Clinical Review: Modified 5 As: Minimal intervention for obesity counseling in primary care.

Dalhousie University, Family Medicine, Suite 4060, Lane Bldg, 5909 Veteran's Memorial Lane, Halifax, NS B3H 2E2. .
Canadian family physician Medecin de famille canadien (Impact Factor: 1.34). 01/2013; 59(1):27-31.
Source: PubMed


To adapt the 5 As model in order to provide primary care practitioners with a framework for obesity counseling.
A systematic literature search of MEDLINE using the search terms 5 A's (49 articles retrieved, all relevant) and 5 A's and primary care (8 articles retrieved, all redundant) was conducted. The National Institute of Health and the World Health Organization websites were also searched.
The 5 As (ask, assess, advise, agree, and assist), developed for smoking cessation, can be adapted for obesity counseling. Ask permission to discuss weight; be nonjudgmental and explore the patient's readiness for change. Assess body mass index, waist circumference, and obesity stage; explore drivers and complications of excess weight. Advise the patient about the health risks of obesity, the benefits of modest weight loss, the need for a long-term strategy, and treatment options. Agree on realistic weight-loss expectations, targets, behavioural changes, and specific details of the treatment plan. Assist in identifying and addressing barriers; provide resources, assist in finding and consulting with appropriate providers, and arrange regular follow-up.
The 5 As comprise a manageable evidence-based behavioural intervention strategy that has the potential to improve the success of weight management within primary care.

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Available from: Michael Vallis, Dec 18, 2013
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    • "Practitioners are now encouraged to use the '5As' to manage patients' weight: Ask, Assess, Advise, Assist and Arrange. This intervention style was originally used in smoking cessation (Fiore et al. 2008) and uses evidence-based behaviour change concepts (Vallis et al. 2013). The new guidelines also follow a patient-centred approach, with the intention that the patient will be intrinsically involved in the planning and implementation of their weight management. "
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    ABSTRACT: Nearly 62% of primary care patients are overweight or obese, and obesity is now a National Health Priority Area. Weight management interventions in primary care currently generate little more than 1 kg of weight loss per patient over a 2-year period. Consequently, further strategies are required to improve the effectiveness of weight management in primary care. The National Health and Medical Research Council (NHMRC) have released updated guidelines for the management of overweight and obese patients in primary care. However, there is some disconnect between establishment of guidelines and their implementation in practice. Barriers to GPs using guidelines for the management of obesity include low self-efficacy, perceived insufficient time in consultations and the challenge of raising the topic of a patient's weight. Nonetheless, patients prefer to receive weight management support from GPs rather than other health professionals, suggesting that the demand on GPs to support patients in weight management will continue. GPs cannot afford to side-line obesity management, as obesity is likely to be the most prevalent modifiable risk factor associated with patients' long-term health. Without further strategies to support GPs in their management of patients' weight, obesity will continue to be an expensive and long-term public health issue.
    Australian Journal of Primary Health 09/2015; DOI:10.1071/PY15018 · 0.96 Impact Factor
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    • "There are substantial direct and indirect costs to the healthcare system; conservative estimate of costs attributable to obesity in Alberta in 2005 totaled $1.27 billion [3]. Studies suggest that a primary care-based obesity treatment model could be cost-effective over the long term [2] and that treating obesity can reduce the incidence of a variety of chronic diseases [4-7]. However, obesity is ‘not effectively managed within our current primary health system’ [4-6]. "
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    ABSTRACT: Background Obesity is a pressing public health concern, which frequently presents in primary care. With the explosive obesity epidemic, there is an urgent need to maximize effective management in primary care. The 5As of Obesity Management™ (5As) are a collection of knowledge tools developed by the Canadian Obesity Network. Low rates of obesity management visits in primary care suggest provider behaviour may be an important variable. The goal of the present study is to increase frequency and quality of obesity management in primary care using the 5As Team (5AsT) intervention to change provider behaviour. Methods/design The 5AsT trial is a theoretically informed, pragmatic randomized controlled trial with mixed methods evaluation. Clinic-based multidisciplinary teams (RN/NP, mental health, dietitians) will be randomized to control or the 5AsT intervention group, to participate in biweekly learning collaborative sessions supported by internal and external practice facilitation. The learning collaborative content addresses provider-identified barriers to effective obesity management in primary care. Evidence-based shared decision making tools will be co-developed and iteratively tested by practitioners. Evaluation will be informed by the RE-AIM framework. The primary outcome measure, to which participants are blinded, is number of weight management visits/full-time equivalent (FTE) position. Patient-level outcomes will also be assessed, through a longitudinal cohort study of patients from randomized practices. Patient outcomes include clinical (e.g., body mass index [BMI], blood pressure), health-related quality of life (SF-12, EQ5D), and satisfaction with care. Qualitative data collected from providers and patients will be evaluated using thematic analysis to understand the context, implementation and effectiveness of the 5AsT program. Discussion The 5AsT trial will provide a wide range of insights into current practices, knowledge gaps and barriers that limit obesity management in primary practice. The use of existing resources, collaborative design, practice facilitation, and integrated feedback loops cultivate an applicable, adaptable and sustainable approach to increasing the quantity and quality of weight management visits in primary care. Trial registration NCT01967797.
    Implementation Science 06/2014; 9(1):78. DOI:10.1186/1748-5908-9-78 · 4.12 Impact Factor
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    • "Recently, the Canadian Obesity Network developed and validated “The 5 As of Obesity Management” for a nonpregnant population to give health practitioners five steps to better manage their patients' weight and related health issues (available at [56]. Currently, a revised 5 As for pregnancy is under development. "
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    ABSTRACT: The quality of the intrauterine environment influences maternal-fetal health and also offspring predisposition to obesity and cardiometabolic disease later in life. Several determinants, including but not limited to pregravid obesity and excessive gestational weight gain, alter the developmental milieu, fetal growth, and child obesity risk. However, the role of sleep and its relationship to healthy pregnancy is not fully established. Given the host of psychosocial and physiological complications associated with childhood obesity, targeting the gestational period is purported to be an opportune time for preventive intervention. Many longitudinal studies suggest that short sleep duration is a risk factor for the development of impaired glycemia and obesity. However, there is a dearth of information concerning the role of sleep hygiene and its role in a healthy pregnancy. Reports note disrupted and poorer quality of sleep during gestation and highlight an association between reduced sleep and risk of gestational diabetes mellitus. Given the lack of well-designed human trials assessing the value of sleep and healthy pregnancy outcomes, this review summarizes current evidence which suggests that incorporating sleep recommendations and utilizing time management strategies that encourage a healthful night 's sleep may improve the health of the mom and the baby.
    02/2014; 2014:928293. DOI:10.1155/2014/928293
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