[5 min read] Women’s obesity & weight management in primary care

Weight management is relevant to everyone, and problems with weight management, although not a common presenting complaint, are often first unearthed by the general practitioner. With 60 per cent of Australian women being overweight or obese, and this proportion expected to increase, weight management is relevant to a large proportion of people attending their GP.

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Weight is a complex issue, determined by many factors, including diet, physical activity, genetics, comorbidities and psychosocial variables. It is important to be mindful that being overweight often carries a significant social stigma, particularly among women.

Management of overweight and obesity in primary care can be addressed using the “5 A’s” model – ask, assess, advise, assist and arrange.

The first step is to ask and assess if weight management is an issue in an individual. A patient’s weight and body mass index (BMI) should be routinely recorded and monitored to easily assess changes. Asking patients about their weight history and what, if any, interventions they have utilised in the past may be useful in guiding future interventions. Asking about weight should occur in a non-judgemental, supportive and sensitive manner. In patients who are identified as overweight or obese, it is important to screen for comorbidities, which may have already occurred or be likely to occur due to weight management issues – such as hypertension, glucose intolerance, hyperlipidaemia and mental health issues.

Every consultation is an opportunity to advise patients and promote the importance of a healthy lifestyle in managing weight. It is useful to explain to patients the meaning of, e.g. BMI and what a healthy weight for them would be. The benefits of weight loss should be discussed with every patient who is overweight or obese. For example, it is important to stress that being overweight or obese increases the risk of many conditions such as cardiovascular disease, type 2 diabetes, gastro-oesophageal reflux disease, musculoskeletal problems, menstrual disorders, mental health problems and cancers. It may be useful to signpost patients to national dietary and physical activity guidelines and explore if the patient’s dietary intake and activity are similar to that recommended.

For those identified as overweight or obese, assistance should be offered for weight loss, which may include lifestyle changes such as changing diet or increasing physical activity, pharmacological interventions and, in some cases, surgery. A weight loss plan should be tailored to the individual based on ability, motivation, comorbidities and risk factors. Weight loss interventions offered should be evidence-based, and focus not only on weight management, but also on other health outcomes such as cardiovascular fitness, mental health and overall wellbeing.

Some women who are overweight or obese may benefit from other specialist services such as a weight management clinic, physiotherapist or dietician. In this case, it is often the role of the general practitioner to arrange and coordinate this. All women who are overweight or obese should be reviewed at regular intervals, to evaluate if interventions are effective. Even if a woman’s weight is stable, long-term follow-up may prevent weight gain in the future.

In summary, asking and advising about weight management should feature in every general practitioner’s daily workload. It is important to approach weight management in a structured and evidence-based manner, utilising evidence-based resources where possible.

Dr Samantha Miller, MBChB

Read another article like this one: Managing breast problems in primary care


References

  1. Australian Bureau of Statistics (2018). National Health Survey. https://www.abs.gov.au/statistics/health/health-conditions-and-risks/overweight-and-obesity/2017-18
  2. Obesity Australia (2022). https://obesityaustralia.squarespace.com/
  3. Australian Government: Department of Health and Aged Care (2022). National Obesity Strategy 2022–2032. https://www.health.gov.au/resources/publications/national-obesity-strategy-2022-2032
  4. Australian Government: Department of Health and Aged Care (2022). Overweight and Obesity. https://www.health.gov.au/health-topics/overweight-and-obesity
  5. National Health and Medical Research Council. Department of Health and Aging (2013). Australian Dietary Guidelines. https://www.eatforhealth.gov.au/sites/default/files/content/n55_australian_dietary_guidelines.pdf
  6. National Health and Medical Research Council (2013). Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children. https://www.nhmrc.gov.au/about-us/publications/clinical-practice-guidelines-management-overweight-and-obesity
  7. BMC Primary Care (2018). Five A’s counseling in weight management of obese patients in primary care: a cluster-randomized controlled trial (INTERACT) https://bmcprimcare.biomedcentral.com/articles/10.1186/s12875-018-0785-7
  8. Department of Health, State Government of Victoria, Australia (2022). Better Health Channel: Weight Management. https://www.betterhealth.vic.gov.au/healthyliving/weight-management
  9. Australian Family Physician (2013). Obesity Recommendations for management in general practice and beyond. https://www.racgp.org.au/afp/2013/august/obesity

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