Dataset Information

The perceptions and experiences of women with a body mass index ? 30 kg m2 who breastfeed: A meta-synthesis.

ABSTRACT: Breastfeeding has copious health benefits for both mother and child, but rates of initiation and maintenance among women with a body mass index (BMI) ? 30 kg m2 are low. Few interventions aiming to increase these rates have been successful, suggesting that breastfeeding behaviour in this group is not fully understood. Therefore, this review aimed to systematically identify and synthesise the qualitative literature that explored the perceptions and experiences of women with a BMI ? 30 kg m2 who breastfed. The search identified five eligible papers, and a meta-ethnographic approach was taken to synthesise the findings. One theme was identified: "weight amplifies breastfeeding difficulties," revealing that women with a BMI ? 30 kg m2 experience common breastfeeding difficulties to a greater degree. In particular, women with a BMI ? 30 kg m2 struggle with the impact of medical intervention, doubt their ability to breastfeed, and need additional support. These findings can inform understanding of breastfeeding models, future research directions, intervention development, and antenatal and post-natal care for women with a BMI ? 30 kg m2 .

SUBMITTER: Lyons S

PROVIDER: S-EPMC6618145 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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The perceptions and experiences of women with a body mass index ≥ 30 kg m<sup>2</sup> who breastfeed: A meta-synthesis.

Lyons Stephanie S Currie Sinead S Peters Sarah S Lavender Tina T Smith Debbie M DM

Maternal & child nutrition 20190426 3

Breastfeeding has copious health benefits for both mother and child, but rates of initiation and maintenance among women with a body mass index (BMI) ≥ 30 kg m<sup>2</sup> are low. Few interventions aiming to increase these rates have been successful, suggesting that breastfeeding behaviour in this group is not fully understood. Therefore, this review aimed to systematically identify and synthesise the qualitative literature that explored the perceptions and experiences of women with a BMI ≥ 30 ...[more]

PMID: 30901509

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Project description:BackgroundTotal knee replacement (TKR) is an effective and cost-effective strategy for treating end-stage knee osteoarthritis. Greater risk for complications among TKR recipients with a body mass index (BMI) of 40 kg/m2 or greater has raised concerns about the value of TKR in this population.ObjectiveTo assess the value of TKR in recipients with a BMI of 40 kg/m2 or greater using a cost-effectiveness analysis.DesignOsteoarthritis Policy Model to assess long-term clinical benefits, costs, and cost-effectiveness of TKR in patients with a BMI of 40 kg/m2 or greater.Data sourcesTotal knee replacement parameters from longitudinal studies and published literature, and costs from Medicare Physician Fee Schedules, the Healthcare Cost and Utilization Project, and published data.Target populationRecipients of TKR with a BMI of 40 kg/m2 or greater in the United States.Time horizonLifetime.PerspectiveHealth care sector.InterventionTotal knee replacement.Outcome measuresCost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs), discounted at 3% annually.Results of base-case analysisTotal knee replacement increased QALYs by 0.71 year and lifetime medical costs by $25 200 among patients aged 50 to 65 years with a BMI of 40 kg/m2 or greater, resulting in an ICER of $35 200. Total knee replacement in patients older than 65 years with a BMI of 40 kg/m2 or greater increased QALYs by 0.39 year and costs by $21 100, resulting in an ICER of $54 100.Results of sensitivity analysisIn TKR recipients with a BMI of 40 kg/m2 or greater and diabetes and cardiovascular disease, ICERs were below $75 000 per QALY. Results were most sensitive to complication rates and preoperative pain levels. In the probabilistic sensitivity analysis, at a $55 000-per-QALY willingness-to-pay threshold, TKR had a 100% and 90% likelihood of being a cost-effective strategy for patients aged 50 to 65 years and patients older than 65 years, respectively.LimitationData are derived from several sources.ConclusionFrom a cost-effectiveness perspective, TKR offers good value in patients with a BMI of 40 kg/m2 or greater, including those with multiple comorbidities.Primary funding sourceNational Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health.

Project description:ImportanceAchieving a body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) of less than 30 is an important goal of bariatric surgery, given the increased risk for weight-related morbidity and mortality with a BMI above this threshold.ObjectiveTo identify predictors for achieving a BMI of less than 30 after bariatric surgery.Design, setting, and participantsThis retrospective study used data from the Michigan Bariatric Surgery Collaborative, a statewide quality improvement collaborative that uses a prospectively gathered clinical data registry. A total of 27 320 adults undergoing primary bariatric surgery between June 2006 and May 2015 at teaching and nonteaching hospitals in Michigan were included.ExposureBariatric surgery.Main outcomes and measuresLogistic regression was used to identify predictors for achieving a BMI of less than 30 at 1 year after surgery. Secondary outcome measures included 30-day postoperative complications and 1-year self-reported comorbidity remission.ResultsA total of 9713 patients (36%; mean [SD] age, 46.9 [11.3] years; 16.6% male) achieved a BMI of less than 30 at 1 year after bariatric surgery. A significant predictor for achieving this goal was a preoperative BMI of less than 40 (odds ratio [OR], 12.88; 95% CI, 11.71-14.16; P < .001). Patients who had a sleeve gastrectomy, gastric bypass, or duodenal switch were more likely to achieve a BMI of less than 30 compared with those who underwent adjustable gastric banding (OR, 8.37 [95% CI, 7.44-9.43]; OR, 21.43 [95% CI, 18.98-24.19]; and OR, 82.93 [95% CI, 59.78-115.03], respectively; P < .001). Only 8.5% of patients with a BMI greater than 50 achieved a BMI of less than 30 after bariatric surgery. Patients who achieved a BMI of less than 30 had significantly higher reported rates of medication discontinuation for hyperlipidemia (60.7% vs 43.2%, P < .001), diabetes (insulin: 67.7% vs 50.0%, P < .001; oral medications: 78.5% vs 64.3%, P < .001), and hypertension (54.7% vs 34.6%, P < .001), as well as a significantly higher rate of sleep apnea remission (72.5% vs 49.3%, P < .001) and higher satisfaction rate (92.8% vs 78.0%, P < .001) compared with patients who did not.Conclusions and relevancePatients with a preoperative BMI of less than 40 are more likely to achieve a BMI of less than 30 after bariatric surgery and are more likely to experience comorbidity remission. Policies and practice patterns that delay bariatric surgery until the BMI is 50 or greater can result in significantly inferior outcomes.

Dataset Information

The perceptions and experiences of women with a body mass index ? 30 kg m2 who breastfeed: A meta-synthesis.

Publications

The perceptions and experiences of women with a body mass index ≥ 30 kg m<sup>2</sup> who breastfeed: A meta-synthesis.

Similar Datasets

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