Severe Obesity and the Ambivalence of Attending Physical Activity

Danielsen, Kjersti; Sundgot‐Borgen, Jorunn; Rugseth, Gro

doi:10.1177/1049732315596152

Cited by 23 publications

(32 citation statements)

References 58 publications

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“…Experiences were temporal and changed over time with new experiences. This concurs with previous findings of how ambivalent feelings towards PA were based on shifting experiences (Danielsen et al, 2016).…”

Section: Discussion Of Findingssupporting

confidence: 93%

Being active when living within a large body: experiences during lifestyle intervention

Toft

Galvin

Nielsen

et al. 2020

International Journal of Qualitative Studies on Health and Well

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Background: In-depth understanding of the experiences of both well-being and suffering in relation to being severely obese and becoming active through lifestyle intervention is lacking. Aim: to explore and describe adults' existential experiences of being active, when living within a large body-before and during a lifestyle intervention. Methods: A longitudinal design of repeated individual interviews with 16 adults with BMI ≥40, based on hermeneutic phenomenology, existential philosophy and a theory of wellbeing was performed. The study was approved by the Danish health authorities. Results: Two dimensions of experiences were found; "Living within a downward spiral" and "Striving for enjoyment and settlement". The themes describing suffering were: 'Sense of being thwarted and defeated ' and "Tackling energy depletion and impact of sense of self". The themes describing well-being were: "Hoping for renewal and energised resoluteness" and "Enduring discomfort and feeling safe". Conclusions: Interacting existential experiences can be facilitators or barriers for physical activity. It seems relevant for health care providers to address the individual's lifeworld experiences of well-being, lack of well-being and suffering. Well-being as a sense of feeling "at home" when physically active may break down an inactivity spiral. Promoting well-being is a legitimate aim of lifestyle intervention. ARTICLE HISTORY

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Section: Discussion Of Findingssupporting

confidence: 93%

Being active when living within a large body: experiences during lifestyle intervention

Toft

Galvin

Nielsen

et al. 2020

International Journal of Qualitative Studies on Health and Well

View full text Add to dashboard Cite

show abstract

“…Four additional papers were identified from included RCTs. In all, 33 papers met our inclusion criteria 17–49…”

Section: Resultsmentioning

confidence: 99%

“…Although not universal, many described particularly valuing the social interactivity of group-based programme activities along with intensive support from/interaction with programme staff 17 19 24 25 28 31 32 34–36 40 47 48. This appeared to function strongly as a motivator to maintain engagement with the WMPs by fostering feelings of accountability and by helping to ensure the achievement of preset goals:…”

Section: Resultsmentioning

confidence: 99%

“…The social interactivity of group-based programme activities was not universally valued by all, with some describing a reluctance to discuss issues within a group setting 19 27 28 40 45 48. This was perhaps particularly pertinent in studies where participants had additional mental health issues:…”

Section: Resultsmentioning

confidence: 99%

“…While many participants described the positive psychological and physical benefits they experienced from exercising,19 24 47 others described struggling to engage in exercise. Some described disliking the perceived high intensity of the exercises (eg, feeling uncomfortable with sweating) 24 28 29. Others discussed how their various physical or mental health comorbidities could prohibit them from full engagement in activities:18 24 28 29 36–39 47…”

Section: Resultsmentioning

confidence: 99%

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Acceptability and feasibility of weight management programmes for adults with severe obesity: a qualitative systematic review

et al. 2019

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ObjectivesTo improve our understanding of the acceptability of behavioural weight management programmes (WMPs) for adults with severe obesity.DesignA systematic review of qualitative evidence.Data sourcesMedline, Embase, PsycINFO, CINAHL, SCI, SSCI and CAB abstracts were searched from 1964 to May 2017.Eligibility criteriaPapers that contained qualitative data from adults with body mass index (BMI) ≥35 kg/m2(and/or the views of providers involved in their care) and considered issues about weight management.Data extraction and synthesisTwo reviewers read and systematically extracted data from the included papers which were compared, and contrasted according to emerging issues and themes. Papers were appraised for methodological rigour and theoretical relevance using Toye’s proposed criteria for quality in relation to meta-ethnography.Results33 papers met our inclusion criteria from seven countries published 2007–2017. Findings were presented from a total of 644 participants and 153 programme providers. Participants described being attracted to programmes that were perceived to be novel or exciting, as well as being endorsed by their healthcare provider. The sense of belonging to a group who shared similar issues, and who had similar physiques and personalities, was particularly important and seemed to foster a strong group identity and related accountability. Group-based activities were enjoyed by many and participants preferred WMPs with more intensive support. However, some described struggling with physical activities (due to a range of physical comorbidities) and not everyone enjoyed group interaction with others (sometimes due to various mental health comorbidities). Although the mean BMI reported across the papers ranged from 36.8 to 44.7 kg/m2, no quotes from participants in any of the included papers were linked to specific detail regarding BMI status.ConclusionsAlthough group-based interventions were favoured, people with severe obesity might be especially vulnerable to physical and mental comorbidities which could inhibit engagement with certain intervention components.

