Helena Piccinini-Vallis

Blame, Shame, and Lack of Support: A Multilevel Study on Obesity Management

In this research, we examined the experiences of individuals living with obesity, the perceptions of health care providers, and the role of social, institutional, and political structures in the management of obesity. We used feminist poststructuralism as the guiding methodology because it questions everyday practices that many of us take for granted. We identified three key themes across the three participant groups: blame as a devastating relation of power, tensions in obesity management and prevention, and the prevailing medical management discourse. Our findings add to a growing body of literature that challenges a number of widely held assumptions about obesity within a health care system that is currently unsupportive of individuals living with obesity. Our identification of these three themes is an important finding in obesity management given the diversity of perspectives across the three groups and the tensions arising among them.

“It is not the diet; it is the mental part we need help with.” A multilevel analysis of psychological, emotional, and social well-being in obesity

ABSTRACT In this research, we explored the psychological, emotional, and social experiences of individuals living with obesity, and perceptions of health care providers. We conducted a theoretical thematic analysis using two theoretical frameworks applied to transcripts from a previous qualitative study. Themes from a mental well-being framework were subsequently categorized under five environmental levels of the Social-Ecological Model (SEM). Key mental well-being themes appeared across all levels of the SEM, except the policy level. For the individual environment, one main theme was food as a coping mechanism and source of emotional distress. In the interpersonal environment, two themes were (a) blame and shame by family members and friends because of their weight and (b) condemnation and lack of support from health professionals. In the organizational environment, one main theme was inadequate support for mental well-being issues in obesity management programmes. In the community environment, one major theme the negative mental well-being impact of the social stigma of obesity. An overarching theme of weight stigma and bias further shaped the predominant themes in each level of the SEM. Addressing weight stigma and bias, and promoting positive mental well-being are two important areas of focus for supportive management of individuals living with obesity.

Successful childhood obesity management in primary care in Canada: what are the odds?

Background. The management of a child presenting with obesity in a primary care setting can be viewed as a multi-step behavioral process with many perceived and actual barriers for families and primary care providers. In order to achieve the goal of behavior change and, ultimately, clinically meaningful weight management outcomes in a child who is considered obese, all steps in this process should ideally be completed. We sought to review the evidence for completing each step, and to estimate the population effect of secondary prevention of childhood obesity in Canada. Methods. Data from the 2009/2010 Canadian Community Health Survey and from a review of the literature were used to estimate the probabilities for completion of each step. A flow chart based on these probabilities was used to determine the proportion of children with obesity that would undergo and achieve clinically meaningful weight management outcomes each year in Canada. Results. We estimated that the probability of a child in Canada who presents with obesity achieving clinically meaningful weight management outcomes through secondary prevention in primary care is around 0.6% per year, with a range from 0.01% to 7.2% per year. The lack of accessible and effective weight management programs appeared to be the most important bottleneck in the process. Conclusions. In order to make progress towards supporting effective pediatric obesity management, efforts should focus on population-based primary prevention and a systems approach to change our obesogenic society, alongside the allocation of resources toward weight management approaches that are comprehensively offered, equitably distributed and robustly evaluated.

Obesity Prevention from Conception: A Workshop to Guide the Development of a Pan-Canadian Trial Targeting the Gestational Period

This report summarizes a meeting, Obesity Prevention from Conception, held in Ottawa in 2012. This planning workshop was funded by the Canadian Institutes of Health Research (CIHR) to bring together researchers with expertise in the area of maternal obesity (OB) and weight gain in pregnancy and pregnancy-related disease to attend a one-day workshop and symposium to discuss the development of a cross-Canada lifestyle intervention trial for targeting pregnant women. This future intervention will aim to reduce downstream OB in children through encouraging appropriate weight gain during the mothers pregnancy. The workshop served to (i) inform the development of a lifestyle intervention for women with a high pre-pregnancy body mass index (BMI), (ii) identify site investigators across Canada, and (iii) guide the development of a grant proposal focusing on the health of mom and baby. A brief summary of the presentations as well as the focus groups is presented for use in planning future research.

Healthcare providers’ gestational weight gain counselling practises and the influence of knowledge and attitudes: a cross-sectional mixed methods study

Objective To understand current gestational weight gain (GWG) counselling practices of healthcare providers, and the relationships between practices, knowledge and attitudes. Design Concurrent mixed methods with data integration: cross-sectional survey and semistructured interviews. Participants Prenatal healthcare providers in Canada: general practitioners, obstetricians, midwives, nurse practitioners and registered nurses in primary care settings. Results Typically, GWG information was provided early in pregnancy, but not discussed again unless there was a concern. Few routinely provided women with individualised GWG advice (21%), rate of GWG (16%) or discussed the risks of inappropriate GWG to mother and baby (20% and 19%). More routinely discussed physical activity (46%) and food requirements (28%); midwives did these two activities more frequently than all other disciplines (P<0.001). Midwives interviewed noted a focus on overall wellness instead of weight, and had longer appointment times which allowed them to provide more in-depth counselling. Regression results identified that the higher priority level that healthcare providers place on GWG, the more likely they were to report providing GWG advice and discussing risks of GWG outside recommendations (β=0.71, P<0.001) and discussing physical activity and food requirements (β=0.341, P<0.001). Interview data linked the priority level of GWG to length of appointments, financial compensation methods for healthcare providers and the midwifery versus medical model of care. Conclusions Interventions for healthcare providers to enhance GWG counselling practices should consider the range of factors that influence the priority level healthcare providers place on GWG counselling.

The 5As of healthy pregnancy weight gain: possible applications in the Brazilian context to improve maternal-fetal health.

Thus, there is a need to promote healthy pregnancy weight gain in an effort to optimize mater-nal-fetal outcomes and secure the future of public health in Brazil.A large body of evidence supports the importance of a healthy lifestyle (i.e. healthy eating behaviour, adequate sleep, stress management, regular physical activity and limiting sedentary behaviour) during pregnancy for both mother and fetus.