Physician Gender Impact on Obesity Care in the Academic Ambulatory Setting

BACKGROUND & OBJECTIVE: The purpose of this study was to assess a nationally representative sample of academic family physicians to determine whether personal physician characteristics are associated with attitudes towards and care of overweight and/or obese patients. METHODS: Questions pertaining to physician’s interactions with overweight and obese patients was administered as the 2012 Council of Academic Family Medicine Educational Research Alliance (CERA) survey to academic family physicians. We analyzed self-reported demographic responses physicians gave with the main outcome the association between self-reported likelihood of engaging in weight loss discussions with overweight or obese patients and physicians’ personal characteristics (gender and physician BMI). RESULTS: 36% of the 1099 physicians surveyed were overweight and 14% were obese (Table 1). We found no differences in the self-reported likelihood of discussing weight loss strategies with either their overweight patients or obese patients by physician BMI category. 77% female vs. 64% male physicians reported being very/extremely likely to discuss weight loss with their obese patients at their most recent visit (p=0.002). Female physicians reported discussing weight loss strategies often or at every visit more than males (females 79%, males 69%; p=0.02). Finally, female physicians self-reported more minutes spent counseling overweight and obese patients (p = 0.0001) (Table 3). CONCLUSION: Female family medicine physicians are more likely than male counterparts to discuss weight loss strategies with obese patients and they report spending more time discussing weight loss strategies with their patients. However, self-reported physician BMI was not associated with these behaviors

Abordagem Terapêutica e Modificação de Hábitos de Vida na Redução do Risco Cardiovascular

Nas últimas décadas tem vindo a ser reportada uma prevalência mundial cada vez mais elevada de obesidade e das condições que a ela são associadas, nomeadamente a síndrome metabólica. A síndrome metabólica apresenta-se como a manifestação de pelo menos três de cinco fatores: obesidade abdominal, elevação dos níveis de triglicéridos, diminuição dos níveis de colesterol HDL, hipertensão arterial e aumento da glicémia em jejum. Uma vez que cada um destes fatores se associa a um elevado risco cardiovascular, os pacientes com síndrome metabólica são especialmente vulneráveis a mortalidade e morbilidade de causa cardiovascular. Assim sendo, efetuou-se uma pesquisa bibliográfica na base de dados Pubmed/Medline com o objetivo de concluir quais as melhores medidas, comportamentais ou farmacológicas, de atuação com vista a reduzir o risco cardiovascular. Concluiu-se que, embora a mudança comportamental se reflita numa notória melhoria dos fatores de risco cardiovascular, nem sempre consegue manter os seus resultados a longo prazo. Posto isto, é comummente necessária a associação de uma terapêutica farmacológica que permita manter, a longo prazo, a redução da mortalidade e morbilidade de causa cardiovascular nestes pacientes.In the last decades, an increasing worldwide prevalence of obesity and associated conditions, namely the metabolic syndrome, have been reported. Metabolic syndrome is a manifestation of at least three of five factors: abdominal obesity, elevated triglyceride levels, decreased levels of HDL cholesterol, hypertension, and increased fasting blood glucose. Since each of these factors is associated with a high cardiovascular risk, patients with metabolic syndrome are especially vulnerable to cardiovascular mortality and morbidity. Therefore, a bibliographic search was performed in the Pubmed / Medline database with the objective of concluding the best behavioral or pharmacological measures to reduce cardiovascular risk. It was concluded that, although the behavioral change is reflected in a marked improvement in cardiovascular risk factors, it is not always able to maintain its results in the long term. Therefore, it is usually necessary to associate a pharmacological therapy that allows to maintain, in the long term, the reduction of mortality and morbidity of cardiovascular cause in these patients

Effects of a cardioselective beta-blocker on postprandial triglyceride-rich lipoproteins, low density lipoprotein particle size and glucose-insulin homeostasis in middle-aged men with modestly increased cardiovascular risk.