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Hospital Quality Improvement Interventions, Statewide Policy Initiatives, and Rates of Cesarean Delivery for Nulliparous, Term, Singleton, Vertex Births in California

Rosenstein

Chang

Sakowski

et al. 2021

JAMA

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IMPORTANCE Safe reduction of the cesarean delivery rate is a national priority.OBJECTIVE To evaluate the rates of cesarean delivery for nulliparous, term, singleton, vertex (NTSV) births in California in the context of a statewide multifaceted intervention designed to reduce the rates of cesarean delivery. DESIGN, SETTING, AND PARTICIPANTSObservational study of cesarean delivery rates from 2014 to 2019 among 7 574 889 NTSV births in the US and at 238 nonmilitary hospitals providing maternity services in California. From 2016 to 2019, California Maternal Quality Care Collaborative partnered with Smart Care California to implement multiple approaches to decrease the rates of cesarean delivery. Hospitals with rates of cesarean delivery greater than 23.9% for NTSV births were invited to join 1 of 3 cohorts for an 18-month quality improvement collaborative between July 2016 and June 2019.EXPOSURES Within the collaborative, multidisciplinary teams implemented multiple strategies supported by mentorship, shared learning, and rapid-cycle data feedback. Partnerships among nonprofit organizations, state governmental agencies, purchasers, and health plans addressed the external environment through transparency, award programs, and incentives. MAIN OUTCOMES AND MEASURESThe primary outcome was the change in cesarean delivery rates for NTSV births in California and a difference-in-differences analysis was performed to compare cesarean delivery rates for NTSV births in California vs the rates in the rest of the US. A mixed multivariable logistic regression model that adjusted for patient-level and hospital-level confounders also was used to assess the collaborative and the external statewide actions. The cesarean delivery rates for NTSV births at hospitals participating in the collaborative were compared with the rates from the nonparticipating hospitals and the rates in the participating hospitals prior to participation in the collaborative.RESULTS A total of 7 574 889 NTSV births occurred in the US from 2014 to 2019, of which 914 283 were at 238 hospitals in California. All California hospitals were exposed to the statewide actions to reduce the rates of cesarean delivery, including the 149 hospitals that had baseline rates of cesarean delivery greater than 23.9% for NTSV births, of which 91 (61%) participated in the quality improvement collaborative. The rate of cesarean delivery for NTSV births in California decreased from 26.0% (95% CI, 25.8%-26.2%) in 2014 to 22.8% (95% CI, 22.6%-23.1%) in 2019 (relative risk, 0.88; 95% CI, 0.87-0.89). The rate of cesarean delivery for NTSV births in the US (excluding California births) was 26.0% in both 2014 and 2019 (relative risk, 1.00; 95% CI, 0.996-1.005). The difference-in-differences analysis revealed that the reduction in the rate of cesarean delivery for NTSV births in California was 3.2% (95% CI, 1.7%-3.5%) higher than in the US (excluding California). Compared with the hospitals and the periods not exposed to the collaborative activities, and after adjusting for patient charact...

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Severe Obesity and the Ambivalence of Attending Physical Activity

Cited by 23 publications

References 58 publications

Being active when living within a large body: experiences during lifestyle intervention

Being active when living within a large body: experiences during lifestyle intervention

Acceptability and feasibility of weight management programmes for adults with severe obesity: a qualitative systematic review

Hospital Quality Improvement Interventions, Statewide Policy Initiatives, and Rates of Cesarean Delivery for Nulliparous, Term, Singleton, Vertex Births in California

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