5As

• 5As

  • Ask for permission to discuss weight
  • Assess obesity related risk and potential causes
  • Advise on obesity risks, discuss benefits and options
  • Agree on realistic weight loss expectations and SMART plan to achieve behavioural goals
  • Assist in addressing drivers and barriers, offer education and resources
• When asking for permission to discuss weight

  • be non judgemental
  • explore readiness for change
  • use motivational interviewing
  • create weight friendly practice
• Example of how to begin conversation on weight

  • would you be interested in addressing your weight
  • are you concerned about your weight
  • on a scale o 0-10 how important is it for you to lose weight/how confident are you that you can lose weight at this time
• What to assess

  • obesity class and stage (BMI, EOSS, waist circumference and body shape)
  • assess for obesity drivers, complications and barriers (4Ms)
  • assess for root causes of weight gain
• 4Ms to assess for obesity drivers, complications and barriers

  • mental (eg: depression, addiction, ED, insomnia)
  • mechanical (eg: OA, incontinence, chronic pain)
  • metabolic (eg: diabetes, HTN, gout, cancer, PCOS)
  • monetary (income, insurance, education)
• Assess for root causes of weight gain

  • slow metabolism: age, hormones, genetics, low muscle mass, weight loss, medication
  • increased food intake: physical hunger, emotional eating, medication, mental health issues
  • reduced activity: economic limitations, physical or emotional limitations, medication
• Advise patients on

  • obesity risks
  • benefits of modest weight loss
  • need for long term stratergies
  • treatment option discussion
• Advise on treatment options

  • sleep time and stress
  • low calorie diet
  • physical activity
  • psychological
  • anti obesity medications
  • bariatric surgery
• Agree on realistic weight loss and on a SMART goal:

  • success should be measured in improvement of health and well being
  • should not be measured with amount of weight lost
• Offering education and other resources is an interdisciplinary approach, often including social worker, nutritionist and doctor
• Certain drivers and barriers

  • could be environmental, socioeconomical, emotional, medical
  • obesogenic meds: antipsychotics, anti-diabetics, anti-convulsants
  • physical barriers limiting access: transportation, limited seating etc