Helping GPs to discuss overweight, obesity and lifestyle changes

A person’s weight can be a very hard subject to broach, even for GPs.
 
But some may be surprised at how many patients are open to being asked about the issue.
 
‘We did a survey of the Australian public, asking about how they may contact their GPs in relation to their weight, and found most people felt comfortable talking to their GP about their weight, and 31% have had a conversation with their doctor about their weight at some point,’ LiveLighter campaign manager and dietitian, Alison McAleese, told newsGP.
 
‘People certainly expect to have a conversation [with their GP] and felt comfortable having it.’
 
LiveLighter was started by the Western Australian Government in 2012 to combat the obesity epidemic by educating the public about the positive impacts of lifestyle changes on their weight and overall health. The campaign is now also active in Victoria and the Northern Territory.
 
As part of its education, LiveLighter also provides health professionals information to pass on to their patients; especially GPs, who Ms McAleese believes are perfectly placed to address the issue of overweight and obesity.
 
‘Close to 80% of Australians see their GP within 12 months,’ Ms McAleese said. ‘And two thirds of Australian adults are above a healthy weight, so that could potentially be most patients that are being seen in primary care.’
 
But when LiveLighter prepared a campaign in Victoria about sugary drinks, it discovered a gap in education for GPs.
 
‘We wanted to inform Victorian GPs about the campaign, and that patients might have questions about their weight or changing their sugar intake,’ Ms McAleese said.
 
‘We had a list of resources they could use, and also wanted to point them towards training and professional development opportunities on the topic – but there wasn’t much available at all.’
 
Dietitian and LiveLighter campaign manager Alison McAleese wants to help GPs feel comfortable talking to patients about their weight.

This lack of training led to the creation of LiveLighter’s ‘Talking to patients about weight’ one-day workshops, which are focused on the problem that, while obesity and overweight are a growing problem in Australia and impact on a range of health concerns from cancers to musculoskeletal problems and chronic diseases, they are also a sensitive subject that can be difficult to raise with patients.
 
‘So that’s really what we focus on [in the training] – raising the topic when someone might be in a consult for something else, and how you can positively approach someone through that conversation to get to a point where they might make some goals that suit them, or perhaps make a decision for a referral,’ Ms McAleese explained.
 
‘We don’t talk about their medical management so much, just about that conversation.’
 
A significant aspect of the training is a focus on motivational interviewing, a patient-centred conversational technique that focuses on collaboration and empathy to drive behavioural change.
 
The course also provides practical advice on simply broaching the subject.
 
‘We spend a fair bit of time on starting the conversation; so different phrases you can use to introduce a topic, or good opportunities when it might be appropriate to bring it up,’ Ms McAleese said.
 
‘For example, GPs are likely to be talking about a range of health conditions related to weight, so if someone’s starting a new medication, or having their blood pressure reviewed or looking at their diabetes management, there is perhaps an opportunity to say, “Changing your lifestyle and losing some weight may help with this condition”.’
 
Evaluations of the training course have shown GPs feel positively about the education they received, with 76% of respondents reporting they use what they learned frequently or daily.
 
Ms McAleese is pleased with these results, hoping the course can help GPs to overcome barriers they have experienced in discussing overweight and obesity in consults, such as fear of embarrassing the patient and not knowing how to start the discussion.
 
‘GPs have said, prior to receiving the training, that they perhaps lacked time, resources and referral options to have the conversation, or that they wanted to have more effective conversations where people did go away and make some changes. This is where we want to have the impact,’ Ms
McAleese said.
 
And as better management of overweight and obesity can impact on so many other conditions, Ms McAleese wants to give GPs and their patients as much help as possible.
 
‘We know that weight gain or being an unhealthy weight is a risk factor for many different chronic diseases,’ she said. ‘It can also increase progression of disease and exacerbate symptoms, for example of Type 2 diabetes.
 
‘So wherever patients are, there’s a big win from helping them to improve their lifestyle.’

General practice education LiveLighter Overweight and obesity Weight management