Hamadi Amani, Clemens Kristin K, Ernst Jaclyn, Attalla David, Moist Louise
Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Division of Endocrinology and Metabolism, Department of Medicine, Western University, London, Ontario, Canada.
Can J Kidney Health Dis. 2023 Jun 28;10:20543581231183369. doi: 10.1177/20543581231183369. eCollection 2023.
The availability and accessibility of patient-centered weight management programs is critical to mitigate the increasing prevalence of obesity in people living with chronic kidney disease (CKD). Little is known about the availability of contemporary programs that can safely and effectively support individuals living with obesity and CKD across North America.
We sought to identify weight management programs specific to those with CKD and explore their safety, affordability, and adaptability to this patient population. We also identified the barriers and facilitators of identified programming including their accessibility to real-world patients (eg, cost, access, support, and time).
Environmental scan of weight management programs.
North America.
People living with CKD.
We identified weight management programs and associated barriers and facilitators, via an Internet-based search of commercial, community-based, and medically supervised weight management programming. We also conducted a gray literature search and contacted weight management experts and program facilitators to explore strategies as well as their barriers and facilitators.
We identified 40 weight management programs available to people living with CKD across North America. Programs were commercial (n = 7), community-based (n = 9), and medically supervised (Canada n = 13, U.S n = 8) in origin. Three programs were specifically tailored to CKD (n = 3). In addition to formal programs, we also identified online nutritional resources and guidelines for weight loss in CKD (n = 8), and additional strategies (self-management tools, group orientated programs, moderate energy restrictions in conjunction with exercise and Orlistat) for weight loss from the gray literature (n = 3). Most common barriers were difficulty accessing some of the suggested nutritious food options due to the high cost, lack of support from family, friends and health practitioners, the time commitment required to participate, and the exclusion from weight management programs due to unique dietary needs for the CKD population. Most common facilitators were programs that were patient-centered, evidence-based, and offered both group and individual formats.
Although our search criteria were broad, it is possible that we did not capture all weight management programs available across North America.
This environmental scan has generated a resource list of existing safe and effective programs for or adaptable to people with CKD. This information will inform future efforts to develop and deliver CKD-specific weight management programs to patients living with comorbid disease. Engaging people living with CKD to understand the acceptability of these programs, is an important focus for future research.
以患者为中心的体重管理项目的可获得性和可及性对于缓解慢性肾脏病（CKD）患者中日益增加的肥胖患病率至关重要。对于北美地区能够安全有效地支持肥胖合并CKD患者的当代项目的可获得性，我们了解甚少。
我们试图确定针对CKD患者的体重管理项目，并探讨其安全性、可承受性以及对该患者群体的适应性。我们还确定了已确定项目的障碍和促进因素，包括它们对现实世界患者的可及性（例如成本、可及性、支持和时间）。
对体重管理项目进行环境扫描。
北美。
CKD患者。
我们通过基于互联网搜索商业、社区和医学监督的体重管理项目，确定体重管理项目以及相关的障碍和促进因素。我们还进行了灰色文献搜索，并联系了体重管理专家和项目推动者，以探讨策略以及他们的障碍和促进因素。
我们确定了北美地区可供CKD患者使用的40个体重管理项目。项目来源包括商业项目（n = 7）、社区项目（n = 9）和医学监督项目（加拿大n = 13，美国n = 8）。有3个项目是专门为CKD量身定制的（n = 3）。除了正式项目外，我们还确定了CKD患者在线营养资源和减肥指南（n = 8），以及灰色文献中关于减肥的其他策略（自我管理工具、团体导向项目、结合运动和奥利司他的适度能量限制）（n = 3）。最常见的障碍是由于成本高难以获得一些建议的营养食物选择、缺乏家人、朋友和医护人员的支持、参与所需的时间投入，以及由于CKD人群独特的饮食需求而被排除在体重管理项目之外。最常见的促进因素是以患者为中心、基于证据且提供团体和个体形式的项目。
尽管我们的搜索标准很宽泛，但有可能我们没有涵盖北美地区所有可用的体重管理项目。
这项环境扫描生成了一份现有安全有效的项目或适用于CKD患者的资源清单。这些信息将为未来为合并疾病患者开发和提供特定于CKD的体重管理项目的工作提供参考。让CKD患者参与以了解这些项目的可接受性，是未来研究的一个重要重点。
