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5As of Obesity Management Framework Increases Weight Management in Primary Care



sharma-obesity-5as-booklet-coverRegular readers will be well aware of the 5As of Obesity Management framework and tools, recently developed and launched by the Canadian Obesity Network.

The 5As tools were specifically designed, through a three year-long intricate process that was funded with close to $1 mill from the Public Health Agency of Canada (PHAC) and the Canadian Institutes of Health Research (CIHR), involving a national panel of leading obesity experts and frontline practitioners with additional input from patients, to facilitate obesity counseling in primary practice.

As most readers will appreciate, obesity counselling in primary care is rare, and when it does occur, it is often of low quality because of poor training and/or competency of providers’ obesity management, lack of time and economical disincentives, and negative attitude towards obesity and obesity management.

Now, the results of a first pilot study presented at Obesity Week here in Atlanta, provide the first evidence that the implementation of the 5As of Obesity Management does in fact promote physician–patient communications, medical assessments for obesity and plans for follow-up care in a primary care setting.

This project tested the impact of implementing this tool in four primary care clinics with over 25 healthcare providers, whereby the intervention consisted of one online training session (90 min) and distribution of the 5As toolkit to HCPs of participating clinics.

Based on measurements performed before (baseline, n = 51) and 1 month after implementing the 5As of Obesity Management (post-intervention, n = 51), we observed a twofold increase in the initiation of obesity management (19 vs. 39%, P = 0.03), and caused a statistically significant increase in the perceived follow-up/coordination efforts (self-reported Patient Assessment of Chronic Illness Care components, 45 ± 22 vs. 67 ± 12 points, P = 0.002), as well as two components of the 5As framework: Assess (50 ± 29 vs. 66 ± 15 points, P = 0.03) and Assist (54 ± 26 vs. 72 ± 13 points, P = 0.01).

These results, now published in Clinical Obesity, clearly suggest that using the 5As of Obesity Management tools and framework facilitates weight management in primary care – the first essential step towards any hope of promoting meaningful obesity management in primary care practice.

Whilst a large-scale evaluation of the implementation of the 5As of Obesity Management framework into primary practice is currently underway in a prospective 18-month cluster randomised trial (5AsT: NCT01967797), this first study evaluating the effectiveness of these tools certainly appears rather promising.

The 5As of Obesity Management toolkit is available through the Canadian Obesity Network.

@DrSharma
Atlanta, GA

4 Comments

  1. I had never heard of the 5As of obesity management, but your link was quite helpful. They seem intuitively appropriate (sometimes common sense is just as good as research) in this area. It does seem like a thoughtful first step in addressing obesity with patients. Sometimes, just this intervention might be enough to have people begin to explore their options while gaining a better understanding of both the dangers of obesity and the relative intractable nature of the disease. What is still needed is better answers as to what to do and how to do it. Something a bit more successful than eating less and moving more would be really appreciated. So far the only thing I am seeing that can qualify as this better option seems to be certain forms of bariatric surgery when combined with nutrition counseling and behavior intervention with an experienced CBT professional. Until and unless science comes up with a better option, I think that’s the very best we have for now.

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  2. The doctor asks the patient if obesity should be discussed?

    People go to a doctor thinking …

    “I hear that obesity isn’t really a problem. I hear that concern over weight is actually prejudice and bias. I hear that people are healthy at any size.”

    If my obesity is a medical problem, my doctor will tell me.
    If my doctor doesn’t tell me that my weight is a problem, there’s no reason for me to talk about it.”

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