How can GPs help patients with obesity to lose weight?

Author: 
Professor Mark Harris and Dr. Catherine Spooner

An overview of the NHMRC's Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia

Written by Professor Mark Harris, Director of COMPaRE-PHC, and Dr. Catherine Spooner, Coordinator of COMPaRE-PHC

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“Adults with overweight or obesity are seen regularly  in general practice and it is important that clinicians can provide weight loss options for these patients.”1

The management of obesity can be complex and frustrating for both the patients and clinicians.

However, obesity can be managed successfully and even small amounts of weight loss are linked with lowered cardiovascular risk and delayed onset of chronic conditions such as diabetes.

The National Health and Medical Research Council (NHMRC) clinical management guidelines provide a helpful framework based upon the 5As for GPs to assist patients with obesity to effectively manage their weight (Figure 1). 2

 

 Figure1. NHMRC 5As framework for weight management. Source: NHMRC Guidelines (2).

After measuring waist circumference and calculating body mass index (BMI), the first step is to discuss the patient’s readiness to change their lifestyle behaviours. Advising on the benefits of weight loss needs to convey that there are lasting benefits to even small amounts of weight loss. Assistance will be more beneficial when this incorporates multicomponent approaches rather than relying on a single intervention. This can require referral to other health professionals, community-based programs or specialists. Lifestyle interventions that target nutrition, physical activity, and behaviour change are generally the first approach for providers when assisting patients with obesity to manage their weight. More intensive interventions such as very low energy diets and medication can be beneficial for some but require close monitoring and support. Bariatric surgery is currently the most effective intervention for those with severe obesity. Regardless of the weight loss treatment approach, follow-up is important. This should be frequent: fortnightly for the first 3 months of a weight-loss program with review and escalation in intensity if there is less than 1% decrease in weight.

Given the high demands upon the time of general practitioners, the practice nurse can also be involved in the assessment and management of overweight and obesity. Previous research has provided evidence of the benefits and cost effectiveness of practice nurse involvement in this area. 3-5

References 

1. Harris M, Spooner C. Weight loss options in general practice (Editorial). Med J Australia 2014;201(4):184-85.

2. National Health and Medical Research Council. Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia. Melbourne: National Health and Medical Research Council, 2013.

3. Karnon J, Afzali H, Gray J, et al. A risk adjusted cost‐effectiveness analysis of alternative models of nurse involvement in obesity management in primary care. Obesity 2013;21(3):472-79.

4. Parkinson AM, Parker R. Addressing chronic and complex conditions: what evidence is there regarding the role primary healthcare nurses can play? Australian Health Review 2013:-.

5. Robinson A, Denney-Wilson E, Laws R, et al. Child obesity prevention in primary health care: Investigating practice nurse roles, attitudes and current practices. Journal of Paediatrics and Child Health 2013;49(4):E294-E99.