Barriers to Obesity Management in Canada

1. Barriers to Obesity Management in Canada Arya M Sharma, MD/PhD, FRCP(C) Professor of Medicine Research ChairforObesity Research & Management University of AlbertaMedicalCo-DirectorAlberta ObesityProgram Edmonton, AB, Canada www.drsharma.ca

2. Summary • Current Obesity Management in Primary Care • Key Principles of Obesity Management • The 5As of Obesity Management™

3. Canadians Do Not Look to Their Doctors for Obesity Help Representative survey of Canadians(IPSOS REID 2010): • Within the last 12 months: • only 5% had asked their family physician about weight loss • only 19% had been advised to lose weight without specifically asking • only 14% reported having their waist circumference measured (96% reported having their blood pressure measured, and 56% reported having a test for diabetes)

4. Patient Focus Groups • Information from physicians seldom helpful • Physicians lack sensitivity in addressing obesity • Patients want more support in self-management • Patients want specific tailored weight-management strategies • Patients want to be directed to reliable resources

5. Interdisciplinary Weight Management is Effective • Individually tailored multi-component long-term interventions are the most effective. However: • Current recommendations look at obesity as a homogeneous condition amenable to simply reducing caloric intake and/or increasing activity. • No attempt is made to distinguish between different causes or stages of obesity. • People seeking weight-loss support often present with a range of barriers, including mental health issues, chronic pain and family or social issues. Kirk S et al. IJO 2011

6. Core Principles of Obesity Management • Practitioner and Expert Interviews regarding key messages that would assist with obesity management in primary care • Primary Practice working group agreed on FIVE Key Principles of Obesity Management • Presented at 2011 National Obesity Summit Workshop

12. 5As Framework for Obesity Management Arya M. Sharma, MD/PhD, FRCPC Scientific Director & CEOCanadian Obesity Network

25. 5As Framework – Practitioner Responses • Canadian Family Medicine Forum, Montreal, Nov 2011 • Ontario Family Medicine Forum, Toronto, Nov 2012 • Ontario Nurse Practitioner Conference, Hamilton, Dec 2011 • Focus Group, Calgary PCN, Dec 2011 • 126 Respondents • 86% (n=107) physicians • 10% (n=13) nurses or nurse practitioners • 77% provided written feedback

26. “The 'five As' provide a useful framework for obesity management in primary care” • 99% “Agree” or “Strongly Agree” • “Helpful” • “Great- it’s about time something like this was available”

27. “The sequencing of Ask, Assess, Advise, Agree, Assist is appropriate” • 99.2% “Agree” or “Strongly Agree” • “It makes sense to ask first. I feel bad bringing it up with patients. Good idea.” • “Would be nice to have some sample approaches/dialogues to help open discussion with patients”

28. “The extent of information provided on this tool is enough to serve as a quick guide” • 86.4 % “Agree” or “Strongly Agree” • “Need more mental health information to show patients” • “Would like an online course on how to use it”

29. “I would use this tool in my practice to discuss weight managements with my patients” • 79% “Agree” or “Strongly Agree” • “I need more patient resources” (n=28) • “Where can I find online resources? I need this electronically or as an EMR” (n=12) • “Need more support. I don’t have time to discuss weight with patients. There is no place to refer patients.” (n=14)

34. www.DrSharma.ca