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Weight Management

Management

  1. If ‘NO’ to any question

    • Review in one year if agreed by patient
    • If the person answers ‘No’ to both ‘Ask’ questions:
      • We will ask you these questions again in one years’ time.
      • Provide an open invite for the person to make a further appointment when they feel reading/willing/able to make changes.
    • If the person scores 5 or less in the

      These questions are important as patients are more likely to attend their appointments and make lifestyle changes if they have a score of 6 and above. Complete before progressing to the Ongoing Management.

      • Ask these questions to determine whether the patient is ready to make lifestyle changes:

      Compared to previous attempts to change your eating, how motivated/willing are you to improve your eating at this time?

      1. Not at all
      2. Slightly
      3. Somewhat
      4. Quite
      5. Extremely

      Considering all outside factors at this time in your life (stress you are feeling at work, your family obligations, etc?), how confident are you that you will stay committed to an improved eating pattern program?

      1. Not at all
      2. Slightly
      3. Somewhat
      4. Quite
      5. Extremely
      it is unlikely they are going to change and the weight management pathway is not suitable at this time.
    • This is OK – use non-judgmental attitudes, tones, and content of communication. Use of motivation interviewing may harness the person’s intrinsic motivation. To learn more about this complete this BMJ learning module or view https://www.kognito.com/changetalk/web/
    • All health care professionals and health care workers can help with: 
    • Brief education for the unwilling. Re-iterate the key messages about eating more vegetables and fruit and being more physically active.
    • Consider utilising the brief intervention flash card resources and posters to support your key messages.
    • Support the person and display empathy whilst people they are trying to get themselves into the ‘readiness head space’.
    • Check with the patient if you can ask these questions in one years’ time.
    • Provide an open invite for the person to make a further appointment when they feel reading/willing/able to make changes.
    • If the patient is being seen in General Practice the doctor may want to explore mental and physical problems that stop people being ABLE to change e.g., problems at home or medical problems.
  2. If ‘YES’ to any question

    • Brief intervention - advise and weigh (B)
    • There should be no limits on coloured vegetables and fruit as most people do not eat enough for good health. Encourage at least 5+ per day (3 vegetables, 2 fruit). Ideally increase to 9+ per day if appropriate (5-6 vegetables, 3-4 fruit. Preserved or cannedoptions are acceptable.
    • Less is best with processed foods, aim for more whole/real food. Encourage shopping around the outer isles of the supermarket.
    • For individuals who are currently sedentary and/or peripherally overweight, start low and go slow when increasing activity levels. Moving more will enhance an individual’s mood.
    • If opportunity and time permit, consider assessing the following within the brief intervention:
      • Current intake of vegetables/fruit/nuts per week
      • Minutes of physical activity per week (and higher intensity exercise)
      • Height, weight, and waist circumference
      • Blood tests when patient is seen in General Practice
    • Print this form out for the 'Ask, Brief Intervention and Readiness to Change' questions.
    • Click here to print a Food and Fluid Diary.
  3. These questions are important as patients are more likely to attend their appointments and make lifestyle changes if they have a score of 6 and above. Complete before progressing to the Ongoing Management.

    • Ask these questions to determine whether the patient is ready to make lifestyle changes:

    Compared to previous attempts to change your eating, how motivated/willing are you to improve your eating at this time?

    1. Not at all
    2. Slightly
    3. Somewhat
    4. Quite
    5. Extremely

    Considering all outside factors at this time in your life (stress you are feeling at work, your family obligations, etc?), how confident are you that you will stay committed to an improved eating pattern program?

