Implementation of Clinical Services for Adults with Obesity in Different Health Systems: A Scoping Review and Causal Loop Diagram

Yan Xue,1 Menghuan Song,1,2 Honho Yu,3 Xianwen Chen,1 Carolina Oi Lam Ung,1,2,4 Hao Hu1,2,4 1State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao SAR, People’s Republic of China; 2Centre for Pharmaceutical Regulatory Sciences...

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Main Authors: Xue Y, Song M, Yu H, Chen X, Ung COL, Hu H
Format: Article
Language:English
Published: Dove Medical Press 2025-05-01
Series:Diabetes, Metabolic Syndrome and Obesity
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Online Access:https://www.dovepress.com/implementation-of-clinical-services-for-adults-with-obesity-in-differe-peer-reviewed-fulltext-article-DMSO
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author Xue Y
Song M
Yu H
Chen X
Ung COL
Hu H
author_facet Xue Y
Song M
Yu H
Chen X
Ung COL
Hu H
author_sort Xue Y
collection DOAJ
description Yan Xue,1 Menghuan Song,1,2 Honho Yu,3 Xianwen Chen,1 Carolina Oi Lam Ung,1,2,4 Hao Hu1,2,4 1State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao SAR, People’s Republic of China; 2Centre for Pharmaceutical Regulatory Sciences, University of Macau, Macao SAR, People’s Republic of China; 3Department of Gastroenterology and Hepatology, Kiang Wu Hospital, Macao SAR, People’s Republic of China; 4Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macao SAR, People’s Republic of ChinaCorrespondence: Hao Hu, Email haohu@um.edu.mo Carolina Oi Lam Ung, Email carolinaung@um.edu.moAbstract: The medical needs of obesity have been underrecognized, though it has posed long-term and enormous challenges to global health. Correspondingly, clinical services for obesity are still uncommon and in their infancy across health systems. It is meaningful to sort out the implementation of such clinical services involving a multiplicity of factors to identify measures for service development, scaling-up and optimization. This study aims to generate a comprehensive understanding of key variables and factors in the utilization and delivery of clinical services for adult patients with obesity and their dynamic patterns and to explore viable options for improved implementation of such services in health systems. We conducted a scoping review of published articles in the database from the lens of system dynamics through causal loop diagramming. Based on the data obtained from the review, we employed the causal loop diagramming as a tool to capture the variables in the implementation of clinical obesity services and their causal relationships. Twenty-one studies were finally included in the review. Based on the evidence consolidated through the review, we developed a causal loop diagram containing 19 causal variables and 38 causal arrows in single directions centered around the service utilization and delivery in the clinical obesity service. The feedback loops revealed potential activation points to intervene to facilitate the service implementation, such as, promotion of obesity as a disease with medical needs and available clinical services, provision of obesity-specific medical education and training opportunities, and prioritization of obesity-specific procedures in clinical protocols. The possible intervention points identified through the causal loop analysis can facilitate the development, implementation, and optimization of clinical obesity services in health systems.Keywords: clinical service, service implementation, adult obesity, causal loop diagram, health systems
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series Diabetes, Metabolic Syndrome and Obesity
spelling doaj-art-d7affa256c174ce0ae619a1e9530b0d42025-08-20T02:24:14ZengDove Medical PressDiabetes, Metabolic Syndrome and Obesity1178-70072025-05-01Volume 18Issue 116951709103188Implementation of Clinical Services for Adults with Obesity in Different Health Systems: A Scoping Review and Causal Loop DiagramXue Y0Song M1Yu H2Chen X3Ung COL4Hu H5State Key Laboratory of Quality Research in Chinese MedicineState Key Laboratory of Quality Research in Chinese MedicineDepartment of gastroenterology and hepatologyState Key Laboratory of Quality Research in Chinese MedicineState Key Laboratory of Quality Research in Chinese MedicineInstitute of Chinese Medical SciencesYan Xue,1 Menghuan Song,1,2 Honho Yu,3 Xianwen Chen,1 Carolina Oi Lam Ung,1,2,4 Hao Hu1,2,4 1State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao SAR, People’s Republic of China; 2Centre for Pharmaceutical Regulatory Sciences, University of Macau, Macao SAR, People’s Republic of China; 3Department of Gastroenterology and Hepatology, Kiang Wu Hospital, Macao SAR, People’s Republic of China; 4Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macao SAR, People’s Republic of ChinaCorrespondence: Hao Hu, Email haohu@um.edu.mo Carolina Oi Lam Ung, Email carolinaung@um.edu.moAbstract: The medical needs of obesity have been underrecognized, though it has posed long-term and enormous challenges to global health. Correspondingly, clinical services for obesity are still uncommon and in their infancy across health systems. It is meaningful to sort out the implementation of such clinical services involving a multiplicity of factors to identify measures for service development, scaling-up and optimization. This study aims to generate a comprehensive understanding of key variables and factors in the utilization and delivery of clinical services for adult patients with obesity and their dynamic patterns and to explore viable options for improved implementation of such services in health systems. We conducted a scoping review of published articles in the database from the lens of system dynamics through causal loop diagramming. Based on the data obtained from the review, we employed the causal loop diagramming as a tool to capture the variables in the implementation of clinical obesity services and their causal relationships. Twenty-one studies were finally included in the review. Based on the evidence consolidated through the review, we developed a causal loop diagram containing 19 causal variables and 38 causal arrows in single directions centered around the service utilization and delivery in the clinical obesity service. The feedback loops revealed potential activation points to intervene to facilitate the service implementation, such as, promotion of obesity as a disease with medical needs and available clinical services, provision of obesity-specific medical education and training opportunities, and prioritization of obesity-specific procedures in clinical protocols. The possible intervention points identified through the causal loop analysis can facilitate the development, implementation, and optimization of clinical obesity services in health systems.Keywords: clinical service, service implementation, adult obesity, causal loop diagram, health systemshttps://www.dovepress.com/implementation-of-clinical-services-for-adults-with-obesity-in-differe-peer-reviewed-fulltext-article-DMSOclinical serviceservice implementationadult obesitycausal loop diagramhealth systems
spellingShingle Xue Y
Song M
Yu H
Chen X
Ung COL
Hu H
Implementation of Clinical Services for Adults with Obesity in Different Health Systems: A Scoping Review and Causal Loop Diagram
Diabetes, Metabolic Syndrome and Obesity
clinical service
service implementation
adult obesity
causal loop diagram
health systems
title Implementation of Clinical Services for Adults with Obesity in Different Health Systems: A Scoping Review and Causal Loop Diagram
title_full Implementation of Clinical Services for Adults with Obesity in Different Health Systems: A Scoping Review and Causal Loop Diagram
title_fullStr Implementation of Clinical Services for Adults with Obesity in Different Health Systems: A Scoping Review and Causal Loop Diagram
title_full_unstemmed Implementation of Clinical Services for Adults with Obesity in Different Health Systems: A Scoping Review and Causal Loop Diagram
title_short Implementation of Clinical Services for Adults with Obesity in Different Health Systems: A Scoping Review and Causal Loop Diagram
title_sort implementation of clinical services for adults with obesity in different health systems a scoping review and causal loop diagram
topic clinical service
service implementation
adult obesity
causal loop diagram
health systems
url https://www.dovepress.com/implementation-of-clinical-services-for-adults-with-obesity-in-differe-peer-reviewed-fulltext-article-DMSO
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