The 5As of Obesity Management: a tool for primary care

Overweight and obesity constitute a significant burden to individuals and to society. This chronic disease is a risk factor for numerous other chronic diseases including type 2 diabetes, coronary artery disease, dyslipidemia, hypertension, osteoarthritis and others. Most primary health care providers confirm that obesity is a chronic disease that needs to be addressed. Furthermore, most patients appreciate their clinicians’ advice, which in turn translates into a higher chance of positive behaviour change when discussions between clinicians and patients occur. However, a substantial amount of research has consistently shown that obesity is addressed infrequently in primary care. Attempts have been made to explain this discrepancy and the relevant research has illustrated that this is a very challenging and complex issue. Physicians wishing to address obesity commonly cite barriers such as lack of time, insufficient remuneration, lack of training regarding the management of obesity, feeling that efforts will not result in any change, and lack of community resources. Furthermore, a clinician’s decision whether or not to raise the subject of obesity can be influenced by personal experience, counselling style and perceived patient receptivity. Addressing obesity can be perceived as potentially detrimental to the doctor-patient relationship and often clinicians simply cite a lack comfort in raising the subject. The Canadian Obesity Network developed a point-of-care tool, the 5As of Obesity Management, based on principles of behaviour change science and patient-centredness. The tool assists clinicians to engage in conversations about weight-related behaviour change with their patients in a systematic manner that incorporates the patient context. Pilot data on the use of this tool showed a two-fold increase in the initiation of weight-related discussions between healthcare providers and their patients.