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5As of Obesity Management in Primary Care

sharma-obesity-5as-booklet-coverThis week I am again touring Ontario to train health professionals in the 5As of Obesity Management (Kingston, Ottawa, St. Catherines).

It is heartening to see the tremendous interest in this topic and how the message about obesity as a chronic disease resonates with health practitioners, few of who have any prior training in obesity management.

It is particularly rewarding to see how well the Canadian Obesity Network’s 5As of Obesity Management framework is received and embraced by those working in the front lines of primary care, as this is exactly the audience for which this framework is intended.

Regular readers may recall that the 5As of Obesity Management framework was developed by the Canadian Obesity Network in an elaborate undertaking involving scores of primary care providers, experts and patients from across Canada. The tools were modelled using the latest in health information design technology and extensively field tested to ensure their applicability and adaptability to primary care practice.

Rather than overloading the tools with intricate algorithms, we opted for a rather general but insightful set of principles and recommendations designed to facilitate professional interactions that seek to identify and address the key drivers and consequence of weight gain as well as help tackle the key barriers to weight management.

Indeed, the 5As of Obesity Management are steeped in a deep understanding of the complex multi-factorial nature of obesity as a chronic (often progressive) disease for which we simply have no cure.

The framework recognizes that health cannot be measured on a scale, BMI is a poor measure of health and that obesity management should be aimed at improving the overall health and well being of those living with obesity rather than simply moving numbers on the scale.

Research on the use of the 5As in primary practice has already shown significant improvements in the likelihood of obesity being addressed in primary practice.

A large prospective randomized trial on the implementation of the 5As of Obesity Management framework in primary care (the 5AsT trial) is currently underway with early results showing promising results.

I, for one, will continue promoting this framework as the basis for obesity counselling and management in primary care – at least until someone comes up with something that is distinctly better.

If you have experience with this approach or have attended one of the many education sessions on the 5As of Obesity Management offered by the Canadian Obesity Network, I’d certainly like to hear about it.

To view an introductory video on the 5As of Obesity Management click here

Ottawa, ON


  1. I try to watch that video through the eyes of my various doctors. It’s interesting. I think it is possible, if they don’t do anything other than watch the video, to use the 5As tool and still not release prejudices and still give bad advice, just more elegantly.

    I think some of the most radical stuff you have said in this blog and elsewhere isn’t in your video. For example, that stopping gradual gain and simply helping a patient establish maintenance, even at an obese BMI, is a success. That’s an important thought!

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  2. I agree with Debral: the 5As help the doctor to be more polite in delivering his advice, but it doesn’t change the advice itself (which is usually dismal and quite judgemental in my experience).

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  3. DEBRA, who comments above, is onto something. The emphasis of the 5A appears to result in the same kinds of self deprivation, self monitoring, and self control rhetoric,— passing as helpful advice except these control srategies are expressed with more “eloquence” (aka sweeter smelling horse shit.) Frankly, i cannot discern the difference between weight loss counceling/management and professional cultural gaslighting.

    Medical professionals who inform fat people of the same bullshit, again and again (and patients are repeatedly being told the same lies about dieting effectiveness , obesity and self regulating) are essentially gaslighting their patient and the process esentially constructs a false reality whereby “failure” (rare long term mainrtenance) is considered a problem existing inside the patient, rather than a problem with social/culural gaslighting strategies that leave fat folks doubting their own perceptions, their own competance, their mental heallth, and their own self worth.

    And the result, of course, is domination passing as health care.

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  4. Thanks for taking on this topic. I can appreciate the efforts as a nurse practitioner. I have heard that the average American gains 5 pounds a year after age 25, and if not then usually after age 40. I am very active, not overweight, but, come from an overweight family. Once my father left his 20 years in the Air Force, he gained about 30 lbs and kept it on, mother as well, and sister, since childhood. It is an every present risk! I appreciate all that you do for patients, that makes a world of difference.

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