1 / 139

NHMRC 2003b

Welcome to managing weight – an interactive workshop designed to assist general practitioners (GPs) and their practice staff to address weight management with patients who are overweight or obese to improve their health and prevent disease.

keitha
Download Presentation

NHMRC 2003b

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Welcome to managing weight – an interactive workshop designed to assist general practitioners (GPs) and their practice staff to address weight management with patients who are overweight or obese to improve their health and prevent disease.

  2. SLIDE PRESENTATION 5 mini cases1: Jenny, 32 years of age, works from home and has a young family2: Paul, 52 years of age, has type 2 diabetes3: Damian, 37 years of age, is office worker with back pain4: Sarah, 32 years of age, is an office administrator5: Susan, 60 years of age, has mild osteoarthritis

  3. Case study 1: Jenny, 32 years of age, works from homeand has a young family• Jenny presents for a change of dressing from a scald a few days ago – the burn is healing well• You notice Jenny has gained weight since last year; she had her last baby 14 months ago• Jenny is otherwise well and has no family history of cardiovascular disease (CVD).

  4. Case study 1: Jenny, 32 years of age, works from homeand has a young family• Jenny lives with her husband and two children (14 months and 3 years) and works from home – most of her time is spent looking after the children and working• You ask Jenny about her diet, which is quite good: – eats plenty of vegetables – fat intake seems quite high (full fat milk, cream, cheese, eating out)• Jenny has never had a cholesterol or blood lipid test done.

  5. Case study 1: Jenny, 32 years of age, works from homeand has a young familyWhile you are changing the dressing you decide to raise the topic of weight gain. This may be a sensitive topic to bring up and a nonjudgmental approach is important.1. How would you raise the topic of weight gain with Jenny?

  6. Case study 1: Jenny, 32 years of age, works from homeand has a young familySome examples of specific weight related questions could be:• Have you noticed a change in your weight over the past year or so?• Have you had any concerns about your weight?• Is your weight a concern for you?

  7. Case study 1: Jenny, 32 years of age, works from homeand has a young family • Weight measurements can be a sensitive issue with some patients, eg. long term overweight or obese patients• Agreement should be reached between the clinician and the patient about: – whether to take measurements – whether/when, if measurements are taken, the patient wishes to be told the results.

  8. Case study 1: Jenny, 32 years of age, works from homeand has a young family While sensitively discussing Jenny’s weight with her, you ask if you can take some measurements and she agrees.2. What is the most appropriate method of assessing health risks associated with excess weight?

  9. Case study 1: Jenny, 32 years of age, works from homeand has a young family The most useful indicator of risk and relative change is a combination of:• BMI• waist circumference.

  10. Case study 1: Jenny, 32 years of age, works from homeand has a young family You take some measurements and, just out of interest, Jenny would like to know what these are:• waist circumference 90 cm• weight 79 kg• blood pressure (BP) 121/73 mmHg• height 165 cm.3. What is Jenny’s BMI?

  11. Case study 1: Jenny, 32 years of age, works from homeand has a young family Jenny:• has a BMI of 29 kg/m2• asks you if she is overweight.4. What level of BMI indicates that a person may be overweight?

  12. Case study 1: Jenny, 32 years of age, works from homeand has a young family • Jenny’s BMI is 29 kg/m2; classified as overweight (range 25– 29.9 kg/m2)• However, BMI is not always an accurate predictor of body fat or fat distribution, particularly in: – older people – muscular and mesomorphic individuals, eg. athletes.

  13. Case study 1: Jenny, 32 years of age, works from homeand has a young family Combining BMI and waist measurement to assess overweight and obesity and disease risk* in adults*Risk of type 2 diabetes, hypertension and CVD.Adapted from NHMRC 2003b

  14. Case study 1: Jenny, 32 years of age, works from homeand has a young family Being overweight or obese is associated with a number of comorbidities caused by metabolic complications and/or the excess weight itself.5. What is Jenny’s disease risk relative to normal?

