#126 General practice for patients living with obesity
3 February 2020
Community GPs can make a difference to the health and wellbeing of patients living with obesity – they just need the right resources and support. Obesity is a condition that affects all body systems, is influenced by social and community factors and has multiple, complex causes. These factors mean that generalist, ongoing care, from a trusted GP is an effective option for patients living with obesity.
For nearly the past decade, Dr Liz Sturgiss, a clinical GP and Monash University academic, has been exploring ways of making life easier for GPs wanting to address obesity with their patients. During her PhD training at the Australian National University (ANU), Liz and Prof Kirsty Douglas led a team of researchers at the ANU Medical School to develop The Change Program.
The Change Program is designed to improve overall health through long-term, sustainable changes in nutrition and physical activity. Initially aided by the RACGP-IPN Foundation grant, The Change Program development team included GPs, consumer representatives, dietitians, psychologists and a graphic designer who produced the program materials. The toolkit comprises of a GP handbook (about 40 pages) and a patient workbook (about 80 pages) that uses psychological behavioural strategies within worksheets and factsheets to promote self-management, improve nutrition and increase physical activity. The program also includes a clinical software template to assist with appointment planning and recording of progress.
The Program provides the ‘how’ to translating the National Health and Medical Research Council's (NHMRC) guidelines on weight loss into action. The core tenets of The Change Program are patient-centredness and therapeutic alliance with the GP. No additional training is required to use the program as it draws on the existing skillset of GPs and the strength of the GP-patient relationship.
While the ideal consultation schedule is fortnightly for the first three months and reducing to monthly sometime during the following three months, the reality is that patients tend to come monthly for the first six months. Consultations can be billed as Level B, C or chronic disease items as appropriate. This ensures sustainability and scalability of the program.
Through an additional grant from the Australian Primary Health Care Research Institute (APHCRI), a feasibility trial of The Change Program showed that it was feasible and acceptable for use by urban and rural GPs for weight management and further, that the therapeutic alliance between the patient and the GP was one of the key aspects of success.
Through a further RACGP Foundation Chris Silagy Grant, Dr Sturgiss explored the GP-patient relationship and when applying it to The Change Program, found that, “A robust therapeutic alliance was strongly associated with patient engagement in the weight management program indicated by number of appointments … also associated with some general health and quality of life outcomes.”
Using both quantitative and qualitative data, Dr Sturgiss found that The Change Program, a structured weight management program for adults in Australian general practice, improved GP’s confidence and self-efficacy in working with patients living with obesity.
Patients who have used The Change Program found the education fact sheets about obesity and weight gain very helpful. They learned why people gain weight and found the focus on the biology of obesity made them feel less guilty about living with obesity. Reducing shame and guilt is an important part of The Change Program.
In 2018, the Commonwealth Department of Health invited the team to present The Change Program to Primary Health Networks as an option for improving health and wellbeing for patients in their area. To date, five PHNs across Australia have adopted The Change Program and discussions are underway with other PHNs. There is no cost to the PHNs to adopt The Program, apart from the printing of the GP handbook and the patient workbook. Once a simple agreement – usually via email – is reached between the PHN and the program owners, the ANU, we provide the PHN with the PDF material and they manage the process as best suits them.
The Change Program is administered through the Academic Unit of General Practice, an affiliate of the ANU Medical School. We have had numerous enquiries from GPs and the public around Australia asking how they can access the program. On behalf of the GPs, we have approached the relevant PHN and commenced discussions towards making it available to them.Until now, no Victorian PHNs have adopted the program, but we would be keen to assist their involvement.
We have received strong positive feedback from GPs who are implementing The Change Program in their clinics. It is great to see primary care research making a real impact in the daily work of GPs across Australia.
Enquiries can be made through either firstname.lastname@example.org or email@example.com
Dr Dagmar Ceramidas PhD
BSc (OT); Grad Dip Adol MH, MA (Couns)
Academic Unit of General Practice, ACT Health
ANU Medical School
Dr Liz Sturgiss
BMed, PhD, FRACGP, MPH, MForensMed, FHEA
Senior Lecturer, Department of General Practice
Visiting Fellow, ANU
References available from the Editor on request.