Browsing by Author "Alberga, Angela"

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    A multi-center, randomized, 12-month, parallel-group, feasibility study to assess the acceptability and preliminary impact of family navigation plus usual care versus usual care on attrition in managing pediatric obesity: a study protocol
    (2023-01-23) Ball, Geoff D. C.; O’Neill, Marcus G.; Noor, Rafat; Alberga, Angela; Azar, Rima; Buchholz, Annick; Enright, Michelle; Geller, Josie; Ho, Josephine; Holt, Nicholas L.; Lebel, Tracy; Rosychuk, Rhonda J.; Tarride, Jean-Eric; Zenlea, Ian
    Abstract Background Pediatric obesity management can be successful, but some families discontinue care prematurely (i.e., attrition), limiting treatment impact. Attrition is often a consequence of barriers and constraints that limit families’ access to obesity management. Family Navigation (FN) can improve access, satisfaction with care, and treatment outcomes in diverse areas of healthcare. To help our team prepare for a future effectiveness trial, the objectives of our randomized feasibility study are to (i) explore children’s and caregivers’ acceptability of FN and (ii) examine attrition, measures of study rigor and conduct, and responses to FN + Usual Care vs Usual Care by collecting clinical, health services, and health economic data. Methods In our 2.5-year study, 108 6–17-year-olds with obesity and their caregivers will be randomized (1:1) to FN + Usual Care or Usual Care after they enroll in obesity management clinics in Calgary and Mississauga, Canada. Our Stakeholder Steering Committee and research team will use Experience-Based Co-Design to design and refine our FN intervention to reduce families’ barriers to care, maximizing the intervention dose families receive. FN will be delivered by a navigator at each site who will use logistical and relational strategies to enhance access to care, supplementing obesity management. Usual Care will be offered similarly at both clinics, adhering to expert guidelines. At enrollment, families will complete a multidisciplinary assessment, then meet regularly with a multidisciplinary team of clinicians for obesity management. Over 12 months, both FN and Usual Care will be delivered virtually and/or in-person, pandemic permitting. Data will be collected at 0, 3, 6, and 12 months post-baseline. We will explore child and caregiver perceptions of FN acceptability as well as evaluate attrition, recruitment, enrolment, randomization, and protocol integrity against pre-set success thresholds. Data on clinical, health services, and health economic outcomes will be collected using established protocols. Qualitative data analysis will apply thematic analysis; quantitative data analysis will be descriptive. Discussion Our trial will assess the feasibility of FN to address attrition in managing pediatric obesity. Study data will inform a future effectiveness trial, which will be designed to test whether FN reduces attrition. Trial registration This trial was registered prospectively at ClinicalTrials.gov (# NCT05403658 ; first posted: June 3, 2022).
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    Design and Feasibility of a Behavioural Weight Loss Treatment for Patients with Atrial Fibrillation and Obesity referred to Cardiac Rehabilitation
    (2024-09-17) Williamson, Tamara Marie; Campbell, Tavis; Rouleau, Codie; Wilton, Stephen; Tomfohr-Madsen, Lianne; Alberga, Angela; McDonough, Megan
    Background: Moderate weight loss (i.e., ≥10%) reduces symptom burden and disease progression among patients with atrial fibrillation (AF) and co-morbid obesity (BMI ≥ 30 kg/m2). Cardiac rehabilitation (CR) improves AF risk factors (e.g., hypertension, cardiorespiratory fitness, lipids) and thus represents an ideal multidisciplinary setting for AF management. Yet, few CR programs include targeted behavioural weight loss treatment (BWLT) for patients with cooccurring obesity. Evidence-based approaches to integrating BWLT into CR are needed to encourage sustainable weight loss in this patient group. Purpose: The purpose of this dissertation was to adapt and establish the acceptability of a Small Change BWLT that could be integrated into an existing CR program for patients with AF and obesity prior to efficacy testing in a randomized clinical trial (RCT). Methods: Chapter 2 was a qualitative descriptive exploration of patients’ preferences, barriers, and enablers to participating in a Small Change BWLT in CR. Chapter 3 was a pre-post feasibility study to adapt the BWLT to patients with AF and obesity, and establish the acceptability of the modified program. Chapter 4 was a protocol for an RCT comparing the efficacy of the BWLT + CR in terms of 12-month weight loss relative to the traditional CR program. Results: Barriers and enablers identified in Chapter 2 were used to adapt the BWLT program and included changes to patient education materials and discussion of AF risk factors. In Chapter 3, patients reported strong liking of the adapted program, however weight loss at 6 months was not clinically or statistically significant. The BWLT was further refined using the findings from Chapter 3 to inform the protocol in Chapter 4, which is currently recruiting patients (NCT05230823). Conclusion: While the benefits of a Small Changes BWLT + CR for weight loss among patients with AF and obesity relative to CR-only remain to be seen, the results of this dissertation provide important acceptability and feasibility evidence suggesting that program uptake, adherence, and completion may be favourable in the RCT. Future directions including the potential addition of adjunct pharmacotherapy to BWLT and additional therapeutic BWLT components (e.g., values-based behaviour change, self-compassion) are discussed.
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    Mapping changes in the obesity stigma discourse through Obesity Canada: A content analysis
    (AIMS Press, 2021-11-15) Kirk, Sara F.L.; Forhan, Mary; Yusuf, Joshua; Chance, Ashly; Burke, Kathleen; Blinn, Nicole; Quirke, Stephanie; Ramos Salas, Ximena; Alberga, Angela; Russell-Mayhew, Shelly
    Background: Stigmatization of persons living with obesity is an important public health issue. In 2015, Obesity Canada adopted person-first language in all internal documentation produced by the organization, and, from 2017, required all authors to use person-first language in abstract submissions to Obesity Canada hosted conferences. The impact of this intentional shift in strategic focus is not known. Therefore, the aim of this study was to conduct a content analysis of proceedings at conferences hosted by Obesity Canada to identify whether or how constructs related to weight bias and obesity stigma have changed over time. Methods: Of 1790 abstracts accepted to conferences between 2008–2019, we excluded 353 abstracts that featured animal or cellular models, leaving 1437 abstracts that were reviewed for the presence of five constructs of interest and if they changed over time: 1) use of person-first versus use of disease-first terminology, 2) incorporation of lived experience of obesity, 3) weight bias and stigma, 4) aggressive or alarmist framing and 5) obesity framed as a modifiable risk factor versus as a disease. We calculated and analyzed through linear regression: 1) the overall frequency of use of each construct over time as a proportion of the total number of abstracts reviewed, and 2) the ratio of abstracts where the construct appeared at least once based on the total number of abstracts. Results: We found a significant positive correlation between use of person-first language in abstracts and time (R2 = 0.51, p < 0.01 for frequency, R2 = 0.65, p < 0.05 for ratio) and a corresponding negative correlation for the use of disease-first terminology (R2 = 0.48, p = 0.01 for frequency, R2 = 0.75, p < 0.001 for ratio). There was a significant positive correlation between mentions of weight bias and time (R2 = 0.53 and 0.57, p < 0.01 for frequency and ratio respectively). Conclusion: Use of person-first language and attention to weight bias increased, while disease-first terminology decreased in accepted abstracts over the past 11 years since Obesity Canada began hosting conferences and particularly since more explicit actions for expectations to use person-first language were put in place in 2015 and 2017.