Practical Strategies for Engaging Individuals with Obesity in Primary Care
In this review article published by the Mayo Clinic, Dr Scott Kahan discusses the best strategies for engaging patients in obesity management, as well as looking at the barriers to good clinical practice. His findings are based on PubMed searches as well as his own clinical experience.
The two strategies identified as being practiced sub-optimally are screening and referral for counselling. Screening for obesity has been shown to be effective as it can lead to better perception of weight status, increased likelihood of trying to lose weight and of starting an obesity management programme. Patients with obesity who receive counselling have been shown to have a four-fold increased chance of losing weight.
The reason for suboptimal implementation of these strategies has been attributed to lack of training in obesity at medical school, with only 25% offering a dedicated nutrition course. Other reasons given by healthcare professionals are insufficient time, training, confidence in the method and resources. From the patient perspectives, stigma, inappropriate facilities (e.g. small waiting room furniture), previous negative care experience and a belief in moral failure in seeking help were found as barriers to care.
The practical guidance for improvement, aims at small changes to many aspects of care. It highlights the importance of people-first language and motivating terminology that encourages the patient rather than demeans them. In addition, improvements to the clinical environment so the patient doesn’t feel embarrassed, for example putting the weighing scales in a private place. Integration of digital technology was highlighted, such as reminders to measure BMI, as this would help with sub-optimal screening. In addition, using available online teaching resources and the multi-disciplinary team to minimize the burden of obesity management, as well improve the effectiveness of counselling technique. Finally, taking a long-term view of the support required, with extended duration weight-loss counselling and monitoring of progress.