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.
    Full-text · Article · Sep 2015 · Australian Journal of Primary Health
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    • "Also, 80% of the participants planned to take additional actions in the future. This was anticipated as Vallis et al. state small success leads to further nutritional motivation in nutritional interventions [11]. Allowing the subjects to set their own health goals in the Nutri One-on-One study ensured that the participant was interested in achieving the goal and taking beneficial actions. "
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    ABSTRACT: Nutri One-on-One was a program with the aim to positively modify medical clinic patients’ nutritional habits and lifestyles through a brief one-on-one health coaching session. Each session was conducted by utilizing motivational interviewing techniques to allow for tailored nutrition education and goal setting. These sessions were followed by a phone call to participants at 1 month following the session. The outcomes assessed were participant perception of achieving personal nutrition and lifestyle goals, retention of knowledge, and participants’ satisfaction with the program. Physicians working in the clinic were assessed for satisfaction with the program. Most of the physicians were generally satisfied with the program and found it to be an asset to their practice. Participants perceived that they achieved their goals, were pleased with the program, and retained knowledge.
    Full-text · Article · Aug 2015
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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.
    Full-text · Article · Jun 2014 · Implementation Science
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