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Being 'fat' in today's world: a qualitative study of the lived experiences of people with obesity in Australia.
Thomas, SL, Hyde, J, Karunaratne, A, Herbert, D, Komesaroff, PA
Health expectations : an international journal of public participation in health care and health policy. 2008;11(4):321-30
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Plain language summary
The obesity epidemic is one of the most pressing contemporary public health problems. The aim of this study was to develop a picture of both lived experiences of obesity and the impact of socio-cultural factors on obesity. The study adopted a qualitative research design (n=76) . A broad interview schedule was developed by the authors aimed at individuals from a broad range of backgrounds and experiences of obesity. Results indicate that: (a) the experiences of obesity are diverse but there are common themes. (b) people living with obesity have heard the messages but find it difficult to act upon them. (c) interventions should be tailored to address both individual and community needs. (d) there should be a different approach towards obesity interventions. Authors conclude that interventions should respond directly to the social and cultural dimensions of communities and clusters of individuals.
Abstract
OBJECTIVE To develop an in-depth picture of both lived experience of obesity and the impact of socio-cultural factors on people living with obesity. DESIGN Qualitative methodology, utilizing in-depth semi-structured interviews with a community sample of obese adults (body mass index >or=30). Community sampling methods were supplemented with purposive sampling techniques to ensure a diverse range of individuals were included. RESULTS Seventy-six individuals (aged 16-72) were interviewed. Most had struggled with their weight for most of their lives (n=45). Almost all had experienced stigma and discrimination in childhood (n=36), as adolescents (n=41) or as adults (n=72). About half stated that they had been humiliated by health professionals because of their weight. Participants felt an individual responsibility to lose weight, and many tried extreme forms of dieting to do so. Participants described an increasing culture of 'blame' against people living with obesity perpetuated by media and public health messages. Eighty percent said that they hated or disliked the word obesity and would rather be called fat or overweight. DISCUSSION AND CONCLUSION There are four key conclusions: (i) the experiences of obesity are diverse, but there are common themes, (ii) people living with obesity have heard the messages but find it difficult to act upon them, (iii) interventions should be tailored to address both individual and community needs and (iv) we need to rethink how to approach obesity interventions to ensure that avoid recapitulating damaging social stereotypes and exacerbating social inequalities.
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Report on an open-label prospective study of divalproex sodium for the behavioral and psychological symptoms of dementia as monotherapy and in combination with second-generation antipsychotic medication.
Forester, B, Vanelli, M, Hyde, J, Perez, R, Ahokpossi, C, Sribney, W, Adkison, L
The American journal of geriatric pharmacotherapy. 2007;(3):209-17
Abstract
BACKGROUND Studies of pharmacotherapy for agitation in dementia have primarily been limited to single-drug trials and have not determined if some forms of agitated behaviors are more responsive to treatment than others. OBJECTIVE The goal of this study was to determine if manifestations of agitation (ie, physical aggression, physically nonaggressive behavior, and verbally agitated behaviors) show different degrees of response to divalproex sodium (extended release or sprinkles) alone or in combination with second-generation antipsychotic agents. METHODS This was a 6-week, open-label, naturalistic pilot study of patients aged >60 years recruited from a geriatric psychiatry inpatient unit, 2 nursing homes, and 4 assisted living residences. Patients were referred for study if they displayed Behavioral and Psychological Symptoms of Dementia. The primary outcome measure was the Cohen-Mansfield Agitation Inventory (CMAI), an instrument whose subscales allow measurement of physically aggressive behaviors, physically nonaggressive behaviors (eg, wandering), and verbally agitated behaviors. The Neuropsychiatric Inventory-Nursing Home version (NPI-NH) was also used to assess patients' behavior. RESULTS Fifteen patients were included in the study (10 men, 5 women; mean [SD] age, 81.9 [7.7] years). Total CMAI improved by 17.1% at week 1, showed an additional improvement of 3.4% at week 3, and no further improvement by week 6 (total score dropped by 1.1%). Aggressive behavior improved at weeks 3 and 6 while physically nonaggressive and verbally agitated behaviors improved at weeks 1 and 3, and lost much of the gains by week 6. The NPI-NH agitation/aggression score decreased a mean (SE) of 1.3 (0.5) points (P = 0.03), the irritability/lability subscale decreased a mean (SE) of 2.3 (0.6) points (P = 0.005), and the disinhibition subscale decreased a mean (SE) of 1.4 (0.4) points (P < 0.01). Seven patients were on divalproex monotherapy and 8 patients were on combination therapy. Daily doses of divalproex (mean dose, 656 mg/d) in combination with a second-generation antipsychotic were 28% lower than divalproex monotherapy (mean dose, 914 mg/d). The most common adverse events were somnolence (7 of 15) and gait disturbance (5 of 15). One death was observed in the study; the death was due to a prior medical condition and was judged unlikely to be study related. CONCLUSIONS Patients with higher levels of agitation receiving divalproex had reduced agitation on the physical aggression subscale of the CMAI. Divalproex was less effective on physically nonaggressive behavior and verbal agitation. Irritability, as measured on the NPI-NH, was also reduced. Patients who received both divalproex and an antipsychotic agent were responsive at lower doses of divalproex. In either case, the effective dosage of divalproex was lower than that commonly used for epilepsy or mania in elderly patients. The most common adverse events included somnolence and gait disturbance.