People living with obesity suffer from multiple health issues, including diabetes and mental health problems. Misinformation about the complex nature of this condition greatly affects the way one manages obesity. This results in unrealistic expectations by both healthcare providers and patients. Effective obesity management must be individually tailored for each patient. The objective of this project was to improve four communication tools by co-designing them with patients. A co-design approach was used to improve the efficacy and applicability of the tools through a working collaboration between patients, care providers, and researchers. While most articles describe processes to create shared-decision making (SDM) tools which compare alternative diagnosis and treatment options, few papers describe models to create SDM tools which go beyond showing benefits and risks. In this paper, we describe our process and approach to the re-design of four of the 5As obesity tools. We hope this study provides a valuable model for other teams.

Background: Quality, evidence-based obesity management training for family medicine residents is needed to better support patients. To address this gap, we developed a comprehensive course based on the 5As of Obesity Management™ (ASK, ASSESS, ADVISE, AGREE, ASSIST), a framework and suite of resources to improve residents' knowledge and confidence in obesity counselling. This study assessed the course's impact on residents' attitudes, beliefs, and confidence with obesity counselling. Methods: The course combines lectures with a bariatric empathy suit experience, standardized and in-clinic patient practice, and narrative reflections. Using a multi-methods design we measured changes in 42 residents' attitudes, beliefs, and self-confidence and thematically analyzed the narrative reflections to understand residents' experience with the course content and pedagogy.

BackgroundChronic disease prevention and screening (CDPS) has been identified as a top priority in primary care. However, primary care providers often lack time, evidence-based tools, and consistent guidelines to effectively address CDPS. Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Primary Care (BETTER) is a novel approach that introduces a new role, that of the prevention practitioner; the prevention practitioner meets with patients, one on one, to undertake a personalised CDPS visit. Understanding patients’ perspectives is important for clinicians and other stakeholders aiming to address and integrate CDPS.AimTo describe patients’ perspectives regarding visits with a prevention practitioner in BETTER 2, an implementation study that was carried out after the BETTER trial and featured a higher proportion of patients in rural and remote locations.Design & settingQualitative description based on patient feedback surveys, completed by patients in three primary care clinics (urban, rural, and remote) in Newfoundland and Labrador, Canada.MethodPatients’ perspectives were assessed based on responses from 91 feedback forms. In total, 154 patients (aged 40–65 years) received ≥1 prevention visit(s) from a prevention practitioner and were asked to provide written feedback. In addition to demographics, patients were asked what they liked about their visit(s), what they would have liked to be different, and invited to make any other comments. Qualitative description was used to analyse the data.ResultsFour main themes emerged from patients’ feedback: value of visit (patients appreciated the visit with a prevention practitioner); visit characteristics (the visit was personalised, comprehensive, and sufficiently long); prevention practitioners' characteristics (professionalism and interpersonal skills); and patients’ concerns (termination of the programme and access to preventative care).ConclusionPatients appreciated the visits they received with a prevention practitioner and expressed their desire to receive sustained CDPS in primary care.

Background: Quality, evidence-based obesity management training for family medicine residents is needed to better support patients. To address this gap, we developed a comprehensive course based on the 5As of Obesity Management™ (ASK, ASSESS, ADVISE, AGREE, ASSIST), a framework and suite of resources to improve residents’ knowledge and confidence in obesity counselling. This study assessed the course’s impact on residents’ attitudes, beliefs, and confidence with obesity counselling. Methods: The course combines lectures with a bariatric empathy suit experience, standardized and in-clinic patient practice, and narrative reflections. Using a multi-methods design we measured changes in 42 residents’ attitudes, beliefs, and self-confidence and thematically analyzed the narrative reflections to understand residents’ experience with the course content and pedagogy. Results: Following the course, residents reported improved attitudes towards people living with obesity and improved confidence for obesity counselling. Pre/post improvement in BAOP scores (n=32) were significant (p<.001)., ATOP scores did not change significantly. Residents showed improvement in assessing root causes of weight gain (p<.01), advising patients on treatment options (p<.05), agreeing with patients on health outcomes (p<.05), assisting patients in addressing their barriers (p<.05), counseling patients on weight gain during pregnancy, (p<.05), counseling patients on depression and anxiety (p<.01), counseling patients on iatrogenic causes of weight gain (p<.01), counseling patients who have children with obesity (p<.05), and referring patients to interdisciplinary provider for care (p<.05). Qualitative analysis of narrative reflections illustrates that experiential learning was crucial in increasing residents’ ability to empathically engage with patients and to critically reflect on implications for their practice. Conclusion: The 5AsT-MD course has the potential to increase residents’ confidence and competency in obesity prevention and management. Findings reflect the utility of the 5As to improve residents’ confidence and competency in obesity management counselling.

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