OBGYN Palladino Presentation - PCOS Nutrition Interventions

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Nutrition Interventions: Feedback from PCOS Focused Practitioners

Wendy ThompsonGraduate Dietetic InternDavis College of Agriculture, Natural Resources and Design

Melanie Clemmer, PhDPamela J. Murray, MD, MHPMelissa Olfert, DrPH, MS, RD

• Multifaceted

• Many phenotypes

• ~60% obese

• 15-20% develop diabetes

prevalence in WV

Polycystic Ovary Syndrome (PCOS)

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National Institutes of Health Office of Disease Prevention, 2012; Daniilidis A. & Dinas K., 2009

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delete the

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Due to the high prevelence of obesity and diabetes with in the state, practitioners in WV see a high number of patients with PCOS.

Pathophysiology of PCOS

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Alex Rotstein, Raginin Srinivasan, Erin WongMcMaster Pathophysiology Review (MPR), 2013

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This is how I would approach this slide:This slide is complicated, but lets just focus on the areas I have highlighted/circled in green. These are the primary issues that women with PCOS expereience. PCOS is associated with a higher prevelance of other comorbidities (box 1) which might directly or indirectly be due to issues with insulin resistance (box 2). An altered endocrine environment leads to androgen excess (box 3) which can be diagnosed visually by box 4. Perhaps most relevant to you as providers of ob/gyn care is anovulation (box 5). The factors that cause PCOS are complex but these symptoms are the most common ones reported by patients with PCOS. (which will lead you into your next slide)

How is PCOS Diagnosed?NIH 1990 Rotterdam 2003 AE-PCOS Society 2006

• Hyperandrogenism• Chronic Anovulation

---Both criteria needed

• Hyperandrogenism• Oligo-and/or anovulation• Polycystic ovaries

---2 of 3 criteria needed

• Hyperandrogenism• Ovarian dysfunction

---Both criteria needed

First developed and most commonly used criteria today

Formulated to expand on NIH diagnostic definition

Formulated to provide an evidence-based definition

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*All possible related disorders must be ruled out

NIH Evidenced Based Methodology Workshop on PCOS, 2012; Shannon et al. 20122

~ 50-75% will visit multiple clinicians before it is identified2

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add an ultrasound image of PCOS. maybe in the right corner... if you need help locating one let me know.

PCOS Treatment

• Lifestyle intervention = first line treatment1-3

• Support medical management

• Weight loss is best achieved though multidisciplinary lifestyle management4:• Dietary• Exercise• Behavioral

• Requires ongoing support for long-term success 5-6

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Teede et al, 20111; Humphreys & Costarellil, 20082; Jeanes et al, 20093; Moran et al, 20094; Himelein, 20065; Stankiewicz, 20066

Physical Activity

DietSmoking Cessation

Stress

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state whole person treatment....this audience will automaticially think infertility and PCOS without that

Benefits of Weight Loss in PCOS• Potential Benefits

Include1-3:• insulin levels

• testosterone

• risk for CVD and diabetes

• Improved dermatological symptoms

• Improved fertility6

• Weight loss of 5% to 10% can improve metabolic and reproductive aspects of PCOS1-2

• Does not reverse PCOS, but helps control associated co-morbidities3

Teede et al, 20111; Farhat et al, 20112; Barthelmess & Naz, 20143

Study Objective

To investigate the current trends and future implications of multidisciplinary PCOS clinics while emphasizing the role and challenges for dietitians.

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Formative Study Design

Phase 2: Focus Groups (N=9)

Phase 1: Survey (N=261)

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• Anonymous, Internet-based

• 30 Questions• Basic Demographics• Current Facility • Future Implications

• Teleconference• 7 Major Questions• Braun & Clarke’s

Thematic Analysis1

Braun & Clark, 20061

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Might want to change this to teleconference. Then you can delete teleconference from the box

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This audience might want to know the make up of the focus group. you could leave this bullet out

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You don't have to write it down, but you will probably want to say that you utilized some field specific email list serves to identify partifipants.

Survey Demographics

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59%

20%

5%

3%3%

3%7%

Provider Type

PhysiciansDietitiansFertility SpecialistResearchersMidlevel ProvidersEducator/CounselorsOther

N=210

64%

36%

Location

USAOther

N=184

Survey Demographics

10Hospita

l/Clin

ic

Private

Office

Researc

h Facil

ityOth

er0

10203040506070 66%

45%

8% 4%

Setting for Care

71%

23%

6%

Population Setting

Urban

Suburban

Rural

N=205

N=141

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you might want to make these graphs instead of tables for ease of reading.