Beta-adrenergic receptor-blocking agents are commonly used for treatment of hypertension, angina pectoris and arrhythmias and as secondary prevention after myocardial infarction. The modest protection against myocardial infarction conferred by these compounds in primary-preventive studies has suggested that beneficial effects of beta-blockade are counteracted by known adverse influences on lipid and glucose metabolism. As most beta-blockers increase plasma triglycerides and decrease the high density lipoprotein (HDL) cholesterol concentration, a randomized, double-blind, cross-over study was conducted to evaluate whether a 12-week treatment with metoprolol (100 mg o.d.) or placebo affected the metabolism of postprandial triglyceride-rich lipoproteins in 15 middle-aged men with a modestly increased cardiovascular risk. Metoprolol treatment significantly increased the postprandial responses of very low density lipoprotein (VLDL) and VLDL remnants to a mixed meal-type of oral fat tolerance test. The effect was particularly prominent for larger (Svedberg flotation rate (Sf) > 400 and Sf 60-400) particle species (P < 0.001 in repeated measures ANOVA), whereas the smaller (Sf 20-60) particles were less affected (P < 0.05). The changes in the postprandial responses of the different VLDL species were mainly related to an effect on the fasting plasma concentrations, with limited or no influences on VLDL catabolism during the postprandial state. In contrast, metoprolol treatment did not significantly influence the postprandial responses of chylomicrons and chylomicron remnants. Notably, the enhanced fasting and postprandial triglyceridaemia during metoprolol treatment was neither accompanied by a rise in fasting or postprandial free fatty acid concentrations, nor by alterations of the glucose and insulin responses to a standard oral glucose challenge. The ensuing shift in the LDL particle size distribution towards smaller particles was limited (fraction small LDL: metoprolol 22.8 +/- 15.7% versus placebo 19.3 +/- 15.0%, P < 0.05). In conclusion, metoprolol treatment primarily enhances fasting and postprandial triglyceridaemia in middle-aged men by increasing the basal hepatic production of VLDL

Magnitude of alimentary lipemia is related to intima-media thickness of the common carotid artery in middle-aged men.

Fat intake leads to generation of potentially atherogenic triglyceride-rich lipoproteins (TRL). To investigate the relationship between early atherosclerotic changes and accumulation of hepatic and intestinal TRL after oral fat intake, an estimate of the intima-media thickness (IMT) was made using ultrasound of the common carotid artery, and postprandial TRL was quantified during a standardized oral fat tolerance test in 30 healthy normo- and hypertriglyceridemic middle-aged men. At base line the expected positive association between the LDL cholesterol level and the IMT of the common carotid artery was observed (r = 0.53, P<0.01). In addition, postprandial plasma triglycerides, in particular those measured late (6 h) after intake of the test meal, correlated positively with the IMT (r = 0.44, P<0.05). Of note, this latter correlation was independent of both the LDL cholesterol and the fasting plasma triglyceride concentrations. In a multivariate analysis, 39% of the total variability for the common carotid IMT were explained by age, LDL cholesterol and the postprandial triglyceride level. In univariate analysis, few statistically significant relations were found between common carotid IMT and postprandial levels of chylomicron remnants, VLDL and VLDL remnants of different particle size, the latter determined by specific measurements of ApoB-48 and ApoB-100 in subfractions of TRL. Therefore, in healthy middle-aged men, elevated postprandial triglyceride levels might identify a metabolic state related to early atherosclerosis

Characteristics of study participants by categories of diabetes, prediabetes and reference category (neither diabetes nor prediabetes).

<p>Continuous data are expressed as mean ± standard deviation or median with the interquartile range within parenthesis.</p><p>(^m) indicates number of individuals with missing value.</p><p><i>p</i>-value for current smokers and ex-smokers, respectively, calculated using never smokers as reference category.</p

Long-term effects on cardiovascular risk of a structured multidisciplinary lifestyle program in clinical practice.

BACKGROUND: Cardiovascular disease is still the leading cause of premature death world-wide with factors like abdominal obesity, hypertension and dyslipidemia being central risk factors in the etiology. The aim of the present study was to investigate the effects on cardiovascular risk factors and cardiovascular risk after 6 months and 1 year, in individuals with increased cardiovascular risk enrolled in a lifestyle multidisciplinary program in a clinical setting. METHOD: Individuals with increased cardiovascular risk were referred from primary health care and hospitals to a program at an outpatient clinic at a department of cardiology. The program consisted of three individual visits including a health check-up with a physical examination and blood sampling, and a person-centered dialogue for support in behavioural change of unhealthy lifestyle habits (at baseline, 6 months and 1 year). Furthermore, five educational group sessions were given at baseline. Cardiovascular risk was assessed according to Framingham cardiovascular risk predicting model. RESULTS: One hundred individuals (mean age 59 years, 64% women) enrolled between 2008 and 2014 were included in the study. Waist circumference, systolic and diastolic blood pressure and total cholesterol decreased significantly over 1 year. In parallel, cardiovascular risk according to the cardiovascular risk profile based on Framingham 10-year risk prediction model, decreased with 15%. The risk reduction was seen in both men and women, and in participants with or without previous cardiovascular disease. CONCLUSION: Participating in a structured lifestyle program over a year was associated with significant improvement in multiple cardiovascular risk factors and decreased overall cardiovascular risk. TRIAL REGISTRATION: The study is registered at www.clinicaltrials.gov (ClinicalTrial.gov ID: NCT02744157 ).Livsstilsmottagningen på Karolinska universitetssjukhuset, Soln