Could directly providing food to patients help support weight loss?

In Australia, it is estimated two in three adults live with overweight or obesity.
 
While the role of GPs in supporting healthy eating and weight management is well known, researchers from Griffith University have set out to uncover how dietary intervention in the direct form of food can assist.
 
They undertook a literature review of four studies, involving more than 400 adults, that were designed to elicit weight loss in primary care settings by directly providing food or supplements to patients. One of the concepts was a farmer’s market.

Hosted in the carpark of a US general practice for 13 weeks, patients were offered a voucher to use at the market as part of routine care. Though the study did not observe significant weight loss, it did find secondary health benefits, such as a significant decrease in glycated haemoglobin (HbA1C) concentrations.
 
As well as improving health, dietitian and lead author Associate Professor Lauren Ball from Menzies Health Institute Queensland says it can also assist patients facing food insecurity. But what was particularly striking, she says, is that directly linking patients with fresh food emphasised the importance of eating well.
 
‘We wanted to best understand what has been done in the space of literally giving food to patients, as that is the most direct way we can support behaviour change,’ she told newsGP.
 
‘[We found that] patients saw their diet as important in the eyes of their GP – even though we all know that it’s important to health professionals already, this is … a tangible action to really demonstrate that to patients.
 
‘We’ve seen that with other research in terms of referrals to weight loss clinics in the UK … whereby if the access point is through the GP, it’s like the GP is saying to the patient “It’s important to me that you go and have this support”.
 
‘So it really helped with that behaviour change, their motivation, their accountability, and so that is really exciting and something that’s completely under-explored in the Australian scene.’
 
Dr Catherine Bacus, Chair of RACGP Specific Interests Obesity Management, agrees that general practice, and more broadly primary care, have a crucial role to play in the management of patients who live with overweight or obesity.
 
But she told newsGP that dietary interventions may not be enough for everybody, as seen in the literature review, and requires a personalised approach.
 
‘I didn’t think that there was strong evidence for the farmers’ market idea for weight loss per se. But that’s not the only measure of health,’ Dr Bacus said.
 
‘Diet and exercise are the cornerstones of weight management, but they are not sufficient in many individuals who have a genetic predisposition for weight.
 
‘A lot of people know the right things to eat but we live in an environment where you’ve got high calorie, low energy density foods that are marketed to individuals, and then we say, “Go and eat well – but here’s a lot of food that you should say no to”. So it’s complex.’
 
Associate Professor Ball’s research team, Healthy Primary Care, has been researching ways to support GPs to feel more confident talking to patients about diet and weight for more than a decade and are aware of the many barriers GPs face, such as a lack of consultation time, as well as insufficient nutrition knowledge and low nutrition self-efficacy.
 
Dr Bacus believes there is a need for GPs to be upskilled in the principles of dietary intervention, as well as how to prescribe very low energy diets, which she says have been shown to be effective for overweight and obesity.
 
‘But again, it is an intervention for weight loss and is not the way that people want to eat for the rest of their life,’ she said.
 
‘They might need more help with more intensive dietary interventions tailored to them, understanding their dietary and cultural preferences, and understanding what they’ve done before for weight loss.

‘Also, understanding the complex drivers of obesity and how to stop a person from re-gaining weight after losing it, understanding the physiological defence against body weight and how to overcome that [is important].
 
‘For example, anti-obesity pharmacotherapy might be part of that solution.’
 
Associate Professor Ball acknowledges that there is a need for more high-quality research in this area, which is what her team is currently setting out to do.
 
They are exploring two pilot studies for select general practices in Queensland, including a farmers’ market concept and a food pantry, where patients take what they need and pay what they can.  
 
‘We’re likely going to pilot a couple of options to see what’s most feasible before conducting a trial to see cost effectiveness-wise and how this is actually affecting patients’ health,’ Associate Professor Ball said.
 
‘It’s so new that we need to be really careful about the logistics behind it if it’s going to be sustainable.
 
‘We’re also thinking about how we can best accommodate clinical circumstances, as not every clinic has space and we don’t want to do anything that’s going to add a burden on to the clinics that are already under the pump.
 
‘But this is a really exciting time on the horizon because the appetite for general practice to move towards prevention is growing day-by-day. GPs are interested in doing more for patients, are aware that the patient’s own behaviour, their social circumstances, their family, [and] their living environment have such an important impact on that behaviour and their choices.
 
‘GPs want this type of innovation. We just have to get it to them.’
 
Log in below to join the conversation.

care food obesity overweight primary supplements weight loss