Cutting health corners.
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Community Health Nursing↗
Biomedical subjects
J Ogden
Publications and source records attributed to J Ogden.
Thanks, but no thanks.
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Ethics, Nursing↗
Practice nurses' beliefs about obesity and weight related interventions in primary care.
OBJECTIVE: 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. DESIGN: Cross sectional questionnaire. SUBJECTS: Questionnaires concerning beliefs about obesity and current practices were completed by 586 practice nurses. RESULTS: 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. CONCLUSION: 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.
Adult↗
The relative effectiveness of two styles of educational package to change practice nurses' management of obesity.
OBJECTIVE: To examine the impact of two styles of educational package on practice nurses' management of obesity. SUBJECTS AND MEASURES: A questionnaire was completed by 66 practice nurses concerning their obesity related beliefs and the content and style of their weight related practices before and one month after being randomly allocated to either the 'learner centred' group (who received a leaflet and were invited to attend an interactive seminar), the 'expert group' (who received the leaflet) or the control group. At the one month follow up, practice nurses were also asked to give a brief questionnaire to five consecutive patients, who they saw for weight loss advice, concerning the content and style of the consultation. After 6 months, practice nurses, and patients were sent a questionnaire about their consultation style and weight loss, respectively. RESULTS: The packages had no differential effects on practice nurses' beliefs about obesity. However, practice nurses in the 'learner group' reported spending longer on their consultations and being more patient centred. Their patients rated themselves as more satisfied with the consultation and reported that they were offered calorie controlled diets less often. In contrast, practice nurses in the 'expert group' reported giving weight loss advice more frequently, being less patient centred and their patients reported greater confidence in, and likelihood of, weight loss and reported that they were more likely to be offered traditional weight loss interventions. The packages had no differential effects on patient weight. CONCLUSION: Practice nurses' and patients' beliefs and behaviour and the style of their interactions can be changed by both expert and learner centred educational packages. The style of packages should be chosen in terms of both the available resources and the desired outcomes.
Adult↗
To treat? To befriend? To prevent? Patients' and GPs' views of the doctor's role.
OBJECTIVE: To examine and compare patients' and GPs' views of the doctor's role and patients' reasons for going to the doctor. DESIGN: A cross sectional questionnaire survey. SETTING: General practices across England. SUBJECTS: 501 patients and 68 GPs. MAIN OUTCOME MEASURES: Beliefs about the doctors' role and beliefs about patients' reasons for going to the doctor in terms of illness treatment, a psychosocial approach and preventive health care. RESULTS: A majority of both patients and GPs agreed that the doctor's role was primarily to treat illness. However, whereas patients showed greater endorsement for preventive health care and a belief that the doctor's role was to keep people healthy, GPs showed greater support for an emphasis on personal problems. In terms of patients' reasons for visiting their doctor, a majority of both patients and GPs agreed that illness prevention and illness treatment were important. However, more patients believed that patients visit the doctor for illness prevention than GPs, more of whom felt that patients seek help with their personal problems. CONCLUSION: The results indicate a mismatch between patients' and GPs' beliefs, which has implications for understanding the impact of recent changes in primary care and the effects on GPs' job satisfaction.
Adult↗
The problem with weighing: effects on mood, self-esteem and body image.
OBJECTIVE: To examine the effect of weighing and comparison with social norms on self-esteem, mood and body dissatisfaction. DESIGN: An experimental design was used. SUBJECTS: Seventy-four normal weight individuals took part in the study. PROCEDURE: Subjects completed a set of measures before and after being weighed and sequentially allocated to either the under, average or over weight conditions according to a fictional height-weight chart. RESULTS: The results showed that subjects allocated to the overweight group showed an increase in depression and a decrease in self esteem following the manipulation, compared to subjects in the average weight group who reported improvements in these measures and the underweight group who similarly showed decreased depression, but showed some deterioration of their self-esteem. CONCLUSION: Weighing and comparison with height weight charts of weight norms is used both to detect and treat overweight and obesity. The results from this study indicate that this procedure may not be as benign as believed and may contribute to the negative psychological state of the individual.
