Primary Care and Primary Healthcare in Obesity Management

Primary care clinicians should initiate patient-centred conversations with their patients about overweight or obesity. The 5As of Obesity Management^TM (Ask-Assess-Advise-Agree-Assist) approach, starting with asking permission to discuss weight, is an appropriate format to use.
Primary care clinicians should promote a holistic approach to weight and health focusing on health behaviours and addressing root causes of weight gain, with care to avoid stigmatizing and using overly simplistic narratives like “eat less and move more.”
Prescribing clinicians must be aware of obesogenic medications and consider alternatives for people living with overweight and obesity. When obesogenic medications must be used, physicians should discuss the risks with patients and institute monitoring for weight gain.
Providers and patients need to be aware of the risks of weight cycling and adopt strategies that focus on sustained changes to maintain healthy habits over time.

For clinicians:

We recommend primary care clinicians identify people with overweight and obesity, and initiate patient-centred, health focused conversations with them (Level 3, Grade C).
We recommend healthcare providers ensure they ask people for their permission prior to discussing weight or taking anthropometric measurements (Level 3, Grade C).
Primary care interventions should be used to increase health literacy in individuals’ knowledge and skill about weight management as an effective intervention to manage weight (Level 1a, Grade A).
Primary care clinicians should refer persons with overweight or obesity to primary care multicomponent programs with personalized obesity management strategies as an effective way to support obesity management (Level 1b, Grade B).
Primary care clinicians can use collaborative deliberation with motivational interviewing to tailor action plans to individuals’ life context in a way that is manageable and sustainable to support improved physical and emotional health, and weight management (Level 2b, Grade C).

Features of primary care and primary healthcare community-based interventions for clinicians and developers:

Interventions that target a specific ethnic group should consider the diversity of psychological and social practices with regards to excess weight, food, physical activity as well as socio-economic circumstances, as they may differ across and within different ethnic groups (Level 1B, Grade B).
Longitudinal primary care interventions should focus on incremental, personalized, small behaviour changes (the “small change approach”) to be effective in supporting people to manage their weight (Level 1B, Grade B).
Primary care multicomponent programs should consider personalized obesity management strategies as an effective way to support people living with obesity (Level 1B, Grade B).
Primary care interventions that are behaviour-based (nutrition, exercise, lifestyle), alone or in combination with pharmacotherapy, should be utilized to manage overweight and obesity (Level 1a, Grade A).
Group-based nutrition and physical activity sessions informed by the Diabetes Prevention Program (DPP) and the Look AHEAD (Action for Health in Diabetes) program should be used as an effective management option for adults with overweight and obesity (Level 1b, Grade A).
Interventions that use technology to increase reach to larger numbers of people asynchronously should be a potentially viable lower-cost intervention in a community-based setting (Level 1b, Grade B).

Educational recommendations to support development of obesity management skills in primary healthcare clinical workforce:

Educators of undergraduate, graduate and continuing education programs for primary healthcare professionals should provide courses and clinical experiences to address the gaps in skills, knowledge of the evidence and attitudes necessary to confidently and effectively support people living with obesity (Level 1a, Grade A).

Prevention of weight gain is crucial and realistic; weight loss is potentially very difficult depending on an individual’s weight drivers. Setting a value-based functional goal shifts the focus from weight to health and quality of life and may help with sustainable changes.
Individualized nutrition counselling can result in modest reductions of weight and waist circumference.
Mindfulness, acceptance and commitment therapies, added to multicomponent behavioural interventions, may be considered in developing a personal weight management strategy.
Many medical issues such as disrupted sleep, pain, mechanical problems, metabolic conditions and psychiatric conditions can contribute to challenges with weight management. People should seek medical help if they are struggling with weight maintenance or gain.
When prescribed a new medication to treat a medical condition, particularly if the medication is intended for long-term use, patients living with obesity should inquire about the potential associated weight effects.