Mary Forhan

The impact of obesity on quality of life

An important association exists between obesity and mental illness that impacts all aspects of an individuals quality of life. This association can begin early in the developmental trajectory and we do not yet completely understand all the mechanisms linking obesity and mental illness. What we e do know is that physical health factors that often occur secondary to obesity, combined with societal attitudes toward those that are obese coupled with iatrogenic treatment factors linked to psychiatric pharmacotherapy and a number of biologic mediators result in an important and increasing common comorbidity. Recognizing this association is essential for the proper management of both conditions. The following review addresses this issue and provides clinical pearls to help deal with this issue.

A multinational examination of weight bias: predictors of anti-fat attitudes across four countries

Background/Objectives:As rates of obesity have increased throughout much of the world, so too have bias and prejudice toward people with higher body weight (that is, weight bias). Despite considerable evidence of weight bias in the United States, little work has examined its extent and antecedents across different nations. The present study conducted a multinational examination of weight bias in four Western countries with comparable prevalence rates of adult overweight and obesity.Methods:Using comprehensive self-report measures with 2866 individuals in Canada, the United States, Iceland and Australia, the authors assessed (1) levels of explicit weight bias (using the Fat Phobia Scale and the Universal Measure of Bias) and multiple sociodemographic predictors (for example, sex, age, race/ethnicity and educational attainment) of weight-biased attitudes and (2) the extent to which weight-related variables, including participants’ own body weight, personal experiences with weight bias and causal attributions of obesity, play a role in expressions of weight bias in different countries.Results:The extent of weight bias was consistent across countries, and in each nation attributions of behavioral causes of obesity predicted stronger weight bias, as did beliefs that obesity is attributable to lack of willpower and personal responsibility. In addition, across all countries the magnitude of weight bias was stronger among men and among individuals without family or friends who had experienced this form of bias.Conclusions:These findings offer new insights and important implications regarding sociocultural factors that may fuel weight bias across different cultural contexts, and for targets of stigma-reduction efforts in different countries.

Obesity, functional mobility and quality of life

Obesity is a health condition that, through a complex interaction of biopsychosocial and environmental factors, is associated with mobility disability. The mobility disability experienced by persons with obesity is associated with reduced health related quality of life (HRQoL) compared to persons without obesity. This paper will review and discuss functional mobility and its relationship to HRQoL for persons living with obesity. This will be done by conducting a review of the literature in the area of obesity and functional mobility and its association with HRQoL. Recommendations to address the known factors that contribute to mobility disability and reduced quality of life are outlined while suggestions for research to contribute to best practice to enable mobility for persons with obesity are made.

Inequities in Healthcare: A Review of Bias and Discrimination in Obesity Treatment

This review is based on an exploration of the published literature over the past 20 years in the area of weight bias, stigma and discrimination and its association with obesity treatment. National and international obesity organizations have identified obesity stigma as a key barrier to effectively addressing the obesity epidemic and have called for theory driven interventions to reduce it. Both the Canadian Obesity Network (http://www.obesitynetwork.ca) and the Obesity Society (http://www.obesity.org) have strategic directions, mission statements and collaborations that strongly oppose weight bias and recognize the potential of such bias to negatively impact obesity treatment. Comprehensive reviews of the literature in the area of weight bias have been published and have subsequently raised awareness of the potential impact of weight bias and discrimination on the health and well-being of individuals living with obesity. The purpose of this review is to highlight drivers of weight bias and to discuss its impact on obesity treatment.

A systematic review of the quality of psychometric evidence supporting the use of an obesity-specific quality of life measure for use with persons who have class III obesity.

With global obesity rates at 42%, there is a need for high‐quality outcome measures that capture important aspects of quality of life for persons with obesity. The aim of this paper was to systematically review and critique the psychometric properties and utility of the impact of weight on quality of life‐lite (IWQOL‐Lite) for use with persons who have class III obesity. Databases were searched for articles that addressed obesity‐specific quality of life. A critical appraisal of the psychometric properties of the IWQOL‐Lite and connection to a quality of life conceptual framework was completed. Raters used a standardized data extraction and quality appraisal form to guide evidence extraction. Two articles that reviewed obesity‐specific quality of life measures were found; none were based on a systematic review. Six articles on the IWQOL‐Lite met the criteria for critical appraisal using guidelines. The mean quality score for these articles was 59.2%. Concepts measured were consistent with the biopsychosocial concept of health defined by the World Health Organization. There is limited but consistent evidence that the IWQOL‐Lite is a reliable, valid and responsive outcome measure that can be used to assess disease‐specific quality of life in persons with class III obesity.

