Obesity care evidence and gap map

A visual map of  research on healthcare service interventions and their relationship with healthcare outcome measures for patients with extreme obesity.  

Who is the map for?

The Evidence Gap Map is intended for clinicians, policymakers, and researchers.

What research is included in the map

All review and primary studies which assessed health service interventions that aimed to improve healthcare outcomes for hospitalised patients with extreme obesity were included. Grey literature such as reports, dissertations and conference abstracts were also included. All relevant, ongoing, and incomplete studies and protocols were included alongside completed studies. The search was completed in August 2023.

The target population were hospitalised adult patients (≥18years) with extreme obesity defined as: BMI ≥40kg/m2; weighing ≥150 kgs or having large physical dimensions which affected mobility and/or made moving and handling difficult.

Studies based in hospital inpatient settings such as critical care, acute care, theatres and rehabilitation where the patient was admitted were included. Outpatient services based within the hospital were excluded. Studies of mixed settings were included, but only if the intervention primarily occurred in the hospital setting with the target population admitted as an inpatient during the main phase of the intervention.

We intend to update the map every 2 years.

Full details of the study protocol.

How to use the map

Each cell compiles the research at the intersection of particular intervention and outcome categories. The number of studies in each cell is denoted by the size of the data point. The quality of the research in each cell is denoted by the colour of the data point.

• Cells: By clicking on any cell, the map displays those items that contribute data to that cell.  You can then browse the references and read or download the article/s of interest. You can rearrange how the list of references is displayed. Selecting ‘segment’ rearranges the list from high to low level of evidence. You can also search for specific references by using key words within the ‘filter’ search box.
• Filters:  Across the top tab, you can use the ‘filter’ feature to narrow your search of the evidence. The filters include: study design, publication status, region, quality of evidence and equity.
• View records: This tab opens all 247 records contained within the EGM. You can then browse the references and read or download the article/s of interest.
• Visual display options: You can change the visual look of the map using the 5 icons along the top right tab bar on the map. The options include a Bubble, Heat, Mosaic, Donut and Text Map (default setting-Bubble). We recommend changing the view display to text map – see right icon on top task bar.

Interventions  (Rows)

Intervention	Definition
Specialist workforce	Designated health professional roles/ positions employed specifically to manage /care for hospitalised patients with extreme obesity
Special care pathways	Processes that guide the care of hospitalised patients with extreme obesity
Assessment tools	Assessment tools used to assess patient risk and guide care during hospital admission
Equipment	Specialist equipment used in the care of hospitalised patients with extreme obesity
Moving and handling	Processes used during care to move or transfer patients with extreme obesity. The lifting, transferring, repositioning, or mobilising of part or all of a patient's body. (The focus of the research is on processes to support staff to enable patient mobilisation)
Specialist care areas	Specific areas/wards where the physical environment has been designed for the care of patients with extreme obesity
Education	Bariatric-specific education or training for professionals designed to improve care services for patients with extreme obesity
Care bundles/ packages	Groupings of care interventions/practices that when implemented collectively improve the reliability of care, and, or patient and healthcare outcomes
Patient mobility	Patient mobility during their hospital admission (Focus of the research is on improving the biomechanics of patient mobility)

Outcomes measures (columns)

Outcome measures	Subcategory	Definition
Safety	Patient injury	Any hospital acquired patient injury, adverse event or care practice that caused harm to the patient
	Patient falls	Any fall that occurred during hospitalisation/ hospital stay
	Staff injury	Any injury or condition caused by the delivery of care to patients with extreme obesity
Effectiveness		Providing services based on scientific knowledge to all those who could benefit and refraining from those who would likely not benefit.  Outcome data represents either the size of the problem or the reduction in harm Patient deterioration Hospital associated infection Medication safety Pressure injuries Falls
Efficiency	Costs	Direct costs of health care provision for hospitalised patients with extreme obesity. Costs accrued during an inpatient care episode.
	Resource utilisation	Maximising the benefit of available resources and avoiding waste. Bed days (ICU LOS, HLOS) Harm avoidance practices
Timely access		Timeliness of health care system's capacity to provide care after a need is recognised. Reducing waiting times and harmful delays. Time to receive care interventions Waiting times to access services
Patient experience	Satisfaction/experience	The overall patient assessment of the quality of care received during their hospital stay using measures like: treated with kindness and respect, listened to, involved in decisions.
	Person-centred	Providing care that responds to individual preference, needs and values.
	Discrimination	The unjust or prejudicial treatment of the patient with extreme obesity because of their physical health condition or appearance
Health equity	Quality of care	Providing care that does not vary in quality on account of the patient having extreme obesity Comparisons made between patients who are non-obese and obese for the same intervention
Access to care		Access to appropriate care based on identified needs of the patient with extreme obesity Comparisons made between patients who are non-obese and obese for the same intervention
Quality improvement		Improvement efforts that aim to improve outcomes for patients with extreme obesity

How to cite this resource

Hales, C., Chrystall, R., Jeffreys, M., Weatherall, R., & Haase, A.M. (2024). Health service interventions to improve the healthcare outcomes of hospital patients with extreme obesity: Evidence and Gap Map. Interactive Map-Version 1. https://www.wgtn.ac.nz/health/research/research-projects/obesity-care-evidence-and-gap-map

Research team

Caz (PhD, BNurs(Hons), RN) is a registered nurse who works in the academic and research field of obesity and clinical care. Her research focuses on advancing safe healthcare practices and equitable services for people living with obesity (PlwO). Her work explores patient and staff factors that impact on quality of care, patients’ experiences, and patient and staff safety, to address educational needs and attitudes of healthcare professionals when providing care to PlwO.

Anne (PhD) specialises in health psychology and behavioural science with current research focusing on physical activity and nutrition behaviour change in people with chronic illness and disease (e.g., cancer, obesity, inflammatory diseases, diabetes and mental illness).  Her work includes defining determinants, designing and implementing interventions/RCTs and process evaluation in health behaviour research and service delivery.

Mona (PhD, MSc, BSc(Hons)) is an epidemiologist, whose current research focusses on health care access. She has a specific interest in health equity, and is involved in a range of projects within this broad area of health services research.

Rebecca (MHlthPsyc, BSc) has a background in Health Psychology and Nutrition. She has worked on a variety of projects focused on improving health, wellbeing and health service delivery for young people, Māori, Pacific peoples and patients of larger size. She is currently based at Imperial College London.

Ruth is an academic whose research on social justice and gender equality, and is involved in a range of projects within this broad area of organisational and management study research. She has a specific interest in domestic violence and the workplace, both in terms of the implementation of workplace policy and the intersection of diversity and access to workplace support.

Contact us

For expressions of interest about including research in the map or general queries about the map.