Improving obesity prevention and management in primary care

The 5As Team (5AsT) Program aims to improve obesity prevention and management in primary care. The interdisciplinary research team, led by Drs. Denise Campbell-Scherer and Arya Sharma, partners with healthcare professionals, educators, and patient advocates to conduct collaborative research that has real-world impact.

The central clinical approach of this program is the 5As of Obesity Management™ (the 5As: Ask, Assess, Advise, Agree, Assist), which consists of a suite of resources and evidence-informed tools developed in collaboration with stakeholders and the Obesity Canada. The framework, tools and resources, have been further extended for use in primary care by the 5As Team Intervention Project. These tools incorporate the Canadian Obesity Clinical Practice Guidelines, the conceptual structure of the Best Practices in Weight Management, and the 5As methodological framework to improve practitioners’ willingness and efficacy in providing obesity management and counseling.

We have developed an approach to obesity assessments and care planning that builds on a shared understanding of patients’ lives and supports people in improving health.  Together with providers and patients we have created a toolkit that will help guide the collaborative conversations with people living with obesity.

Download the 5AsT Toolkit

Working together with front line healthcare providers, the research team developed an intervention aimed at changing provider behaviour around obesity prevention and management. The intervention was found to be effective in addressing provider-identified gaps and lead to increased confidence in conducting obesity assessments and interdisciplinary work. Integration of new knowledge required that providers change their own mental models of their practice and increased success was achieved when the entire team developed a new way of working together to integrate their different roles to support patients and each other. This work has resulted in the 5AsT toolkit which consists of tools and resources to help support clinicians in their practice.

Publications

  1. Campbell-Scherer DL, Asselin J, Osunlana AM, Fielding S, Anderson R, Rueda-Clausen CF, Johnson JA, Ogunleye AA, Cave A, Manca D, Sharma AM. Implementation and Evaluation of the 5As Framework of Obesity Management in Primary Care: Design of the 5As Team (5AsT) Randomized Control Trial. Implementation Science 2014, 9:78-87. https://www.implementationscience.com/content/9/1/78
  2. Osunlana AM, Asselin J, Anderson R, Ogunleye AA, Cave A, Sharma AM, Campbell-Scherer DL. 5As Team Obesity Intervention in Primary Care: Development and Evaluation of Shared-Decision-Making Weight-Management Tools. Clinical Obesity 2015, 5(4): 219-25.
  3. Asselin  J, Osunlana AM, Ogunleye AA, Sharma AM, Campbell-Scherer DL. Missing an Opportunity: The Embedded Nature of Weight Management in Primary Care. Clinical Obesity 2015 Dec; 5(6):325-32. doi: 10.1111/cob.12115.
  4. Ogunleye AA, Osunlana AM, Asselin J, Anderson R, Cave A, Sharma AM, Campbell-Scherer DL. The 5As Team Intervention: Bridging the Knowledge Gap in Obesity Management Among Primary Care Practitioners.  BMC Research Notes 2015, Dec 22. 8:810. DOI 10.1186/s13104-015-1685-8
  5. Asselin J, Osunlana AM, Ogunleye AA, Sharma AM, Campbell-Scherer, DL. Challenges in Interdisciplinary Weight Management in Primary Care: Lessons Learned from the 5As Team (5AsT) Study. Clinical Obesity, 2016, 6(2): 124-32. doi: 10.1111/cob.12133
  6. Campbell-Scherer DL, Sharma AM. Improving Obesity Prevention and Management in Primary Care in Canada. Current Obesity Reports, 2016, 5(3), 1-6. doi: 10.1007/s13679-016-0222-y
  7. Asselin J, Salami E, Osunlana AM,  Ogunleye AA, Cave A, Johnson JA, Sharma AM, Campbell-Scherer DL. Impact of the 5As Team study on clinical practice in primary care obesity management: a qualitative study. CMAJOpen, 2017, 5:2; E322-9. doi:10.9778/cmajo.20160090
  1. Campbell-Scherer DL, Asselin J, Osunlana AM, Ogunleye AA, Fielding S, Anderson R, Cave A, Johnson J, Sharma AM. Changing provider behaviour to increase chronic disease nurse visits for obesity in family practice: The 5As Team Randomized Control Trial. CMAJOpen 2019 May; 7(2):E371-378.

The following learning modules were created during the course of the 5As Team Intervention Project. The topics addressed in each module were identified by frontline healthcare providers as being areas where they felt more education and training was needed in order for them to provide better care for their patients living with obesity.

In most of the modules you will find:

  1. A video presentation from an expert in the field
  2. A copy of the PowerPoint slides to help you follow along with the presentation
  3. A discussion guide to help facilitate further reflection following the video
  4. A list of tools and/or resources for additional information

The research team explored patient perspectives on the role of primary care in obesity management in an effort to better understand what patients want and to develop more effective management strategies. Findings of this qualitative study revealed patients want their family physician to have these discussions with them and they want to have a personalized assessment and plan.