  15. Case study 1: Jenny, 32 years of age, works from homeand has a young family Jenny’s disease risk relative to normal measures is high.*Risk of type 2 diabetes, hypertension and CVD.Adapted from NHMRC 2003b

  16. Case study 1: Jenny, 32 years of age, works from homeand has a young family Clear relationship between increasing BMI and increasing mortality• Linear or curvilinear relationship• Begins at BMI ~20–22 kg/m2• True for males and females• May change with age, race and fitness• Cancer and CVD are the main causes of the elevated mortality.NHMRC 2003a

  17. Case study 1: Jenny, 32 years of age, works from homeand has a young family You let Jenny know that according to current recommended levels she is overweight, and discuss possible comorbidities and the need for screening tests.6. What are the:• potential comorbidities that Jenny may be facing?• screening tests that may be required?

  18. Case study 1: Jenny, 32 years of age, works from homeand has a young family • Jenny is overweight and has a high disease risk for: – type 2 diabetes – hypertension – CVD• There is a need to consider the following tests: – fasting glucose – fasting cholesterol/lipid screening.

  19. Case study 1: Jenny, 32 years of age, works from homeand has a young family • You ask Jenny if she would be able to return for another appointment when her test results are ready • In the meantime, you talk to Jenny about the benefits of losing weight as a preventive action to reduce disease risk. 7. What questions could you ask Jenny to gauge her motivation to lose weight?

  20. Case study 1: Jenny, 32 years of age, works from homeand has a young family The GP can assess the patient’s motivation to lose weight by determining:• their initiative, and previous attempts, to lose weight• how important it is for them to lose weight (scale of 1–10)• their confidence in losing weight (scale of 1–10)• how much weight they expect to lose and the benefits of losing weight• their readiness to change.

  21. Case study 1: Jenny, 32 years of age, works from homeand has a young family Weight gain is common at various life stages, eg. after pregnancy.Jenny says, ‘Putting on weight after pregnancy is normal. I don’t think there would be too many benefits of trying to lose weight at the moment. And anyway with a young child and a 3 year old, exercise is the last thing on my mind’.8. What is Jenny’s stage of change?

  22. Case study 1: Jenny, 32 years of age, works from homeand has a young family Jenny is in the precontemplative stage.Stages of change modelNPS 2002

  23. Case study 1: Jenny, 32 years of age, works from homeand has a young family Factors associated with weight maintenance and regainElfhag 2005, NHMRC 2003b

  24. Case study 1: Jenny, 32 years of age, works from homeand has a young family At the moment Jenny is NOT motivated to change. 9. How would you assist Jenny to manage her weight?

  25. Case study 1: Jenny, 32 years of age, works from homeand has a young family Patients in the early stages of readiness (precontemplation, contemplation and preparation) respond best to cognitive approaches, such as:• pointing out the risks of being overweight or obese• suggesting benefits of behaviour change and ways to reduce risk• pinpointing obstacles and methods of overcoming these obstacles• setting manageable goals.

  26. Case study 1: Jenny, 32 years of age, works from homeand has a young family 10. What are some of the issues you could discuss in a brief intervention that could help Jenny?

  27. Case study 1: Jenny, 32 years of age, works from homeand has a young family In a brief intervention, provide written information, and discuss:• and personalise disease risk due to being overweight or obese • the benefits of losing weight, and how much weight needs to be lost for a benefit to be gained. Highlight that losing as little as 5– 10% of starting weight can have important health benefits. In Jenny’s case this is 4–8 kg.

  28. Case study 1: Jenny, 32 years of age, works from homeand has a young family In a brief intervention:• discuss dietary guidelines and information on the importance of being in a healthy weight range• be able to answer any questions that Jenny may have and address perceived barriers• discuss the importance of moderate activity; this does not need to be strenuous, eg. brisk walking• provide knowledge, eg. health benefits associated with weight loss of 5–10%.

  29. Case study 2: Paul, 52 years of age, has type 2 diabetesPaul:• presents for review after starting metformin (he is responding well)• is married with three children• has a Maltese background• has a family history of diabetes.

  30. Case study 2: Paul, 52 years of age, has type 2 diabetesPaul:• tells you he is worried about having diabetes• knows how this condition affected his sister and grandmother• knows that Maltese people have a higher rate of diabetes.1. How would you raise the topic of weight management with Paul?

  31. Case study 2: Paul, 52 years of age, has type 2 diabetesExamples of appropriate questions could be: • Are you aware of the link between diabetes and being overweight?• Are you happy with your current weight?• Have you considered losing weight as part of your diabetes management?

