a General Practitioner-delivered weight management
program for adults in primary care

“The Change Program” – a new innovation for weight management in primary care

Our research team has developed a GP-delivered weight management program for adults in primary care based on the current Australian guidelines.  "The Change Program" was developed in collaboration with clinical GPs, consumer representatives and allied health practitioners. It provides GPs with practical support in managing overweight and obese adults, making the current guidelines accessible and implementable in a clinical setting.  

“The Change Program” toolkit consists of:

  • GP handbook

  • Patient workbook

  • Templates that interact with clinical software for appointment planning and recording.

The toolkit uses worksheets and factsheets to promote self-management strategies to improve nutrition, increase physical activity and provide support with psychological and behavioural strategies.

“The Change Program” is currently being used in a pilot implementation trial funded by an Australian Primary Health Care Research Institute Foundation Grant. Five general practices (four urban and one rural), twelve GPs and twenty three patients are currently enrolled. The pilot is assessing the useability and feasibility of the program for both GPs and patients using a mixed methods approach. We will have final results from this pilot in early 2016.

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Who is the program for?

This program is for adult patients who are overweight or obese. It is important to discuss with the patient that the program runs over a 2 year period, with more intensity earlier in the program. A slow transition to a healthier lifestyle is the goal rather than a quick diet change, which is often unsustainable. Encourage the patient to see the program as a lifestyle change that they should be aiming to sustain for the rest of their life.

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Program Schedule

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About Us

The Change Program was developed by a group of clinical GPs in Australia at the Australian National University Medical School. They built the idea from their clinical experience of patient’s asking for assistance with weight loss and not having a structured program to work from.
Authors:

Dr Liz Sturgiss

Prof Kirsty Douglas  

Dr Sonia Res

Dr Rebecca Kathage

Academic Unit of General Practice, ANU Medical School

We have collaborated with a number of other researchers, clinicians and stakeholders including:

  • Dr Duncan Mackinnon (Bega Valley Medical Practice, ANU Rural Clinical School)

  • Emily Haesler (Visiting Fellow, ANU Medical School)

  • Dr Alex Stevenson

  • Dr Freya Ashman (Academic Unit of General Practice)

  • Nicholas Elmitt (Academic Unit of General Practice)

  • Diane Percy (Heart Foundation ACT)

  • Caroline Salisbury (Dietitian, Canberra)

  • Sue Mackinnon (Bega Valley Medical Practice)

  • Prof Chris van Weel (Emeritus Professor of General Practice, Radboud University  Nijmegen; Professor Primary Health Care Research, ANU)

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Publications

Published

Elizabeth Ann Sturgiss, Nicholas Elmitt, Emily Haesler, Chris Van Weel, Kirsty Douglas: Feasibility and acceptability of a general practitioner-delivered weight management program. Family Practice, 2016; 1-6. DOI:10.1093/fampra/cmw105

Elizabeth Ann Sturgiss, Kirsty Douglas: A collaborative process for developing a weight management toolkit for general practitioners in Australia—an intervention development study using the Knowledge To Action framework. Pilot and Feasibility Studies, 2016; 2:20. DOI: 10.1186/s40814-016-0060-4

Freya Ashman, Elizabeth Ann Sturgiss, Emily Haesler: Exploring self-efficacy in Australian general practitioners managing patient obesity: a qualitative survey study. International Journal of Family Medicine, 2016; Volume 2016, 8212837.

Elizabeth Ann Sturgiss, Sonia Res, Rebecca Kathage, Kirsty Douglas: A synthesis of selected clinical guidelines for the management of obesity in general practice. Australian Family Physician, 2016; 45(5):327-331.

Accepted

Elizabeth Ann Sturgiss, Ginny Sargent, Emily Haesler, Elizabeth Rieger, Kirsty Douglas: Therapeutic alliance and obesity management in primary care – a cross sectional pilot using the Working Alliance Inventory? (Clinical Obesity, accepted September 2016)

Elizabeth Ann Sturgiss, Lauren Bell, Sarah Jansen, Chris van Weel, Kirsty Douglas: Obesity management: where has the general practitioner gone? (Australian Journal of Primary Health, accepted September 2016)

Under review

Elizabeth Ann Sturgiss, Emily Haesler, Nicholas Elmitt, Chris Van Weel, Kirsty Douglas: Increasing general practitioners’ confidence and self-efficacy in managing obesity: a mixed methods study. (BMJOpen, under review)

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Funding

This work has been funded by:

RACGP/IPN Pty Ltd Foundation Grant 2013

Obesity is a leading cause of morbidity and mortality in the Australian community. As general practitioners (GPs) we are often approached by obese patients for assistance in losing weight. The therapeutic relationship between a GP and a patient has been used to great advantage in managing other conditions such as drug and alcohol addictions and smoking cessation. The GP is in an excellent position to provide individualised management advice to patients who are seeking to lose weight. Currently Australian guidelines to assist GPs in managing overweight and obese patients are in existence, but there are no management programs that incorporate this advice in a practical format. Our research aims to develop an evidence based complete treatment program that can be delivered by GPs to their overweight and obese patients within their own practices. We will complete a systematic review of current evidence and review current Australian guidelines. This review will be used to develop a concise treatment strategy manual for GPs suitable for use in consultations along with a self-management workbook for patients. We will then seek feedback from GPs and consumer representatives on the program that will be used to further develop the resource.

Australian Primary Health Care Research Institute Foundation Grant 2014

This pilot study aims to evaluate the feasibility of a GP-delivered weight management program for overweight and obese adults in primary care ("The Change Program").  In 2006—08 over 3 million GP patient attendances involved a patient that was overweight or obese (BEACH data).  As GPs we are often consulted by patients wanting assistance to lose weight.  Current standard obesity treatment requires referral outside the GP environment.  However sometimes patients are unable to access providers apart from their GP – due to cost, rurality, time pressures or preference.

In a survey of NSW general practices, 78% patients (n=227) thought their GP did have a role to play in weight management and 78% were also keen on regular review with their GP.

There has only been one international RCT from the USA in which a primary care doctor was involved in delivery of an intervention to overweight and obese adults.  Most studies have involved interventions with allied health care professionals or trained lay people.

Currently there are clear Australian guidelines on the management of overweight and obese adults in general practice, however the guidelines are long and not is a useable format for the clinical GP.

Our group has developed a practical, GP-delivered weight loss program for overweight and obese adults in primary care, The Change Program.  The program has already undergone qualitative review from both GPs and consumer representatives. This stage of the research is a pilot study - a range of GPs, both urban and rural, will implement The Change Program with their patients.  We will receive both qualitative and quantative feedback from the GPs and the patients regarding the usefulness, practicality and implementation of the program.  This feedback will be used to improve The Change Program prior to a single-blinded, randomised control trial in primary care. 

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External Links

National Health and Medical Research Council Clinical Practice Guidelines for the Management of Overweight and Obesity in Adults, Adolescents and Children in Australia (2013)

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Contact Us

Academic Unit of General Practice
Australian National University Medical School
PO Box 11, Woden, ACT, 2606
AUSTRALIA

Email - change.program@anu.edu.au

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Copyright: This information on The Change Program is published as an open access document under a creative commons license. The authors own the copyright. This means that you do not have to pay to use it, but it also means that you cannot sell it or charge for its use as part of some other service.

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