Publications:

Torti J, Luig T, Borowitz M, Johnson JA, Sharma AM, Campbell-Scherer DL. Patient Perspectives on the Role of Primary Care in Obesity Management. BMC Family Practice, 2017, 18:10; 1-10.

In this project we partnered with patients and healthcare providers to explore how to achieve personalized, meaningful conversations about obesity. The goal was to develop an approach to obesity assessment and care planning that builds on a shared understanding of patients’ lives and supports people in improving health. We observed patient-provider encounters and explore their experiences of the encounter and everyday impacts through interviews and patient journals. We learned that it was important for providers and patients to explore the patient’s story together to make sense of root causes, life circumstances, and emotional aspects of living with obesity. Participants found helpful to orient their care plan on improving whole-person health, recognizing their strengths, learning about the complexity of obesity, and collaboratively planning actions that meaningfully fit with their lives. Through this process patients experienced more hope, confidence, and success in making changes to improve health.

Publications:

  1. Luig T, Anderson R, Sharma AM, Campbell-Scherer DL. Personalizing obesity assessment and care planning in primary care: patient experience and outcomes in everyday life and health. Clinical Obesity, 2018; 8(6): 411-423.
  2. Luig T, Elwyn G, Anderson R, Campbell-Scherer DL. Facing obesity: adapting the collaborative deliberation model to deal with a complex long-term problem. Journal of Patient Education and Counseling. Feb:102(2):291-300.
  3. Luig T, Keenan L, Campbell-Scherer DL. Transforming health experiences and action through shifting the narrative on obesity in primary care encounters. Qualitative Health Research (in press).

Building on our research around personalized, collaborative consultations, this project focused on refining some of the existing tools developed by the 5As Team research program to support collaborative conversations between patients and care providers.  A co-design approach was used to improve the efficacy and applicability of the tools. We used personas, role playing, dialogue prompters, and prototypes to foster collaboration and communication between patients, health professionals and researchers. The tools need to help us understand the uniqueness and complexity of each case: the person behind the medical conditions. The tools should foster iterative inquiry to understand the patient’s circumstances to tailor treatment and care.

Publications:

  1. Noël G, Luig T, Campbell-Scherer DL. Creating caring conversations for patients living with obesity. The 5As Team program.Design4Health, 2018. Available at https://research.shu.ac.uk/design4health/wp-content/uploads/2018/09/683.pdf
  2. Noël G, Luig T, Heatherington, M, & Campbell-Scherer DL. Developing tools to support patients and healthcare providers when in conversation about obesity: The 5As Team Program. Information Design Journal, 2018; 24(2):131-150

The 5AsT-MD course is a comprehensive educational program that provides care providers with knowledge and training in obesity prevention and management. The course combines interactive lectures with experiential learning including an experience with a bariatric simulation suit and standardized and in-clinic patient practice. Evaluation of our pilot study, shows improved attitudes towards people living with obesity and improved confidence in weight management practice. The course has now been implemented with residents in family medicine, pediatrics, psychiatry and internal medicine at the University of Alberta and, under the direction of Dr. Sonja Wicklum, has been implemented within the family medicine residency program at the University of Calgary as well. We are now looking to expand our reach both nationally and internationally to bring awareness of the need to create obesity-focused objectives and training opportunities with professional medical boards and associations.

Obesity Management Workshop Manual

Obesity Management Workshop Manual – PowerPoint Slides

Medication weight gain cards, graphs on expectations of weight loss, the 4Ms of obesity management (brochure and desktop cards), patient decision making tools and goal sheets, and information on obesity, physical activity guidelines, weight regulation, and stress and how it relates to obesity.

Vision: All health professionals are comfortable and well trained in engaging in person-centered obesity prevention and management in a way that is respectful and avoids stigma.

Mission: Our mission is to lead an international coalition of medical educators, clinicians, researchers, policy makers and persons with lived experience, to establish strong partnerships and knowledge dissemination channels for expansion and implementation of effective, tools and resources including advocating for changes in educational accreditation and licensure standards by 2030.

Interested in joining the coalition?

Contact:

