Do the five A's work when physicians counsel about weight loss?

Durham VA Medical Center, Durham, NC 27705, USA.
Family medicine (Impact Factor: 1.17). 03/2011; 43(3):179-84.
Source: PubMed

ABSTRACT More than two thirds of Americans are overweight or obese. Physician counseling may help patients lose weight; however, physicians perceive these discussions as somewhat futile and time-consuming. An effective and efficient tool for smoking cessation is the Five A's (Ask, Advise, Assess, Assist, and Arrange). We studied the effectiveness of the Five A's in weight-loss counseling.
We audiorecorded primary care encounters between 40 physicians and 461 of their overweight or obese patients. All were told the study was about preventive health, not weight specifically. Encounters were coded for physician use of the Five A's. Patients' motivation and confidence were assessed before and immediately after the encounter. Three months later, we assessed patient change in dietary fat intake, exercise, and weight.
Generalized linear models were fit adjusting for patient clustering within physician. Physicians used at least one of the Five A's often (83%). Physicians routinely Ask and Advise patients to lose weight; however, they rarely Assess, Assist, or Arrange. Assist and Arrange were related to diet improvement, whereas Advise was associated with increases in motivation and confidence to change dietary fat intake and confidence to lose weight.
Similar to smoking cessation counseling, physicians routinely Asked and Advised patients to lose weight; however, they rarely Assessed, Assisted, or Arranged. Given the potential impact of using all of these counseling tools on changing patient behavior, physicians should be encouraged to increase their use of the Five A's when counseling patients to lose weight.

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Available from: Christy Boling Turer, Sep 28, 2015
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    • "Introduction Nutrition and physical activity matter Good counseling works Motivational interviewing Introduction What is motivational interviewing? Ask open-ended questions Practice reflective listening Praise positive behaviors Your goals for using MI Behaviors to avoid Your goals for behaviors to avoid Summary The 5 A's Explanation An example Your examples Teen communication Introduction Explanation An example Summary Take-home messages What other doctors are doing What teens are doing Additional resources To obtain these audio clips, first we coded the baseline encounters for the MI techniques using the Motivational Interviewing Treatment Integrity (MITI) Code [24] and 5 A's with a codebook adapted from our other study with primary care physicians and overweight adult patients [22]. The MITI Code has been previously validated for convergent and discriminant validity [25]. "
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