  32. Case study 2: Paul, 52 years of age, has type 2 diabetesYou ask Paul about his current lifestyle in relation to diet and exercise. He:• is ‘not good with vegetables’• frequently eats restaurants and buys lunch on most days• drinks 3–4 glasses of red wine at night and a ‘few beers’ at the weekend• has a sedentary lifestyle and drives everywhere.

  33. Case study 2: Paul, 52 years of age, has type 2 diabetesPaul is happy for you to take measurements to assess his weight:• height 176 cm • weight 105 kg• waist circumference 104 cm• blood pressure 145/88 mmHg. 2. What is Paul’s BMI?

  34. Case study 2: Paul, 52 years of age, has type 2 diabetes3. With a BMI of 33.9 kg/m2, which weight category does Paul fit into?A. OverweightB. Normal weightC. Severe obesityD. Obesity.

  35. Case study 2: Paul, 52 years of age, has type 2 diabetesAnswer D. Obesity.Normal weight: BMI 18.5–24.9 kg/m2Overweight: BMI 25–29.9 kg/m2Obesity: BMI 30–39.9 kg/m2Severe obesity: BMI ≥40 kg/m2 NHMRC 2003b

  36. Case study 2: Paul, 52 years of age, has type 2 diabetes4. What comorbidities does Paul have and what tests might be required?

  37. Case study 2: Paul, 52 years of age, has type 2 diabetes• Paul has diabetes and is borderline for developing hypertension• The following tests are required: – fasting glucose – cholesterol/lipid testing – absolute cardiovascular risk assessment.

  38. Case study 2: Paul, 52 years of age, has type 2 diabetesPaul’s last cholesterol screen was taken over 1 year ago and his LDL-C and triglyceride levels were not on target:• HDL-C – 1.8 mmol/L (target level >1.0 mmol/L)• LDL-C – 3.1 mmol/L (target level <2.5 mmol/L)• total cholesterol – 5.9 mmol/L • triglycerides – 4.0 mmol/L (target level <1.5 mmol/L).Heart Foundation & CSANZ 2001 & 2005

  39. Case study 2: Paul, 52 years of age, has type 2 diabetesYou emphasise to Paul how weight reduction and an increase in activity will help his diabetes, cardiovascular risk and general wellbeing.

  40. Case study 2: Paul, 52 years of age, has type 2 diabetesPaul:• replies, ‘I know that weight is important in diabetes’• had an appointment with a dietician which he didn’t attend, but is willing to give it another try• rates his current motivation at 7/10• may have an increased motivation of 9/10 if he believes that losing 5–7 kg could help him to manage his diabetes.5. What is Paul’s stage of change?

  41. Case study 2: Paul, 52 years of age, has type 2 diabetesPaul is in the contemplative stage.Stages of change modelNPS 2002

  42. Case study 2: Paul, 52 years of age, has type 2 diabetes6. Paul asks you about the benefits of losing weight. What is your answer?

  43. Case study 2: Paul, 52 years of age, has type 2 diabetes• Weight loss may help Paul to: – improve his blood glucose control – lower his BP – reduce his risk of developing other conditions such as osteoarthritis – feel better in general and be able to do more• Paul also needs to know that diabetes is a condition that will not go away.

  44. Case study 2: Paul, 52 years of age, has type 2 diabetes7. Paul asks you how much weight he would have to lose in order to gain these benefits. What is your answer?

  45. Case study 2: Paul, 52 years of age, has type 2 diabetes• With Paul at the contemplative stage, keep advice simple and realistic• A 5–10% loss of initial body weight can result in significant improvements in metabolic health• Around 1–4 kg per month would be a good start, and 1–4 cm around the waist per month.

  46. Case study 2: Paul, 52 years of age, has type 2 diabetes8. What other types of brief advice could you discuss with Paul at this stage?

  47. Case study 2: Paul, 52 years of age, has type 2 diabetesYou could discuss with Paul:• disease risk from being overweight or obese • dietary guidelines and information on the importance of being in a healthy weight range• any questions that he may have about a weight management program • simple advice to reduce alcohol consumption• importance of moderate intensity activity.

  48. Case study 2: Paul, 52 years of age, has type 2 diabetes9. What advice should you give Paul on his alcohol intake?

  49. Case study 2: Paul, 52 years of age, has type 2 diabetesAlcohol intake should be limited to low risk drinking levels, ie. no more than 2 standard drinks per day.

  50. Case study 2: Paul, 52 years of age, has type 2 diabetes10. What would be your follow up plan for Paul?

More Related