Australian-first program to help GPs work with patients with obesity

Doug Hendrie

18/12/2018 2:49:54 PM

The Change Program has been rolled out to the 850 GPs in the Western Sydney Primary Health Network, with more areas coming next year.

The Change Program includes a patient workbook with practical steps on nutrition, exercise, goal-setting, wellbeing and meal plans. (Image: World Obesity Image Bank)
The Change Program includes a patient workbook with practical steps on nutrition, exercise, goal-setting, wellbeing and meal plans. (Image: World Obesity Image Bank)

Developed by GP–researcher Dr Liz Sturgiss and her PhD supervisor Professor Kirsty Douglas, the Change Program is designed to help GPs work with patients to achieve longer-term lifestyle changes.
In addition to the Western Sydney Primary Health Network (PHN), the ACT’s Capital Health Network PHN will introduce the program early next year, and a number of other PHNs have expressed strong interest.
Dr Sturgiss told newsGP she had the idea for the program, which has been developed over five years, when patients came to her and asked for help with their weight and she realised she ‘had no idea how to help them’.
‘We have really good guidelines from the National Health and Medical Research Council [NHMRC], but we didn’t have good ways to practically put them into practice, day to day,’ Dr Sturgiss said.
‘The guidelines say, help people with their nutrition. But how do you actually do that?’
Dr Sturgiss decided to find out. With the help of dietitian and clinical psychologists, she developed a toolkit and patient workbook based on psychological techniques and collaborative goal-setting.  
The workbook has practical steps on nutrition, exercise, goal-setting, wellbeing and meal plans. It includes setting realistic exercise goals, pantry stocktakes, troubleshooting for relapses and a nutrition diary.
Dr Sturgiss then ran a small feasibility trial with 12 GPs and 23 patients, which led to one-third of patients losing around 5% of their body weight.
The resulting study, published in Family Practice, found that most patients strongly preferred to have their GP involved in weight management, and the program helped GPs feel more confident.
The Change Program focuses on helping patients structure their week with good nutrition, exercise and good social networks, with a section on the barriers people commonly face in making healthy choices.
‘We also found it affected behaviours of family members and friends. It was fantastic to see the ripple effect through communities,’ Dr Sturgiss said.
‘It is not a fad diet, it is about serious lifestyle change and things you can do on an ongoing basis.’
Dr Sturgiss said GPs are ideally placed to tackle the issue by placing it in a medical context.
‘GPs know the whole picture of a patient and their family and can look at obesity holistically. For patients that want the option of working with their GP, this program provides the resources to do it,’ she said.
‘GPs are in a really good position to treat obesity. We manage people with chronic disease all the time, and obesity is a chronic condition. We expect people will need care longer-term.
‘Patients say [that] because they’re working with a GP, it means it’s a health issue – not cosmetic or the way they looked – which they really appreciate.
‘Having it in a health model is really good in tackling that stigma, because we focus not just on losing kilos, but on improving health. Patients improved their quality of life, and that’s the most important thing.
‘GPs in our trial found that it improved their confidence, so they could talk about weight management more openly.’
Dr Sturgiss said the choice of a printed workbook was deliberate.
‘Using a physical object helps people engage,’ she said. ‘With apps on your phone, it’s easy to forget about it. But with a paper book, we saw family and friends of patients in the study picking it up and asking, “Hey, what are you trying here?”
‘We know social supports around you are essential when you’re aiming for behaviour change. GPs know patient’s families, which is why they’re well placed.’ 
Canberra GP Dr Melian Deery has used the program successfully with patients.
‘It was designed by GPs for GPs, so it is a really great tool for us to use with patients,’ she said.
‘Through the project we helped a number of patients lose between 5–8 kilos, which is a significant amount of weight, and we’ve continued to use the skills we’ve learned to support our patients to lose weight.’
Canberra GPs Dr Rebecca Kathage and Dr Sonia Res also contributed to the program, which was funded by an Australian Primary Health Care Research Institute Foundation Grant.
‘Unfortunately, the institute has now been defunded. So this is a really good example of where primary care research funding is needed to improve general practice,’ Dr Sturgiss said.

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Elizabeth Hearn   20/08/2019 10:02:16 PM

I would love help to loose my mid fat
70 yrs fit slim build
Been on prednisone for 6 yrs for birdshot rye disease gradually down from 60 mg to 2 mg over 2 yrs take 150 Effexor daily