Improving Obesity Management Training in Family Medicine: Multi-methods evaluation of the 5AsT-MD Pilot Course

Abstract

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.

Effective strategies in ending weight stigma in healthcare

“…Two interventions combined general education and causal information 111,112 . A self‐learning online module, designed to address the multiple causes of obesity and increase awareness of weight stigma, was shown to decrease the likelihood of stigmatizing attitudes in HCPs 1‐month after completion 111 .…”

“…However, results were based on participants' subjective evaluation of their awareness and attitudes of obesity, bearing risk of social desirability bias. Luig et al 112 assessed a pilot course aiming to improve family medicine residents' knowledge and confidence with obesity counselling. The program focused on general knowledge and counselling skills, but combined lectures with a bariatric empathy suit experience and reflective writing.…”

“…Eight interventions utilized a mix of various methods, mostly causal information, empathy evoking and stigma awareness raising. With most interventions being delivered in lecture or tutorial format, with or without additional video, reflective writing or role-play components.Two interventions combined general education and causal information 111,112. A self-learning online module, designed to address the multiple causes of obesity and increase awareness of weight stigma, was shown to decrease the likelihood of stigmatizing attitudes in HCPs 1-month after completion 111.…”