Melanie Heatherington                                                                     

Program Coordinator                                                     

mnoakes@ualberta.ca

780-492-8987

  1. Campbell-Scherer DL, Asselin J, Osunlana AM, Fielding S, Anderson R, Rueda-Clausen CF, Johnson JA, Ogunleye AA, Cave A, Manca D, Sharma AM. Implementation and evaluation of the 5As framework of obesity management in primary care: Design of the 5As team (5AsT) randomized control trial. Implementation Science, 2014; 9:78-87. doi:10.1186/1748-5908-9-78.
  2. Osunlana AM, Asselin J, Anderson R, Ogunleye AA, Cave A, Sharma AM, Campbell-Scherer DL. 5As Team obesity intervention in primary care: development and evaluation of shared-decision-making weight-management tools. Clinical Obesity, 2015; 5(4): 219-25. doi: 10.1111/cob.12105.
  3. Asselin J, Osunlana AM, Ogunleye AA, Sharma AM, Campbell-Scherer DL. Missing an opportunity: The embedded nature of weight management in primary care. Clinical Obesity, 2015 Dec; 5(6):325-32. doi: 10.1111/cob.12115.
  4. Ogunleye AA, Osunlana AM, Asselin J, Anderson R, Cave A, Sharma AM, Campbell-Scherer DL. The 5As Team intervention: Bridging the knowledge gap in obesity management among primary care practitioners. BMC Research Notes, 2015 Dec 22; 8:810. doi 10.1186/s13104-015-1685-8.
  5. Asselin J, Osunlana AM, Ogunleye AA, Sharma AM, Campbell-Scherer, DL. Challenges in interdisciplinary weight management in primary care: Lessons learned from the 5As Team (5AsT) study. Clinical Obesity, 2016; 6(2): 124-32. doi: 10.1111/cob.12133.
  6. Campbell-Scherer DL, Sharma AM. Improving obesity prevention and management in primary care in canada. Current Obesity Reports, 2016; 5(3): 1-6. doi: 10.1007/s13679-016-0222-y.
  7. Sharma AM, Campbell-Scherer DL. Redefining obesity: Beyond the numbers. Obesity, 2017; 25:4, 660-1. doi: 10.1002/oby.21801.
  8. Sturgiss E, Jay M, Campbell-Scherer DL, van Weel C. Challenging assumptions in obesity research. BMJ, 2017;359: j5303. doi: 10.1136/bmj.j5303.
  9. Asselin J, Salami E, Osunlana AM, Ogunleye AA, Cave A, Johnson JA, Sharma AM, Campbell-Scherer DL. Impact of the 5As Team study on clinical practice in primary care obesity management: A qualitative study. CMAJOpen, 2017; 5(2): E322-9. doi:10.9778/cmajo.20160090.
  10. Torti J, Luig T, Borowitz M, Johnson JA, Sharma AM, Campbell-Scherer DL. Patient perspectives on the role of primary care in obesity management. BMC Family Practice, 2017; 18(10):1-10. doi 10.1186/s12875-017-0596-2.
  11. Luig T, Asselin, J, Sharma AM, Campbell-Scherer DL. Understanding implementation of complex interventions in primary care teams. JABFM, 2018; 31(3), 431-44. doi: 10.3122/jabfm.2018.03.170273.
  12. Noël G, Luig T, Campbell-Scherer DL. Creating caring conversations for patients living with obesity. The 5As Team program. Extract of the Proceedings of the 5th International Conference on Design4Health, 2018. Available at https://research.shu.ac.uk/design4health/wp-content/uploads/2018/09/683.pdf
  13. Luig T, Anderson R, Sharma AM, Campbell-Scherer DL. Personalizing obesity assessment and care planning in primary care: Patient experience and outcomes in everyday life and health. Clinical Obesity, 2018; 8(6): 411-423. doi: 10.1111/cob.12283
  14. Noël G, Luig T, Heatherington, M, & Campbell-Scherer DL. Developing tools to support patients and healthcare providers when in conversation about obesity: The 5As Team Program. Information Design Journal, 2018; 24(2):131-150. doi.org/10.1075/idj.00004.noe.
  15. Sturgiss E, Luig T, Campbell-Scherer DL, Lewanczuk R, Green LA. Using concept maps to compare obesity knowledge between policy makers and primary care researchers in Canada. BMC Research Notes, 2019; 12(23):1-6. doi.org/10.1186/s13104-018-4042-x.
  16. Luig T, Elwyn G, Anderson R, Campbell-Scherer DL. Facing obesity: Adapting the collaborative deliberation model to deal with a complex long-term problem. Journal of Patient Education and Counseling. 2019; 102(2):291-300. doi: 10.1016/j.pec.2018.09.021
  17. Campbell-Scherer DL, Asselin J, Osunlana AM, Ogunleye AA, Fielding S, Anderson R, Cave A, Johnson J, Sharma AM. Changing provider behaviour to increase chronic disease nurse visits for obesity in family practice: The 5AsTeam randomized control trial. CMAJOpen. 2019 May; 7(2):E371-378. doi.org/10.9778/cmajo.20180165.
  18. Luig T, Wicklum S, Heatherington M, Vu A, Cameron E, Klein D, Sharma AM, Campbell-Scherer DL. Improving obesity management training in family medicine: multi-methods evaluation of the 5AsT-MD pilot course. BMC Medical Education, 2020; 20(5): 1-11. doi.org/10.1186/s12909-019-1908-0.
  19. Luig T, Keenan L, Campbell-Scherer DL. Transforming health experiences and action through shifting the narrative on obesity in primary care encounters. Qualitative Health Research. 2020; 30(5):730-44. doi.org/10.1177/1049732319880551