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Characterization of the Distribution of Body Mass Index in People with Type 2 Diabetes in the Portuguese Population
Publication . Silva-Nunes, José; Teixeira-Rodrigues, António; Guerreiro, José; Rojais, Carolina; Cary, Maria; Conde, Vasco; Neves, João Sérgio
Introduction: Type 2 diabetes (T2D) is a global health concern, closely linked to the obesity epidemic. In Portugal, the high prevalence of T2D, alongside important rates of overweight and obesity, highlights the need for targeted interventions.
Methods: This multicentre, cross-sectional observational study aimed to characterize the Portuguese T2D population based on body mass index (BMI) and waist circumference (WC), while examining associated sociodemographic, clinical, and therapeutic factors. Adult patients with self-reported T2D were recruited from community pharmacies in June 2024. Data on anthropometric characteristics, clinical history, lifestyle, and antidiabetic medication were collected via questionnaires and pharmacy records. Results: A total of 1,132 participants were included (mean age 68.3 years [SD
10.8]; 51.0% female), 41.3% were overweight, 37.7% presented obesity (26.2% class I, 8.8% class II, 2.7% class III), and 21.0%
had a BMI <25 kg/m2. Higher BMI correlated with younger age, female gender, unemployment, increased WC, and higher rates of comorbidities like hypertension, sleep apnoea, and chronic venous insufficiency of the lower limbs. Overall, 98.2% of participants were treated with non-insulin glucose-lowering agents, most commonly fixed-dose combinations of oral therapies (44.0%).
Conclusion: Our findings highlight a high prevalence of overweight/obesity among individuals with T2D in Portugal. This finding emphasizes the need to optimize clinical follow-up and implementing more effective interventions for the prevention and management of obesity among individuals with T2D. Routine BMI and WC assessments are vital, and integrated, for individualized T2D management that should address both glycaemic control and obesity-related risks to improve quality of life and prevent premature morbidity and mortality
Cultural Translation and Validation of the Stigmatizing Situations Inventory-Brief into European Portuguese
Rego de Figueiredo, Inês; Palmeira, Lara; Silva-Nunes, José
Introduction: Stigma is a tendency to exclude people’s perceived difference by society. It can be external or discrimination and internal or self-stigma. There are a variety of tools to assess weight stigma. However, there was a lack of a tool in European Portuguese to assess external stigma. Therefore, the aim of this study was to perform translation, validation, and cultural adaptation of the Stigmatizing Situations Inventory-Brief (SSIB) questionnaire into European Portuguese.
Methods: A crosssectional study was performed by completion of two questionnaires by patients with obesity followed at a multidisciplinary obesity treatment clinic: SSI-B questionnaire and the validated translated Portuguese version of the Everyday Discrimination Scale. Direct translation followed reviewing, back-translation, comparison, and pilot testing
were performed. The retest was done 1 month after the baseline. The following psychometric properties were
assessed: convergent validity between SSI-B and the Everyday Discrimination Scale, internal consistency, and reproducibility between test and retest. Results: A total of 175 patients were included, with a mean age of 47 ± 11 years old and a mean BMI of 43±6 kg/m2. The mean stigma scores were 21 ± 18 on the SSIB and 9 ± 9 on the Everyday Discrimination Scale. Regarding the psychometric properties, convergent validity yielded a Spearman’s r coefficient of 0.727, the Cronbach’s alpha coefficient for internal consistency was 0.88, and reproducibility produced a Spearman’s r coefficient of 0.7 and an intraclass correlation coefficient of 0.699.
Conclusion: This translation demonstrates acceptable psychometric properties, supporting its future application
in clinical practice in Portugal.
Psychopathology among Patients with Obesity Who Are Candidates to Bariatric Surgery
Publication . Rego de Figueiredo, Inês; Vasques Carvalho, Miguel; Cunha, Nelson; Martins, Diana; Silva-Nunes, José
Introduction: Obesity is often associated with disturbed eating patterns and disorders, as well as mental health issues
such as personality disorders, and psychological diseases. This is often described as psychopathology of obesity. In this work, we attempted to establish the prevalence of certain psychopathological traits in patients with obesity (PwO) who
were candidates for bariatric surgery when compared to lean controls: (1) obsessivity-compulsivity, (2) depression/anxiety, (3) cravings, and (4) impulsivity.
Methods: A cross-sectional study was performed by asking patients and controls to fill out the Yale-Brown Obsessive-Compulsive Scale, the Hospital Anxiety and Depression Scale, the State and Trait FoodCravings Questionnaires, and the Barrat Impulsiveness Scale.
Results: We included 253 PwO and 52 lean controls. Obsessive-compulsive (OC) traits, anxiety, cravings, and impulsiveness were more prevalent in the group of PwO, even after adjusting for the age and gender differences between the groups. Anxiety and impulsivity were both
correlated with emotional eating, and cravings were associated with emotional and night eating.
Conclusion: Most of our results are in line with the literature in this area. However, the high expression of OC traits in this population of PwO might be due to the high prevalence of depression. Surprisingly, high attentional impulsivity (that is reported to be really expressed in PwO) was not observed in our cohort. It is of interest the association observed for most of the psychopathological traits with emotional eating
Before a Diagnosis of Secondary Catatonia Due to Chronic Nitrous Oxide Use is Made, all Alternative Causes Must Be Ruled Out
Publication . Gama Marques, João; Finsterer, Josef
Public Policies on Healthy Diet: Analyzing the Portuguese Experience
Publication . Almeida Marques, Bruno; Morais Nunes, Alexandre; Catarino, João Ricardo
Abstract: In Portugal, public policies promoting a healthy diet have gained prominence in recent years, reflecting a growing concern with the population’s health status and its individual, social, economic, and political impact. These policies aim to mitigate the impact of inadequate eating habits as a determinant of health and the population’s disease burden. Based on a document analysis, the main objective of this article is to explore public healthy diet policies in Portugal following the 2017 implementation of the Estratégia Integrada para a Promoção da Alimentação Saudável (Integrated Strategy for the Promotion of a Healthy Diet), which is the primary guiding instrument for these policies. Among the most impactful legislative measures found in this sector, we highlight the reformulation
of food products, food taxation, food marketing regulation, food incentives, and food labeling. Despite significant progress in promoting healthy diets, some challenges still remain, particularly the growing prevalence of behavior-related chronic non-communicable diseases, like obesity, such as the maintenance of a set of health determinants related to inadequate nutrition. Thus, the continuity and deepening of such policies, combined with continuous impact assessments, are crucial to ensuring a healthier future.