Although health care professionals (HCP) are generally not the first people that people living with obesity turn to for help, when they do, the advise they get is not always helpful. This is perhaps because most health care professionals don’t fully understand what exactly patients with obesity do find helpful (no, it is not advice to “eat less and move more”!).
Obviously the best way to find out what patients find helpful, is by actually asking them and listening to their answers.
This is exactly what we did in a paper by my colleague Thea Luig published in Clinical Obesity which reports on extensive analyses of video recordings of patient-HCP consultation as well as patient interviews and journals.
Participants included 20 patients presenting in primary care, who were re-interviewed 2 and 4-8 weeks after the initial consultation.
The initial consultation was was guided by the 5As of Obesity Management (Obesity Canada), 5As Team (5AsT) tools, Kushner’s obesity-focused life history, literature on aetiology and management, patient perceptions and provider–patient communication.
As readers may be aware, core principles of the 5As approach include framing of obesity as a multifaceted, chronic disease and a focus on improving health rather than just on losing weight. Goals aim at improving function (functional goals) and regaining the ability to do things that are of value and enhance quality of life (value goals).
Based on the extensive analyses of hundreds of pages of verbatim transcribed notes, eight important themes emerged (all extensively discussed in the paper):
1) Engendering compassion and ‘real’ listening
2) Making sense of root causes and contextual factors in the patient’s story
3) Recognizing strengths
4) Reframing misconceptions about obesity
5) Focusing on whole-person health
6) Orienting actions on value goals
7) Fostering reflection
8) Experimenting and reevaluating
The immediate impacts of the 5AsT approach during the consultation led to five cognitive and emotional shifts:
1) Sense-making of the linkages between life context, emotions and health
2) Focus on whole person health rather than weight loss
3) Recognition of own strengths in overcoming difficulties
4) Sense of direction for action
5) Self-compassion, self-acceptance, hope and confidence to make changes and improve health.
Although limited by the relatively short follow-up period, identifiable reported outcomes were generally positive and covered a range of improvements including activation, establishing healthy sustainable habits, improved function, as well as benefits for perceived mental, physical and social health.
I will explore each of the identified themes in upcoming posts – stay tuned.
@DrSharma
Edmonton, AB
Post a Comment