Five A’s counseling in weight management of obese patients in primary care: a cluster-randomized controlled trial (INTERACT)

Abstract

BackgroundObesity is one of the most prevalent health problems in western societies. However, it seems not effectively managed in the healthcare system at present. Originating from smoking cessation a tool called the 5As for obesity management has been drafted and adapted by the Canadian Obesity Network (CON) to improve weight counseling and provider-patient-interaction. This paper describes the rationale and design of the INTERACT study. The objective of the INTERACT study is to evaluate the effectiveness and intervention costs of a 5As eLearning program for obesity management aimed specifically at general practitioners (GPs).MethodsThe INTERACT study is a cluster randomized controlled trial aimed at implementing and evaluating an online-tutorial for obesity management based on the 5As approach in cooperating primary health care practices. Effectiveness of the 5As intervention will be evaluated by assessing patients and doctors perspectives on obesity management in primary care before and after the training. GPs in the intervention group will get access to the 5As obesity management online-tutorial while GPs in the control group will be assigned to a waiting list. Outcome measures for patients and GPs will be compared between the intervention group (treatment as usual + training of the GP) and the control group (treatment as usual). Hierarchical regression models will be used to analyze effects over time pre- and post-intervention.DiscussionThe 5As present physicians with a simple mnemonic for patient counseling in the primary care context. While the use of the 5As in weight counseling seems to be associated with improved doctor-patient interaction and motivation to lose weight, intervention studies assessing the effectiveness of a short 5A eLearning tutorial for physicians on secondary outcomes, such as weight development, are lacking.Trial registrationThe study has been registered at the German Clinical Trials Register (DRKS00009241; date of registration: 03.02.2016).

Treatment of overweight and obesity – who, when and how? Interdisciplinary position of the Expert Team

“…-Ask -wytłumaczenie pacjentowi istoty choroby i jej konsekwencji oraz ocena jego gotowości do zmiany, -Assess -ocena stanu zdrowia, przyczyn przyrostu masy ciała i występowania powikłań spowodowanych nadmiarem tłuszczu w organizmie, -Advice -przedstawienie metod leczenia, które można zastosować u konkretnego pacjenta, -Agree -uzyskanie zgody pacjenta na proponowany cel terapeutyczny i plan leczenia, -Assist -wspieranie pacjenta w procesie terapeutycznym [6].…”

“…: Minimalne cele w zależności od powikłań zostały określone w rekomendacjach amerykańskich towarzystw endokrynologicznych z 2016 r. i przedstawione w tabeli 1. Trzeba podkreślić, że nie u każdego chorego cel minimalny pozwoli na uzyskanie poprawy i wtedy należy rozpocząć kolejny etap osiągania celu zwiększonego o podobną wartość [6].…”

“…Zgodnie z rekomendacjami amerykańskich towarzystw endokrynologicznych krótkotrwałe (3-6 miesięcy) leczenie farmakologiczne otyłości nie wykazało w badaniach klinicznych długotrwałych korzyści zdrowotnych i nie jest zalecane [6]. Dlatego też dla uzyskania wstępnych celów terapeutycznych lek powinno się stosować minimum 6 miesięcy (oczywiście jeżeli jest dobrze tolerowany i pacjent uzyskał redukcję masy ciała o co najmniej 5% początkowej masy ciała w czasie pierwszych 16 tygodni terapii).…”

A Follow-Up Phone Call to Post-Operative Patients Using the Five A’s

“…The study identified 32% of patients still had questions even when counseled in the hospital, the results stress the importance of implementing a post-discharge follow-up phone call addressing questions and concerns the patient may have (Stroud, Adunlin, & Skelley, 2019). The 5 A's Behavior Change Model is a patient centered counseling tool to encourage certain behavioral habits (Welzel et al, 2018). One article that used the 5 A's Model for weight management strategies, found that its principals engaged patients to be more motivated for change (Welzel et al, 2018).…”

“…The 5 A's Behavior Change Model is a patient centered counseling tool to encourage certain behavioral habits (Welzel et al, 2018). One article that used the 5 A's Model for weight management strategies, found that its principals engaged patients to be more motivated for change (Welzel et al, 2018). One article documented its successful use in multiple healthy behavior modification such as smoking cessation, weight management, physical activity, and alcohol moderation (Dosh etal., 2005).…”