Primary Care And Primary Healthcare In Obesity Management

  • We call for obesity to be acknowledged as a complex chronic disease and included in the Structured Chronic Disease Management Programme for General Medical Scheme (GMS)/General Practice Visit Card (GPVC) patients in Ireland.
  • We call for obesity medications to be included for reimbursement under GMS/Drugs Payment Scheme/ Long Term Illness (LTI) schemes to ensure equal access to evidence-based treatments based on healthcare need rather than of ability to pay.
  • We call for adequate resourcing and implementation of the Model of Care for the Management of Adult Overweight and Obesity as developed by the National Clinical Programme for Obesity.
  • We call for continuing medical education for primary care healthcare professionals to address the gaps in skills, knowledge of evidence and attitudes in order to adequately support people living with overweight and obesity.
  • We call for increased research and funding of research into primary care-based management of overweight and obesity in Ireland.
  • Primary care teams should initiate patient-centred conversations with their patients about overweight or obesity. The 5As of Obesity ManagementTM (ask, assess, advise, agree, assist) approach, starting with asking permission to discuss weight, is an appropriate format to use.
  • Primary care clinicians should promote a holistic approach to weight and health, focusing on health behaviours and addressing root causes of weight gain, with care to avoid stigmatising and using overly simplistic narratives like “eat less and move more”.
  • Prescribing clinicians must be aware of weightpromoting medications and consider alternatives for people living with overweight and obesity. When weight-promoting medications must be used, clinicians should discuss the risks with patients and institute monitoring for weight gain.
  • Healthcare professionals and patients need to be aware of the risks of weight cycling and adopt strategies that focus on sustained changes to maintain health and health-promoting habits over time.

For clinicians:

  1. We recommend primary care clinicians identify people with overweight and obesity, and initiate patient-centred, healthfocused conversations with them (Level 3, Grade C)1.
  2. We recommend healthcare professionals (HCPs) ask patients for their permission prior to discussing weight or taking anthropometric measurements (Level 3, Grade C)2.
  3. Primary care interventions should be used to increase health literacy in individuals’ knowledge and skill about weight management as an effective intervention to manage weight (Level 1a, Grade A)3.
  4. Primary care clinicians should refer persons with overweight or obesity to primary care multi-component programmes, where available (Level 2 services – Community Specialist Ambulatory Care), with personalised obesity management strategies as an effective way to support obesity management (Level 1b, Grade B)4-8.
  5. Primary care clinicians can use collaborative deliberation with motivational interviewing to tailor action plans to individuals’ life context in a way that is manageable and sustainable to support improved physical and emotional health, and weight management (Level 2b, Grade C)9.

Features of primary care and primary healthcare community-based interventions for clinicians and developers10:

  1. Interventions that target a specific ethnic group should consider the diversity of psychological and social practices with regards to excess weight, food, and physical activity, as well as socio-economic circumstances, as they may differ across and within different ethnic groups (Level 1b, Grade B)11.
  2. Longitudinal primary care interventions should focus on incremental, personalised, small behaviour changes (the “small change approach”) to be effective in supporting people to manage their weight (Level 1b, Grade B)12.
  3. Primary care multi-component programmes should consider personalised obesity-management strategies as an effective way to support people living with obesity (Level 1b, Grade B)7,8,13.
  4. Primary care interventions that are behaviour-based (nutrition, exercise, lifestyle), alone or in combination with pharmacotherapy, should be utilised to manage overweight and obesity (Level 1a, Grade A)14-16.
  5. Group-based nutrition and physical activity sessions (e.g., interventions at Level 2 of the Irish Model of Care)17 and those informed by the Diabetes Prevention Program and the Look AHEAD (Action for Health in Diabetes) programme should be used as an effective management option for adults with overweight and obesity (Level 1b, Grade A)18-21.
  6. Intensive weight management within routine primary care, as informed by the primary care-led interventions for remission of type 2 diabetes (e.g., Diabetes Remission Clinical Trial) should be considered as a management option for adults with overweight and obesity (Level 1a, Grade A, adapted from Chapter 8 Medical Nutrition Therapy in Obesity Management)10.
  7. Interventions that use technology to increase reach to larger numbers of people asynchronously should be a potentially viable lower-cost intervention in a community-based setting (Level 1b, Grade B)22. Virtual group consultations also offer a novel and potentially scalable approach22,23.

Educational recommendation to support development of obesity-management skills in the primary healthcare clinical workforce:

  1. Educators of undergraduate, graduate and continuing education programmes for primary HCPs should provide courses and clinical experiences to address the gaps in skills, knowledge of the evidence and attitudes necessary to confidently and effectively support people living with obesity (Level 1a, Grade A)24.
  • Prevention of weight gain is important and potentially more realistic than weight loss, given the many factors that make it difficult to sustain weight reduction in the longer term. Setting value-based functional goals shifts the focus from weight to health and, most importantly, quality of life, and may help with sustainable changes.
  • Individualised nutrition counselling can result in some reductions in weight and improvements in health.
  • Mindfulness, acceptance and commitment therapies, added to multi-component behavioural interventions, may be considered in developing a personal obesitymanagement strategy.
  • Many medical issues, such as disrupted sleep, pain, mechanical problems, metabolic conditions and psychiatric conditions, can contribute to challenges with obesity management. People should seek medical help if they are struggling with weight maintenance or weight gain.
  • When prescribed a new medication to treat a medical condition, particularly if the medication is intended for long-term use, patients living with obesity should inquire about the potential associated weight effects.

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