Adolescent↗
GPs' views of a new counselling service.
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Attitude of Health Personnel↗
Psychosocial theory and the creation of the risky self.
This paper examines the transformation of individual identity in twentieth century psychological theory from the passive through to the interactive to the intra-active using models of behaviour, learning, beliefs, stress and pain. This shift in identity and the corresponding realignment of individual and environment is discussed in terms of changing locations of risks to health and the construction of the contemporary risky self.
Attitude to Health↗
Attributions for illness and treatment interventions by community nurses.
The present study evaluated community nurses' attributions for a case patient's heart attack and their recommendations for treatment. Eighty-nine district nurses and health visitors completed a set of rating scales following a case vignette describing a patient who had suffered a heart attack and prior to which had either adopted a healthy lifestyle (n = 47) or had maintained unhealthy behaviours (n = 42). The results suggest that subjects in the unhealthy-behaviour condition rated the case patient as less likely to follow advice, more responsible for his/her condition and rated the heart attack as more preventable. In addition, the results suggest that subjects were more likely to offer recommendations for behavioural change to the unhealthy case patient and that these recommendations were significantly related to internal attributions of patient responsibility. The results are discussed in terms of theories of health professionals' beliefs and behaviours.
Adult↗
Beliefs about condoms in 12/13 and 16/17 year olds.
The present study examined the beliefs and attitudes which surround condoms and their use. Qualitative data in the form of short essays were collected from 12/13 (n = 148) and 16/17 (n = 63) year olds. The results suggest that condoms are conceptualized in terms of a complex set of factual and evaluative factors such as feelings, responsibility and risk and that younger subjects hold more positive beliefs than the older subjects. The results are discussed in terms of models of preventive behaviour and the role of sex education at an early age.
Adolescent↗
Examination of the use of smoking for weight control in restrained and unrestrained eaters.
Recent research has examined the perceived benefits of smoking and suggests that continued smoking may be related to contemporary concerns for weight and shape. The present study examined the role of restrained eating in predicting smoking for reasons of weight control, reports of weight gain following cessation, and reasons for relapse and intentions to quit. Eighty-four restrained eaters and 83 unrestrained eaters completed a questionnaire examining their smoking behavior. The results suggest that the restrained eaters gave significantly greater endorsement than the unrestrained eaters to statements relating to smoking initiation and smoking maintenance for weight control, the role of weight gain in previous experiences of smoking relapse, intentions to quit following weight loss, and intentions to quit in 5 years. No differences were found between the restrained and unrestrained eaters in terms of experiences of post cessation weight gain, the number of attempts to quit, and intentions to quit in 6 months. The results are discussed in terms of developing a model of the relationship between smoking and weight concerns.
Adolescent↗
Effects of smoking cessation, restrained eating, and motivational states on food intake in the laboratory.
Twenty smokers, 20 abstaining smokers (for 24 hr), and 20 nonsmokers completed ratings of motivational state before and after a taste test, to examine the mediating effects of motivations to eat and smoke, cross-motivational satiating effects, and restrained eating on post-smoking-cessation food intake in the laboratory. The results suggest that the abstaining smokers consumed more carbohydrates, calories, fat, protein, and mass than the smokers; that food intake was related to the urge to eat, the urge to smoke, and craving for a cigarette; and that eating could reduce the desire to smoke. However, these effects were only apparent for the female smokers. In addition, restrained eating predicted increases in postcessation food intake. The results are discussed in terms of a substitution theory of motivational states.
Adult↗
The measurement of restraint: confounding success and failure?
