gms | German Medical Science

Background: Obesity belongs to the most prevalent health problems in western societies. The primary health care setting is considered as a key starting position in successful weight management. Research indicates, however, insufficient weight counseling in primary care. Barriers include negative attitudes towards obese patients, lack of familiarity with current guidelines and lack of self-efficacy in weight counseling amongst others. A tool called the 5As of obesity management has been proposed by the Canadian Obesity Network (CON) to improve weight counseling and provider-patient-interaction.

Objectives: The objective of this study is to evaluate the effectiveness of a short 5A e-learning program for obesity management aimed specifically at general practitioners.

Methods: The study design is a cluster-randomized controlled trial, in which participating general practitioners (GPs) were randomized to an intervention group (GPs with access to the 5A e-learning program immediately after patient inclusion) or a control group (GPs assigned to a waiting list, access to the 5A e-learning program after the trial). Patients were recruited through participating GPs. The 5A intervention will be evaluated by assessing patients and GPs perspectives on obesity management in primary care before and after the training. Outcome measures (including provider-patient-interaction, quality of life and weight development of patients, self-stigma and stigma, counseling behavior of GPs) will be compared between the intervention group and the control group.

Results: An e-learning program was developed based on the 5As guidance of obesity management by the CON. The 5A e-learning program aimed at GPs covers recommendations on how to discuss weight with the patient (“ASK”), assess obesity related risks and causes of weight gain (“ASSESS”), advise on treatment options (“ADVISE”), agree on weight loss expectations and treatment plan (“AGREE”) and assist the patient in the ongoing process of losing weight (“ASSIST”). Data collection of the study is ongoing. First results will be expected in summer 2017.

Discussion: The 5As present physicians with a simple mnemonic for patient counseling in the primary care context. First studies using the 5As in weight loss settings show that their use is positively correlated with patient motivation and intention to lose weight. However, results on the effectiveness of the 5A intervention on secondary outcomes, such as weight development, are lacking and an implementation and evaluation in the German health care system is now needed. This intervention study contributes to this goal and expands the present research to the German primary health care context.

Practical implications: After successful evaluation, the 5A online tool will be made accessible to providers in relevant networks and support local management of obese patients.