    1. Not at all
    2. Slightly
    3. Somewhat
    4. Quite
    5. Extremely
  4. If score of 5 or less on “Readiness to Change” questions

    • Review in one year if agreed by patient
    • If the person answers ‘No’ to both ‘Ask’ questions:
      • We will ask you these questions again in one years’ time.
      • Provide an open invite for the person to make a further appointment when they feel reading/willing/able to make changes.
    • If the person scores 5 or less in the ‘Readiness to change’ questions it is unlikely they are going to change, and the weight management pathway is not suitable for you at this time.
    • This is OK – use non-judgmental attitudes, tones, and content of communication. Use of motivation interviewing may harness the person’s intrinsic motivation. To learn more about this complete this BMJ learning module or view https://www.kognito.com/changetalk/web/
    • All health care professionals and health care workers can help with: 
      • Brief education for the unwilling. Re-iterate the key messages about eating more vegetables and fruit and being more physically active.
      • Consider utilising the brief intervention flash card resources and posters to support your key messages.
      • Support the person and display empathy whilst people they are trying to get themselves into the ‘readiness head space’.
      • Check with the patient if you can ask these questions in one years’ time.
      • Provide an open invite for the person to make a further appointment when they feel reading/willing/able to make changes.
    • If the patient is being seen in General Practice the doctor may want to explore mental and physical problems that stop people being ABLE to change e.g., problems at home or medical problems.
  5. If score of 6 or more on “Readiness to Change” questions 

    • Comprehensive Assessment Tool and Goal Setting
      • Readiness to change score: Scores of 6 and above indicate the person’s readiness and/or confidence to change. Make an appointment for the first weight management assessment and intervention. Goals should be agreed with the person based on the findings from the first weight management assessment, in the meantime encourage the person to eat more vegetables and fruit and being more physically active.  Set a SMART goal with the patient.
    • SMARTA goal setting:
      • Goals are things put in place to do i.e., an activity which is measurable.
      • Outcomes such as weight loss are more unpredictable and are not suitable goals.
    • Encourage the patient to set a goal around eating more vegetables and fruit and/or moving more. Brief interventions are implemented with motivational interviewing and SMARTA Goals.  For the best outcome, utilise motivational interviewing skills to develop SMART goal partnership with the person.
    • SMARTA: Specific, Measureable, Achievable, Realistic, Timely and Agreed this is very important, do not come up with the goal for the patient.
      • If the person was doing no exercise, agreeing on a specific, achievable goal such as going for a 10 minute walk twice a week is an improvement. This goal can/should be built upon over time with the aim of getting to recommended levels.
      • If the person is eating small amounts of vegetables, adding even just one handful of coloured vegetables per day is a real improvement. This will increase the nutritional quality of their diet even if they make no other changes.
    • If opportunity and time permit, consider the following within the brief intervention (A & B screening tools) which assess:
      • Current intake of vegetables/fruit /nuts per week
      • Minutes of physical activity per week (and higher intensity exercise)
      • Height, weight, waist circumference
      • Blood tests when patient is seen in General Practice
      • Begin the Comprehensive Assessment Tool (CAT) Paper version or Online version Note: Give your email address to your patient for the results to be sent back to you.
        • The Comprehensive Assessment Tool (CAT) can be initiated during the first appointment for on-going management. This assessment will highlight areas for potential change and guide your management.
        • The CAT can be completed online in Best Practice or printed off and filled out by hand (patient can also take the form to fill out at home).
        • The first assessment could take some time (around 45 minutes) if done all at once.
        • For some people the assessment can be revealing and emotional as this may identify issues which have not been revealed previously. The CAT utilises Te Whare Tapa Whā as the framework.
  6. General practice for ongoing management (O)

Information

 

Disclaimer: These pathways, for the care and management of patients within Bay of Plenty, have been developed jointly by primary and secondary care clinicians. They provide guidance for General Practice teams to diagnose and manage patients suffering from a number of different conditions, and contain patient information resources. The pathways are maps of publicly-funded services accessed by referral from the community, and are strongly evidence based, but are not full clinical guidelines. As the pathways are suggested guidance only, while using them you must exercise your own clinical judgement and pertinent clinical data when treating your patient. This site is intended to be flexible and frequently updated. While every effort has been made to ensure accuracy, all information should be verified.