The present study examined the concept of restrained eating as measured by the Restraint Scale and the restrained eating section of the Dutch Eating Behaviour Questionnaire. The results showed that when answering questionnaires, subjects do not differentiate between items relating to attempts at dieting and actual restrictive behavior and that restrained eating can be conceptualized in terms of both successful and failed restraint. In addition, the results suggest that subjects who report high scores on both these measures of restraint represent a population of dieters prone to overeating behavior. The results are discussed in terms of the population selected by measures of restrained eating and in relation to the definition of restraint.
Adult↗
Cognitive changes to preloading in restrained and unrestrained eaters as measured by the Stroop task.
Restraint theory has identified overeating in response to a high calorie preload as characteristic of restrained eaters. The present study evaluated cognitive and motivational changes to preloading using both self-report rating scales and Stroop tasks. The results suggest that the restrained eaters responded to a high calorie preload with increased feelings of rebelliousness, defiance, and a desire to challenge the limitations set by the diet, described as an active state of mind, as measured by both the Stroop task and the rating scales. The restrained eaters also showed retardation in the color naming of the body size words and food words after the high calorie preload, suggesting that the consumption of a forbidden food may increase the dieter's concern about food and her shape and weight. The results are discussed in terms of the effects of preloading and possible mediating variables involved in the transition from successful restraint to overeating.
Adult↗
Asthma campaign aims to cut deaths.
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Adolescent↗
Eating style and eating behaviour in adolescents.
The relationship between eating style, attitudes towards food and food intake was investigated in 846 British adolescent schoolchildren. Eating style was assessed with the Dutch Eating Behaviour Questionnaire, attitudes towards food with a series of specially prepared questions, and food intake with a diet history taken by a dietitian. The results showed that restraint, external and emotional eating were associated with very different profiles of attitudes and behaviour. Restrained subjects had a higher body weight, more negative attitudes towards food, a lower likelihood of overeating and a lower overall energy intake. External eaters had a lower body weight, positive attitudes to food, and reported a higher energy intake. Emotional eaters fell in between in some ways, with some signs of situational loss of control combined with a negative attitude towards overeating. While external eating appeared to be attenuated by restraint, emotional eating was enhanced by it. The implications of these eating styles for later patterns of eating and weight are discussed.
Adolescent↗
Contribution of elevated protein turnover and anorexia to cachexia in patients with hepatocellular carcinoma.
Severe cachexia of extremely rapid onset typifies the young Black African patient with hepatocellular carcinoma (HCC). In order to assess whether this is a consequence of tumor-associated increases in protein metabolism or simply due to inadequate dietary intake, the following study was undertaken. The technique of constant i.v. infusion of 14C-labeled leucine was used to measure whole body protein flux, breakdown, synthesis, and oxidation rates in 8 adults with HCC, 4 patients with massive hepatomegaly due to metastatic adenocarcinoma from bowel, 6 patients with chronic liver disease, and 10 controls. Endogenous protein breakdown and oxidation were similar between patients with chronic liver disease (breakdown, 4.4 +/- 1.2 g/kg/day; oxidation, 0.8 +/- 0.4 g/kg/day) and controls but were significantly (P less than 0.002) higher in patients with liver tumors, the highest rates being observed in those with HCC (breakdown, 8.5 +/- 4.3 g/kg/day; oxidation, 1.4 +/- 0.5 g/kg/day). Protein turnover was generally higher in the HCC group, with increased rates of reincorporation of amino acids into protein synthesis (P less than 0.05). In one HCC patient a synchronized diagnostic liver biopsy demonstrated high fractional synthesis of rates of HCC proteins of 86%/day. In addition, the incorporation rates of labeled amino acid into fibrinogen, immunoglobulin G, and transferrin were also highest (P less than 0.03) in HCC patients. In order to assess the relative importance of diet in weight loss, dietary intake levels were assessed from hospital records of HCC patients and by dietary recall during the week prior to study. Intakes ranged from 30 to 70% of calculated requirement levels. In conclusion, our results suggest that the rapid wasting seen in patients with HCC is due to an imbalance between the metabolic demands, which can be elevated in some patients, and inadequate dietary replenishment.
Adolescent↗