randomised control trial and patients will be allocated to receive either usual care or the bariatric rehabilitation service pre and post bariatric surgery. Follow up measures of weight loss and psychological issues will be taken at baseline (2 weeks preoperatively), 3, 6 and 12 months postoperatively. The contents of the bariatric service and the follow up measures are based on previous pilot work and have been developed further by the research team working closely with two patient support groups (BOSPA & WLSinfo). This study will take place in St Richards Hospital in Chichester in the UK.DiscussionIt is predicted that a bariatric rehabilitation service will improve weight loss following surgery and will also facilitate changes in other psychological variables such as quality of life, dietary control, self esteem, coping and emotional eating. This also has cost implications for the NHS and other healthcare providers as improved effectiveness of bariatric surgery reduces the health costs of obese patients in the longer term.Trial registrationClinicalTrials.gov NCT01264120.

Informed choice to undergo prenatal screening for thalassemia: a description of written information given to pregnant women in Europe and beyond

To investigate whether prenatal screening for thalassemia is presented as a choice, and how the condition is described in written information given to pregnant women in different countries.

Gaining weight after taking orlistat: A qualitative study of patients at 18-months follow-up:

Orlistat is currently the only prescribed form of pharmacological management for obesity and functions by reducing the amount of fat absorbed from food eaten. Although frequently prescribed, there is marked variability in outcomes. A total of 10 participants’ experiences of gaining weight after taking orlistat were analysed using thematic analysis. Participants attributed their failed weight loss to mechanisms of the medication, emphasised a medical model of obesity with barriers to their weight loss and other weight-loss methods which had also failed. Overall, their weight gain was considered an inevitable part of their self-identity, reflecting their self-fulfilling prophecy of being a perpetual dieter.

Reply to Comment on “The Impact of Psychological Support on Weight Loss Post Weight Loss Surgery: a Randomised Control Trial” Ratcliffe et al.

Dear Editor, Denise Ratcliffe and colleagues provide a thorough and useful critique of our paper in terms of the design of the trial and the content of the intervention [1]. In particular, they question the design in terms of the choice of weight loss as the being primary outcome, the end point being 12 months and the content of the intervention in terms of its focus, duration, timing, and dose. As a result, they challenge our conclusion which is described as Bpsychological input for bariatric patients is not necessary or useful^. We completely agree that weight loss is not the only important outcome from bariatric surgery. We acknowledge that there are tangible psychological outcomes such as binge eating and quality of life, as well as less tangible ones such as Bfeeling supported^ and Bwelcoming the chance to talk through problems with someone^. Hence, we published our second study on these psychological outcomes [2]. We also agree that 12 months is not the end of the story for bariatric patients. However, for pragmatic reasons (i.e., funding), the end point of the study was at 12 months post-surgery. Furthermore, we recognize the limitations of the intervention arm of our trial, and it is true that the intervention could have been different (e.g., longer sessions, more frequent sessions, multidisciplinary sessions, and group session). However, we designed an intervention that we considered would be practical and deliverable by the NHS if the trial demonstrated an improvement in outcomes. Finally, we also endorse their criticism that an intervention immediately before and after surgery may not be best placed given the history of weight regain and psychological problems which tend to occur between 18 and 24 months. This was included, however, as ameans to reflect theNICE guidelines which recommend that psychological support is provided before and after surgery. We do not, however, agree with their criticism of our conclusion that Bpsychological input for bariatric patients is not necessary or useful^ as this is not our conclusion. The conclusion of our randomized controlled trial was that Bpsychological support immediately preand post-surgery was found to have no effect on weight loss at 1 year .̂ We discussed that Bpsychological support may therefore be more effective if delivered after this first year^ and that Bpsychological input may best be reserved in a targeted manner rather than being applicable to every patient in the postoperative setting^. NICE guidelines argue for psychological support preand post-surgery. NHS funding is limited and most patients are not * Jane Ogden J.Ogden@surrey.ac.uk

Health-Related Quality of Life Before and After Bariatric Surgery

Over recent years it has become increasingly clear that health related quality of life (HRQoL) is an important outcome for assessing the effectiveness of bariatric surgery. HRQoL can be measured using uni dimensional tools to assess factors such as mobility, mood, self esteem or eating behavior or multidimensional tools which assess health status in the broadest sense. This chapter will present these different measurement tools and describe their use across a range of studies in the context of bariatric surgery. It will then evaluate the pros and cons of each tool and consider the issues relevant for identifying the best tool for any given situation. Finally, the chapter will conclude that there is no one measure of HRQoL that meets all research or clinical needs for bariatric surgery and that the choice of measure should take into account the definition of HRQoL being used, the function of the measure being used and the practicalities of the data collection process.