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The 3Ds - Discussion, diagnosis and direction: Elements for effective obesity care by healthcare professionals.

  • Alfadda, Assim A1
  • Caterson, Ian D2
  • Coutinho, Walmir3
  • Cuevas, Ada4
  • Dicker, Dror5
  • Halford, Jason C G6
  • Hughes, Carly A7
  • Iwabu, Masato8
  • Kang, Jae-Heon9
  • Nawar, Rita10
  • Reynoso, Ricardo11
  • Rhee, Nicolai11
  • Rigas, Georgia12
  • Salvador, Javier13
  • Vázquez-Velázquez, Verónica14
  • Sbraccia, Paolo15
  • 1 Obesity Research Center and the Department of Internal Medicine, College of Medicine, King Saud University, P.O. Box 2925 (98), Riyadh 11461, Saudi Arabia. Electronic address: [email protected] , (Saudi Arabia)
  • 2 Boden Collaboration, Charles Perkins Centre, D17, University of Sydney, NSW 2006, Sydney, Australia. , (Australia)
  • 3 Pontifícia Universidade Católica do Rio de Janeiro (PUC-Rio), Instituto Estadual de Diabetes e Endocrinologia (IEDE), Rio de Janeiro, RJ, Brazil. , (Brazil)
  • 4 Center for Advanced Metabolic Medicine and Nutrition (CAMMYN) Avda Las Condes 9460, office 501, Santiago, Chile. , (Chile)
  • 5 Department of Internal Medicine D, Hasharon Hospital-Rabin Medical Center, Petah-Tikva, Israel; Sackler School Of Medicine, Tel Aviv University Tel Aviv, Israel. , (Israel)
  • 6 School of Psychology, University of Leeds, University Road, Woodhouse, Leeds LS2 9JZ, UK.
  • 7 Weight Management Service, Fakenham Medical Practice, Meditrina House, Trinity Road, Fakenham, NR21 8SY, UK.
  • 8 Department of Diabetes and Metabolic Diseases, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. , (Japan)
  • 9 Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, South Korea. , (North Korea)
  • 10 The Weight Care Clinic, Dubai Healthcare City, Building 64, Block A, 2nd Floor, 2004, P.O. Box: 505042, Dubai, United Arab Emirates. , (United Arab Emirates)
  • 11 Novo Nordisk Health Care AG, Thurgauerstrasse 36/38, 8050 Zürich, Switzerland. , (Switzerland)
  • 12 Department of Bariatric Surgery, St George Private Hospital, Suite 3, Level 5, 1 South St, Kogarah, Sydney, Australia. , (Australia)
  • 13 Department of Endocrinology & Nutrition, Clínica Universidad de Navarra, Pamplona, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain. , (Spain)
  • 14 Clínica de Obesidad y Trastornos de la Conducta Alimentaria, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Tlalpan, Belisario Domínguez Sección XVI, 14080 Ciudad de México, Mexico. , (Mexico)
  • 15 University of Rome Tor Vergata, Department of Systems Medicine, Via Montpellier,1, I-00133 Rome, Rome, Italy. , (Italy)
Published Article
European journal of internal medicine
Publication Date
Sep 01, 2021
DOI: 10.1016/j.ejim.2021.01.012
PMID: 33495083


The care of people with obesity is often suboptimal due to both physician and patient perceptions about obesity itself and clinical barriers. Using data from the ACTION-IO study, we aimed to identify factors that might improve the quality of obesity care through adoption of the 3D approach (Discussion, Diagnosis and Direction [follow-up]) by healthcare professionals (HCPs). An online survey was completed by HCPs in 11 countries. Exploratory beta regression analyses identified independent variables associated with each component of the 3D approach. Data from 2,331 HCPs were included in the statistical models. HCPs were significantly more likely to initiate weight discussions and inform patients of obesity diagnoses, respectively, if (odds ratio [95% confidence interval]): they recorded an obesity diagnosis in their patient's medical notes (1.59, [1.43-1.76] and 2.16 [1.94-2.40], respectively); and they were comfortable discussing weight with their patients (1.53 [1.39-1.69] and 1.15 [1.04-1.27]). HCPs who reported feeling motivated to help their patients lose weight were also more likely to initiate discussions (1.36 [1.21-1.53]) and schedule follow-up appointments (1.21 [1.06-1.38]). By contrast, HCPs who lacked advanced formal training in obesity management were less likely to inform patients of obesity diagnoses (0.83 [0.74-0.92]) or schedule follow-up appointments (0.69 [0.62-0.78]). Specific actions that could improve obesity care through the 3D approach include: encouraging HCPs to record an obesity diagnosis; providing tools to help HCPs feel more comfortable initiating weight discussions; and provision of training in obesity management. NCT03584191. Copyright © 2021. Published by Elsevier B.V.

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