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you might also want to tell the audience what type of patient your providers that answered the survey were seeing....tell about the patient population, age, etc.

Multidisciplinary Specialties Involved

59%

41%

Multidisciplinary Status

Yes

No

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Specialty # Involved % Involved

Dietitian/Nutritionist 94 71%

Physician 89 67%

Nurse 63 48%

Fertility Specialist 46 35%

Mid-Level Providers 37 28%

Social Worker 37 28%

Psychologist 34 26%

N=132

Strengths and Weaknesses of the Current System

05

10152025303540

34%30%

10%

Needs Improvement

% o

f Pro

vide

rs

12More Multidisc

iplinary

Involve

ment

Expand Nutriti

on & Exercise

Programs Elim

inate Access

Barriers*

* Wait-Time, Cost, InsuranceN=88

0

5

10

15

20

2521% 21% 20%

17%

Current Strengths

% o

f Pro

vide

rs

Management of S

ymptoms

Lifesty

le Changes

N=87Patient E

ducation & Counseling

Multidisciplin

ary Collaboration

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maybe change title to strengths and weaknesses of the current system

Potential Barriers for Future Multidisciplinary Clinics

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Money and resources (30%)

Insurance/reimbursement (26%)

Difference of opinions (16%)

Time

(12%)

Potential Advantages for Multidisciplinary Clinics

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Increased access to

more disciplines (10%)

Better communication between providers (15%)

Better results & long-term outcomes (18%)

Convenience & efficiency (30%)

Comprehensive and integrated care (32%)

Ideal Involvement of Providers

Specialty N Highly Involved Involved Neutral Occasionally

InvolvedNever

Involved

Dietitian 110 59% 30% 6% 3% 2%

Endocrinologist 109 48% 36% 6% 7% 3%

Gynecologist 110 45% 43% 5% 5% 2%

Fertility Specialist 97 30% 33% 14% 13% 9%

Exercise Physiologist 95 18% 40% 18% 9% 15%

Health Psychologist 105 11% 45% 21% 15% 8%

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Focus Group Results

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Phase 2

Focus Group Demographics• Dietitians• PCOS (4)

• Physicians• Adolescent/Internal

Medicine• Pediatric

Endocrinologist (2)

• Other• LN/CNS • Health Psychologist

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67%33%

Multidisciplinary Clinic

YesNo

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abstract says 3 dieticians

When is Dietary Intervention Warranted

For PCOS?

• Always important to discuss and provide nutrition counseling

• Equally important regardless of BMI

• Immediately upon on diagnosis patients should meet with RD• First line treatment

How Accessible are Dietary Interventions

for PCOS?

• Not very accessible!

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Challenges for Dietitians

Insurance

Lack of knowledge on PCOS

Lack of physician referrals

Patient follow-through

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add about PCOS

Importance of Involving RDs• Access to adequate

lifestyle interventions

• Physicians should not be fully responsible:• Little to no training

• “They can only be the experts on so many things”

• Takes time • “More than just handing

the patient a 1,200 kcal diet plan”

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Conclusions• PCOS patients require special attention with

individualized, focused, multidisciplinary care – ideally in one facility

• The most common challenges for dietitians include insurance, lack of knowledge, and lack of physician referrals

• Dietitians are highly overlooked when it comes to the care of PCOS

• Education for PCOS and lifestyle interventions need to be increased across providers 21

Did you ever wonder how your lifestyle is affecting you?

Ask today about speaking with our Registered Dietitian to discuss methods for:

Improving your nutritional statusIncludes a nutrition assessment

Meeting your physical activity needsImproving your BMIImproving your fertilityImproving your overall health

WVU Center for Reproductive Medicine Welcomes…

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Acknowledgments

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Dr. Melissa OlfertDr. Melanie ClemmerDr. Pamela J. Murray

Dr. Rajesh NazDr. Michael VernonOlfert Research Lab

Questions

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OBGYN Palladino Presentation - PCOS Nutrition Interventions

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Transcript of OBGYN Palladino Presentation - PCOS Nutrition Interventions