The Experience of Participation in Everyday Occupations for Adults with Obesity

Background. Participation in occupations of everyday life, such as self-care, work, and leisure, contribute to health and well-being. Obesity has been shown to influence health-related quality of life, but it is unclear how obesity influences participation in specific occupations. Purpose. To describe the lived experience of adults with class III obesity and the associated impact on participation in occupations of daily living. Methods. Ten adults enrolled in an obesity treatment program were interviewed. Data were interpreted using descriptive phenomenological methods. Findings. Participants underscored the tensions, barriers, and coping strategies across and within specific occupations. Although participation across occupations of daily living was described, the quality and diversity of occupations was influenced by real and perceived barriers within the environment. Implications. Participation in daily occupations is limited for persons with class III obesity. Intervention approaches should address health-related concerns and consider environmental adaptations that facilitate meaningful engagement in everyday life.

An analysis of disability models and the application of the ICF to obesity.

Purpose. Given the significant increase in obesity rates and associated health risks, understanding obesity treatment in the context of disability is important to rehabilitation practitioners. Method. Published literature in the area of obesity research and clinical practice was reviewed within the medical, social and biopsychosocial conceptual models of disability. Results. There is universal agreement that disability is experienced by obese persons. However, interventions for rehabilitation practitioners are not articulated clearly in the literature. No specific conceptual model to underpin rehabilitation treatment is recommended. Conclusions. This article provides a rationale for rehabilitation practitioners to use a biopsychosocial model (the International Classification of Functioning, Disability and Health) as a universal framework to classify disability related to the condition of obesity.

Complexities during transitions to adulthood for youth with disabilities: person–environment interactions

Abstract Purpose: The purpose of this qualitative study was to explore the experiences of youth with different disabilities from across Canada during their transitions from adolescence to adulthood. Methods: Qualitative methods, using a phenomenological tradition, explored the meaning of the lived experiences of youth with disabilities in transition to adulthood. Purposeful sampling was used to select people with a range of experiences, background, location and demographic characteristics. Individual interviews with key informants and a focus group with an “expert panel” of participants were the methods of data collection. Data analysis was iterative and followed established practices of phenomenology. Results: Over 50 people, including youth with different disabilities, parents/caregivers and service providers from different organizations and systems across Canada participated in individual and/or focus group interviews. An overarching theme of “complexities” emerged from the data analysis. Complexities were related to the interactions between person and environment during transition experiences. Six subthemes about complexities were explored in depth to describe the primary person–environment interactions that were identified by study participants. Conclusions: The complexities involved in the interactions between person and environment during transitions to adulthood appear to be similar for youth with different types of disabilities. Recommendations are provided to address these complexities using holistic and collaborative approaches in service delivery and future research. Implications for Rehabilitation The complexities involved in transitions to adulthood appear to be similar for youth with different types of disabilities. Rehabilitation service providers can address these complexities using holistic, strengths-based and collaborative approaches. Service providers and researchers in rehabilitation need to acknowledge the interactions between person and environment rather than addressing each component separately. Future research should include youth, families and community members on research teams to ensure that complexities are adequately addressed.

Predicting Exercise Adherence for Patients with Obesity and Diabetes Referred to a Cardiac Rehabilitation and Secondary Prevention Program

BACKGROUND Cardiac rehabilitation (CR) is associated with mortality and morbidity benefits. Treatment adherence rates of 20% to 60% for patients with diabetes and obesity undermines CR effectiveness. Identification of factors that account for poorer adherence to CR in these populations is needed. METHODS Data from 12 003 CR patients from 1995 to 2010 were analyzed. Differences in characteristics were compared between groups of patients classified by the presence or absence of diabetes mellitus and obesity. Sequential logistic regression was conducted to examine the extent to which biopsychosocial factors account for the higher likelihood of CR non-adherence. RESULTS The proportion of CR non-adherence was 44% for patients without obesity or diabetes, 52% for patients with diabetes and no obesity, 56% for patients with obesity and no diabetes and 59% for patients with diabetes and obesity. After adjustment for all baseline factors, the presence of obesity or diabetes remained associated with an increased risk of CR nonadherence compared to no obesity or no diabetes (diabetes only [odds ratio (OR) 1.22; 95% confidence interval (CI) 1.08-1.38; p=0.001]; obesity only [OR 1.19; 95% CI 1.04-1.36; p=0.01]). The presence of both diabetes and obesity and their relationship to CR nonadherence is not significant (OR 1.14, 95% CI 0.947-1.37; p=0.16) after adjusting for body fat percentage and waist circumference. CONCLUSIONS Diabetes and obesity were independent determinants of CR program nonadherence. The influence of having both diabetes and obesity was moderated by waist circumference and body fat percentage. Patients with diabetes mellitus, obesity or both may require greater attention and consideration with respect to CR delivery.

Cross-national perspectives about weight-based bullying in youth: nature, extent and remedies

No cross‐national studies have examined public perceptions about weight‐based bullying in youth.